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Neurological Disorders A Report on Disorders of the Brain, Spinal Cord and Nerves 2013 REPORT Medicines in Development presented by america’s biopharmaceutical research companies Biopharmaceutical Companies Researching and Developing Nearly 450 Medicines for Neurological Disorders Medicines in Development For Neurological Disorders Application Submitted Phase III Phase II Phase I 82 on ’s •28 medicines for epilepsy and seizures, which impact more than 3 million Americans. •27 medicines for Parkinson’s disease, which affects as many as 1 million Americans. ins Pa in 27 Pa rk ps y cle ro sis eS ipl ult M or s Ep ile Tu m er’ s eim •Gene therapy to reverse the effects of Parkinson’s disease. •38 medicines for multiple sclerosis, which afflicts an estimated 500,000 Americans. 28 Br ain •82 medicines for Alzheimer’s disease, which afflicts more than 5 million Americans. •62 medicines for brain tumors—nearly 70,000 Americans are diagnosed each year with a primary brain tumor. 38 zh Other medicines in development target amyotrophic lateral sclerosis (ALS), brain injuries, Huntington’s disease, spinal cord injury, cerebral palsy, and stroke. Among the many promising new medicines in development are: •82 medicines for pain—100 million U.S. adults experience chronic pain. 82 62 Al Neurological disorders—such as epilepsy, multiple sclerosis and Parkinson’s disease—inflict great pain and suffering on patients and their families, and every year costs the U.S. economy billions of dollars. Biopharmaceutical research companies are developing 444 new medicines to prevent and treat neurological disorders. The medicines in development are either in human clinical trials or under review at the Food and Drug Administration. They include: •25 medicines for headache, including migraine, a condition that affects more than 37 million people. •A medicine that prompts the immune system to protect neurons affected by ALS. •Gene therapy for the treatment of Alzheimer’s disease. The new medicines being developed by biopharmaceutical research companies reflect a growing understanding of the underlying mechanisms of neurological disorders, which fuels scientific progress and pharmaceutical research. These medicines offer patients hope that more effective treatments may soon be available. Contents Key Issues.......................................2 Disease Facts...................................7 Medicines in Development................11 Glossary....................................... 49 Drug Development/ Approval Process........................ 51 Innovative Medicines in the Pipeline orders such as Duchenne muscular dystrophy (DMD). In DMD, DNA deletions cause mutations in important genes that encode for dystrophin, a structural protein found in normal muscle. The loss of this protein causes muscle fibers to disintegrate faster than they can be regenerated. One medicine in development targets restoration of dystrophin function and, as dystrophin expression increases, there have been demonstrated improvements in patients’ ability to walk. Of the 444 medicines in development in the United States listed in this report (see page 11), many present innovative new ways to target diseases. Some of them include: •Gene Therapy to Restore Neuronal Function in Alzheimer’s—A gene therapy for the treatment of Alzheimer’s disease in clinical trials is designed to deliver nerve growth factor (NGF) to the brain. NGF is a naturally occurring protein important for neuron survival. The gene treatment is injected into the brain region where neuron degeneration occurs in Alzheimer’s disease. It is thought that the resulting sustained expression of NGF in the neurons can restore their lost function, leading to memory and cognition improvement. •Gene Therapy as a Possible Approach for Parkinson’s Disease—Inserting genes into cells can alter the impact the genes have on the proteins that are involved in a particular disease. These genes might alter or replace a mutated gene or produce a new therapeutic protein entirely. In Parkinson’s disease, there are a number of treatments addressing the disease’s symptoms, but none that replace the lost nerve cells resulting from Parkinson’s or that would stop disease progression. More than one gene therapy in clinical trials uses an adeno-associated virus (AAV) as a vector •Targeted RNAi Therapy Approach for Duchenne Muscular Dystrophy—In clinical trials, RNAi therapies have shown potential in treating neuromuscular dis- Medicines in Development for Neurological Disorders By Disease and Phase Some medicines are listed in more than one category Alzheimer’s Disease 82 Amyotrophic Lateral Sclerosis (ALS) 8 Attention-Deficit/Hyperactivity Disorder Phase III 19 Brain Injury Phase II 8 Brain Tumors 28 Genetic Disorders 14 Headache Huntington’s Disease 25 7 Multiple Sclerosis Muscular Dystrophy 38 7 Pain 82 Parkinson’s Disease Spasticity Spinal Cord Injury Stroke Other 2 Phase I 62 Epilepsy Application Submitted 27 6 9 19 33 Medicines in Development Neurological Disorders 2013 to deliver neurturin to restore cells damaged in Parkinson’s patients and to protect them from further degeneration; these inactivated viruses present a safe way to get these important therapeutic options to patients. IMPORTANCE TREATMENT OF ALZHEIMER’S 5 •ALS: Fighting a Devastating Disease—ALS, or Lou Gehrig’s disease, is a progressive neurodegenerative disease that causes the brain to lose control over body movement, ultimately resulting in paralysis and death. The one drug approved to treat ALS can modestly slow progression of the disease, but new treatments are needed. As our scientific understanding of the disease has grown, researchers are pursuing many new approaches to halt or slow disease, including the use of the patient’s own bone marrow stem-cells to create healthy neuron-like cells to replace diseased neurons. Other trials are studying ways to prompt the immune system to protect neurons affected by ALS. MILLION AMERICANS ARE LIVING WITH ALZHEIMER’S DISEASE 15 MILLION AMERICANS Alzheimer’s: Effective Treatment is Needed Alzheimer’s is the 6th leading cause of death in the United States, and its impact on patients and the health care system is growing. Existing medicines are able to treat the symptoms of the disease but cannot slow, prevent, or reverse the progressive dementia. Disease-modifying treatments that could delay the onset of the disease could reduce the cost of care of Alzheimer’s patients in 2050 by $447 billion. Researchers continue to unravel the mysteries of the disease and are studying many new treatments in this area. Recent research has focused on the plaques and tangles which form in the brains of Alzheimer’s patients and are thought to contribute to the death of nerve cells. One medicine in development has shown promise in reducing both brain plaques and tangles. A gene therapy also in clinical trials is being explored to restore lost neuron function. Medicines in Development Neurological Disorders 2013 BY 2050, THE NUMBER OF PATIENTS COULD TRIPLE WITHOUT EFFECTIVE TREATMENT 2050 2013 203 1.2 $ $ TRILLION BILLION ALZHEIMER’S COSTS SOCIETY $203 BILLION AND COULD INCREASE TO $1.2 TRILLION BY 2050 5 50% YEARS DELAYED ONSET = FEWER VICTIMS 447 + $ BILLION SAVED DELAYING DISEASE ONSET BY 5 YEARS COULD RESULT IN 50% FEWER PATIENTS/SAVE $447 BILLION BY 2050 3 Advancing Biomedical Science Over the past decade, scientific advances and new technologies have dramatically changed how medicines are discovered. This new information is critical to the development of new treatments for neurological disorders. Greater knowledge of how diseases work at the genetic and molecular level has allowed researchers to pursue new targets for therapy and better predict how certain biopharmaceuticals will affect specific subpopulations of patients. • B ioinformatics—Bioinformatics use systems and mathematical models to advance the scientific understanding of living systems. At its simplest level, bioinformatics involves the creation and maintenance of biological databases, including DNA sequences. • Biomarkers—Every disease leaves a signature of molecular “biomarkers” in our body—genes that turn on and off or proteins released into the bloodstream. Biomarkers measured in blood and other samples can tell us the state of our health and how we might respond to treatment. • Molecular Targeting—The idea behind molecular targeting is to design drugs that specifically attack the molecular pathways that cause disease without disrupting the normal functions in our cells and tissues. • Nanotechnology—You can’t see it, but soon it will be everywhere. Nanotechnology is the science of building microscopic devices at the molecular and atomic levels. In medicine, nanotechnology may also be used to help diagnose and treat diseases. • Personalized Medicine—The sequencing of the human genome produced a “map” of the human genes in DNA. This new genetic knowledge opens up the possibility of developing “targeted” therapies for people with specific gene sequences, and it can help physicians choose the best treatments based on individual genetic, lifestyle, and environmental factors. 4 Breakthrough Research in Neurological Disorders Early research discoveries often fuel the drug development pathways that biopharmaceutical company researchers undertake. These discoveries help researchers target a specific disease through certain mechanisms that may have been unknown before. Some noteworthy recent scientific discoveries in the field of neurology include: • R esearchers at Mount Sinai Medical Center found 10 genes that account for half of the genetic risk for Alzheimer’s. • R esearch at the National Institutes of Health found that a protein linked with some early-onset Parkinson’s disease cases regulates how the body processes dietary fats. The study suggests there could be a link between the defective protein and early-onset Parkinson’s disease. • S cientists at the University of Chicago have uncovered a previously unknown process of protein production where a single gene can create two separate proteins from the same messenger RNA simultaneously. They believe this discovery will open the door for new research into therapies for neurological disorders. • R esearch at the University of Missouri suggests that two identical neurons can reach the same electrical activity in different ways and could help doctors in treating patients with epilepsy. • T wo separate research groups have identified a mutation on the TREM2 gene that may increase a person’s chance of developing late-stage Alzheimer’s disease by three to five times. • W hile studying at PennVet, a researcher discovered the gene responsible for Alexander disease, a rare, genetic neurological disorder where the white matter in the brain is destroyed and Rosenthal fibers form causing both mental and physical declines. Medicines in Development Neurological Disorders 2013 • A t the University of Notre Dame, researchers have created a prodrug (an inactive drug that is converted into its active form once it’s in the body) of an inhibitor of the gelatinase enzyme. Gelatinase is associated with certain neurological disorders, such as strokes, aneurysms and traumatic brain injury. • R esearchers at the Manchester Institute of Biotechnology in the United Kingdom have identified an enzyme in the brain that interacts with a compound for Huntington’s disease to inhibit its activity. Animal studies have shown that by switching off the enzyme’s activity through drug-binding, the enzyme is effective in treating brain disorders such as Huntington’s, Alzheimer’s, and Parkinson’s. The BRAIN Initiative Brain Research through Advancing Innovative Neurotechnologies is a research effort launched by the Obama Administration to map the human brain and increase our understanding of how the human mind works. Approximately $100 million will be directed to government agencies, such as the National Institutes of Health, beginning in FY 2014. The BRAIN Initiative aims to accelerate the development and application of new technologies to help researchers understand the interworking’s of the brain, leading to new ways to treat and maybe one day prevent or cure diseases, such as Alzheimer’s, epilepsy and traumatic brain injury. Public/Private Partnerships Critical to Advancing Science Collaboration among partners in the entire medical innovation ecosystem is critical to help advance scientific understanding of some of the most complex diseases facing patients. Federal research institutions, academia, biopharmaceutical research companies and patient communities all play an important role in furthering research in the neurological field. These evolving partnerships take many forms, for example: • O ne biopharmaceutical company recently formed a research consortium to bring together several leading academic research centers to coordinate their research and share results. Through this collaboration, researchers hope to accelerate their understanding of the disease and identify new approaches for targeting and treating amyotrophic lateral sclerosis (ALS). • T he Alzheimer’s Disease Neuroimaging Initiative is a collaborative effort between several federal agencies, non-profit organizations, and biopharmaceutical industry members. The goal of the Initiative is to track Alzheimer’s disease progression, establish quality standards, and validate biomarkers to be used in clinical Medicines in Development Neurological Disorders 2013 trials. Data collected are made available at no cost to researchers when designing clinical trials and research projects. • A nother biopharmaceutical company is collaborating with a medical school’s neurodegenerative disease research center to screen for Alzheimer’s drug candidates. The company is sharing their basic research with the research center’s screening assays and knowledge of the biology of the tau protein, which is thought to play a significant role in Alzheimer’s disease. • T he Coalition Against Major Diseases, a program of the Critical Path Institute, is a consortium of biopharmaceutical research companies, academic institutions, regulatory agencies, patient advocacy groups, research foundations, scientific associations and consultants that work collaboratively through a precompetitive partnership to accelerate development of therapeutics for neurodegenerative diseases. 