Novartis recently inked an exclusive worldwide license and collaboration agreement with regenerative therapy venture Mesoblast to develop, commercialize and manufacture remestemcel-L for the treatment of acute respiratory distress syndrome (ARDS), including that associated with COVID-19. Novartis put up $50 million in upfront cash payment and equity/share subscription, plus performance-based milestones and royalties for access to a stem-cell therapy based platform with worldwide rights to range of potential indications. As the COVID-19 pandemic intensifies in this second wave worldwide, Novartis now positions to capitalize on a novel therapy that may address an area of unmet need, with an approximately 40% mortality rate with the current standard of care, which includes prolonged ICU treatment and mechanical ventilation. Remestemcel-L uses mesenchymal stromal cells (MSCs), a cell-based platform technology, to treat this deadly condition and improve outcomes. The regenerative cell-based therapy is currently under investigation in COVID-19 related ARDS in an ongoing 300-patient Phase 3 clinical trial. Novartis now intends to initiate a Phase 3 clinical trial in non-COVID-19 related ARDS after the anticipated closing of the license agreement and successful completion and outcome of the current study.
An Important Potential New Therapy
John Tsai, MD heads up Global Drug Development and serves Novartis as Chief Medical Officer. He was on the record that Novartis was in a good position to advance this novel therapy while declaring “Novartis is committed to, and has demonstrated success with, cell-based therapies and transforming care for a spectrum of respiratory diseases. This makes remestemcel-L an important addition to our pipeline. It has the potential to be the first treatment for the most critically ill ARDS patients, and it provides us with an opportunity to apply years of specialized experience directly to the work of saving lives.”
Recent Study Evidence
In March, an open label compassionate use program was conducted, which included 12 patients with COVID-19-related ARDS, who were being supported with mechanical ventilation. Remestemcel-L treatment was associated with an 83% survival rate.Based on those results, remestemcel-L is being studied in this population in an ongoing 300-patient Phase III study, conducted in collaboration with the Cardiothoracic Surgical Network, which is anticipated to be completed in early 2021.After the anticipated closing of the license agreement and successful completion and outcome of this ongoing study, Novartis and Mesoblast will work together to develop appropriate critical quality attributes that meet U.S. Food and Drug Administration requirements for remestemcel-L in advance of initiation of the Phase III study in non-COVID-19-related ARDS.
Under the license agreement, Novartis will acquire the exclusive worldwide rights to develop, commercialize and manufacture remestemcel-L for ARDS, and will obtain access to an innovative cell-therapy platform with a range of potential applications in severe respiratory conditions and beyond. Novartis will make a $25 million upfront payment and invest $25 million in Mesoblast equity with additional payments and royalties due on achievement of agreed development, regulatory and commercial milestones. In addition, Novartis will provide certain support to enable commercial manufacturing scale-up. Novartis has the option, if exercised, to distribute remestemcel-L for graft versus host disease (GVHD) (outside Japan). Both parties have rights to co-fund development and commercialization for other non-respiratory indications. The closing of the license agreement is subject to the expiration or termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act and certain other conditions.
Remestemcel-L, is an investigational therapy comprising culture-expanded mesenchymal stromal cells derived from the bone marrow of an unrelated donor. Remestemcel-L is thought to have immunomodulatory properties to counteract the cytokine storms that are implicated in various inflammatory conditions by down-regulating the production of pro-inflammatory cytokines, increasing production of anti-inflammatory cytokines, and enabling recruitment of naturally occurring anti-inflammatory cells to involved tissues.In the Phase III study in COVID-19-related ARDS, remestemcel-L is administered as two infusions of 2x10MSC/kg given three to four days apart.The administration of remestemcel-L for the treatment of all-cause ARDS could be the subject of further exploration.
About mesenchymal stromal cells
Mesenchymal stromal cells (MSCs) are isolated from bone marrow, adipose tissue and other sources that can be expanded in culture to larger quantities. In preclinical studies MSCs have been suggested to transiently accumulate in the pulmonary circulation and have potent immunomodulatory functions.They express receptors for multiple chemokine, cytokine and growth factor receptors and in inflammatory conditions secrete immunomodulatory mediators that have broad-acting effects to promote resolution of inflammation and tissue repair.MSCs have been infused into over 1,000 patients, including young children, without serious adverse events to date, testifying to the general safety of this therapeutic approach.