Denali plans to submit the drug, tividenofusp alfa, for accelerated approval early this year in the hopes that the treatment will become available to patients by the end of 2025 or early 2026.\n After winning a breakthrough therapy designation for its Hunter syndrome enzyme replacement therapy, Denali Therapeutics is climbing closer to its goal of accelerated approval by unveiling data showing the drug met its primary safety endpoints and reduced key biomarkers of the disease.Treated patients also experienced long-term improvements in their hearing and cognition, the company said in a Feb. 6 release. The phase 1/2 open-label trial enrolled 47 boys around the age of 5. Patients received weekly intravenous infusions of the drug, tividenofusp alfa (tivi), in either fixed or escalating doses. The primary analysis looked at data after 24 weeks of treatment, with the long-term follow-up planned for about five years. So far, some patients have more than three years of follow-up.Denali will present the phase 1/2 results at the 21st Annual WORLDSymposium conference in San Diego, California.The trial\'s primary endpoints are the rates of adverse events and infusion-related reactions, as well as other safety indicators, according to the presentation.Side effects were common, with 72% of patients experiencing mild to moderate treatment-emergent adverse events, according to the presentation. In the 24-week treatment period, the most common adverse events were infusion-related reactions, anemia, vomiting, fever, upper respiratory infection and rash.Though three patients experienced serious but manageable adverse events—and one patient discontinued treatment due in part to a reaction to the drug infusion—the trial met its safety expectations, the company said in the release.The company plans to submit the drug for accelerated approval early this year in the hopes that the treatment will become available to patients by the end of 2025 or early 2026, Denali said in its Feb. 6 press release.“Safety and tolerability endpoints are met and we consider tividenofusp alfa to be ‘well tolerated,’” Denali said in an emailed comment to Fierce Biotech. Hunter syndrome is rare and the trial is small, so there are no pre-defined standards for the safety endpoints to be compared against, Denali said. \"Today’s update is in line with prior updates and reinforces tivi’s potential as a best-in-class treatment option for Hunter syndrome, including normalization of multiple central and peripheral markers,\" analysts from William Blair wrote on Feb. 6. \"While early and in a limited number of patients, these appear to be translating to clinical benefit.\"Hunter syndrome, also called mucopolysaccharidosis type II (MPS II), is characterized by patients\' inability to break down certain sugars, which leads to tissue and organ damage that ultimately causes stiff joints, delayed growth and an enlarged spleen and liver, among other symptoms. The disease can also lead to cognitive and behavioral problems, and in severe cases, patients may not survive beyond their teenage years.There is one approved enzyme replacement therapy for Hunter syndrome in Takeda’s Elaprase. The Japanese drugmaker acquired the medicine when it bought Shire Pharmaceuticals in 2019.In the latest presentation, Denali said that patients saw a sharp decline of the biomarker heparan sulfate in both their cerebrospinal fluid and urine after 24 weeks, with levels dropping by an average of about 90% from baseline. These lower levels persisted for as long as 153 and 177 weeks, respectively, according to the biotech. Heparan sulfate is a liver sugar that patients with Hunter syndrome have difficulty breaking down.Tivi also restored patients’ liver volumes to normal and reduced levels of neurofilament, a sign of neuron damage, in the blood, according to the presentation. Neurofilament levels increased slightly at 24 weeks, a data point that drew scrutiny from analysts when first presented as an exploratory endpoint in 2021. By 49 weeks, neurofilament dropped by about 20%, with the decline then escalating to more than 70% in subsequent measurements, according to Denali. The investigators also tested patients’ hearing using pure tone average, a measurement of hearing sensitivity at sound frequencies important for speech. At 24 weeks, the volume a sound needed to be played in order for patients to respond dropped by an average of nearly nine decibels. In the eight patients tested at 153 weeks, the threshold dropped by more than 12 decibels.Patients also saw statistically significant improvements in two tests of cognition and behavior, the Bayley Scales of Infant and Toddler Development and the Vineland Adaptive Behavior Scales, Denali said.“Our primary analysis in 47 participants with MPS II and the additional long-term data in up to more than four years support the potential of tividenofusp alfa to address neurocognitive, behavioral and physical effects for all individuals living with MPS II,” Denali chief medical officer Carole Ho, M.D., said in the release. “We expect the progress achieved in our Hunter syndrome program to inform and accelerate additional therapeutics programs in our lysosomal storage disease portfolio, including Sanfilippo syndrome Type A.”While Denali plans to submit tivi for accelerated approval early this year, the company is also continuing its investigation of the drug in an ongoing phase 2/3 double-blind, randomized trial in about 54 pediatric and young adult patients with Hunter syndrome.Tivi is a version of the iduronate 2-sulfatase enzyme that is engineered to penetrate the blood-brain barrier by binding to transferrin receptor 1, which normally shuttles iron into the brain. Editor\'s note: This story was updated at 2:15 p.m. ET on Feb. 6 to include an analyst note.