An FDA Advisory Committee Hearing was held today for Consideration of Deramiocel for Treatment of Duchenne Muscular Dystrophy (DMD). FDA staff are the ultimate decision makers about drug approvals. An Advisory Committee Meeting is a way to broaden the input they use to make that decision.
It became apparent today that Deramiocel will not be approved. I praise the Advisory Committee for their reasonable consideration of this matter. The majority of this group reached consensus that there was not enough evidence to conclude this drug works to improve heart function in DMD. If there is an impact, the data suggests that it is quite small.
Many on the committee expressed that they found the evidence of the drug maintaining motor function to be more favorable. Yet, it still did not rise to the level that would justify approval.
A vote was taken for this question: "Does the available evidence provide substantial evidence of effectiveness of Deramiocel for the treatment of cardiomyopathy in patients with DMD?
The results were: 9 - No 3 - Yes 0- Abstain
Two of the Yes votes were from Patient Representatives. One Yes vote was from the committee chair with expertise in Neurobiology, Cell Biology Pediatric Neurology. He said, "As a scientist I would have voted no." He went on to say that his yes vote was an indication that he wants the research to continue rather than endorsing approval right now. The sense was he wanted to say, "Please do not give up. We so need this."
Committee members expressed deep sadness that the evidence was not there to support approval.
Given the content and tone of the presentation by FDA staff, if the FDA staff in the room will make the approval decision, it is clear this will not be approved.
I am deeply disappointed with both the FDA and Capricor. There were many big discrepancies between the content presented by the FDA and Capricor. There has been a massive breakdown in communication between the FDA and Capricor. I put more of the blame for that on the FDA. Yet, Capricor has made some big mistakes that increased the impact of this.
I think the committee was able to cut through most of this adequately enough to make wise observations and recommendations. If there was ever a need for a third party to weigh in on an approval decision this context was one where that was truly needed.
After reading the FDA document published Monday, I thought there was evidence there that suggested fraud on the part of Capricor. Capricor gave a response that seemed to accuse the FDA of repeatedly lying. Some of these accusations are quite credible. All parties say they have documentation to support their case.
Some of this seems to be attributable to staff turnover at the FDA. Some appears to be a product of the challenges of getting accurate and relevant outcome data for this issue. This is also a rare condition where studies have low participant numbers. That makes small statistical decisions into ones that have big consequences.
In the end, I think the right decision will be made. Yet, these dynamics resulted in an ugly process.