Amgen and UCB Push Forward with Bone-Building Antibody
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April 04, 2012 Amgen and UCB push forward with bone-building antibody Jonathan Gardner Promising mid-stage results for what could be the first bone-building antibody to treat osteoporosis have encouraged two companies that could use a little help from their pipelines to initiate a phase III trial. Amgen the world’s biggest biotech and UCB the Belgian specialty pharma company today announced plans to test AMG 785 (CDP7851) in 5,000 women in a trial that should report in 2015, and show whether the therapy can reduce the incidence of fractures. Introducing an expensive biological into what will be a very genercised market – even Eli Lilly’s bone-building incumbent Forteo will be nearing the end of its market exclusivity by the time the Amgen/UCB antibody can reach prescribing physicians – will be a big ask. Still, Forteo, itself a biological, has been able to carve out blockbuster sales even going up against off-patent drugs by targeting high-risk patients and those intolerant to bisphosphonates, suggesting there is still a place for new treatments. Building bone Bisphosphonates have shown themselves able to improve bone mineral density and reduce the risk of fractures by preventing bone resorption, the process by which mature tissue is removed from the skeleton. By contrast, AMG 785 aims to stimulate bone formation; it does so by inhibiting the action of sclerostin, a protein that inhibits bone formation, on bone morphogenetic proteins. Sclerostin levels are low in patients with sclerosteosis, a disease characterised by excessive bone growth. Likewise, Forteo, or teriparatide, a recombinant form of parathyroid hormone, increases the number and action of bone-building osteoblasts. However, as a more costly once-daily injectable biological, it is indicated in patients with a high risk of fracture, meaning those with multiple risk factors - past fractures or signs of vertebral fractures as well as those who are unable to take other osteoporosis medications. Whilst a largely safe drug, bisphosphonates do have side effects such as oesophagitis, which have raised concerns about the possibility of oesophageal cancer. Forteo itself has a black-box warning for risk of osteosarcoma. Whether AMG 785 will have similar problems is a question that the Amgen/UCB antibody will need to answer among other matters, in a long-term trial. Clarity needed So far, AMG 785 has shown promising data in a six-month phase I/II study, which was associated with a 5% improvement in spinal bone mineral density over six months. In a March 14 note, analysts from Deutsche Bank wrote that based on phase I/II trial results a 10% improvement in bone mineral density could be expected over one year. Comparative numbers are 6-8% per year for Forteo, 2-5% a year for bisphosphonates and 3-5% a year with Amgen’s marketed anti-osteoporosis antibody Prolia. Additionally, Amgen and UCB announced success in a phase II trial a year ago, which pitted the antibody dosed once monthly and once every three months against placebo, Forteo and Fosamax, over one year. The companies announced significant increases in bone mineral density when compared to placebo and that the antibody “compared positively” with the two active treatment arms. No specific numbers have been disclosed yet, however – more detail is expected at the American Society of Bone Mineral Research in October, giving observers few clues as to the efficacy. Mark Schoenebaum, an analyst with ISI Group, noted today that the phase III trial design is for two years of treatment versus three years for Prolia, indicating the companies may be confident of a “giant” benefit in fracture reduction, on a par with Forteo’s 65% reduction. Reinforcing his belief of the confidence that the companies have in AMG 785, Mr Schoenebaum also said it is much smaller than Merck’s trial for bone drug odanacatib, which is enrolling 17,000 (Merck’s odanacatib has high hurdles to clear, September 20, 2011). Should it succeed in the clinic and with regulators, obanacatib probably will not launch until 2015, giving it about two years’ head start on AMG 785. Given its 2015 reporting date, few analysts are willing to attach forecast numbers to the antibody – none of the banks that cover Amgen have sales estimates, and of UCB analysts Morgan Stanley forecasts $295m and Barclays Capital $299m in 2018. The two companies have a worldwide profit-sharing deal. Thus much mystery still surrounds the molecule; its promise may become clearer when data from the 12- month phase II trial is released. Despite the competition and the unknowns, AMG 785 remains one to watch. More from Evaluate Vantage Evaluate HQ 44-(0)20-7377-0800 Evaluate Americas +1-617-573-9450 Evaluate APAC +81-(0)80-1164-4754 © Copyright 2021 Evaluate Ltd..