Sarepta’s Muscular Dystrophy Drug Improves With Time; Stock Booms

7/24/12Follow @xconomy

[Updated: 2:30 pm PT] Sarepta Therapeutics, the company formerly known as AVI Biopharma, has gone through a rough patch ever since its experimental drug for Duchenne Muscular Dystrophy generated mixed clinical results in April. But now the story is taking a new twist, as the drug is starting to look more effective as a small number of patients are being followed over time.

Bothell, WA-based Sarepta (NASDAQ: SRPT) said today that four boys with Duchenne Muscular Dystrophy on a high dose of its drug eteplirsen saw their walking ability decline by just 8.7 meters on a standard 6-minute walk test after 36 weeks of treatment. That was a statistically significant improvement compared with boys on the placebo, who lost 78 meters of walking ability over the same period of time, Sarepta said. So far, there have been no drug-related adverse events, and no patients have dropped out of the study because of side effects, Sarepta said.

Shares of Sarepta boomed on the findings, rising $5.06, or 146 percent, to $8.52 at the close of trading today.

Still, the findings should be taken with a grain of salt for a number of reasons. The data are from a small study of just 12 boys at a single site in Columbus, OH, and the final data from the full 48-week study isn’t yet available. The 6-minute walk test isn’t a perfect measurement of clinical success, although the FDA has used it many times for trials of drugs for rare diseases.

Although the results are still preliminary, they could spark new optimism that Sarepta is heading on the right track, after it disappointed investors in April. Back then, the company reported its drug was able to help boys produce 22.5 percent of the normal levels of the dystrophin protein they need for muscle function—a scientifically tantalizing result. But the picture was muddied when that readout from muscle biopsies didn’t appear to translate into a statistically significant improvement in the 6-minute walk test at 24 weeks.

Based on what it has learned so far from the muscle biopsy tests, which show that it can take 12 to 24 weeks for patients to start building up their dystrophin levels, Sarepta is betting that there’s a delayed effect working in its favor. The most valid data to support such an idea is still to come, but Sarepta is hoping that today’s 36-week data will bode well for what’s to come at the final 48-week analysis, expected in October.

Chris Garabedian

“I don’t think we could be in a better position at this point, given the small sample size in this trial,” says Sarepta CEO Chris Garabedian.

Any whiff of progress Sarepta makes is bound to attract significant attention from patient advocates, who are crying out for some good news for the treatment of this disease. About one out of every 3,500 boys worldwide has Duchenne Muscular Dystrophy, which usually puts them in a wheelchair before they are teenagers.

Sarepta’s program is being closely watched by scientists in particular because of its novel mode of action. This compound, given as a once-weekly infusion, is designed to work by helping patients’ muscle cells skip past a faulty section of gene for making dystrophin, so they can make enough of the critical protein to keep their muscles working.

Sarepta has already said that the results are promising enough to advance to the third and final phase of clinical trials, but much still needs to be determined before Sarepta can get there. The company needs to gather the 48-week data, discuss it with the FDA, and then agree on key ingredients of a pivotal study—like how many patients should enroll, the number of sites, the right dose, the right scientific and clinical measurements, and how long patients should be tracked.

It’s also too early to say whether the Sarepta finding is dose-dependent, that is, whether the drug works better at higher doses. But Sarepta did see a 69.4 meter difference in walking distance at 36 weeks among patients who got the high dose of 50 milligrams per kilogram of body weight, compared with a placebo. The benefit appeared to widen the longer the boys took the drug, as those same patients saw a 59.9 meter improvement in walking distance after 32 weeks of follow-up.

Sarepta doesn’t know if the improvements in walking ability are directly connected to greater dystrophin production, because the study wasn’t designed to capture muscle biopsies at that point—although that critical scientific measurement will be part of the final 48-week analysis. A lower dose of the Sarepta drug, at 30 milligrams per kilogram of body weight, didn’t appear to offer a statistically significant advantage over the placebo, although the performance of that quartet of patients was skewed by two boys who had particularly severe disease that left them unable to walk after 24 weeks. Given how long scientists say it takes for the Sarepta drug to help boost dystrophin production, the company believes those boys simply got too sick too fast for the drug to have a chance, Garabedian says.

If Sarepta’s data holds up after 48 weeks, and it can reproduce the data in a larger pool of patients, the improvements in 6-minute walk test could be medically meaningful. Other drugs for patients with rare genetic diseases that have been judged by that goal, including Genzyme’s alglucosidase (Myozyme) and BioMarin Pharmaceuticals’ laronidase (Aldurazyme) weren’t able to show such a large improvement in 6-minute walk distance, Garabedian says.

The company plans to hold a conference call at 8 am ET/5 am PT to discuss the latest results with investors.

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  • jenn mcnary

    Luke i have to wonder if you yourself understand the chemistry of duchenne. two of my sons, ages 13 and 10 have duchenne, the youngest has been on the mentioned drug for the past 48 weeks. Duchenne children are missing dystrophin, this drug makes the child produce dystrophin as proved in the 24 week biopsy. This fact alone is enough to make this a viable drug, in my mind and the minds of those impacted by the disease. Couple that finding with the ones released today and you have a drug that slows or stops the progression of this terminal illness in a randomized group of boys that would otherwise have declined greatly during the past year (according to natural history) . i know my personal experience does not translate to clinically meaningful data, but i feel compelled to state that while my younger son has been on eteplirson for the past 48 weeks my older son has not. my younger son is the same age his brother was when he stopped being able to walk, yet instead of transitioning to a wheelchair we are telling him to stop running in the house, we are watching the thrill on his face as he jumps, climbs, runs . this drug works, i invite you to meet my sons and then decide for yourself whether to take the results with a grain of salt. i have to applaud a company who has shown such dedication to this small patient population , especially as they struggle financially, without the support of wall-street, as well as the patient advocacy groups such as cureduchenne and parent project muscular dystrophy without whom we wouldn’t be where we are today. thanks jenn.

    • A. Lang

      Great post, jenn. It’s hard to argue with what you’ve seen in your boy thanks to this drug. I’ll guess he’s on the higher dose. it seems like it could turn out the kids reach a plateau – as the lower dose kids (although there are only 2 to look at here) stayed just stable after 24 weeks. Hard to say, actually. It does seem that DMD kids should start taking this benign drug (no side effects at all) at perhaps age 3 or so – so that perhaps they never show ANY symptoms of the disease. For older kids like your other son they should go for a 100mg/kg dose and try anything else to increase the drug’s efficiency. But it looks like this stuff is kicking in and it should only get better from here. Thanks for your sacrifices in enrolling in this hopefully key trial for all the other DMD boys out there. It looks this this was the real thing at last!

  • luketimmerman

    Jenn—appreciate your comments here, and I’m happy for you and your son. But I’ve seen cases of companies and their investigators getting carried away with enthusiasm before. I think this is encouraging signal to see at 36 weeks, but I think it’s wise to wait and see what the 48-week data says, and whether the clinical improvements in this small population are correlated with increased dystrophin production. If Sarepta can deliver on both of those points in October, then the evidence will be more compelling.