On July 30, 2020, the Magistrate Judge considering our lawsuit against the FDA filed a Report and Recommendation in which she recommended to the District Judge handling the case that she grant the FDA’s and Jacobus’ motions for summary judgment and deny our motion for summary judgment. On September 29, 2020, the District Judge adopted the Report and Recommendation of the Magistrate Judge, granted the FDA’s and Jacobus’ motions for summary judgment, and dismissed our case. We appealed the District Court’s decision to the Eleventh Circuit Court of Appeals. The case was fully briefed, and oral argument was held in March 2021.
On September 30, 2021, a three-judge panel of judges on the Eleventh Circuit Court of Appeals issued a unanimous decision overturning the District Court’s decision. The court adopted our argument that the FDA’s approval of Ruzurgi
®
violated our rights to Orphan Drug Exclusivity and remanded the case to the District Court with orders to enter summary judgment in our favor. This decision reverses the FDA’s approval of Ruzurgi
®
. We are presently waiting to see if the FDA or Jacobus will seek rehearing of the case from the full Eleventh Circuit Court of Appeals or appeal the appellate court’s decision to the Supreme Court. Until the appeal period ends it is likely that Ruzurgi
®
will continue to be available on the market.
In light of the Eleventh Circuit decision, we are actively working with parents and physicians of pediatric LEMS patients to make sure that such patients will be able to obtain Firdapse
®
. In addition, we intend to file an application with the FDA seeking approval for use of Firdapse
®
by pediatric LEMS patients, though any effort to obtain such authorization will take some time and is not guaranteed. For the larger number of adult LEMS patients who have been receiving Ruzurgi
®
off-label,
we are already working with prescribers to be in a position to transition such patients to Firdapse
®
.
We are currently developing a long-acting formulation of amifampridine phosphate. A number of candidate formulations have been prepared, and three of the most promising formulations were evaluated in a pharmacokinetic (PK) study completed during the fourth quarter of 2020. The results of this first PK study are being used to inform the design and refinement of future product formulations and additional PK work to be conducted. We have also completed an advisory board meeting with both patients and doctors in order to establish the optimum target characteristics of the long-acting formulation of amifampridine phosphate that are desired by the LEMS patient community and treating physicians. There can be no assurance that we will be able to successfully develop a long-acting formulation of amifampridine phosphate, that any such formulation will be approved by the FDA for marketing, or that any such formulation will be commercially viable.
On August 10, 2020, we announced the
top-line
results from our Phase 3 clinical trial
(MSK-002)
evaluating Firdapse
®
for the treatment of adults with
MuSK-MG.
Unfortunately, the
MSK-002
trial did not achieve statistical significance on its primary endpoint or its secondary endpoint. Following our receipt of these results, we analyzed the data and proposed a plan to FDA to perform an additional study evaluating Firdapse
®
for
MuSK-MG.
In response, the FDA provided written comments that were unfavorable towards our proposed revised study design and further questioned the ability of the initial
MuSK-MG
pilot study to be supportive. These remarks make it unlikely that a single study similar design to
MSK-002
would be sufficient for potential approval of the
MuSK-MG
indication. We also held an appropriate expert panel to discuss options and review the likelihood of success for a
MuSK-MG
indication for Firdapse
®
. Based upon the input of FDA and advisors that was received, we have concluded that the use of Firdapse
®
as a first line therapy for
MuSK-MG
is unlikely and therefore we have decided not to continue to pursue this indication.
We previously announced our intent to conduct a
study evaluating Firdapse
®
as a treatment for Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). The scientific basis for considering this indication is that leakage of neuron potassium channels is observed in HNPP. Since Firdapse
®
is a potassium channel blocker, it may mitigate the pathological effects of the potassium channel leakage in HNPP patients. The FDA requested that a new, patient centric endpoint be researched and used for our proposed study, without assurance that such endpoint would be acceptable for approval. Based upon the uncertainty of such an endpoint, we have decided not to conduct this as a company sponsored study. We continue to offer the opportunity for an interested investigator to conduct this study as an investigator-initiated study.
There can be no assurance that any future clinical trials of Firdapse
®
that we undertake will be successful. Further, there can be no assurance that we will ever be granted the right to commercialize Firdapse
®
for any additional indications.
Our NDS filing for Firdapse
®
for the symptomatic treatment of LEMS was approved by Health Canada on July 31, 2020. In August 2020, we entered into a license agreement with KYE Pharmaceuticals (KYE), pursuant to which we licensed the Canadian rights for Firdapse
®
for the treatment of LEMS to KYE. Pursuant to the license agreement, KYE was obligated to pay us an
up-front
payment based on approval, a milestone upon attainment of marketing authorization and product supply, milestones based on achievements of sales and regulatory milestones, and a sharing of defined net sales following commercialization.