5 New Neurological Medicines Approved for Patients The new medicines being developed today build on the medical progress seen over the last decade or so. Below are examples of innovative medicines approved recently to treat some neurological conditions. Attention-Deficit/Hyperactivity Disorder (ADHD) • Vyvanse® (lisdexamphetamine dimesylate) is the first stimulant prodrug approved for the treatment of ADHD. It is an oral biologic medicine that is therapeutically inactive until metabolized in the body. It is intended to provide a safer, abuse-resistant and effective alternative to amphetamine-based therapies for ADHD. Alzheimer’s Disease • N amenda® (memantine) is the first treatment approved for moderate to severe Alzheimer’s disease. It was also the first in a new class of medicines called NMDA receptor antagonists to be approved for the disease. Namenda interferes with the effects of excess glutamate release—glutamate plays a key role in the neural pathways associated with learning and memory. 6 Multiple Sclerosis (MS) • T ecfidera™ (dimethyl fumarate; BG-12) is a first-line oral treatment for relapsing forms of MS. It is believed to treat the disease in a new way by stimulating the Nrf2 transcriptional pathway that provides a way for cells in the body to defend against inflammation and neuronal death that is induced by oxidative stress. In clinical trials it was shown to reduce relapses and the development of brain lesions, as well as slow disability progression. • G ilenya® (fingolimod) is a first-in-class oral medicine also approved to treat relapsing forms of MS. With a different mechanism of action, it binds to the S1PR lipid and traps certain white blood cells in the lymph nodes, thereby reducing the immune system’s attack on the central nervous system (CNS). By preventing the blood cells from reaching the CNS where they can damage the covering around the nerve fibers, this medicine can reduce damage to the nerve cells. Seizures • P otiga® (ezogabine) is a first-in-class potassium channel blocker approved for the adjunctive treatment of partial-onset seizures in adults. While the exact mechanism of action is unknown, it is believed to work by opening the potassium channels, which are thought to stabilize the neurons and reduce brain excitability. Medicines in Development Neurological Disorders 2013 Selected Facts about Neurological Disorders Alzheimer’s Disease and Other Dementias1 •An estimated 5.4 million Americans have Alzheimer’s disease (AD). Today, someone in America develops AD every 68 seconds. By 2050, there is expected to be one new case of AD every 33 seconds, or nearly a million new cases per year, and AD prevalence is projected to be 11 million to 16 million. •AD is the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age 65 and older. Amyotrophic Lateral Sclerosis2 •An estimated 30,000 Americans may have amyotrophic lateral sclerosis (ALS) at any given time, and some 5,600 people in the United States are diagnosed with ALS each year. It is estimated that ALS is responsible for nearly 2 deaths per 100,000 population annually. Brain Injury3 •According to the U.S. Centers for Disease Control (CDC) Injury Prevention Center, the leading causes of traumatic brain injury (TBI) are: falls, 35.2 percent; unknown/other, 21 percent; motor vehicle, 17.3 percent; head strikes, 16.5 percent; assault, 10 percent. •Traumatic brain injury is the leading cause of disability and death in children and adolescents in the United States. According to the CDC, the two age groups at greatest risk for TBI are ages 0-4 and 15-19. Among children ages 0 to 14 years, each year TBI results in an estimated: 2,685 deaths; 37,000 hospitalizations; and 435,000 emergency department visits. • Approximately 1,300 U.S. children experience severe or fatal brain trauma from child abuse every year. Brain Tumors4 •An estimated 69,720 new cases of primary brain tumors (those that begin and tend to stay in the brain) are expected to be diagnosed in 2013, including both malignant (24,620) and non-malignant (45,100) brain tumors. •In 2010, more than 688,096 people in the United States were living with the diagnosis of a primary brain or central nervous system tumor—more than 138,054 were malignant tumors and more than 550,042 were non-malignant. •Gliomas, a broad term which includes all tumors arising from the gluey or supportive tissue of the brain, represent 30 percent of all brain tumors and 80 percent of all malignant tumors. Glioblastomas represent 17 percent of all primary brain tumors and 54 percent of all gliomas. Medicines in Development Neurological Disorders 2013 7 Selected Facts about Neurological Disorders Epilepsy5 •Epilepsy affects nearly 3 million Americans. Epilepsy is the fourth most common neurological disorder in the United States after migraine, stroke, and Alzheimer’s disease. And it costs society $17.6 billion in direct and indirect costs. •Epilepsy strikes most often among the very young and the very old, although anyone can develop the disorder at any age. In this country, it affects more than 300,000 children under the age of 15—more than 90,000 of whom have seizures that cannot be adequately treated. •The number of epilepsy cases in the elderly is climbing as the baby boom generation reaches retirement age. More than 300,000 adults age 65 and above have the condition. Genetic Disorders6 •More than 6,000 known genetic disorders account for a significant portion of human disease and conditions and can present themselves in several different ways, such as Down syndrome, spina bifida, and sickle cell anemia. •Up to 4 percent of the approximately 4 millon babies born each year have a genetic disease or major birth defect. More than 20 percent of infant deaths are caused by birth defects or genetic conditions (e.g., congenital heart defects, abnormalities of the nervous system, or chromosomal abnormalities). •Approximately 10 percent of all adults and 30 percent of children in hospitals are there due to genetically-related problems. Headache •Headaches are the most prevalent neurological disorders and among the most frequent symptoms seen in general practice—50 percent of the general population have headaches during any given year, and more than 90 percent report a lifetime history of headache.7 •Chronic headache (a headache that occurs 15 or more days per month) affects 3 percent of the general population, and those people are the most severely disabled.7 •More than 37 million Americans suffer from migraine, with women being affected three times more often than men. This vascular headache is most commonly experienced between the ages of 15 and 55, and 70 percent to 80 percent of sufferers have a family history of migraine.8 •The financial cost of headache arises partly from direct treatment costs, but much more from loss of work time and productivity. The annual U.S. direct medical costs attributable to migraine were estimated at $1 billion in 1999.7 Huntington’s Disease9 •More than 15,000 Americans have Huntington’s disease (HD). At least 150,000 others have a 50 percent risk of developing the disease, and thousands more of their relatives live with the possibility that they, too, might develop HD. 8 Medicines in Development Neurological Disorders 2013 Selected Facts about Neurological Disorders Muscular Dystrophy10 •The incidence rates of muscular dystrophies (MD) vary depending on the specific type. Duchenne MD is the most common MD and is sex-linked, with an inheritance pattern of 1 case per 3,500 live male births. Becker MD is the second most common form, with an incidence of 1 case per 30,000 live male births. Other types of MD are rare. For example, limb-girdle dystrophy occurs in only 1.3 percent of patients with MDs. Multiple Sclerosis11 •Some 350,000 to 500,000 patients suffer from multiple sclerosis (MS) in the United States. Most cases are diagnosed between 20 and 50 years. Pain12 •In 2011, at least 100 million adult Americans had common chronic pain conditions. •Recent Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS) data suggest substantial rates of pain from various causes and that most people in chronic pain have multiple sites of pain. For U.S. adults reporting pain, causes include: severe headache or migraine (16.1 percent), low back pain (28.1 percent), neck pain (15.1 percent), knee pain (19.5 percent), shoulder pain (9.0 percent), finger pain (7.6 percent), and hip pain (7.1 percent). •Pain is a significant public health problem that costs society at least $560-$635 billion annually (an amount equal to about $2,000.00 for everyone living in the United States). Parkinson’s Disease •In the United States, 50,000-60,000 new cases of Parkinson’s disease (PD) are diagnosed each year, adding to the 1 million people who currently have PD. The U.S. Centers for Disease Control and Prevention rated complications from Parkinson’s disease as the 14th leading cause of death in the United States.13 • Men are one and a half times more likely to have Parkinson’s than women.14 •The combined direct and indirect costs of Parkinson’s, including treatment, Social Security payments and lost income from inability to work, is estimated to be nearly $25 billion per year in the United States. Medication costs for an individual person with PD average $2,500 a year, and therapeutic surgery can cost up to $100,000 dollars per patient.14 Spasticity15 •Spasticity is a common finding in multiple sclerosis (MS), stroke, traumatic brain injury (TBI), cerebral palsy (CP), and spinal cord injury (SCI). Within those patient populations, spasticity occurs at a variable rate. Studies have shown that spasticity affects between 37 percent and 78 percent of people with MS, 40 percent of those with SCI, approximately 35 percent of those with stroke, more than 90 percent with CP, and approximately 50 percent of patients with TBI. Medicines in Development Neurological Disorders 2013 9 Selected Facts about Neurological Disorders Spinal Cord Injury16 •The estimated annual incidence of spinal cord injury (SCI), not including those who die at an accident scene, is approximately 12,000 new cases each year. The estimated number of people living today with SCI ranges from 238,000 to 332,000. •The costs for those living with SCI vary greatly according to injury severity. For example, the lifetime direct medical costs are more than $4.6 million for someone with high quadriplegia injured at age 25, compared with the more than $1.5 million it will cost someone injured at the same age who has incomplete motor functions. Stroke17 •Stroke is the nation’s fourth leading killer and a leading cause of long-term disability. Each year, about 795,000 people suffer a stroke. On average, someone in the United States has a stroke every 40 seconds, and every 4 minutes someone dies from one. •Deaths from ischemic stroke, the most common type, are predicted to nearly double between 2000 and 2032. Conservative estimates forecast that ischemic stroke alone will cost the United States $2.2 trillion from 2005 to 2050. •The direct and indirect costs of stroke in the United States for 2009 were $38.6 billion, with an average per person expenditure of $6,018. Sources: 1. Alzheimer’s Association, www.alz.org 2. ALS Association, www.alsa.org 3. Brain Injury Association of America, www.biausa.org 4. American Brain Tumor Association, www.abta.org 5. Epilepsy Foundation, www.epilepsyfoundation.org 6.NetWellness from Case Western Reserve University, Ohio State University and University of Cincinnati, www.netwellness.org 7. International Association for the Study of Pain, www.iasp-pain.org 8. National Headache Foundation, www.headaches.org 9. National Institute of Neurological Disorders and Stroke, www.ninds.nih.gov 10. E-Medicine, www.emedicine.medscape.com 11. Multiple Sclerosis Foundation, www.msfocus.org 12. The American Academy of Pain Medicine, www.painmed.org 13. National Parkinson Foundation, www.parkinson.org 14. Parkinson Disease Foundation, www.pdf.org 15. Medscape, www.medscape.org 16. National Spinal Cord Injury Statistical Center, www.nscisc.uab.edu 17. American Heart Association, www.heart.org/advocacy 10 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase* AAB-003/PF-05236812 (beta-amyloid protein inhibitor mAB) Janssen Alzheimer Immunotherapy South San Francisco, CA