Immunovant, Inc.

The FDA approved a new rare disease drug that Johnson & Johnson hopes can compete with established medicines — and some that are yet to be approved — and become a megablockbuster. Regulators on Wednesday gave the thumbs-up to nipocalimab, which will be branded as Imaavy, for patients 12 and up with generalized myasthenia gravis, an autoimmune disease that causes muscle weakness, particularly in the eyes, face, throat and lungs. J&J did not immediately share information about how the drug will be priced. The approval sets up a showdown with Rystiggo and Zilbrysq — both of which are marketed by UCB — as well as argenx’s Vyvgart. Through its $39 billion acquisition of Alexion in 2020, AstraZeneca also has a pair of approved drugs: Soliris and Ultomiris. The FDA’s decision came on time, with the agency expected to approve or reject Imaavy by Tuesday (though J&J did not disclose the PDUFA date). The timing of new drug approvals is under increased scrutiny in light of the widespread cuts at the FDA under Commissioner Marty Makary and HHS Secretary Robert F. Kennedy Jr. Stealth BioTherapeutics on Tuesday reported a delay in the FDA’s decision for its Barth syndrome drug, and a person familiar with the situation said it wasn’t related to safety, efficacy or manufacturing. Myasthenia gravis is a category in which biopharma companies have invested heavily in recent years, and the market is expected to reach between $3 billion and $7 billion by the early 2030s, according to analyst estimates. J&J acquired Imaavy in its $6.5 billion acquisition of Momenta in 2020. Soliris was the first drug to be approved for myasthenia gravis in 2017, but sales have been rising for UCB’s drugs and Vyvgart, all of which have different mechanisms of action than Soliris and Ultomiris and are viewed as the next generation of therapies. In 2024, Rystiggo had $202 million in sales — up from just $19 million in 2023 when it launched — and Zilbrysq reached $72 million in its first year on the market. Vyvgart, meanwhile, has already proved itself a rare disease blockbuster, tallying nearly $2.2 billion in sales in 2024 across its IV and subcutaneous formulations. In addition to myasthenia gravis, Vyvgart also received approval last year in another disease called CIDP, which is when a patient’s immune cells attack the peripheral nervous system. J&J has high hopes for Imaavy, saying it expects the drug can reach more than $5 billion in peak sales across all potential indications, should it continue to win approvals. But to carve out a piece of the market, J&J will have its work cut out for it. Amgen is testing its rare disease drug Uplizna in myasthenia gravis, with a filing expected before the end of June. Immunovant also has a drug in late-stage development, while Biohaven has a program expected to soon start Phase 1 studies in myasthenia gravis. Cartesian Therapeutics is working on a cell therapy program as well.

