BrainStorm Cell Therapeutics ALS Data Not As Promising As Press Releases Indicate

April 6, 2017 - als

BrainStorm Cell Therapeutics (NASDAQ:BCLI) is posterior a eminent and formidable goal, a branch dungeon formed diagnosis for patients pang from Amyotrophic Lateral Sclerosis (“ALS”), ordinarily famous as Lou Gehrig’s disease as a approval of one of a disease’s many critical victims.

ALS is progressive, debilitating neuromuscular illness that causes a chairman to turn gradually and gradually weaker and is roughly always a genocide sentence. This on-going debility is due to a lapse of nerves in a anterior horn of a spinal cord, that broadcast information from a mind to a muscles of a body. ALS is a comparatively singular disease. According to a Center for Disease Control, about 12,000-15,000 people in a United States have ALS and each year about 5,000 some-more people are afflicted.

BCLI’s ALS therapy is formed on a chronicle of autologous mesenchymal branch cells that are grown underneath exclusive conditions to raise a cells’ prolongation of neurotrophic factors (NTFs). NTFs are expansion factors famous to support a presence of neurons in a accumulation of conditions and in animal models of many neurodegenerative diseases. These cells are copyright underneath a name, NurOwn. A finish reason of a prolongation routine of NurOwn can be found here.

In Jul 2016, BrainStorm expelled Phase II formula for a ALS hearing where a primary endpoint was reserve and tolerability. The hearing was not powered to uncover efficacy. On, a primary endpoint for a hearing was settled as: “Number of patients with inauspicious events [Time Frame: At all examine visits: Visit 1 by revisit 10]“. Although a association announced in a July 18, 2016, press release that a hearing met this primary endpoint, it was transparent that there were some-more inauspicious effects seen in a treated organisation than in a remedy group. This list from a BrainStorm display creates this extravagantly clear:

Note a final difference on a page: Post-therapy SAEs compared to illness march (e.g. G-tubes) were some-more revisit in a MSC-NTF cells group. SAEs are critical inauspicious effects and G-Tubes, usually one instance given of post therapy SAEs, are feeding tubes by an opening into a stomach.

Given a earnest of ALS, patients pang from a illness would acquire any diagnosis that could stabilise or, improved yet, retreat a assault of this appalling illness even if some critical inauspicious effects were a cost to pay. However, notwithstanding promising headlines from a association about a Phase II clinical results, there is no justification that a patients treated with NurOwn have seen a illness possibly stabilise or retreat by a finish of a 24 week trial.

There were dual delegate endpoints of a hearing that were designed to magnitude efficiency formed on a slopes of these dual timeless ALS measurements:

  1. ALSFRS-R – a 48-point dimensions scale that covers 12 activities of daily vital and tellurian duty for patients with Amyotrophic Lateral Sclerosis (ALS). The ALSFRS-R provides a physicians-generated theory of patient’s grade of organic impairment, that can be evaluated serially to objectively consider any response to diagnosis or march of disease.
  2. Forced Vital Capacity (FVC) – an index of respiratory duty that might be used to prove intensity respiratory concede in ALS.

From ClinicalTrials.Gov:

Secondary Outcome Measures:

  • Change in Amyotrophic Lateral Sclerosis (ALS) Functional Rating Scale (ALS-FRS) slopes from a pre-transplantation duration to a post-transplantation duration between a diagnosis and remedy groups by 24 weeks post-transplantation. [Time Frame: At all examine visits: Visit 1 by revisit 10 ]
  • Change in SVC slopes from a pre-transplantation duration to a post-transplantation duration between a diagnosis and remedy groups by 24 weeks post-transplantation [ Time Frame: Visits 1,2,3,5,6,7,8,9,10 ]

It’s usually healthy for a association to surveillance a tools of information that expel a formula in a brightest light. However, an financier needs to demeanour during a altogether hint of a information that yield a many picturesque comment of intensity efficacy.

