Tag Archive | "atrial fibrillation"

Institute of Medicine report lists top priorities for comparative effectiveness research

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A committee of the Institute of Medicine issued a report on comparative effectiveness research for medical treatments which lists 100 priority topics for review. The IOM’s list, released Tuesday, includes recommendations to compare treatment strategies in the US for atrial fibrillation, inflammatory diseases, prostate cancer, Alzheimer’s disease and attention-deficit hyperactivity disorder, among other health conditions and health-related topics.

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The report is intended to provide guidance for spending a portion of the $1.1 billion in economic-stimulus funds provided by the US government for such research. Commenting on the matter, Kathleen Buto, vice president for health policy at Johnson & Johnson, stated that “comparative effectiveness research should inform medical decisions and not replace medical judgement or be used to limit treatment choices.” She added that “the ultimate decision about which treatment or intervention is best for a particular individual should remain between a doctor and patient based on real-world data and analyses.”

Meanwhile, panel co-chairman Harold Sox, who is also the editor of the Annals of Internal Medicine, said “healthcare decisions too often are a matter of guesswork, because we lack good evidence to inform them.” He also remarked that medical-product manufacturers had a “muted” response to the panel’s efforts to prioritise the funding, noting that of the approximately 2000 public comments and recommendations the panel received, 28 came from makers of drugs, biologic products or medical devices.

Drugmakers have recently bolstered lobbying efforts aimed at deterring the US government from using comparative drug studies as a possible means of reducing healthcare costs.

Source: FirstWord

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Merck & Co. Buys Rights to Atrial Fibrillation Therapy from Cardiome for $60M Up Front

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Merck & Co. will pay an initial fee of $60 million to Cardiome Pharma for rights to vernakalant, a drug candidate for atrial fibrillation (AF). Cardiome has already received a $100 million credit facility and could earn an additional $640 million through success-based fees.

The agreement gives Merck an exclusive global license to the oral formulation of vernakalant for the maintenance of normal heart rhythm in patients with atrial fibrillation. Cardiome successfully completed a Phase IIb study evaluating this indication in July 2008.

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The deal also provides Merck’s Switzerland affiliate with exclusive rights outside North America to the intravenous formulation for rapid conversion of acute atrial fibrillation to normal heart rhythm. The drug has completed Phase III development in the U.S., and is under FDA review.

“For a Phase III asset with a filed NDA, the price of the deal is not too surprising, but the market for AF has been elusive,” notes Seamus Fernandez, equity researcher at Leerink Swann’s major pharmaceuticals division.

Cardiome has the right to access in tranches beginning in 2010, the secured, interest-bearing credit facility. The firm could also obtain $200 million based on the achievement of development and approval goals, including $35 million for initiation of a Phase III program for vernakalant oral and submission for regulatory approval in Europe of vernakalant IV. Approvals in other indications with either formulations will trigger up to $100 million in milestones. Finally, besides tiered royalty payments, Cardiome could receive up to $340 million in milestone fees if certain sales thresholds are met.

Cardiome has retained an option to co-promote vernakalant oral with Merck through a hospital-based sales force in the U.S. Merck will be responsible for all future development, manufacturing, and commercialization costs. “In this kind of financial climate, the alternative of developing the oral asset is really not available to us,” says CEO Bob Rieder. “This partnership with Merck gives this drug the highest rate of success.”

As to how the company will invest the money it receives, Rieder says that at a time when milestone achievements no longer necessarily drive the value of the company, they intend to take a cautionary stand on developing pipeline assets as they look for financial stability.

Vernakalant works by selectively blocking multiple ion channels in the heart that are known to be active during episodes of atrial fibrillation. In August 2008, FDA told Cardiome and its North American partner, Astellas Pharma, that the agency needed to establish a better risk-benefit profile before granting final approval.

FDA thus requested the firms to submit data on the risk of previously identified events experienced by a subset of patients during the clinical trials. FDA also asked for a safety update from ongoing or completed studies of vernakalant, regardless of indication, dosage form, or dose level.

“To us, it appears that Merck is taking a broad approach to new mechanisms in cardiovascular (CV) disease,” Fernandez remarks. “Merck now has several new mechanisms for treatment of various CV diseases, including rolofylline for acute heart failure, vernakalant for arrhythmia, TRA for platelet inhibition, and CETP and niacin for atherosclerosis.

“We are intrigued by the risk/reward of this strategy. The only remaining major medium-stage asset that remains to be added would be an anticoagulant. We’re most positive on prospects for Factor Xa inhibitors.”

Source: GEN News

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Sanofi-aventis’ Multaq recommended for approval by FDA advisory panel

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An FDA advisory panel voted 10 to 3 in favour of approval for sanofi-aventis’ anti-arrhythmic drug Multaq (dronedarone) on Wednesday, for the treatment of patients with non-permanent atrial fibrillation.

In reference to study data submitted to the agency by the drugmaker, Norman Stockbridge, the director of the FDA’s Cardiovascular & Renal Drugs division, remarked that there was no dispute that Multaq was effective in treating atrial fibrillation by delaying the time of symptom recurrence, “but we have two studies that give different results on mortality and morbidity.”

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Sanofi-aventis and the FDA agreed that Multaq should not be used by patients with severe heart failure, but the regulator indicated that more information is needed for doctors about how to determine when patients shift from moderate to severe heart failure. Panellists said the company should not be able to claim that Multaq reduced the risk of cardiovascular hospitalisations or death, as sanofi-aventis had proposed based on findings from one study.

The company is seeking approval for Multaq to help restore and maintain normal heart rhythms in patients with atrial fibrillation. A final decision is expected by April 30.

Source: FIrstWord

Popularity: 7% [?]

Researchers identify 14 drugs for which off-label uses should be studied

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Based on an analysis of US prescribing data, researchers identified 14 drugs for which future study on off-label uses is warranted. Specifically, the investigators noted a “high volume of off-label prescribing in the absence of good evidence for a substantial number of drugs, particularly antidepressants, antipsychotics and anxiolytic-sedatives.” The findings are published in the December issue of the journal Pharmacotherapy.

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The researchers used nationally representative prescribing data to estimate the number of off-label drug uses by indication from January 2005 through June 2007, and then categorised the indications according to adequacy of scientific support. The investigators analysed drug safety, the volume of off-label use with inadequate evidence and a composite of cost and marketing factors.

The list, which includes six antidepressants and three antipsychotics, was topped by AstraZeneca’s Seroquel (quetiapine). Researchers discovered that the schizophrenia drug was prescribed off-label 76 percent of the time, mainly to treat bipolar disorder, an indication for which the product was approved in October. Other treatments on the list are compounds that have been approved for hypertension, atrial fibrillation, asthma, joint sprain/strain and chronic renal failure.

Senior author Randall Stafford commented that “it’s not that these off-label uses are necessarily harmful or that these drugs don’t work,” but that the appropriate studies have not been done. In response to the findings, PhRMA spokesperson Diedtra Henderson said that the organisation could not comment on off-label prescribing. “That’s nothing being driven by our companies,” she remarked, adding that “this is an activity that our companies aren’t allowed to do under FDA regulations.”‘

Source: FirstWord

Popularity: 3% [?]

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