Pfizer New York, NY Alzheimer’s disease Phase I www.janssenrnd.com www.pfizer.com ABT-126 (alpha-7-NNR antagonist) AbbVie North Chicago, IL Alzheimer’s disease Phase II www.abbvie.com ABT-288 (neurotransmitter receptor modulator) AbbVie North Chicago, IL Alzheimer’s disease Phase II completed www.abbvie.com ABT-384 AbbVie North Chicago, IL Alzheimer’s disease (see also other) Phase II completed www.abbvie.com ABT-957 (calpain inhibitor) AbbVie North Chicago, IL Alzheimer’s disease Phase I www.abbvie.com AC-1204 (glucose stimulant) Accera Broomfield, CO mild to moderate Alzheimer’s disease Phase II/III www.accerapharma.com AD02 vaccine (amyloid-beta protein inhibitor) Affiris Vienna, Austria GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer’s disease Phase II www.affiris.com www.gsk.com AD03 vaccine (amyloid-beta protein inhibitor) Affiris Vienna, Austria GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer's disease Phase I www.affiris.com www.gsk.com APH-0703 (protein kinase C stimulant) Aphios Corporation Woburn, MA Alzheimer’s disease Phase I/II www.aphios.com ARC029 (nilvadipine) Archer Pharmaceuticals Sarasota, FL Alzheimer’s disease Phase I/II www.archerpharma.com ARC031 (soluble amyloid reducing/clearing agent) Archer Pharmaceuticals Sarasota, FL Alzheimer’s disease Phase I www.archerpharma.com ASP0777 Astellas Pharma US Northbrook, IL Alzheimer’s disease Phase I www.astellas.com *For more information about a specific medicine or company in the report, please use the website provided. Medicines in Development Neurological Disorders 2013 11 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase AVN 101 (serotonin 5-HT6 receptor antagonist) Avineuro Pharmaceuticals San Diego, CA Alzheimer’s disease Phase II www.avineuro.com AVN 322 (serotonin 6 receptor antagonist) Avineuro Pharmaceuticals San Diego, CA Alzheimer’s disease Phase I www.avineuro.com AVN 397 Avineuro Pharmaceuticals San Diego, CA Alzheimer’s disease Phase II www.avineuro.com AVP-923 (dextromethorphan/quinidine fixed-dose combination) Avanir Pharmaceuticals Aliso Viejo, CA agitation in Alzheimer’s disease (see also pain) Phase II www.avanir.com AZD1446 (alpha4/beta2 neuronal nicotinic receptor agonist) AstraZeneca Wilmington, DE Targacept Winston-Salem, NC Alzheimer’s disease Phase I www.astrazeneca.com www.targacept.com AZD2184 (PET enhancer) Navidea Pharmaceuticals Dublin, OH Alzheimer’s disease (diagnosis) Phase I www.navidea.com AZD2995 (PET enhancer) Navidea Pharmaceuticals Dublin, OH Alzheimer’s disease (diagnosis) Phase I www.navidea.com AZD3293 (beta secretase) Astex Pharmaceuticals Dublin, CA AstraZeneca Wilmington, DE Alzheimer’s disease Phase I www.astx.com www.astrazeneca.com AZD5213 (histamine-3 receptor antagonist) AstraZeneca Wilmington, DE Alzheimer’s disease Phase II www.astrazeneca.com BACE inhibitor Janssen Pharmaceuticals Titusville, NJ Shionogi Florham Park, NJ Alzheimer’s disease Phase I www.janssenpharmaceuticalsinc.com www.shionogi.com BAN2401 (amyloid beta-protein inhibitor) Eisai Woodcliff Lake, NJ early stage Alzheimer’s disease Phase II www.eisai.com BIIB037 (human anti-amyloid beta mAb) Biogen Idec Weston, MA Alzheimer’s disease Phase I www.biogenidec.com bisnorcymserine (BNC) QR Pharma Berwyn, PA Alzheimer’s disease Phase I www.qrpharma.com BMS-241027 (microtubule stabilizer) Bristol-Myers Squibb Princeton, NJ Alzheimer’s disease Phase I www.bms.com 12 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase CAD106 (amyloid beta-protein inhibitor) Novartis Pharmaceuticals East Hanover, NJ Alzheimer’s disease Phase II www.novartis.com CERE-110 (AAV-NGF) Ceregene San Diego, CA Alzheimer’s disease Phase II www.ceregene.com crenezumab (anti-amyloid-beta mAb) Genentech South San Francisco, CA Alzheimer’s disease Phase II www.gene.com davunetide intranasal Allon Therapeutics Vancouver, Canada Alzheimer’s disease (see also Parkinson’s, other) Phase II www.allontherapeutics.com donepezil/memantine extended release (fixed-dose combination) Adamas Pharmaceuticals Emeryville, CA Forest Laboratories New York, NY moderate to severe Alzheimer’s disease Phase II www.adamaspharma.com www.frx.com DSP-8658 (PPAR alpha/gamma agonist) Sunovion Pharmaceuticals Marlborough, MA Alzheimer’s disease Phase I www.sunovion.com E2212 (amyloid precursor protein secretase modulator) Eisai Woodcliff Lake, NJ Alzheimer’s disease Phase I completed www.eisai.com E2609 (BACE1 protein inhibitor) Eisai Woodcliff Lake, NJ Alzheimer’s disease Phase I www.eisai.com ELND005 Speranza Therapeutics Dublin, Ireland neuropsychiatric symptoms in Alzheimer’s disease (Fast Track) Phase II EVP-0962 (gamma secretase modulator) EnVivo Pharmaceuticals Watertown, MA Alzheimer’s disease Phase II www.envivopharma.com EVP-6124 (alpha7 nicotinic acetylcholine receptor agonist) EnVivo Pharmaceuticals Watertown, MA Alzheimer’s disease Phase II www.envivopharma.com Exebryl-1® amyloid-beta-protein/tau protein inhibitor ProteoTech Kirkland, WA Alzheimer’s disease Phase I www.proteotech.com F-18 T808 (PET imaging) Siemens Medical Solutions Malvern, PA Alzheimer’s disease (diagnosis) Phase 0 www.usa.healthcare.siemens.com F18-florbetaben (molecular imaging agent) IBA Molecular Dulles, VA Piramal Healthcare Mumbai, India Alzheimer’s disease (diagnosis) application submitted www.iba-molecular.com www.piramal.com Medicines in Development Neurological Disorders 2013 13 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase F18-flutemetamol (PET imaging agent) GE Healthcare Waukesha, WI Alzheimer’s disease (diagnosis) application submitted www.gehealthcare.com gantenerumab (RG1450) Roche Nutley, NJ early stage Alzheimer’s disease Phase II/III www.roche.com GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA Alzheimer’s disease (see also amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s, spinal cord injury, stroke) Phase I www.genervon.com GSK2647544 (Lp-PLA2 inhibitor) GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer’s disease Phase I www.gsk.com GSK2981710 (medium chain triglycerides) GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer’s disease Phase I www.gsk.com HPP-854 (BACE1 inhibitor) High Point Pharmaceuticals High Point, NC Alzheimer’s disease Phase I www.highpointpharma.com JNJ-54861911 Janssen Research & Development Raritan, NJ Alzheimer’s disease Phase I www.janssenrnd.com KU-046 (amyloid beta-protein modulator) Kareus Therapeutics La Chaux-de-Fonds, Switzerland Alzheimer’s disease Phase I www.kareustherapeutics.com LMTX (TRx-0238) TauRx Pharmaceuticals Singapore Alzheimer’s disease, frontotemporal dementia Phase III www.taurx.com Lu AE58054 (5-HT6 receptor antagonist) Lundbeck Deerfield, IL Otsuka America Pharmaceutical Rockville, MD Alzheimer’s disease (cognition) Phase II www.lundbeck.com www.otsuka.com LY2886721 (beta secretase inhibitor) Eli Lilly Indianapolis, IN Alzheimer’s disease (slow disease progression) Phase I www.lilly.com LY3002813 (biological) Eli Lilly Indianapolis, IN Alzheimer’s disease Phase I www.lilly.com Lym Pro® neurotrophic factor companion diagnostic Amarantus BioSciences Sunnyvale, CA Alzheimer’s disease (diagnosis) Phase II www.amarantus.com MK-8931 (BACE1 protein inhibitor) Merck Whitehouse Station, NJ Alzheimer’s disease Phase II/III www.merck.com 14 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase MSDC-0160 (mTOT modulator insulin sensitizer) Metabolic Solutions Development Company Kalamazoo, MI Alzheimer’s disease Phase II www.msdrx.com NAV4694 (fluorine-18 labeled precision radiopharmaceutical) Navidea Biopharmaceuticals Dublin, OH Alzheimer’s disease (diagnosis) Phase II www.navidea.com NAV5001 (123I-labelled imaging agent) Navidea Biopharmaceuticals Dublin, OH dementia with Lewy bodies (diagnosis) (see also Parkinson’s) Phase II www.navidea.com NIC5-15 (amyloid precursor protein secretase inhibitor) Humanetics Minneapolis, MN Alzheimer’s disease Phase II www.humaneticscorp.com PF-05212377 (SAM-760) Pfizer New York, NY Alzheimer’s disease Phase II www.pfizer.com pioglitazone companion diagnostic Takeda Pharmaceuticals U.S.A. Deerfield, IL Zinfandel Pharmaceuticals Chapel Hill, NC Alzheimer’s disease (diagnosis) Phase I www.takeda.com Posiphen® R-phenserine QR Pharma Berwyn, PA Alzheimer’s disease, mild cognitive impairment (see also Parkinson’s) Phase II www.qrpharma.com RG1577 (MAO-B inhibitor) Roche Nutley, NJ Alzheimer’s disease Phase II www.roche.com RG7129 (BACE1 protein inhibitor) Roche Nutley, NJ Alzheimer’s disease Phase I www.roche.com rilapladib (Lp-PLA2 inhibitor) GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer’s disease Phase II www.gsk.com RVX-208 (BET protein inhibitor) Resverlogix Calgary, Canada Alzheimer’s disease Phase I www.resverlogix.com SAR110894 (H3 antagonist) Sanofi US Bridgewater, NJ Alzheimer’s disease Phase II www.sanofi.com SAR228810 (anti-protofibrillar AB mAb) Sanofi US Bridgewater, NJ Alzheimer’s disease Phase I www.sanofi.com SB742457 (5HT6 antagonist) GlaxoSmithKline Rsch. Triangle Park, NC Alzheimer’s disease Phase II www.gsk.com Medicines in Development Neurological Disorders 2013 15 Medicines in Development for Neurological Disorders Alzheimer’s Disease Product Name Sponsor Indication Development Phase sGC 1061 (nomethiazole) sGC Pharma Wellesley, MA Alzheimer’s disease Phase I www.sgcpharma.com solanezumab (amyloid-beta protein inhibitor) Eli Lilly Indianapolis, IN mild Alzheimer’s disease Phase III www.lilly.com ST101 Sonexa Therapeutics San Diego, CA Alzheimer’s disease Phase II www.sonexa.com T3D-959 (dual PPAR agonist) T3D Therapeutics Rsch. Triangle Park, NC Alzheimer’s disease Phase I completed www.t3dtherapeutics.com T-817MA Toyama Chemical Tokyo, Japan Alzheimer’s disease Phase II www.toyama-chemical.co.jp TC-1734 (ispronicline) Targacept Winston-Salem, NC Alzheimer’s disease Phase II www.targacept.com TC-5619 (alpha7nAChR) Targacept Winston-Salem, NC Alzheimer’s disease Phase I www.targacept.com TD-8954 (5-HT4 agonist) Targacept Winston-Salem, NC Alzheimer’s disease Phase I www.targacept.com TTP488 Transtech Pharma High Point, NC Alzheimer’s disease (Fast Track) Phase II www.ttpharma.com TTP4000 Transtech Pharma High Point, NC Alzheimer’s disease Phase I www.ttpharma.com V950 vaccine Merck Whitehouse Station, NJ Alzheimer’s disease Phase I www.merck.com vanutide cridificar (ACC-001/PF-05236806) Janssen Alzheimer Immunotherapy South San Francisco, CA Pfizer New York, NY Alzheimer’s disease Phase II www.janimm.com www.pfizer.com VI-1121 VIVUS Mountain View, CA Alzheimer’s disease Phase II www.vivus.com XEL 001HP (transdermal patch) Xel Pharmaceuticals Draper, UT Alzheimer’s disease Phase I www.xelpharmaceuticals.com 16 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Amyotrophic Lateral Sclerosis Product Name Sponsor Indication Development Phase arimoclomol (Orphan Drug) ALS Association Washington, DC Orphazyme Copenhagen, Denmark University of Miami Miami, FL amyotrophic lateral sclerosis (ALS) (Fast Track) Phase II/III www.orphazyme.com GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA ALS (Fast Track) (see also Alzheimer’s, multiple sclerosis, Parkinson’s, spinal cord injury, stroke) Phase II www.genervon.com NP001 (macrophage regulator) Neuraltus Pharmaceuticals Palo Alto, CA ALS Phase II www.neuraltus.com NSI-566 (stem cell therapy) (Orphan Drug) Neuralstem Rockville, MD ALS Phase II www.neuralstem.com NurOwn™ GDNF-producing adult stem cell therapy (Orphan Drug) BrainStorm Cell Therapeutics New York, NY ALS Phase II www.brainstorm-cell.com ozanezumab (NOGO-A mAb) GlaxoSmithKline Rsch. Triangle Park, NC ALS Phase II www.gsk.com stem cell therapy TCA Cellular Therapy Covington, LA ALS (see also spinal cord injury) Phase I www.tcacellulartherapy.com tirasemtiv (Orphan Drug) Cytokinetics South San Francisco, CA ALS (Fast Track) Phase II www.cytokinetics.com Attention-Deficit/Hyperactivity Disorder Product Name Sponsor Indication Development Phase AR08 (adrenergic receptor agonist) Arbor Pharmaceuticals Atlanta, GA attention-deficit/hyperactivity disorder (ADHD) Phase II www.arborpharma.com COL-171 (sustained release) Collegium Pharmaceuticals Cumberland, RI ADHD in clinical trials www.collegiumpharma.com Medicines in Development Neurological Disorders 2013 17 Medicines in Development for Neurological Disorders Attention-Deficit/Hyperactivity Disorder Product Name Sponsor Indication Development Phase d-amphetamine transdermal (ATS) Noven Pharmaceuticals Miami, FL ADHD Phase II www.noven.com EB-1020 (triple reuptake inhibitor) Neurovance (Euthymics) Cambridge, MA ADHD Phase I www.euthymics.com edivoxetine (norepinephrine reuptake inhibitor) Eli Lilly Indianapolis, IN ADHD (pediatric) Phase II/III www.lilly.com eltoprazine (serotonin 1A/1B partial agonist) PsychoGenics Tarrytown, NY ADHD (adults) Phase II www.psychogenics.com HDL-100 (amphetamine modified release) Highland Therapeutics Toronto, Canada ADHD Phase I www.highlandtherapeutics.com HDL-200 (methylphenidate modified-release) Highland Therapeutics Toronto, Canada ADHD Phase I www.highlandtherapeutics.com KP106 (d-amphetamine prodrug) KemPharm North Liberty, IA ADHD Phase I completed www.kempharm.com KRL-401 Krele Pharmaceuticals (TONIX Pharmaceuticals) New York, NY ADHD in clinical trials www.krele.com methylphenidate extended release Purdue Pharma Stamford, CT Rhodes Pharma Coventry, RI ADHD Phase III www.purduepharma.com