Today, a brief rundown of news involving Akeso and Novavax, as well as updates from Regeneron, Gilead and Alumis that you may have missed.Akeso said Wednesday that ivonescimab, an experimental cancer immunotherapy its co-developing with Summit Therapeutics, succeeded in another Phase 3 trial in lung cancer. The study compared a combination of chemotherapy and ivonescimab, a so-called PD-1/VEGF inhibitor, to chemo and a drug that only blocks the PD-1 protein. Akeso didnt provide specific details from the trial, which only took place in China, but said that the ivonescimab combination slowed tumor progression at an interim data check. Akeso and Summit could report results in 2027 from a global study testing a similar regimen against the Keytruda-chemo combination thats standard care for most lung cancers. Ben FidlerShares of Novavax rose by double digits Wednesday after the Food and Drug Administration asked it to generate additional clinical data on its COVID-19 vaccine following regulatory approval. The agency missed an April 1 deadline to convert the companys emergency use authorization to a traditional approval, spurring concerns that prominent anti-vaccine activist and Health and Human Services secretary Robert F. Kennedy Jr. might be impacting the reviews of new shots. In a short statement, though, Novavax said the FDA has since called for a commitment to accrue study results after approval and the company is working expeditiously to address the request. Novavax declined to provide more details when contacted by BioPharma Dive. Delilah AlvaradoRegeneron Pharmaceuticals will nearly double its commercial drug manufacturing capacity in the U.S. via a new deal with FUJIFILM Diosynth Biotechnologies, the companies said Tuesday. Through the alliance, Regeneron will pay Fujifilm $3 billion over the next decade to produce drugs at a new facility in Holly Springs, North Carolina. That facility will open later this year and be expanded in the future. Regeneron is already investing $3.6 billion in a planned expansion of its campus in Tarrytown, New York, is building another facility in Rensselaer, New York, and recently acquired property in Saratoga Springs. The combined investments in North Carolina and New York are expected to exceed $7 billion. Delilah AlvaradoGilead Sciences said a combination of its antibody-drug conjugate Trodelvy, chemo and Merck & Co.s Keytruda significantly delayed disease progression in women with a tough-to-treat form of breast