NEU 3.02% $20.46 neuren pharmaceuticals limited

Ann: Half Yearly Report and Accounts, page-7

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    In the announcement of the licensing deal with Acadia it was stated that the Phase 3 trial of trofinetide in Rett syndrome would enrol ~180 patients. Assuming a 50:50 split between drug and placebo that would be ~90 patients to be dosed with trofinetide over 6 months. If manufacture of the drug for the trial is costing AU$6.7 million, that would average out to a cost of AU$74,000 per patient for 6 months of drug supply, which seems exraordinarily high to me. Of course, it's possible that they could be stockpiling product in advance for future planned trials. But allowing, conservatively, a guaranteed 2 year shelf life for the lyophilized powder, and taking into consideration that the Phase 3 Rett trial won’t complete before late 2020, I’d say there’s a solid chance that the next trial in Fragile X will overlap with the Phase 3 Rett trial.

    We know that the Phase 2 paediatric trial in Fragile X has been on hold because the Division of Psychiatry at the FDA ruled that chronic tox study results were needed first. This tox study is also necessary before the Phase 3 Rett trial can start and is yet to be completed. The tox study requirement and the need for “drug supply from the commercial process being developed for the Rett syndrome program” were mentioned in the latest Annual Report (see below). It was also mentioned that the Fragile X trial will likely use higher doses (perhaps 200mg/kg BID like the Rett trial?) and be longer (than the 6 week duration of the paediatric Rett trial, I assume). The trial sample size may be larger as well.

    If the company’s statement that the next Fragile X trial requires drug supply to come from the commercial process being developed for the Rett syndrome program means that it requires commercially produced drug product, which I think is normally only a requirement for Phase 3 trials, I wonder if a potentially pivotal Phase 2/3 trial for Fragile X is being considered.

    The next Phase 2 trial in Fragile X syndrome will likely enrol younger children and examine higher doses with longer treatment duration, as well as refining the outcome measures that may be used in a Phase 3 trial. Before such a trial can start, results from the chronic dosing toxicity study that is currently in progress for the Rett syndrome program are required to be submitted to the FDA Division of Psychiatry Products. The trial will also require drug supply from the commercial process being developed for the Rett syndrome program.
 
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