www.rhodespharma.com NT0202 (amphetamine controlled release) Neos Therapeutics Grand Prairie, TX ADHD application submitted www.neostx.com NWP09 (methylphenidate extended-release chewable tablets) Pfizer New York, NY ADHD Phase III completed www.pfizer.com OPC-34712 (brexpiprazole) Lundbeck Deerfield, IL Otsuka America Pharmaceutical Rockville, MD ADHD (adults) Phase II www.lundbeck.com www.otsuka.com 18 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Attention-Deficit/Hyperactivity Disorder Product Name Sponsor Indication Development Phase ORADUR®-ADHD (sustained-release oral gel) DURECT Cupertino, CA ADHD Phase I www.durect.com SEP-225289 (triple reuptake inhibitor) Sunovion Pharmaceuticals Marlborough, MA ADHD Phase II www.sunovion.com SPN-810 (molindone) Supernus Pharmaceuticals Rockville, MD impulsive aggression in ADHD (pediatric) Phase II completed www.supernus.com SPN-812 (norepinephrine uptake inhibitor) Supernus Pharmaceuticals Rockville, MD ADHD Phase II completed www.supernus.com TD-9855 (monoamine reuptake inhibitor) Theravance South San Francisco, CA ADHD Phase II www.theravance.com Product Name Sponsor Indication Development Phase BHR-100 (intravenous progesterone infusion) (Orphan Drug) BHR Pharma Herndon, VA traumatic brain injury (Fast Track) Phase III www.bhr-pharma.com ciclosporin intravenous (Orphan Drug) Maas Biolab Albuquerque, NM NeuroVive Pharmaceutical Lund, Sweden traumatic brain injury Phase I www.maasbiolab.com www.neurovive.com methamphetamine intravenous Sinapis Pharma Jacksonville, FL traumatic brain injury (see also stroke) Phase I completed www.sinapispharma.com NNZ-2566 (cytokine inhibitors/neuropeptide receptor modulator) Neuren Pharmaceuticals Bethesda, MD traumatic brain injury (Fast Track) (see also other) Phase II www.neurenpharma.com NTx-428® cell differentiation, nerve growth factor and stem cell stimulant Stem Cell Therapeutics Toronto, Canada traumatic brain injury Phase II www.stemcellthera.com Oxycyte® perfluorocarbon oxygen carrier Oxygen Biotherapeutics Morrisville, NC traumatic brain injury Phase II www.oxybiomed.com Brain Injury Medicines in Development Neurological Disorders 2013 19 Medicines in Development for Neurological Disorders Brain Injury Product Name Sponsor Indication Development Phase RP-1127 (glibenclamide) Remedy Pharmaceuticals New York, NY moderate to severe traumatic brain injury (see also stroke) Phase II www.remedypharmaceuticals.com SAR127963 (P75 receptor antagonist) Sanofi US Bridgewater, NJ traumatic brain injury Phase I www.sanofi.com Product Name Sponsor Indication Development Phase 8H9 mAb United Therapeutics Silver Spring, MD metastatic brain cancer Phase I www.unither.com ABT-414 (EGFR antagonist) AbbVie North Chicago, IL glioblastoma Phase I www.abbvie.com AEE788 (multiple tyrosine kinase inhibitor) Novartis Pharmaceuticals East Hanover, NJ glioblastoma Phase I/II www.novartis.com afatinib (ErbB tyrosine kinase inhibitor) Boehringer Ingelheim Pharmaceuticals Ridgefield, CT glioblastoma Phase I/II www.boehringer-ingelheim.com AMG 595 (anti-EGFRvIII antibody-drug conjugate) Amgen Thousand Oaks, CA anaplastic astrocytoma, glioblastoma Phase I www.amgen.com ANG1005 (paclitaxel prodrug) AngioChem Montreal, Canada glioma Phase I www.angiochem.com ARC 100 (tubulin polymerisation inhibitor) Archer Biosciences New York, NY recurrent glioblastoma Phase II www.archerbiosciences.com ----------------------------------------Phase I/II www.archerbiosciences.com Brain Tumors -------------------------------------medulloblastoma, recurrent neuroblastoma AT-101 (Bcl-2 inhibitor) Ascenta Therapeutics Malvern, PA glioblastoma Phase II www.ascenta.com Avastin® bevacizumab Genentech South San Francisco, CA first-line glioblastoma Phase III www.gene.com Azedra™ iobenguane I-131 (Orphan Drug) Progenics Pharmaceuticals Tarrytown, NY neuroblastoma (pediatric) (Fast Track) Phase II www.progenics.com 20 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Brain Tumors Product Name Sponsor Indication Development Phase BKM120 (PI3K inhibitor) Novartis Pharmaceuticals East Hanover, NJ glioblastoma Phase I www.novartis.com ch14.18 mAb (Orphan Drug) United Therapeutics Silver Spring, MD neuroblastoma Phase III www.unither.com cilengitide (Orphan Drug) EMD Serono Rockland, MA glioblastoma Phase III www.emdserono.com cilengitide companion diagnostic EMD Serono Rockland, MA MDxHealth Irvine, CA glioblastoma (diagnosis) Phase III www.emdserono.com www.mdxhealth.com cintredekin besudotox (IL13-PE38QQR) (Orphan Drug) INSYS Therapeutics Chandler, AZ National Institute of Neurological Disorders and Stroke Bethesda, MD glioma (Fast Track) Phase I www.insysrx.com CLR 1404 I-124 (PET imaging) Novelos Therapeutics Madison, WI brain tumor (diagnosis) Phase I/II www.novelos.com Cotara® (iodine-131 radiolabeled TNT mAb) (Orphan Drug) Peregrine Pharmaceuticals Tustin, CA recurrent glioblastoma (Fast Track) Phase II www.peregrineinc.com crenolanib (receptor tyrosine kinase inhibitor) (Orphan Drug) AROG Pharmaceuticals Dallas, TX glioma (pediatric) Phase I www.arogpharma.com dacomitinib (PF-00299804) Pfizer New York, NY glioblastoma Phase II www.pfizer.com DCVax®-Brain dendritic cell vaccine (Orphan Drug) Northwest Biotherapeutics Bethesda, MD glioblastoma Phase III www.nwbio.com DNX-2401 (cell death stimulant) DNAtrix Houston, TX glioblastoma Phase I www.dnatrix.com E7080 (lenvatinib) Eisai Woodcliff Lake, NJ glioma Phase II www.eisai.com Medicines in Development Neurological Disorders 2013 21 Medicines in Development for Neurological Disorders Brain Tumors Product Name Sponsor Indication Development Phase eflornithine (CPP-1X) Cancer Prevention Pharmaceuticals Tucson, AZ neuroblastoma Phase II www.canprevent.com ETS2101 (synthetic terpene-based cannabinoid) e-Therapeutics Oxfordshire, United Kingdom University of California San Diego, CA glioma Phase I www.etherapeutics.co.uk F18-ML-10 (molecular imaging agent) IBA Molecular Dulles, VA Aposense Petach-Tikva, Israel brain tumors (diagnosis) Phase II www.iba-molecular.com www.aposense.com firtecan pegol (Orphan Drug) Belrose Pharma Princeton, NJ neuroblastoma Phase I/II www.belrosepharma.com galunisertib (LY2157299) Eli Lilly Indianapolis, IN glioblastoma Phase II www.lilly.com ----------------------------------------Phase I/II www.lilly.com -------------------------------------newly diagnosed glioma GDC-0084/RG7666 (PI3K inhibitor) Genentech South San Francisco, CA glioma Phase I www.gene.com GliAtak™ cancer gene therapy (Orphan Drug) Advantagene Auburndale, MA malignant glioma Phase II www.advantagene.com Glionix™ belagenpumatucel-L subcutaneous NovaRx San Diego, CA glioma Phase I www.novarx.com Hiltonol® poly-ICLC (Orphan Drug) Oncovir Washington, DC glioblastoma Phase II www.oncovir.com ICT-107 (autologous dendritic cell-based vaccine) (Orphan Drug) ImmunoCellular Therapeutics Woodland Hills, CA glioblastoma Phase II www.imuc.com IMA950 (tumor-associated peptide vaccine) Immatics Biotechnologies Tuebingen, Germany glioblastoma Phase I www.immatics.com LDE225 (SMO protein inhibitor) Novartis Pharmaceuticals East Hanover, NJ medulloblastoma Phase III www.novartis.com 22 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Brain Tumors Product Name Sponsor Indication Development Phase LEE011 (cyclin-dependent kinase-4/6 inhibitor) Novartis Pharmaceuticals East Hanover, NJ neuroblastoma Phase I www.novartis.com macitentan Actelion Pharmaceuticals South San Francisco, CA recurrent glioblastoma Phase I www.actelion.us mibefradil Tau Therapeutics Charlottesville, VA recurrent glioma Phase I www.tautherapeutics.com NEO100 (perillyl alcohol intranasal) (Orphan Drug) NEONC Technologies Woodland Hills, CA glioblastoma in clinical trials www.neonctech.com neuroblastoma vaccine MabVax San Diego, CA neuroblastoma Phase I www.mabvax.com onartuzumab (anti-c-Met mAb) Genentech South San Francisco, CA recurrent glioblastoma Phase II www.gene.com Opaxio® paclitaxel poliglumex (Orphan Drug) Cell Therapeutics Seattle, WA glioblastoma Phase II www.celltherapeutics.com palbociclib (PD-0332991/CDK4-6 kinase inhibitor) Pfizer New York, NY Rb-positive glioblastoma Phase II www.pfizer.com perifosine AEterna Zentaris Basking Ridge, NJ glioma Phase II www.aezsinc.com PLX3397 Plexxikon Berkeley, CA glioblastoma Phase II www.plexxikon.com PX-866 (PI-3 kinase inhibitor) Oncothyreon Seattle, WA glioblastoma Phase II www.oncothyreon.com Reolysin® pelareorep Oncolytics Biotech Calgary, Canada glioma Phase I/II completed www.oncolyticsbiotech.com rindopepimut (EGFR varient III vaccine) (Orphan Drug) Celldex Therapeutics Needham, MA first-line glioblastoma (Fast Track) -------------------------------------recurrent glioblastoma (Fast Track) Phase III www.celldextherapeutics.com ----------------------------------------Phase II www.celldextheraputics.com SB-313 (T-cell receptor gene stimulant) Sangamo Biosciences Richmond, CA City of Hope National Medical Center Duarte, CA glioblastoma Phase I www.sangamo.com Medicines in Development Neurological Disorders 2013 23 Medicines in Development for Neurological Disorders Brain Tumors Product Name Sponsor Indication Development Phase SL-701 (dendritic cell vaccine) Stemline Therapeutics New York, NY glioma Phase I/II www.stemline.com Tarceva® erlotinib Astellas Pharma US Northbrook, IL recurrent ependymoma (pediatric) Phase III www.astellas.com terameprocol (intravenous) Erimos Pharmaceuticals Raleigh, NC glioma Phase I/II www.erimos.com Toca 511/Toca FC (fluorouracil prodrug gene therapy) Tocagen San Diego, CA recurrent glioblastoma Phase I/II www.tocagen.com ----------------------------------------Phase I www.tocagen.com -------------------------------------late-stage glioma TRC105 (ENG protein inhibitor) Tracon Pharmaceuticals San Diego, CA glioblastoma Phase II www.traconpharma.com TSC (trans-sodium crocetinate) Diffusion Pharmaceuticals Charlottesville, VA glioblastoma Phase I/II www.diffusionpharma.com TVI-Brain-1 (cancer vaccine) TVAX Biomedical Lenexa, KS glioma Phase II www.tvaxbiomedical.com Tykerb® lapatinib GlaxoSmithKline Rsch. Triangle Park, NC Jonsson Comprehensive Cancer Center Los Angeles, CA glioblastoma Phase II www.gsk.com VAL-083 (Orphan Drug) Del Mar Pharmaceuticals Vancouver, Canada glioblastoma Phase I/II www.delmarpharma.com VB-111 (gene therapy) VBL Therapeutics Or Yehuda, Israel glioblastoma Phase I/II www.vblrx.com veliparib AbbVie North Chicago, IL brain metastases Phase II www.abbvie.com vemurafenib Roche Nutley, NJ brain metastases Phase II www.roche.com vitespen (G-100 prophage) Agenus Lexington, MA glioma Phase II www.agenusbio.com Xeloda® capecitabine Roche Nutley, NJ glioma (pediatric) Phase II www.roche.com 24 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Epilepsy Product Name Sponsor Indication Development Phase Banzel® rufinamide (Orphan Drug) Eisai Woodcliff Lake, NJ Lennox-Gastaut syndrome (pediatric) Phase III www.eisai.com BGG492 (selurampanel) Novartis Pharmaceuticals East Hanover, NJ partial seizures (see also headache) Phase II completed www.novartis.com brivaracetam UCB Smyrna, GA epilepsy Phase III www.ucb.com CPP -15 (GABA-aminotransferase inhibitor) (Orphan Drug) Catalyst Pharmaceutical Partners Coral Gables, FL complex partial seizures, infantile spasms Phase I www.catalystpharma.com diazepam intranasal spray (Orphan Drug) Acorda Therapeutics Ardsley, NY acute repetitive seizures Phase III www.acorda.com DSP-0565 (sodium/calcium channel blocker) Sunovion Pharmaceuticals Marlborough, MA epilepsy Phase I www.sunovion.com ezogabine extended release GlaxoSmithKline Rsch. Triangle Park, NC Valeant Pharmaceuticals North America Bridgewater, NJ partial onset seizures Phase III www.gsk.com www.valeant.com Fycompa® perampanel Eisai Woodcliff Lake, NJ generalized seizures Phase III www.eisai.com ----------------------------------------Phase II www.eisai.com -------------------------------------partial-onset seizures (pediatric) ganaxolone (Orphan Drug) Marinus Pharmaceuticals New Haven, CT infantile spasms (infants), partial-onset seizures (adults) Phase II www.marinuspharma.com INS-001 (huperzine A) Insero Health Miami, FL epilepsy Phase I www.insero.com I.V. carbamazepine Lundbeck Deerfield, IL epilepsy Phase III www.lundbeck.com JZP8 (clonazepam intranasal) Jazz Pharmaceuticals Palo Alto, CA recurrent acute repetitive seizures Phase II www.jazzpharma.com Lyrica® pregabalin Pfizer New York, NY generalized tonic clonic seizures (see also pain) Phase III www.pfizer.com midazolam intranasal (USL261) Upsher-Smith Laboratories Maple Grove, MN acute repetitive seizures (Fast Track) Phase III www.upsher-smith.com Medicines in Development Neurological Disorders 2013 25 Medicines in Development for Neurological Disorders Epilepsy Product Name Sponsor Indication Development Phase naluzotan (serotonin 1A receptor agonist/ sigma-1 receptor antagonist) Proximagen London, United Kingdom epilepsy Phase II www.proximagen.com NRL-1 (diazepam intranasal) Biotie Therapies Turku, Finland Neuralis San Diego, CA epilepsy Phase I www.biotie.com PF-04895162 Pfizer New York, NY epilepsy Phase I completed www.pfizer.com Potiga™ ezogabine GlaxoSmithKline Rsch. Triangle Park, NC Valeant Pharmaceuticals North America Bridgewater, NJ Lennox-Gastaut syndrome, partial onset seizures (patients age 12 and older) Phase III www.gsk.com www.valeant.com pregabalin