cancer when compared to Keytruda and chemo alone. The trial evaluated the two regimens in women whose newly diagnosed, metastatic triple-negative breast tumors express a protein, PD-L1, linked to a response to immunotherapies like Keytruda. Gilead didnt provide specifics, but said the Trodelvy regimen led to a statistically significant and clinically meaningful improvement in progression-free survival and an early trend in improvement on survival.Trodelvy is currently approved to treat triple-negative breast cancer in people whose disease has progressed following two systemic therapies. Jonathan GardnerAlumis and Acelyrin have changed the terms of their planned merger, announcing Monday that the formers shareholders would own 52% of the combined company, and the latter 48%, upon the deals closing. Acelyrin stockholders were going to receive 45% of the new companys equity under the original deal announced in February. However, discussions with stockholders yielded an amended deal, according to Acelyrin board chair Bruce Cozadd. Following those talks, Acelyrins equity holders now stand to benefit from a greater interest in Alumis long-term upside potential, Cozadd said in the statement. Gwendolyn WuTempest Therapeutics will lay off 21 of its 26 full-time employees effective April 30, the company said in a regulatory filing. The layoffs were revealed less than two weeks after the company began exploring strategic alternatives to help raise the necessary funds to advance a liver cancer drug into Phase 3 testing. Tempest said it will incur $1.5 million in expenses in conjunction with the job cuts, mostly in severance payments. The company added that key employees within the affected group would transition to consulting agreements and be available to help advance the cancer medicine. Jonathan GardnerImmunovant has replaced its CEO alongside a series of other leadership and strategic changes that gives majority owner Roivant Sciences closer control of the immune drug developer. The company on Monday said that current head Pete Salzmann has stepped down from his post and Eric Venker, Roivants president and chief operating officer, will take his place. Immunovant is also switching CFOs, with Tiago Girao, an executive at another Roivant affiliate, taking over for Renee Barnett. The executive changes are part of a broader strategic transition that gives Roivant increasing operational involvement and strategic oversight of the company, which Roivant spun out in 2019 but still owns 57% of, Immunovant said. Ben Fidler '

