Competing with Ozempic is harder than it sounds

Altimmune, a small biotech company trying to elbow into the blockbuster market for novel weight-loss drugs, lost more than half of its value yesterday after its lead medicine failed to meet lofty expectations.

As STAT's Allison DeAngelis reports, the highest tested dose of Altimmune's pemvidutide led to a nearly 10% reduction in body weight compared to placebo after 24 weeks of treatment. That's roughly comparable to 24-week data from Novo Nordisk's Ozempic and Eli Lilly's Mounjaro, but Altimmune's drug had no beneficial effect on blood sugar, and 27% of patients on the high dose dropped out due to side effects.

Altimmune's data, which left the company trading at its cash value, serve as a reminder that the success of Ozempic and Mounjaro hardly guarantees the same fate for the many follow-on medicines in development, including drugs from Amgen, Pfizer, Lilly, and Structure Therapeutics.

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Markets

Illumina might be missing Carl Icahn's point

Last week, famed activist investor Carl Icahn published an open letter accusing Illumina of woeful mismanagement in its ill-fated acquisition of the cancer-testing company Grail. This week, Illumina responded with a letter of its own that both engages with Icahn's criticisms and arguably misses his point.

Illumina's Grail predicament is this: The company spent $8 billion on a company that would struggle to fetch half that in today's market, and because European regulators are contesting the merger, Illumina is burning money by running Grail at arm's length. In its self-defense letter, Illumina points out that neither Icahn nor his three nominees for the company's board have any experience in cancer blood testing or European antitrust negotiations. "Icahn has no ability to accelerate the legal and regulatory processes and neither do his nominees," Illumina said.

But Icahn isn't proposing to accelerate any regulatory processes; he's proposing Illumina simply stop throwing good money after bad when it comes to Grail. According to his letter, "we believe it is essential that Illumina extricate itself immediately from the dire position it might well sink into financially if it remains on this perilous course."

Illumina's pitch to shareholders is a tacit acknowledgement that the Grail deal has gone sideways coupled with a confident claim that the company's current leadership is up to the task of fixing the situation. But the company's stock price is up about 14% since Icahn published his letter, suggesting shareholders are more than intrigued by the notion of just ditching Grail altogether.

Politics

Moderna is not backing down

In a likely preview of Moderna CEO Stéphane Bancel's testimony before a Senate committee today, the company is making the case that it has long since made good on all that federal money it received and is justified in raising the price of its Covid-19 vaccine.

Speaking to Bloomberg, Moderna President Stephen Hoge pointed out that the U.S. government paid about $12.6 billion for doses of Pfizer's vaccine and $10.1 billion for doses of Moderna's. That $2.5 billion discrepancy more than accounts for the roughly $1.7 billion in federal grants Moderna received, and thus "we think we've paid it back and then some," Hoge said.

As for the price increase, Hoge told Reuters that Moderna expects to charge about $130 per dose of its vaccine once purchasing shifts from the federal government to private payers. The company had previously said it was considering a range of between $110 and $130 per dose.

Policy

In defense of a wonky tool under fire

In the decades-long effort to figure out whether new medicines are worth their escalating prices, researchers came up with a metric called quality-adjusted life year, or QALY, which measures a drug's value based on patients' life expectancy and overall health for the years they spend on receiving treatment. The humble QALY has been the subject of ardent debate, and now there's federal legislation that would ban the government from employing it.

But all the backlash over QALY misunderstands the tool's utility, three academics argue. The case against QALY asserts that by defining quality of life, the metric is inherently biased against people with diseases that cause long-term disability. Writing in STAT, researchers at Tufts Medical Center contend that the opposite is true.

"By placing greater value on life years with improved quality, the QALY rewards health care that improves functioning, reduces pain, and helps people with serious and disabling conditions re-engage in work and other activities," the researchers write. "It is a measure of the health gains of treatments, not a measure of the value of people."

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