controlled release Pfizer New York, NY epilepsy (adjunctive treatment) (see also pain) Phase III www.pfizer.com Stedesa® eslicarbazepine acetate Sunovion Pharmaceuticals Marlborough, MA partial seizures in adults (adjunctive therapy) -------------------------------------partial seizures (monotherapy) application submitted www.sunovion.com ----------------------------------------Phase III www.sunovion.com tonabersat (USL260) Upsher-Smith Laboratories Maple Grove, MN epilepsy Phase I www.upsher-smith.com topiramate extended release (USL255) Upsher-Smith Laboratories Maple Grove, MN partial-onset seizures application submitted www.upsher-smith.com topiramate intravenous (Captisol®-enabled) CyDex Pharmaceuticals (Ligand Pharmaceuticals) Lenexa, KS epilepsy Phase I www.ligand.com Trokendi XR™ topiramate controlled release Supernus Pharmaceuticals Rockville, MD epilepsy application submitted www.supernus.com Vanquix® Auto-Injector diazepam injection Pfizer New York, NY acute repetitive seizures (intermittent therapy) Phase III www.pfizer.com Vimpat® lacosamide UCB Smyrna, GA epilepsy (monotherapy) Phase III www.ucb.com ----------------------------------------Phase II www.ucb.com -------------------------------------epilepsy in patients 2-17 years of age (adjunctive therapy), primary generalized tonic clonic seizures (adjunctive therapy) 26 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Epilepsy Product Name Sponsor Indication Development Phase VX-765 (caspase 1 inhibitor) Vertex Pharmaceuticals Cambridge, MA treatment-resistant partial epilepsy Phase II www.vrtx.com YKP-3089 SK biopharmaceuticals Fair Lawn, NJ epilepsy (see also pain) Phase II www.skbp.com Product Name Sponsor Indication Development Phase Afinitor® everlimus Novartis Pharmaceuticals East Hanover, NJ seizures associated with tuberous sclerosis complex (TSC) Phase III www.novartis.com deferiprone ApoPharma Toronto, Canada pantothenate kinase-associated neurodegeneration Phase III www.apotex.com ecopipam (D1 dopamine receptor antagonist) (Orphan Drug) Psyadon Pharmaceuticals Germantown, MD Lesch-Nyhan syndrome (see also other) Phase III www.psyadonrx.com Gammagard Liquid™ immune globulin Baxter Healthcare Deerfield, IL Friedreich’s ataxia Phase II www.baxter.com HuCNS-SC® adult neural stem cell therapy StemCells Newark, CA Pelizaeus-Merzbacher disease (see also spinal cord injury) Phase I www.stemcellsinc.com ISIS-SMNRx (antisense oligonucleotide) (Orphan Drug) Biogen Idec Weston, MA Isis Pharmaceuticals Carlsbad, CA spinal muscular atrophy (Fast Track) Phase II www.biogenidec.com www.isispharm.com ISIS-TTRRx (antisense RNA modulator) (Orphan Drug) Isis Pharmaceuticals Carlsbad, CA familial amyloid polyneuropathy (Fast Track) Phase II/III www.isispharm.com Lenti-D™ adrenoleukodystrophy gene therapy (Orphan Drug) Bluebird Bio Cambridge, MA childhood cerebral adrenoleukodystrophy Phase I/II www.bluebirdbio.com PF-06687859 (DcpS protein inhibitor) (Orphan Drug) Pfizer New York, NY spinal muscular atrophy Phase I www.pfizer.com RG2833 (HDAC inhibitor) (Orphan Drug) Repligen Waltham, MA Friedreich’s ataxia Phase I completed www.repligen.com Genetic Disorders Medicines in Development Neurological Disorders 2013 27 Medicines in Development for Neurological Disorders Genetic Disorders Product Name Sponsor Indication Development Phase tafamidis meglumine (transthyretin dissociation inhibitor) (Orphan Drug) Pfizer New York, NY transthyretin familial amyloid polyneuropathy (Fast Track) application submitted www.pfizer.com vatiquinone (EPI-743) (Orphan Drug) Edison Pharmaceuticals Mountain View, CA mitochondrial myopathies Phase II/III www.edisonpharma.com ----------------------------------------Phase II www.edisonpharma.com VP20629 ViroPharma Exton, PA Friedreich’s ataxia Phase I www.viropharma.com UX001 sialic acid (sialic acid extended release) Ultragenyx Pharmaceuticals Novato, CA hereditary inclusion body myositis Phase II www.ultragenyx.com Product Name Sponsor Indication Development Phase ALD403 (CGRP inhibitor mAb) Alder Biopharmaceuticals Bothell, WA prevention of migraine (subcutaneous) -------------------------------------prevention of migraine (intravenous) Phase II www.alderbio.com ----------------------------------------Phase I www.alderbio.com AMG 334 (CGRP receptor antagonist mAb) Amgen Thousand Oaks, CA migraine Phase I www.amgen.com Amrix® cyclobenzaprine extended release Cephalon (Teva) Frazer, PA migraine Phase III www.tevapharm.com AP-1531 (EPH receptor antagonist) Ariel Pharmaceuticals Broomfield, CO migraine Phase I AVP-825 (sumatriptan intranasal) Avanir Pharmaceuticals Aliso Viejo, CA migraine Phase III www.avanir.com AZ-104 (Staccato® loxapine low dose) Alexza Pharmaceuticals Mountain View, CA migraine Phase II completed www.alexza.com -------------------------------------Friedreich’s ataxia, Leigh’s disease Headache 28 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Headache Product Name Sponsor Indication Development Phase BGG492 (selurampanel) Novartis Pharmaceuticals East Hanover, NJ migraine (see also epilepsy) Phase II www.novartis.com Botox® onabotulinumtoxinA Allergan Irvine, CA prevention of migraine (adolescents) (see also pain, other) Phase III www.allergan.com CL-H1T (sumatriptan) Charleston Laboratories Charleston, SC migraine Phase II www.charlestonlabs.com doxepin intranasal Winston Pharmaceuticals Vernon Hills, IL chronic daily headache Phase II www.winstonlabs.com DR-105 (ethinylestradiol/levonorgestrel) Duramed Pharmaceuticals (Teva) North Wales, PA menstrual migraine Phase II completed www.tevapharm.com lasmiditan (serotonin 1F receptor agonist) CoLucid Pharmaceuticals Durham, NC migraine Phase II www.colucid.com LBR-101 (CGRP mAb) Labrys Biologics San Mateo, CA prevention of chronic migraine Phase I www.labrysbiologics.com Levadex® dihydroergotamine mesilate inhalation Allergan Irvine, CA MAP Pharmaceuticals Mountain View, CA migraine (adults) application submitted www.allergan.com LY2951742 (calcitonin gene-related peptide antagonist mAb) Arteaus Therapeutics Cambridge, MA Eli Lilly Indianapolis, IN prevention of migraine Phase II www.arteaus.com www.lilly.com NVD-201 (sumatriptan oral spray) NovaDel Bridgewater, NJ migraine Phase II www.novadel.com NXN-188 (nNOS inhibitor/5-HT agonist) NeurAxon Mississauga, Canada acute migraine Phase II completed www.neuraxon.com odansetron/rizatriptan fixed-dose combination MonoSol Rx Warren, NJ migraine Phase I www.monosolrx.com rizatriptan oral film IntelGenx Ville St-Laurent, Canada RedHill Biopharma Tel Aviv, Israel migraine application submitted www.intelgenx.com www.redhillbio.com RT001 (botulinum toxin A topical) Revance Therapeutics Newark, CA migraine Phase II www.revance.com Medicines in Development Neurological Disorders 2013 29 Medicines in Development for Neurological Disorders Headache Product Name Sponsor Indication Development Phase SPRIX® ketorolac intranasal Regency Therapeutics Shirley, NY migraine Phase III www.regencytherapeutics.com TI-001 (oxytocin intranasal) Trigemina Moraga, CA chronic migraine, daily headache Phase II www.trigemina.com ubrogepant (MK-1602) Merck Whitehouse Station, NJ migraine Phase II www.merck.com zolmitriptan intranasal Shin Nippon Biomedical Laboratories USA Everett, WA migraine Phase I www.snblusa.com zucapsaicin (TRPV-1 agonist) Winston Pharmaceuticals Vernon Hills, IL cluster headache (see also pain) Phase III www.winstonlabs.com Huntington’s Disease Product Name Sponsor Indication Development Phase EX-527 (SIRT1 protein inhibitor) Siena Biotech Siena, Italy Huntington’s disease Phase I completed www.sienabiotech.com GSK356278 (PDE4 inhibitor) GlaxoSmithKline Rsch. Triangle Park, NC Huntington’s disease Phase I www.gsk.com OMS-824 (PDE10 inhibitor) Omeros Seattle, WA Huntington’s disease Phase I www.omeros.com PBT2 (metal protein-attenuating compound) Prana Biotechnology Parkville, Australia Huntington’s disease Phase II www.pranabio.com pridopidine (Orphan Drug) Teva Pharmaceutical North Wales, PA Huntington’s disease Phase III www.tevapharm.com RP103 (mercaptamine bitartrate delayed release) Raptor Pharmaceuticals Novato, CA Huntington’s disease Phase II/III www.raptorpharma.com SD-809 (VMAT inhibitor) Auspex Pharmaceuticals La Jolla, CA Huntington’s disease (see also other) Phase I www.auspexpharma.com 30 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Multiple Sclerosis Product Name Sponsor Indication Development Phase ABT-413 (sphingosine-1 phosphate receptor modulator) AbbVie North Chicago, IL multiple sclerosis Phase I www.abbvie.com anti-LINGO (LINGO-1-protein-inhibitor) Biogen Idec Weston, MA multiple sclerosis Phase II www.biogenidec.com ARX424 (peginterferon beta-1a) Ambrx La Jolla, CA multiple sclerosis Phase I www.ambrx.com ATX-MS-1467 (immune tolerizing agent) EMD Serono Rockland, MA multiple sclerosis Phase I www.emdserono.com AZ01 (peginterferon beta) Allozyne Seattle, WA multiple sclerosis Phase I www.allozyne.com BHT-3009 (DNA vaccine) Bayhill Therapeutics Palo Alto, CA relapsing-remitting multiple sclerosis Phase II completed www.bayhilltx.com Copaxone® glatiramer acetate for injection (20 mg) Teva Pharmaceutical North Wales, PA multiple sclerosis application submitted www.tevapharm.com daclizumab AbbVie North Chicago, IL Biogen Idec Weston, MA multiple sclerosis, relapsing forms Phase III www.abbvie.com www.biogenidec.com firategrast (dual alpha4-integrin antagonist) GlaxoSmithKline Rsch. Triangle Park, NC multiple sclerosis Phase II www.gsk.com GEH-120714 (18F-labeled imaging agent) GE Healthcare Waukesha, WI multiple sclerosis (diagnosis) Phase I www.gehealthcare.com GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA multiple sclerosis (see also Alzheimer’s, amyotrophic lateral sclerosis, Parkinson’s, spinal cord injury, stroke) Phase I www.genervon.com GSK239512 (H3 receptor inhibitor) GlaxoSmithKline Rsch. Triangle Park, NC multiple sclerosis Phase II www.gsk.com GSK2618960 (IL-7 modulator mAb) GlaxoSmithKline Rsch. Triangle Park, NC multiple sclerosis Phase I www.gsk.com idebenone Santhera Pharmaceuticals Liestal, Switzerland U.S. National Institutes of Health Bethesda, MD primary progressive multiple sclerosis (see also other) Phase I/II www.santhera.com Medicines in Development Neurological Disorders 2013 31 Medicines in Development for Neurological Disorders Multiple Sclerosis Product Name Sponsor Indication Development Phase imilecleucel-T Opexa Therapeutics The Woodlands, TX secondary progressive multiple sclerosis (Fast Track) Phase II www.opexatherapeutics.com IR208 (immunostimulant vaccine) Immune Response BioPharma New York, NY multiple sclerosis Phase II www.immuneresponsebiopharma. com laquinimod Teva Pharmaceutical North Wales, PA multiple sclerosis (Fast Track) Phase III www.tevapharm.com Lemtrada™ alemtuzumab Bayer HealthCare Pharmaceuticals Wayne, NJ Genzyme Cambridge, MA multiple sclerosis (Fast Track) application submitted www.bayerpharma.com www.genzyme.com masitinib AB Science USA Short Hills, NJ multiple sclerosis, primary progressive multiple sclerosis, secondary progressive multiple sclerosis Phase II/III www.ab-science.com MEDI-551 (anti-CD19 mAb) MedImmune Gaithersburg, MD multiple sclerosis Phase I www.medimmune.com MOR103 (GM-CSF antagonist mAb) GlaxoSmithKline Rsch. Triangle Park, NC multiple sclerosis Phase I/II completed www.gsk.com ocrelizumab (humanized anti-CD20 mAb) Biogen Idec Weston, MA Genentech South San Francisco, CA primary progressive multiple sclerosis, relapsing-remitting multiple sclerosis Phase III www.biogenidec.com www.gene.com ofatumumab subcutaneous (CD20 human mAb) Genmab US Princeton, NJ GlaxoSmithKline Rsch. Triangle Park, NC relapsing-remitting multiple sclerosis Phase II www.genmab.com www.gsk.com ONO-4641 (oral S1P receptor modulator) EMD Serono Rockland, MA multiple sclerosis Phase II www.emdserono.com Plegridy™ peginterferon beta-1a Biogen Idec Weston, MA multiple sclerosis, relapsing forms (Fast Track) application submitted www.biogenidec.com plovamer acetate (second-generation peptide copolymer) EMD Serono Rockland, MA multiple sclerosis Phase I www.emdserono.com 32 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Multiple Sclerosis Product Name Sponsor Indication Development Phase ponesimod Actelion Pharmaceuticals South San Francisco, CA multiple sclerosis Phase II completed www.actelion.com rHIgM22 (myelin protein stimulant mAb) Acorda Therapeutics Ardsley, NY multiple sclerosis Phase I www.acorda.com RPC1063 (S1P1 receptor agonist) Receptos San Diego, CA relapsing multiple sclerosis Phase II/III www.receptos.com RTL1000 (T-lymphocyte modulator) Artielle ImmunoTherapeutics San Mateo, CA multiple sclerosis Phase I www.artielle.com Sativex® nabiximols GW Pharmaceutical Wiltshire, United Kingdom muscle spasticity in multiple sclerosis Phase II www.gwpharm.com secukinumab (AIN457) Novartis Pharmaceuticals East Hanover, NJ multiple sclerosis Phase II www.novartis.com siponimod (BAF312) Novartis Pharmaceuticals East Hanover, NJ multiple sclerosis Phase III www.novartis.com Trimesta™ estriol succinate Synthetic Biologics Rockville, MD multiple sclerosis Phase II www.syntheticbiologics.com TSO (trichuris suis ova/CNDO-201) Coronado Biosciences Burlington, MA multiple sclerosis Phase II www.coronadobiosciences.com Tysarbi® natalizumab Biogen Idec Weston, MA multiple sclerosis (first-line