作者｜小麦近日，全球知名医药数据公司Evaluate Pharma对2025年医药行业发展趋势发表见解，其中包括对一些Biopharma的核心资产进行预测，特别是关注到Biopharma都在押宝什么？（图1）图1. Biopharma的十大潜在重磅核心资产从这些管线中，我们可以看出在过去的几年里，生物制药公司已经将大量注意力转移到免疫学上，近期又转向了代谢领域，尤其是司美格鲁肽的爆火引爆了GLP-1类减肥药的研发。除了司美格鲁肽，诺和诺德、礼来和安进都把宝押在GLP-1类药物上，包括诺和诺德的复方减肥药Cagrisema、礼来的三重激动剂Retatrutide、小分子GLP-1R激动剂Orforglipron以及安进的每月一次给药的MariTide。Immunovant/Roivant把希望寄托在靶向FcRn（新生儿 Fc 受体）的药物IMVT-1402和Batoclimab，它们是一类新型的免疫调节药物，主要用于治疗 IgG 介导的自身免疫性疾病，IMVT-1402有望成为Best-in-class的靶向FcRn药物。在Evaluate Pharma所关注到核心管线中，只有一款是用于治疗肿瘤的，即康方生物靶向PD-1xVEGF 双抗药物Ivonescimab。2022年底，康方生物与 Summit Therapeutics就Ivonescimab 的全球开发和商业化达成高达 50 亿美元的合作和许可协议，由此可见Ivonescimab的价值无限。除此之外，还有两款RNA类药物，包括安进的靶向脂蛋白(a)（Lp(a)）的小干扰 RNA（siRNA）药物Olpasiran、Moderna/Merck的一种基于 mRNA 的个性化新抗原疗法mRNA-4157以及一款自免药物即Moonlake的Sonelokimab。  01  诺和诺德：Cagrisema诺和诺德在GLP-1类减肥药领域取得巨大成功，其重磅产品司美格鲁肽（Semaglutide）在2024年的总销售额达到了2018.49亿丹麦克朗，约合293亿美元，占据诺和诺德公司2024年总营收的约69.5%。除此之外，诺和诺德积极布局寻找下一个强力增长点，他们把希望放在了CagriSema身上。CagriSema是由司美格鲁肽和胰淀素类似物Cagrilintide组成的一种新型复方减肥药，司美格鲁肽能够刺激胰岛素的生成，抑制胰高血糖素分泌，延缓胃排空，并通过中枢性的食欲抑制来减少进食量，从而降低血糖和减轻体重，胰淀素是一种与饥饿和饱腹感相关的激素，也能参与胰岛素的调节，两种药物通过减少饥饿感、增加饱腹感，来减少食物和热量的摄入，从而降低体重。此前，CagriSema的一项临床2期结果显示：CagriSema注射液（司美格鲁肽2.4mg和Cagrilintide 2.4mg组成）组患者的HbA1c水平降低了2.18%，体重减轻了15.6%，减重和降糖效果均优于司美格鲁肽2.4mg组或cagrilintide 2.4mg组（图2）。图2. CagriSema的临床2期结果自去年年底至今，诺和诺德相继公布了CagriSema的两项3期研究结果，包括REDEFINE 1和REDEFINE 2。2024年12月，诺和诺德宣布了全球REDEFINE计划的3期试验 REDEFINE 1 的主要结果：安慰剂相比，CagriSema在第68周时的体重减轻具有统计学意义且更好，从而达到了其主要终点。具体来说，在评估所有受试者都坚持治疗的情况下的治疗效果时，接受 CagriSema 治疗的患者在68周后实现了22.7%的体重减轻，而2.4 mg cagrilintide治疗组减少了11.8%，司美格鲁肽2.4 mg组减少了16.1%，单独使用安慰剂组减少了2.3%。此外，40.4%接受CagriSema治疗的患者在68周后体重减轻了25% 或更多，而 cagrilintide 2.4 mg组为6.0%，司美格鲁肽2.4 mg组为16.2%，安慰剂组为0.9%（图3）[1,2]。图3. REDEFINE 1试验结果2025年3月10日，诺和诺德宣布了CagriSema的另一项全球 REDEFINE 计划的3期试验REDEFINE 2的主要结果：在评估治疗效果时，如果所有人都坚持治疗，则接受 CagriSema 治疗的人在68周后实现了15.7%的体重减轻，而安慰剂组为3.1%。68周后体重减轻5%或以上是共同主要终点，89.7%的 CagriSeama患者实现了体重减轻，而安慰剂组为30.3%（图4）。图4. REDEFINE 2试验结果然而虽然CagriSema的两项3期试验都取得积极结果，但是都不达预期，这也导致近期诺和诺德股价大跌。  02  礼来：Retatrutide和OrforglipronRetatrutide 是礼来开发的一种靶向GLP-1、葡萄糖依赖性促胰岛素多肽（GIP）和胰高血糖素（GCG）的由39个氨基酸组成的三重受体激动剂，这些受体中的每一种都在调节新陈代谢中起着重要作用，特别关注胰岛素分泌、能量消耗和血糖水平（图5）[3]。图5. Retatrutide作用机制Retatrutide 的首次人体试验于2019年在新加坡进行。这项1期概念验证研究涉及47名参与者，每周接受0.1 mg至6 mg的retatruide。研究结果表明，Retatrutide对食欲调节、食物摄入和代谢标志物有积极的影响，同时该研究还显示了了retatrutide的良好安全性[4]。Retatrutide 的一项2期研究结果显示：在48周时，retatrutide在1 mg组中使受试者体重下降8.7%，在联合 4 mg 组下降17.1%，8 mg联合组下降22.8%，12 mg组下降24.2%，而安慰剂组下降2.1%（图6）[5]。图6. Retatrutide 的2期研究结果目前Retatrutide正在开展多项TRIUMPH 3期临床试验，旨在评估Retatrutide在肥胖或超重患者中的安全性和有效性，包括TRIUMPH 1-4等（图7）[6]。图7. Retatrutide的临床试验除此之外，Retatrutide还在开展TRANSCEND系列3期试验，预计明年至后年完成（图8）。图8. Retatrutide的临床试验Orforglipron是由Chugai开发的一种可口服的小分子GLP-1R激动剂, 每日服用一次，主要用于治疗肥胖症和2型糖尿病。2018年9月，礼来与中外制药达成许可协议，以5000万美元首付款获得该产品的全球开发权和商业化权。临床前研究表明，Orforglipron降糖效果与艾塞那肽相当。在食蟹猴中进行的药代动力学实验结果显示，Orforglipron的半衰期为3.4~4.6h，生物利用度达到21~28%（图9）。