There are many charts and tables in a BrainStorm BCT-001-US Phase II clinical hearing display and meddlesome investors are speedy to examination all of it, make their possess evaluations and also listen to a compared webcast. However, in my view, a following singular draft best captures a design with courtesy to a altogether efficiency of all patients in a trial. It compares a treated organisation to a remedy organisation with courtesy to a slope of a ALSFRS-R score:

In my view, a many poignant aspect of a successful ALS diagnosis is not either illness march has slowed down. It should be about either patients are indeed stabilizing or improving. In a above chart, anything subsequent a 0 line means continued decrease in patients’ good being and anything above a line indicates patients’ improvement. At 2 weeks and 4 weeks, a treated organisation on normal indeed showed improvement, while a remedy organisation continued to decline. However, during 8 weeks, a treated organisation started to regression once again and during weeks 12-24, a treated organisation was indeed doing worse than a remedy organisation on a ALSFRS-R scale.

Equally poignant is what is NOT shown in a BrainStorm presentation. Why is there no discuss during all of a other critical delegate efficiency endpoint, Forced Vital Capacity? FVC a really critical predictor of presence and illness march according to this mention from a examine on this subject that can be found here:

Our information denote that baseline FVC, simply performed early in a illness course, and typically during a initial clinical visit, might offer as an early predictor of presence and illness march in an ALS sanatorium population. Because FVC directly assesses pulmonary function, a decrease of that is a many common means of genocide or ongoing respiratory support in ALS patients a commentary were not surprising. However, to a knowledge, no prior certain information about a predictive value of FVC on illness march in ALS have been published, and other investigators were incompetent to endorse a association between ALS organic rating scale and FVC.

It is not formidable to take an prepared theory on because FVC information were not reported. They approaching didn’t support a grounds that NurOwn shows guarantee in treating ALS.

Recently, BrainStorm released a press release that was a matter that lead me to take this new demeanour during a association and led me to write this article. This is a initial divide of that press release:

HACKENSACK, N.J. and PETACH TIKVAH, Israel, Mar 1, 2017 /PRNewswire/ — BrainStorm Cell Therapeutics Inc., a heading developer of adult branch dungeon technologies for neurodegenerative diseases, announced currently that is has sealed a Memorandum of Understanding (MOU) with The Medical Research, Infrastructure, and Health Services Fund of a Tel Aviv Sourasky Medical Center (Ichilov Hospital) to try a probability of creation NurOwn® accessible to Amyotrophic Lateral Sclerosis (ALS) patients underneath a supplies of Hospital Exemption regulation. The MOU also covers a appearance of Tel Aviv Sourasky Medical Center in a designed Phase 3 hearing that will examine NurOwn in ALS.

At initial glance, it seemed probable from a press recover that BrainStorm could have an early income tide even if there is tiny justification that NurOwn provides any suggestive benefit. However, on serve investigation, if this therapy is done accessible to patients in allege of a designed Phase III trial, it would need remuneration by patients for an initial diagnosis with no open funding. This is an mention from a form minute sent out by a participating sanatorium in Israel to inquiries about a BCLI press recover (the capitalization of a word tiny was directly from a letter):

Please take also into comment that a formula shown with this record prove a SMALL improvement, and each studious has to make a offset preference between this tiny outcome and a costs of a diagnosis and costs and logistics of abroad travel.

The whole minute is trustworthy to this article.

Brainstorm has disclosed that it recently finished a successful End-of-Phase 2 Meeting with a FDA and has reached ubiquitous agreement to ensue to a Phase 3 trial. The FDA has supposed a pivotal elements of a Phase 3 module to support a Biologic License Application (BLA) for NurOwn in ALS. The designed Phase 3 clinical hearing will be a randomized, double-blinded, placebo-controlled multi-dose hearing that will be conducted during mixed sites in a U.S. and in Israel. The hearing is approaching to start enrolling patients in a second entertain of 2017.


Is it probable that a multi-dose fast of NurOwn in a Phase III hearing will retreat a march of ALS? Anything is probable though formed on a Phase II ALSFRS-R data, there is tiny reason for optimism. Furthermore, a miss of ANY information per Forced Vital Capacity information in presentations to investors can usually be noticed as a large red flag. Finally, as an autologous dungeon therapy, NurOwn will no doubt be intensely expensive, generally with a combined stairs of cryopreservation and mixed dosing. It will approaching need to heal ALS or during slightest stop illness march in a marks to remonstrate word companies that it is value a price.

Disclosure: I/we have no positions in any bonds mentioned, though might trigger a brief position in BCLI over a subsequent 72 hours.

I wrote this essay myself, and it expresses my possess opinions. we am not receiving remuneration for it (other than from Seeking Alpha). we have no business attribute with any association whose batch is mentioned in this article.

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