therapy) in patients negative for JCV antibodies -------------------------------------secondary-progressive multiple sclerosis application submitted www.biogenidec.com ----------------------------------------Phase III www.biogenidec.com VX15 (SEMA-4D mAb) Teva Pharmaceutical North Wales, PA Vaccinex Rochester, NY multiple sclerosis Phase I www.tevapharm.com www.vaccinex.com XP23829 (NF-kappa B inhibitor) Xenoport Santa Clara, CA multiple sclerosis Phase I www.xenoport.com Medicines in Development Neurological Disorders 2013 33 Medicines in Development for Neurological Disorders Muscular Dystrophy Product Name Sponsor Indication Development Phase AAV1-FS344 (gene therapy-delivered myostatin inhibitor) (Orphan Drug) Milo Biotechnology Cleveland, OH Duchenne muscular dystrophy Phase I/II www.milobiotechnology.com ataluren (Orphan Drug) PTC Therapeutics South Plainfield, NJ Duchenne muscular dystrophy (Fast Track) Phase III www.ptcbio.com drisapersen (antisense oligonucleotide) (Orphan Drug) GlaxoSmithKline Rsch. Triangle Park, NC Prosensa Leiden, Netherlands Duchenne muscular dystrophy Phase III www.gsk.com eteplirsen (RNA interference) Sarepta Therapeutics Cambridge, MA Duchenne muscular dystrophy (Fast Track) Phase II www.sareptatherapeutics.com GNE lipoplex (muscular dystrophy gene therapy) Gradalis Carrollton, TX hereditary inclusion body myopathy Phase I www.gradalisinc.com HT-100 (halofunginone) (Orphan Drug) Halo Therapeutics Newton, MA Duchenne muscular dystrophy Phase I/II www.halotherapeutics.com PF-06252616 Pfizer New York, NY muscular dystrophy Phase I www.pfizer.com Product Name Sponsor Indication Development Phase ABT-639 (T-type calcium channel antagonist) AbbVie North Chicago, IL diabetic neuropathy Phase II www.abbvie.com ABT-652 (histamine H3 receptor modulator) AbbVie North Chicago, IL diabetic neuropathy Phase II www.abbvie.com AF-219 (purinergic P2 receptor antagonist) Afferent Pharmaceuticals San Mateo, CA osteoarthritis pain Phase II www.afferentpharma.com agomelatine (NRT-31/36) Nectid Princeton, NJ neuropathic pain, pain associated with multiple sclerosis Phase II www.nectid.com Pain 34 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase ALO-02 (oxycodone/naltrexone core/ abuse resistant) Pfizer New York, NY moderate to severe chronic pain Phase III www.pfizer.com AmiKet™ amitriptyline/ketamine EpiCept Tarrytown, NY neuropathic pain (Fast Track) Phase II www.epicept.com ARA 290 (erythropoietin receptor agonist) Araim Pharmaceuticals Yorktown, NY diabetic neuropathy Phase II www.araim.org ARC-2022 (lidocaine topical gel) Arcion Therapeutics Baltimore, MD postherpetic neuralgia Phase I/II www.arciontherapeutics.com ARRY-797 (p38 MAP kinase inhibitor) Array BioPharma Boulder, CO osteoarthritis pain Phase II www.arraybiopharma.com AS-3201 (ranirestat) Eisai Woodcliff Lake, NJ diabetic neuropathy Phase III www.eisai.com ATx08 001 (PPAR-gamma agonist) Aestus Therapeutics East Windsor, NJ postherpetic neuralgia Phase II www.aestustherapeutics.com AV-101 (NMDA receptor antagonist) VistaGen Therapeutics South San Francisco, CA neuropathic pain Phase I www.vistagen.com AVP-786 (deuterated dextromethorphan) Avanir Pharmaceuticals Aliso Viejo, CA chronic pain Phase I www.avanir.com AVP-923 (dextromethorphan/quinidine fixed-dose combination) Avanir Pharmaceuticals Aliso Viejo, CA diabetic neuropathy (see also Alzheimer’s) -------------------------------------central neuropathic pain in multiple sclerosis Phase III www.avanir.com ----------------------------------------Phase III www.avanir.com BEMA buprenorphine transmucosal BioDelivery Sciences International Raleigh, NC neuropathic pain Phase III www.bdsi.com Botox® onabotulinumtoxinA Allergan Irvine, CA osteoarthritis pain (see also headache, other) Phase II www.allergan.com Butrans™ Transdermal System CIII buprenorphine transdermal Purdue Pharma Stamford, CT chronic pain (adolescents) Phase III www.purduepharma.com Celebrex® celecoxib Pfizer New York, NY chronic pain application submitted www.pfizer.com Medicines in Development Neurological Disorders 2013 35 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase clonidine topical gel BioDelivery Sciences Raleigh, NC diabetic neuropathy (Fast Track) Phase II www.bdsi.com CNSB015 (flupirtine-based pain therapy) Relevare Pharmaceuticals Melbourne, Australia neuropathic pain Phase I/II www.relevarepharma.com COL-003 (oxycodone extended release/ abuse-resistant formulation) Collegium Pharmaceuticals Canton, MA chronic lower back pain Phase III www.collegiumpharma.com COL-172 (oxymorphone extended release/ abuse resistant) Collegium Pharmaceuticals Canton, MA chronic lower back pain (Fast Track) Phase I www.collegiumpharma.com C-peptide long-acting (CBX129801) Cebix La Jolla, CA diabetic neuropathy (Fast Track) Phase II www.cebix.com CR845 (opioid kappa receptor agonist) Cara Therapeutics Shelton, CT chronic pain Phase I www.caratherapeutics.com CTP-354 (GABA-A receptor modulator) Concert Pharmaceuticals Lexington, MA neuropathic pain (see also spasticity) Phase I www.concertpharma.com diclofenac nano-formulation Iroko Pharmaceuticals Philadelphia, PA osteoarthritis pain Phase III www.iroko.com DS-5565 (CACNA2D1 protein modulator) Daiichi Sankyo Parsippany, NJ chronic pain Phase II www.dsi.com Eladur® bupivacaine transdermal (Orphan Drug) DURECT Cupertino, CA post-herpetic neuralgia Phase II www.durect.com ELI-154 (oxycodone controlled release) Elite Pharmaceuticals Northvale, NJ chronic pain Phase II www.elitepharma.com ELI-216 (oxycodone/naltrexone fixed-dose combination) Elite Pharmaceuticals Northvale, NJ moderate to severe chronic pain Phase II www.elitepharma.com EMA401 (angiotensin-type-2 receptor antagonist) Spinifex Pharmaceuticals South Yarra, Australia postherpetic neuralgia Phase I www.spinifexpharma.com.au Fentora® fentanyl buccal Cephalon (Teva) Frazer, PA chronic pain application submitted www.tevapharm.com 36 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase filorexant (dual orexin receptor antagonist) Merck Whitehouse Station, NJ diabetic neuropathy Phase II www.merck.com fulranumab (nerve growth factor inhibitor) Janssen Research & Development Raritan, NJ neuropathic pain Phase II www.janssenrnd.com GRT6005 (ORL-1 receptor agonist) Forest Laboratories New York, NY pain due to osteoarthritis of the knee Phase II www.frx.com hydrocodone extended release (CEP-33237) Cephalon (Teva) Frazer, PA chronic pain Phase III www.tevapharm.com hydromorphone intrathecal Mallinckrodt Hazelwood, MO chronic pain Phase III www.mallinckrodt.com K-103-IP (COX inhibitor) Kowa Research Institute Morrisville, NC arthritis pain Phase I www.kowaus.com KRN5500 (protein synthesis inhibitor) DARA Biosciences Raleigh, NC peripheral neuropathy (Fast Track) Phase II www.darabio.com levorphanol extended release (abuse-deterrent drug delivery system) Relmada Therapeutics Blue Bell, PA moderate to severe chronic pain Phase I www.relmada.com Lyrica® pregabalin Pfizer New York, NY peripheral neuropathic pain (see also epilepsy) Phase III www.pfizer.com mavatrep Janssen Research & Development Raritan, NJ chronic pain Phase I www.janssenrnd.com meloxicam nano-formulation Iroko Pharmaceuticals Philadelphia, PA osteoarthritis pain Phase III www.iroko.com NCE Eli Lilly Indianapolis, IN osteoarthritis pain Phase I www.lilly.com neublastin Biogen Idec Weston, MA NsGene Ballerup, Denmark neuropathic pain Phase I www.biogenidec.com NKTR-181 (mu-opioid agonist) Nektar Therapeutics San Francisco, CA moderate to severe chronic pain (Fast Track) Phase II www.nektar.com Medicines in Development Neurological Disorders 2013 37 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase NP-1998 (capsaicin topical liquid) Acorda Therapeutics Ardsley, NY neuropathic pain Phase II www.acorda.com NXN-462 (nNOS inhibitor) NeurAxon Mississauga, Canada postherpetic neuralgia Phase II www.neuraxon.com oxycodone/naloxone controlled release (OXN) Purdue Pharma Stamford, CT severe chronic lower back pain Phase II www.purduepharma.com PA65020 (aspirin 650mg/omeprazole 20mg fixed-dose combination) POZEN Chapel Hill, NC chronic pain Phase I www.pozen.com Pennsaid® 2% diclofenac transdermal second-generation Nuvo Research Mississauga, Canada osteoarthritis pain application submitted www.nuvoresearch.com PF-05089771 (Nav1.7 sodium channel inhibitor) Pfizer New York, NY chronic pain Phase I www.pfizer.com PF-06273340 Pfizer New York, NY chronic pain Phase I www.pfizer.com PF-06305591 Pfizer New York, NY chronic pain Phase I www.pfizer.com PLX1100 (ibuprofen/phosphatidylcholine) PLx Pharma Houston, TX osteoarthritis pain Phase II www.plxpharma.com pregabalin controlled release Pfizer New York, NY postherpetic neuralgia (see also epilepsy) Phase III www.pfizer.com PTI-202 (abuse-resistant opioid) Pain Therapeutics Austin, TX moderate to severe chronic pain Phase I completed www.paintrials.com PTI-721 (abuse-resistant opioid) Pain Therapeutics Austin, TX moderate to severe chronic pain Phase I completed www.paintrials.com Qutenza® capsaicin 8% patch Astellas Pharma Tokyo, Japan NeurogesX San Mateo, CA HIV-associated neuropathy (Fast Track) application submitted www.astellas.com www.neurogesx.com ----------------------------------------Phase III www.astellas.com www.neurogesx.com 38 -------------------------------------diabetic neuropathy Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase Remoxy™ oxycodone controlled release (Mu-type opioid receptor agonist/ abuse resistant) Pain Therapeutics Austin, TX Pfizer New York, NY moderate to severe chronic pain application submitted www.pfizer.com rezatomidine (alpha adrenergic receptor agonist) ACADIA Pharmaceuticals San Diego, CA Allergan Irvine, CA diabetic neuropathy Phase II www.acadia-pharm.com www.allergan.com S-117957 Purdue Pharma Stamford, CT Shionogi Florham Park, NJ neuropathic pain Phase I www.purduepharma.com www.shionogi.com SAR292833/GRC15300 (TRVP3 antagonist) Glenmark Pharmaceuticals Mumbai, India Sanofi US Bridgewater, NJ neuropathic pain, osteoarthritis pain Phase II www.sanofi.com SD-254 (deuterium-substituted venlafaxine analogue) Auspex Pharmaceuticals La Jolla, CA neuropathic pain Phase I www.auspexpharma.com SEP-228432 (SRNDI inhibitor) Sunovion Pharmaceuticals Marlborough, MA neuropathic pain Phase I www.sunovion.com SKL-NP SK biopharmaceuticals Fair Lawn, NJ neuropathic pain Phase II www.skbp.com sufentanil (transdermal delivery system) DURECT Cupertino, CA chronic pain Phase II www.durect.com TAK-428 (neurotrophic factor production accelerator) Takeda Pharmaceuticals International Deerfield, IL diabetic neuropathy Phase II www.takeda.com TEM (senrebotase) Allergan Irvine, CA postherpetic neuralgia Phase II www.allergan.com V116517 Purdue Pharma Stamford, CT pain due to osteoarthritis of the knee, postherpetic neuralgia Phase II www.purduepharma.com V158866 (FAAH inhibitor) Vernalis Winnersh, United Kingdom neuropathic pain Phase II www.vernalis.com Medicines in Development Neurological Disorders 2013 39 Medicines in Development for Neurological Disorders Pain Product Name Sponsor Indication Development Phase VBY-036 (protease inhibitor) Virobay Menlo Park, CA neuropathic pain Phase I www.virobayinc.com verapamil Calosyn Pharma Sharon, MA osteoarthritis pain Phase I/II www.calosynpharma.com Vicodin® CR hydrocodone/paracetamol controlled release AbbVie North Chicago, IL back pain, osteoarthritis pain application submitted www.abbvie.com VM202 (modified hepatocyte growth factor gene therapy) ViroMed Seoul, South Korea diabetic neuropathy Phase II www.viromed.co.kr XEN402 Teva Pharmaceutical North Wales, PA Xenon Pharmaceuticals Burnaby, Canada postherpetic neuralgia Phase II www.tevapharm.com www.xenon-pharma.com YKP-509 (carisbamate) SK biopharmaceuticals Fair Lawn, NJ neuropathic pain Phase II www.skbp.com YKP-3089 SK biopharmaceuticals Fair Lawn, NJ neuropathic pain (see also epilepsy) Phase II www.skbp.com Z160 (N-type calcium channel antagonist) Zalicus Cambridge, MA neuropathic pain, postherpetic neuralgia Phase II www.zalicus.com Z944 (T-type calcium channel antagonist) Zalicus Cambridge, MA neuropathic pain Phase I www.zalicus.com Zohydro ER™ hydrocodone extended-release Zogenix San Diego, CA moderate to severe chronic pain application submitted www.zogenix.com zucapsaicin (TRPV-1 agonist) (Orphan Drug) Winston Pharmaceuticals Vernon Hills, IL chronic pain, postherpetic neuralgia (see also headache) application submitted www.winstonlabs.com 40 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Parkinson’s Disease Product Name Sponsor Indication Development Phase AFQ056 (mavoglurant) Novartis Pharmaceuticals East Hanover, NJ drug-induced dyskinesia in Parkinson’s disease Phase II www.novartis.com AQW051 (alpha7 nicotinic acetylcholine receptor agonist) Novartis Pharmaceuticals East Hanover, NJ drug-induced dyskinesia in Parkinson’s disease Phase II completed www.novartis.com autologous stem cell therapy NeuroGeneration Los Angeles, CA Parkinson’s disease Phase I www.neurogeneration.com AVE-8112 (PDE4 inhibitor) Sanofi US Bridgewater, NJ The Michael J. Fox Foundation for Parkinson’s Research New York, NY Parkinson’s disease Phase I www.sanofi.com www.michaeljfox.org AZD3241 (myeloperoxidase inhibitor) AstraZeneca Wilmington, DE Parkinson’s disease Phase II www.astrazeneca.com CERE-120 (AAV-NTN) Ceregene San Diego, CA Parkinson’s