图9. Orforglipron的结构与活性Orforglipron目前正在临床上开展多项试验，包括针对肥胖症的3期ATTAIN-1和ATTAIN-2试验、针对2型糖尿病患者的3期临床试验以及针对阻塞性睡眠呼吸暂停的3期临床试验等（图10和图11）。图10. Orforglipron的临床试验图11. Orforglipron的临床试验此前针对肥胖症的2期临床研究显示，接受高剂量Orforglipron治疗的肥胖或超重成人在36周后平均体重减轻了14.7%。针对2型糖尿病患者2期临床试验结果显示，经过26周的治疗后，45mg 剂量组患者的糖化血红蛋白（HbA1c）平均降幅达到2.1%，体重平均下降 10.1kg。礼来计划在2025年在美国、欧盟、日本递交 Orforglipron 的上市申请。如果一切顺利，Orforglipron最快有望在2026年获批上市。  03  安进：MariTideMariTide是由安进（Amgen）开发的一种新型双特异性分子药物，属于抗体-多肽偶联物（Peptibody）。与其它GLP-1类激动剂不同，它是葡萄糖依赖性促胰岛素多肽受体（GIPR）拮抗剂和胰高血糖素样肽-1（GLP-1）受体激动剂（图12）。与传统的GLP-1受体激动剂（如司美格鲁肽）和GIPR激动剂（如替尔泊肽）不同，MariTide是首个将GLP-1激动剂与GIPR拮抗剂结合的药物。GLP-1 受体激动剂能够刺激胰岛素分泌，抑制食欲；而 GIPR 拮抗剂则通过抑制 GIP 的作用，减少胰岛素分泌，从而降低食欲和体重。图12. MariTide作用机制2024年11月26日，安进公司宣布了一项双盲、剂量探索的2期研究 MariTide的52周阳性数据：在没有2型糖尿病的肥胖或超重患者中，MariTide 在第52周时平均体重减轻了高达~20%，没有体重减轻平台期，这表明52周后体重可能会进一步减轻（图13）[7]。该研究还显示，肥胖或超重患者以及 2 型糖尿病患者通常在 GLP-1 疗法中减轻的体重较少。平均体重减轻高达~17%，也没有体重减轻平台期，并在第52.1周将平均血红蛋白A1C（HbA1c）降低高达2.2%，总之，在两个研究人群中，均未观察到体重减轻平台期，再次表明52周后体重进一步减轻的可能性。图13. MariTide基本信息  04  Immunovant/Roivant：IMVT-1402和BatoclimabIMVT-1402是一种由Immunovant公司开发的潜在“best-in-class”新生儿 Fc受体（FcRn）靶向抗体，主要用于治疗IgG介导的自身免疫性疾病（图14）[8-11]。图14. IMVT-1402基本信息FcRn是一种免疫球蛋白G（IgG）和白蛋白的特异性受体，由MHC I类相关分子和β2微球蛋白组成。它通过酸碱度依赖的方式与IgG和白蛋白结合，使它们免于被溶酶体降解，从而延长其在血浆中的半衰期。此外，FcRn还具有实现IgG和白蛋白的跨膜转运及促进抗原提呈的作用（图15）。图15. FcRn作用FcRn与多种IgG介导的自身免疫性疾病密切相关，包括重症肌无力（MG）、慢性炎症性脱髓鞘性多发性神经病（CIDP）、甲状腺眼病（TED）、免疫性血小板减少症（ITP）以及格雷夫斯病（Graves’ Disease）等（图16）。 图16. FcRn与多种IgG介导的自身免疫性疾病密切相关在1期临床试验中，IMVT-1402表现出剂量依赖性地显著降低IgG水平。在300mg多剂量组中，经过4周的皮下注射，平均IgG降低63%；在600mg 多剂量组中，经过4次皮下注射，平均IgG降低74%（图17）。图17. IMVT-1402的1期试验结果IMVT-1402在格雷夫斯病中显示出“Best and First-in-class”特征。与 Batoclimab对比，IMVT-1402的IgG降低效果与Batoclimab类似，Batoclimab在高剂量（680 mg）下可使 IgG 降低 76%（图18）。图18. IMVT-1402在格雷夫斯病中显示出“Best and First-in-class”特征目前IMVT-1402正处于临床2期，正在开展针对类风湿关节炎和格雷夫斯病的临床试验，同时准备开展IMVT-1402在重症肌无力（MG）和慢性炎症性脱髓鞘性多发性神经病（CIDP）等4至5种适应症的临床项目，并计划在次年拓展至10种适应症（图19）。图19. IMVT-1402的临床试验计划Batoclimab（RVT-1401/HL161）是由Immunovant开发的一款早于IMVT-1402的靶向FcRn的一种全人源IgG1单克隆抗体，通过阻断FcRn与IgG的结合来降低致病性IgG水平。近期，Immunovant公布了Batoclimab治疗MG的3期研究的顶线结果，以及CIDP的2b期研究的第1期初步结果。Batoclimab治疗MG的3期研究结果显示：Batoclimab组在12周时达到了AChR人群中MG-ADL相对于基线变化的主要终点，其中高剂量组提高了5.6分（平均IgG减少74%），低剂量组提高了4.7分（平均 IgG 减少 64%）（图20）。图20. Batoclimab治疗MG的3期研究结果Batoclimab治疗CIDP的2b期研究的第1期初步结果：Batoclimab组调整后的 INCAT 残疾评分平均改善1.8，IgG 降低超过70%的患者反应率为 84%（图21）。图21. Batoclimab治疗CIDP的2b期研究的第1期初步结果在这两项 batoclimab 研究中，IgG 减少的程度更深与一系列评估和时间点的更好临床结果相关。  05  Moonlake Immunotherapeutics：SonelokimabSonelokimab（SLK，M1095）是由MoonLake Immunotherapeutics研发的一种~40 kDa人源化纳米抗体，由三个VHH结构域组成，这些结构域通过灵活的甘氨酸-丝氨酸间隔区共价连接。Sonelokimab 的两个结构域，以高亲和力选择性结合IL-17A和IL-17F，从而抑制 IL-17A/A、IL-17A/F和IL-17F/F二聚体，从而抑制炎症。第三个中心结构域与人白蛋白结合，促进sonelokimab在炎性水肿部位的进一步富集（图22）[12]。图22. Sonelokimab作用机制Sonelokimab正在评估化脓性汗腺炎（HS）和银屑病关节炎（PsA）这两个主要适应症，同时，MoonLake也在寻求皮肤病学和风湿病学的其他适应症（图23）。