NPC is a very rare childhood disease that is associated with an inability to transport Cholesterol and lipids in the cells. Over time, these substances accumulate in the tissues of many organs, including the brain, causing progressive damage. The disease is caused by a very rare recessive gene and can occur at any age, but the disease is invariably fatal in younger patients. The terrible progression of the disease in children can be seen from their hideous nickname: “Childhood Alzheimer’s.” In the United States, about 40 children are diagnosed with this disease each year.
Adrabetadex is a form of cyclodextrin, part of the Family of complex sugars known as oligosaccharides. Cyclodextrins were often used as delivery means for other drugs, and the particular form that led to onedrabetadex was discovered when it was listed as a Active ingredient in a study for another drug. The first tests of adrabetadex were so compelling that the National Institutes of Health (NIH) helped get the drug into human trials, almost immediately, across a number of families as part of an expanded compassionate use program that is ongoing Received permission to start treatment.
Although it has been hailed as a “breakthrough drug” and significant anecdotal evidence of improvement has been gathered from families and doctors, continued production of adrabetadex was then stopped Mallinckrodt delivered a heartbreaking letter to families saying: “With immediate effect, Mallinckrodt recommends stopping treatment with Adrabetadex as soon as possible … ”Both the study and the compassionate use program should be terminated and the remaining doses of the drug should be used by September.
The history of the drug, human trials, and the incredible hurdles that NPC kids and their families face were covered in Part I and Part II of a lengthy April article.
Johnson & Johnson
One hope in the NPC community was that Johnson & Johnson would be able to manufacture and distribute the adrabetadex. Johnson & Johnson had made the cyclodextrin originally used in the NIH studies and continues to make similar compounds for their original use as delivery agents. In addition, a handful of patients – those from the early days of the compassionate use program – had always received their treatment from Johnson & Johnson.
But shortly after that first article was published, Johnson & Johnson made it clear that this was not going to happen. Although the company would allow those still in their expanded care program to continue treatment, they would not be adding new patients.
Given the complexity of handling a drug that was officially owned by another pharmaceutical company that originally paid over $ 1 billion for a company whose entire value was reduced to its rights adrabetadex, that wasn’t surprising. However, this meant that several patients were excluded from any possible treatment.
That included the recently diagnosed 21-month-old boy named Woodrow Miller.
But Woodrow’s story, shared to the NPC community in an open letter from parents who teamed up to create Don’t Give Up on NPC, turned out to be a major win for Woodrow, his mother, Denise Miller, and for all NPC parents.
Woodrow Miller with Emma Peterka, who was featured in the previous articles.
Several NPC parents reached out directly to their members of Congress showing that this can be effective even in these anything but bipartisan times, and Woodrow’s family and friends eventually penned a letter from the unlikely trio of Sen. Kyrsten Sinema, Sen. Mark Kelly and Republican MPs Debbie Lesko. Lesko even made a video aimed at the new Minister of Health and Social Affairs, Xavier Becerra.
The result of all of these efforts by Woodrow’s mother and the expanded NPC community is that Woodrow Miller is now the first person added since the expanded usage program Mallinckrodt pulled the plug. He started treatment with Dr. Elizabeth Berry-Kravis of Rush University Medical Center, described by parents as “the cornerstone of optimism and caring.”
But there is one other factor that enabled Woodrow to join the program, and that is the factor that generates the greatest hope – and concern – in the community. Because if everything goes well adrabetadex will soon no longer be one of them Mallinckrodt.
As Businesswire reported on May 19, Mandos has entered into an agreement to acquire Adrabetadex. And the way in which this announcement has been worded has created a tremendous commotion.
This acquisition, if approved, will enable Mandos to pursue both the continuation of the US Expanded Access program under the Rush University Medical Center (RUMC) and the future research and development of Adrabetadex for patients with NPC1.
The possible continuation of the expanded access program would be a tremendous relief for parents of young children currently facing NPC. This is especially true when, as in Woodrow’s case, more patients can be admitted.
But the bigger implication here is that Mandos intends to resume the Adrabetadex attempt. In conversations with parents and others Mallinckrodt researchers have admitted that the original Phase 3 study was flawed in several ways. Last but not least, it was just too short to tell if Adrabetadex is effective at slowing down or stopping a disease that can be difficult to measure over a period of months. Mallinckrodt’s Chief Scientific Officer suggested that an effective effort be made with that adrabetadex would take about three years.
As part of the announced agreement, Mallinckrodt will transfer sponsorship for a new FDA approval application to Mandos. Mallinckrodt will then support Mandos in completing the existing clinical trial and transitioning all current trial patients to the extended access program. All of this requires the approval of the US bankruptcy court for the Delaware district, as it is still taking place as part of the reorganization of Mallinckrodt to Chapter 11.
But while both Mallinckrodt and Mando’s statements regarding the transfer contain hopeful phrases about “improving understanding” of NPC and the future potential of Adrabetadex, there does not seem to be a definitive commitment to resume a new study and obtain full approval of the FDA adrabetadex long term. And that has to happen.
Because NPC patients and their families not only deserve access to treatment, they also know if that treatment is really effective. Right now, despite the early promise and confusing nature of Mallinckrodt’s retreat, the The effectiveness of Adrabetadex is not known. There is a lot of hope in this drug, and everyone involved needs to know that hope is deserved.