disease Phase II www.ceregene.com CVT-301 (levodopa inhalation) Civitas Therapeutics Chelsea, MA Parkinson’s disease Phase II www.civitastherapeutics.com davunetide intranasal Allon Therapeutics Vancouver, Canada Parkinson’s disease (see also Alzheimer’s, other) Phase I www.allontherapeutics.com dipraglurant (ADX48621) (immediate release) Addex Therapeutics Geneva, Switzerland levodopa-induced dyskinesia in Parkinson’s disease Phase II www.addextherapeutics.com DM-1992 (carbidopa/levodopa controlled-release) Depomed, Inc. Newark, CA Parkinson’s disease Phase II www.depomed.com Duopa® levodopa/carbidopa intestinal gel (LCIG) (Orphan Drug) AbbVie North Chicago, IL advanced Parkinson’s disease (Fast Track) application submitted www.abbvie.com fipamezole (alpha-2 adrenergic receptor antagonist) Santhera Pharmaceuticals Liestal, Switzerland Parkinson’s disease (Fast Track) Phase II completed www.santhera.com Medicines in Development Neurological Disorders 2013 41 Medicines in Development for Neurological Disorders Parkinson’s Disease Product Name Sponsor Indication Development Phase GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA Parkinson’s disease (see also Alzheimer’s, amyotrophic lateral sclerosis, multiple sclerosis, spinal cord injury, stroke) Phase II www.genervon.com GZ404477 (AAV-hAADC gene therapy) Genzyme Cambridge, MA Parkinson’s disease Phase I www.genzyme.com HT-1067 (MOA-B reversible inhibitor) Dart NeuroScience San Diego, CA Parkinson’s disease Phase I www.dartneuroscience.com KW-6002 (istradefylline) Kyowa Hakko Kirin America Princeton, NJ Parkinson’s disease application submitted www.kyowa-kirin.com levodopa/carbidopa extended release IMPAX Laboratories Hayward, CA Parkinson’s disease application submitted www.impaxlabs.com NAV5001 (123I-labelled imaging agent) Navidea Biopharmaceuticals Dublin, OH Parkinsonian disorder (diagnosis) (see also Alzheimer’s) Phase III www.navidea.com Nurelin™ ADS-5102/amantadine ER Adamas Pharmaceuticals Emeryville, CA levodopa-induced dyskinesia in Parkinson’s disease Phase III www.adamaspharma.com NuroPro® neurotrophic factor companion diagnostic Amarantus BioSciences Sunnyvale, CA Parkinson’s disease (diagnosis) Phase II www.amarantus.com opicapone (COMT inhibitor) Bial Lisbon, Portugal Parkinson’s disease Phase I www.bial.com OS-320 (levodopa/carbidopa) Osmotica Pharmaceutical Wilmington, NC Parkinson’s disease Phase III www.osmoticausa.com Posiphen® R-phenserine QR Pharma Berwyn, PA Parkinson’s disease (see also Alzheimer's) Phase II www.qrpharma.com PYM-50028 Phytopharm Huntingdon, United Kingdom early stage Parkinson’s disease Phase II www.phytopharm.com safinamide Newron Pharmaceuticals Bresso, Italy Zambon Bresso, Italy Parkinson’s disease Phase III www.newron.com www.zambonpharma.com tozadenant (adenosine A2A receptor antagonist) Biotie Therapies South San Francisco, CA UCB Brussels, Belgium Parkinson’s disease Phase II/III www.biotie.com www.ucb.com 42 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Parkinson’s Disease Product Name Sponsor Indication Development Phase XP21279 (dopamine receptor agonist) Xenoport Santa Clara, CA Parkinson’s disease Phase II www.xenoport.com Product Name Sponsor Indication Development Phase CK-2127107 Cytokinetics South San Francisco, CA muscular atrophy associated with neuromuscular dysfunction, muscular weakness, and/or muscle fatigue Phase I www.cytokinetics.com CTP-354 (GABA-A receptor modulator) Concert Pharmaceuticals Lexington, MA muscle spasticity (see also pain) Phase I www.concertpharma.com Dysport® abobotulinumtoxinA Ipsen Biopharmaceuticals Basking Ridge, NJ focal spasticity of upper and lower limb in adults, adolescents and children Phase III www.ipsen.com OS-440 (arbaclofen extended release) Osmotica Pharmaceutical Marietta, GA muscle spasticity due to multiple sclerosis Phase III www.osmotica.com SUN 09 (baclofen extended release) Sun Pharma Advanced Research Mumbai, India muscle spasticity due to multiple sclerosis Phase III www.sunpharma.in Xeomin® incobotulinumtoxinA Merz Pharmaceuticals Greensboro, NC post-stroke spasticity Phase III www.merzusa.com Product Name Sponsor Indication Development Phase AC105 (nervous system modulator) Acorda Therapeutics Ardsley, NY spinal cord injury (Fast Track) Phase II www.acorda.com ATI355 (anti-NOGO-A mAb) (Orphan Drug) Novartis Pharmaceuticals East Hanover, NJ spinal cord injury Phase I www.novartis.com Spasticity Spinal Cord Injury Medicines in Development Neurological Disorders 2013 43 Medicines in Development for Neurological Disorders Spinal Cord Injury Product Name Sponsor Indication Development Phase autologous stem cell therapy DaVinci Biosciences Costa Mesa, CA spinal cord injury in clinical trials www.dvbiosciences.com BA-210 (Rho GTP-binding protein-inhibitor) (Orphan Drug) BioAxone BioSciences Ft. Lauderdale, FL spinal cord injury Phase II www.bioaxonebio.com GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA spinal cord injury (see also Alzheimer’s, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s, stroke) Phase I www.genervon.com HuCNS-SC® adult neural stem cell therapy StemCells Newark, CA chronic spinal cord injury (see also genetic) Phase I/II www.stemcellsinc.com NEU2000 GNT Pharma Yongin, South Korea spinal cord injury (see also stroke) Phase I completed www.gntpharma.com stem cell therapy TCA Cellular Therapy Covington, LA spinal cord injury (see also amyotrophic lateral sclerosis) Phase I www.tcacellulartherapy.com SUN13837 (FGF-receptor agonist) Daiichi Sankyo Parsippany, NJ spinal cord injury Phase II www.dsi.com Product Name Sponsor Indication Development Phase 3K3A-APC (recombinant human activated protein C) ZZ Biotech Houston, TX stroke Phase I www.zzbiotech.com ALD-401 (bone marrow-derived adult stem cell therapy) Cytomedix Gaithersburg, MD stroke Phase II www.cytomedix.com allogeneic mesenchymal bone marrow cell therapy Stemedica Cell Technologies San Diego, CA ischemic stroke Phase I/II www.stemedica.com Ampyra® fampridine sustained-release Acorda Therapeutics Ardsley, NY post-stroke deficits (see also other) Phase II www.acorda.com Stroke 44 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Stroke Product Name Sponsor Indication Development Phase betrixaban Portola Pharmaceuticals South San Francisco, CA prevention of stroke in patients with atrial fibrillation Phase II www.portola.com CNTO-0007 (cell therapy) Janssen Research & Development Raritan, NJ stroke Phase I/II www.janssenrnd.com desmoteplase Lundbeck Deerfield, IL stroke (Fast Track) Phase III www.lundbeck.com GM6 (peptide therapeutic) Genervon Biopharmaceuticals Pasadena, CA stroke (see also Alzheimer’s, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson’s, spinal cord injury) Phase II www.genervon.com GSK249320 (myelin-associated glycoprotein mAb) GlaxoSmithKline Rsch. Triangle Park, NC stroke Phase II www.gsk.com methamphetamine intravenous Sinapis Pharma Jacksonville, FL stroke (see also brain injury) Phase I completed www.sinapispharma.com MP-124 (PARP inhibitor) Mitsubishi Tanabe Pharma America Jersey City, NJ acute ischemic stroke Phase I www.mt-pharma.co.jp MultiStem® stem cell therapy Athersys Cleveland, OH stroke Phase II www.athersys.com NA-1 (signal transduction pathway inhibitor) NoNO Toronto, Canada acute ischemic stroke Phase II completed www.nonoinc.ca NEU2000 GNT Pharma Yongin, South Korea stroke (see also spinal cord injury) Phase I completed www.gntpharma.com PF-03049423 Pfizer New York, NY stroke recovery Phase II www.pfizer.com RP-1127 (glibenclamide) Remedy Pharmaceuticals New York, NY stroke (see also brain injury) Phase II www.remedypharmaceuticals.com SAR126119 (TAFIa inhibitor) Sanofi US Bridgewater, NJ acute ischemic stroke Phase I www.sanofi.com SB623 (stem cell therapy) SanBio Mountain View, CA stroke Phase I/II www.san-bio.com Medicines in Development Neurological Disorders 2013 45 Medicines in Development for Neurological Disorders Stroke Product Name Sponsor Indication Development Phase TS01 (recombinant complement C1-inactivator-protein) Thrombolytic Science International Cambridge, MA stroke Phase I www.tsillc.com Product Name Sponsor Indication Development Phase 18F-AV-133 imaging agent Avid Radiopharmaceuticals Philadelphia, PA neurodegenerative disorders (diagnosis) Phase I/II www.avidrp.com Abilify® aripiprazole (once-weekly) Otsuka America Pharmaceutical Rockville, MD Tourette’s syndrome Phase III www.otsuka.com ABT-354 (serotonin-6 receptor antagonist) AbbVie North Chicago, IL neurological disorders Phase I www.abbvie.com ABT-384 AbbVie North Chicago, IL neurological disorders (see also Alzheimer’s) Phase I completed www.abbvie.com Ampyra® fampridine sustained release Acorda Therapeutics Ardsley, NY cerebral palsy (see also stroke) Phase II www.acorda.com AP-1101 Ariel Pharmaceuticals Broomfield, CO neuroprotection against postoperative cognitive decline and memory loss in patients undergoing extracorporeal cardiopulmonary bypass Phase II Botox® onabotulinumtoxinA Allergan Irvine, CA juvenile cerebral palsy (see also headache, pain) Phase III www.allergan.com BYM338 (type II-B activin receptor modulator mAb) Novartis Pharmaceuticals East Hanover, NJ inclusion body myositis Phase II www.novartis.com CX1739 (AMPA receptor agonist) Cortex Pharmaceuticals Glen Rock, NJ central sleep apnea Phase I www.cortexpharm.com davunetide intranasal (Orphan Drug) Allon Therapeutics Vancouver, Canada progressive supranuclear palsy (Fast Track) (see also Alzheimer’s, Parkinson’s) Phase II/III www.allontherapeutics.com Other 46 Medicines in Development Neurological Disorders 2013 Medicines in Development for Neurological Disorders Other Product Name Sponsor Indication Development Phase ecopipam (D1 dopamine receptor antagonist) Psyadon Pharmaceuticals Germantown, MD Tourette’s syndrome (see also genetic) Phase I/II www.psyadonrx.com EVP-0334 (HDAC inhibitor) EnVivo Pharmaceuticals Watertown, MA neurodegenerative disorders Phase I www.envivopharma.com Firdapse™ amifampridine (Orphan Drug) Catalyst Pharmaceutical Partners Coral Gables, FL Lambert-Eaton myasthenic syndrome Phase III www.catalystpharma.com Gilenya® fingolimod Novartis Pharmaceuticals East Hanover, NJ chronic inflammatory demyelinating polyradiculoneuropathy Phase III www.novartis.com glycerol phenylbutyrate (Orphan Drug) Hyperion Therapeutics South San Francisco, CA hepatic encephalopathy Phase II completed www.hyperiontx.com human immune globulin (subcutaneous) CSL Behring King of Prussia, PA chronic inflammatory demyelinating polyradiculoneuropathy Phase III www.cslbehring.com idebenone (Orphan Drug) Columbia University New York, NY Santhera Pharmaceuticals Liestal, Switzerland MELAS syndrome (see also multiple sclerosis) Phase II www.santhera.com interleukin-7 Cytheris Rockville, MD progressive multifocal leukoencephalopathy Phase II www.cytheris.com IPX159 IMPAX Pharmaceuticals Hayward, CA restless legs syndrome Phase II www.impaxpharma.com MK-8616 (sugammadex) Merck Whitehouse Station, NJ neuromuscular blockade application submitted www.merck.com NBI-98854 (VMAT2 inhibitor) Neurocrine Biosciences San Diego, CA drug-induced dyskinesia (Fast Track) Phase II www.neurocrine.com NH001 (apomorphine subcutaneous) (Orphan Drug) NeuroHealing Pharmaceuticals Waban, MA coma (Fast Track) Phase II www.neurohealing.com Medicines in Development Neurological Disorders 2013 47 Other Product Name Sponsor Indication Development Phase NNZ-2566 (cytokine inhibitors/neuropeptide receptor modulator) Neuren Pharmaceuticals Bethesda, MD Rett syndrome (Fast Track) (see also brain injury) Phase I www.neurenpharma.com OCR-002 (ornithine phenylacetate) (Orphan Drug) Ocera Therapeutics San Diego, CA hepatic encephalopathy in patients with acute liver failure (iv) (Fast Track) -------------------------------------hepatic encephalopathy in patients with liver cirrhosis (oral) (Fast Track) Phase II www.ocerainc.com ----------------------------------------Phase I www.ocerainc.com placulumab Cephalon (Teva) Frazer, PA sciatica Phase I/II www.tevapharm.com pomaglumetad (LY2140023 monohydrate) Eli Lilly Indianapolis, IN CNS disorders Phase I www.lilly.com SD-809 (VMAT inhibitor) Auspex Pharmaceuticals La Jolla, CA drug-induced dyskinesias, Tourette’s syndrome (see also Huntington’s) Phase I www.auspexpharma.com Soliris® eculizumab (Orphan Drug) Alexion Pharmaceuticals Cheshire, CT myasthenia gravis, severe and relapsing neuromyelitis optica Phase II www.alxn.com SPI-017 Sucampo Pharmaceuticals Bethesda, MD lumbar spinal stenosis Phase II www.sucampo.com SPI-3608 Sucampo Pharmaceuticals Bethesda, MD spinal stenosis Phase I www.sucampo.com Tardoxyl™ pyridoxal phosphate Medicure Pharma Somerset, NJ drug-induced dyskinesia (Fast Track) Phase II www.medicure.com uridine triacetate (PN401) Wellstat Therapeutics Gaithersburg, MD neurodegenerative disorders Phase I www.wellstattherapeutics.com vigabatrin (GABA-AT inhibitor) Catalyst Pharmaceutical Partners Coral Gables, FL Tourette’s syndrome Phase I/II www.catalystpharma.com 48 Medicines in Development Neurological Disorders 2013 Glossary Alzheimer’s disease—The most common form of dementia, characterized by progressive and chronic deterioration of cognitive functions, including memory, thinking and reasoning. Early manifestations include forgetfulness, impaired ability to focus, and changes in mood and personality. As