今年1月8日，MoonLake宣布，已在青少年化脓性汗腺炎 （HS）、掌跖脓疱病 （PPP） 和中轴型脊柱关节炎 （axSpA） 患者三个新适应症的三项新试验中筛选了患者，以评估 sonelokimab，一种旨在治疗炎症性疾病的研究性纳米抗体®。这将使 MoonLake 主导的临床试验数量增加到 10 项，并与自 2021 年公司成立以来招募 3,000 多名患者参加 sonelokimab 临床试验的计划保持一致。图23. Sonelokimab临床试验2023 年 6 月，sonelokimab 的2期MIRA 试验 （NCT05322473） 在 12 周时的顶线结果显示，该试验达到了其主要终点，即化脓性汗腺炎临床反应 （HiSCR）75，与其他临床试验中使用的 HiSCR50 指标相比，该指标的临床反应指标更高，树立了一个里程碑（图24）。图24. Sonelokimab的MIRA试验结果2023年10月，MIRA 试验在24周时的完整数据集显示，sonelokimab 维持治疗进一步改善了HiSCR75反应率和其他高阈值临床和患者相关结局（图25）。sonelokimab 在 MIRA 试验中的安全性特征与之前的试验一致，未检测到新的安全性信号。图25. Sonelokimab的MIRA 试验24周时的完整数据2024年2月，MoonLake宣布FDA和EMA对sonelokimab治疗化脓性汗腺炎（HS）的3期试验的监管路径给予积极反馈，基于此，MoonLake开展了3期VELA-1 和 VELA-2临床试验。对于 PsA，继2024年3月宣布全球2期ARGO试验（M1095-PSA-201） 的完整数据集后，sonelokimab正在3期试验 IZAR-1和IZAR-2中评估在24周内对活动性PsA患者的疗效和安全性（图26）。图26. Sonelokimab的 3期试验 IZAR方案Sonelokimab的ARGO试验结果显示在所有关键结局中均观察到显著改善，包括约60%的sonelokimab治疗患者在第24周达到美国风湿病学会（ACR）50 缓解和最小疾病活动度（MDA）（图27）。注：ACR 50 是美国风湿病学会（ACR）制定的用于评估类风湿关节炎（RA）患者治疗反应的标准之一。它表示患者在治疗后，疾病活动度相比基线改善了 50% 或以上。图27. Sonelokimab的ARGO试验结果这是继 2023 年 11 月的积极顶线结果之后，该试验达到了主要终点，与安慰剂组相比，接受 sonelokimab 60mg 或 120mg（诱导）治疗的患者在第 12 周达到 ACR50 反应的比例具有统计学意义。试验中的所有关键次要终点均达到 60 mg和 120 mg诱导剂量[13]。  小结  今年Evaluate Pharma对Biopharma的未来潜力管线进行了预测，其中大部分药物都是治疗代谢疾病的，主要是GLP-1类药物，有三款免疫药物，即IMVT-1402、Batoclimab和Sonelokimab，另有两款RNA类药物，包括Olpasiran和 mRNA-4157以及一款肿瘤药物Ivonescimab。一款药物的成功不仅使患者受益，也能使企业得到丰厚的回报。 主要参考文献 1. Novo Nordisk A/S: CagriSema demonstrates superior weight loss in adults with obesity or overweight in the REDEFINE 1 trial2. Novo Nordisk– a focused healthcare company Investor presentation Full year 20243. The power of three: Retatrutide's role in modern obesity and diabetes therapy, European Journal of Pharmacology Volume 985, 15 December 2024, 1770954. Retatrutide | Reviews, Clinical Data, Benefits & Side Effects5. Triple–Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial, N Engl J Med 2023;389:514-266. ELI LILLY AND COMPANY Q4 2024 EARNINGS CALL 02.06.257. AMGEN ANNOUNCES ROBUST WEIGHT LOSS WITH MARITIDE IN PEOPLE LIVING WITH OBESITY OR OVERWEIGHT AT 52 WEEKS IN A PHASE 2 STUDY8. Immunovant Development Update9. Targeted science, Tailored solutions for people with autoimmune disease2025 J.P. Morgan Healthcare Conference January 14, 2025，immunovant10. Targeted science, Tailored solutions for people with autoimmune disease MG & CIDP Results March 202511. Immunovant Announces Positive Results for Batoclimab Myasthenia Gravis (MG) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Studies12. MoonLake Immunotherapeutics October 2024 Corporate Presentation13. MoonLake initiates three new clinical trials and further expands the portfolio of indications for the Nanobody® sonelokimab共建Biomedical创新生态圈！如何加入BiG会员？