the disease progresses, there is a loss of computational ability, in addition to word-finding problems and difficulty with ordinary activities. Ultimately, the disease leads to severe memory loss, complete disorientation, social withdrawal, loss of independence, and is fatal. amyotrophic lateral sclerosis (ALS)— Also known as Lou Gehrig’s disease, the most common of the motor neuron diseases, a group of rare disorders in which the nerves that control muscular activity degenerate within the brain and spinal cord causing weakness and wasting of the muscles. application submitted—An application for marketing has been submitted by the company to the Food and Drug Administration (FDA). attention deficit/hyperactivity disorder (ADHD)—ADHD is a complex neurological impairment that results in an overactive behavior pattern and a difficulty concentrating. While it primarily affects children, a growing number of adults are being diagnosed with the disorder. Boys are affected about three times as often as girls. Children with ADHD are fidgety, impulsive, reckless, irritable, emotionally immature and sometimes aggressive. Because their attention span is short, they do not conform to orderly routine. ADHD often leads to anti-social acts and difficulty learning, although IQ is normal. No definite cause has been established, but some researchers now believe genetics plays a role. cerebral palsy—A general term for disorders of movement and posture resulting from damage to the brain in pregnancy, during birth, in the newborn period or in early childhood. dementia—Degeneration of central nervous functions, such as memory and Medicines in Development learning capacity. The natural decline of these functions with age is grossly exaggerated in dementia. problems such as clumsy or awkward movements and unsteadiness, occurs in many different diseases and conditions. Duchenne muscular dystrophy—An inherited disorder that involves rapidly worsening muscle weakness. Other muscular dystrophies get worse much more slowly. Duchenne’s is caused by a defective gene. Because of the way the disease is inherited, males are more likely to develop symptoms than are women. glioblastoma multiforme—The most common and most malignant of the astrocytomas. The tumor grows so fast that it increases pressure in the brain, producing headaches, slowed thinking, and if severe enough, sleepiness and coma. epilepsy—Recurrent seizures—transient neurological abnormalities caused by abnormal electrical activity in the brain— or temporary alteration in one or more brain functions. Seizures are a symptom of brain dysfunction and can result from a wide variety of diseases or injury. Fast Track—A process designed to facilitate the development and expedite the review of drugs to treat serious diseases and fill an unmet medical need. The status is assigned by the U.S. Food and Drug Administration. The purpose is to get important new drugs to the patient earlier. Fast Track addresses a broad range of serious diseases. Generally, determining factors include whether the drug will have an impact on such factors as survival, day-to-day functioning, or the likelihood that the disease, if left untreated, will progress from a less severe condition to a more serious one. Filling an unmet medical need is defined as providing a therapy where none exists or providing a therapy which may be potentially superior to existing therapy. Once a drug receives Fast Track designation, early and frequent communication between the FDA and a drug company is encouraged throughout the entire drug development and review process. The frequency of communication assures that questions and issues are resolved quickly, often leading to earlier drug approval and access by patients. Friedreich’s ataxia—An inherited disease that causes progressive damage to the nervous system resulting in symptoms ranging from gait disturbance and speech problems to heart disease. “Ataxia,” which refers to coordination Neurological Disorders 2013 glioma—A type of brain tumor arising from the supporting glial cells within the brain. Gliomas make up about 60 percent of all primary brain tumors. Huntington’s disease—Huntington’s chorea is an uncommon, inherited disease in which degeneration of the basal ganglia (structures deep in the brain) results in chorea (rapid, jerky, involuntary movements) and dementia (progressive mental impairment). Lennox-Gastaut syndrome—Characterized by seizures and mental retardation in infants and young children. metastases/metastatic—Areas of secondary cancer that have spread from the primary or original cancer site. migraine—Severe headache resulting from an abnormal dilation of blood vessels deep within the brain. It can last from two hours to several days and is often accompanied by nausea, vomiting and sensitivity to noise and/or light. multiple sclerosis (MS)—Progressive disease of the central nervous system in which scattered patches of the covering of nerve fibers (myelin) in the brain and spinal cord are destroyed. Symptoms range from numbness and tingling to paralysis and incontinence. muscular dystrophy—Inherited muscular disorder of unknown cause in which muscle fibers slowly degenerate. Duchenne MD is the most common type. myasthenia gravis—A chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The hallmark of myasthenia gravis 49 Glossary is muscle weakness that increases during periods of activity and improves after periods of rest. neuroblastoma—A tumor of the adrenal glands or sympathetic nervous system (the part of the nervous system responsible for certain automatic body functions, such as the control of heart rate). Neuroblastomas are the most common extracranial (outside the skull) solid tumors of childhood. neuropathic pain—Caused by disease, inflammation, or damage to the peripheral nerves, which connect the central nervous system (brain and spinal cord) to the sense organs, muscles, glands, and internal organs. neuropathy—Disease, inflammation, or damage to the peripheral nerves, which connect the central nervous system to the sense organs, muscles, glands, and internal organs. Orphan Drug—A drug to treat a disease that has a patient population of 200,000 or less, or a disease that has a patient population of more than 200,000 and a developmental cost that will not be recovered from sales in the United States. Parkinson’s disease—Chronic neurologic disease of unknown cause, characterized by tremors, rigidity and an abnormal gait. Phase 0—First-in-human trials conducted in accordance with FDA’s 2006 guidance on exploratory Investigational New Drug (IND) studies designed to speed up development of promising drugs by establishing very early whether the tested compound behaves in human subjects as was anticipated from preclinical studies. Phase I—Safety testing and pharmacological profiling in humans. Phase II—Effectiveness testing in humans. Phase III—Extensive clinical trials in humans. postherpetic neuralgia—A burning pain that may recur at the site of an attack of shingles months or even years after the illness. prodrug—An inactive medicine that becomes active inside the body through metabolic processes. Prodrugs can be used to improve how a specific medicine is absorbed, distributed, metabolized or excreted. restless legs syndrome—Restless legs syndrome is an overwhelming urge to move the legs usually caused by uncomfortable or unpleasant sensations in the legs. spinal cord injury—Damage to the spinal cord which can cause loss of sensation, muscle weakness or paralysis. stroke—Usually caused by atherosclerosis. It results in death or serious brain damage, such as paralysis or loss of speech. An ischemic stroke is caused by blocked or narrowed arteries that prevent sufficient blood and oxygen from reaching the brain. Tourette syndrome (TS)—A neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics. The early symptoms of TS are typically noticed first in childhood, with the average onset between the ages of 3 and 9. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as 1 in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst tic symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood. The content of this report has been obtained through public, government and industry sources, and the Adis “R&D Insight” database based on the latest information. Report current as of July 18, 2013. The medicines in this report include medicines being developed by U.S. based companies conducting trials in the United States and abroad, PhRMA-member companies conducting trials in the United States and abroad, and foreign companies conducting clinical trials in the United States. The information in this report may not be comprehensive. For more specific information about a particular product, contact the individual company directly or go to www.clinicaltrials.gov. The entire series of Medicines in Development is available on PhRMA’s website. A publication of PhRMA’s Communications & Public Affairs Department. (202) 835-3460 www.phrma.org | www.innovation.org | www.pparx.org Provided as a Public Service by PhRMA. Founded in 1958 as the Pharmaceutical Manufacturers Association. Copyright © 2013 by the Pharmaceutical Research and Manufacturers of America. Permission to reprint is awarded if proper credit is given. Pharmaceutical Research and Manufacturers of America • 950 F Street, NW, Washington, DC 20004 50 Medicines in Development Neurological Disorders 2013 The Drug Discovery, Development and Approval Process Developing a new medicine takes an average of 10-15 years; For every 5,000-10,000 compounds in the pipeline, only 1 is approved. PRECLINICAL 5,000 – 10,000 CLINICAL TRIALS FDA REVIEW LG-SCALE MFG 5 250 ONE FDAAPPROVED DRUG 3 – 6 YEARS PHASE 1 PHASE 3 PHASE 2 NUMBER OF VOLUNTEERS 20 –80 100 – 300 1,000 – 3,000 6 – 7 Y EARS NDA SUBMIT T ED COMPOUNDS IND SUBMIT T ED P R E - DI S COVERY DRUG DISCOVERY LON G , RISKY ROAD 0. 5 – 2 Y EARS PHASE 4: POST-M AR K ET I N G SU RVEI L L A N C E Drug Discovery and Development: A The Drug Development and Approval Process The U.S. system of new drug approvals is perhaps the most rigorous in the world. It takes 10-15 years, on average, for an experimental drug to travel from lab to U.S. patients, according to the Tufts Center for the Study of Drug Development. Only five in 5,000 compounds that enter preclinical testing make it to human testing. And only one of those five is approved for sale. On average, it costs a company $1.2 billion, including the cost of failures, to get one new medicine from the laboratory to U.S. patients, according to a recent study by the Tufts Center for the Study of Drug Development. Once a new compound has been identified in the laboratory, medicines are usually developed as follows: Preclinical Testing. A pharmaceutical company conducts laboratory and animal studies to show biological activity of the compound against the targeted disease, and the compound is evaluated for safety. Investigational New Drug Application (IND). After completing preclinical testing, a company files an IND with the U.S. Food and Drug Administration (FDA) to begin to test the drug in people. The IND shows results of previous experiments; how, where and by whom the new studies will be conducted; the chemical structure of the compound; how it is thought to work in the body; any toxic effects found in the animal studies; and how the compound is manufactured. All clinical trials must be reviewed and approved by the Institutional Review Board (IRB) where the trials will be conducted. Progress reports on clinical trials must be submitted at least annually to FDA and the IRB. Clinical Trials, Phase I—Researchers test the drug in a small group of people, usually between 20 and 80 healthy adult volunteers, to evaluate its initial safety and tolerability profile, determine a safe dosage range, and identify potential side effects. Clinical Trials, Phase II—The drug is given to volunteer patients, usually between 100 and 300, to see if it is effective, identify an optimal dose, and to further evaluate its short-term safety. Clinical Trials, Phase III—The drug is given to a larger, more diverse patient population, often involving between 1,000 and 3,000 patients (but sometime many more thousands), to gener- ate statistically significant evidence to confirm its safety and effectiveness. They are the longest studies, and usually take place in multiple sites around the world. New Drug Application (NDA)/Biologic License Application (BLA). Following the completion of all three phases of clinical trials, a company analyzes all of the data and files an NDA or BLA with FDA if the data successfully demonstrate both safety and effectiveness. The applications contain all of the scientific information that the company has gathered. Applications typically run 100,000 pages or more. Approval. Once FDA approves an NDA or BLA, the new medicine becomes available for physicians to prescribe. A company must continue to submit periodic reports to FDA, including any cases of adverse reactions and appropriate quality-control records. For some medicines, FDA requires additional trials (Phase IV) to evaluate long-term effects. Discovering and developing safe and effective new medicines is a long, difficult, and expensive process. PhRMA member companies invested an estimated $48.5 billion in research and development in 2012.