In a significant win for both patients and biotech investors, the U.S. Food and Drug Administration has given the thumbs-up to a groundbreaking new drug from Denali Therapeutics Inc. (DNLI). The drug, called Avlayah, isn't just another treatment; it's the first FDA-approved biologic that can actually cross the infamous blood-brain barrier to treat a disease from the inside out.
Think of the blood-brain barrier as a highly selective bouncer at an exclusive club, keeping most things—including many potential drugs—from getting into the brain. Denali's technology figured out how to get its therapy past that bouncer. Avlayah is an enzyme replacement therapy approved for the neurological manifestations of Hunter syndrome, a rare and devastating genetic disorder. For kids with this condition, their bodies can't properly break down certain complex sugars, leading to a toxic buildup that damages tissues and organs throughout the body, including the brain.
The FDA granted this approval under its accelerated pathway, which means the agency is convinced the drug is reasonably likely to predict a clinical benefit based on a surrogate endpoint. In this case, that endpoint was the reduction of a key biomarker in spinal fluid called cerebrospinal fluid heparan sulfate (CSF HS). The data was compelling: in a Phase 1/2 trial, Avlayah demonstrated a 91% reduction in CSF HS levels from baseline after 24 weeks of treatment. Even more striking, 93% of the treated patients (41 out of 44) had CSF HS levels fall into the normal range seen in people without Hunter syndrome.
"The FDA approval of Avlayah represents a breakthrough advance as the first therapeutic innovation for the Hunter syndrome community in nearly 20 years," said Joseph Muenzer, the lead investigator of the clinical trial. The approval does come with a standard string attached for accelerated approvals: continued marketing is contingent on verification of clinical benefit in a larger, confirmatory trial. Denali is already running that Phase 2/3 study, called COMPASS.
As a sweetener, the FDA also tossed Denali a Rare Pediatric Disease Priority Review Voucher. This is a valuable coupon in the biotech world; the company can use it to get a future drug application reviewed faster, or it can sell it to another company for a hefty sum—often hundreds of millions of dollars.
The timing of this approval is particularly interesting when you look at the competitive landscape. Just last month, the FDA issued a Complete Response Letter (essentially a rejection) for a rival Hunter syndrome treatment from REGENXBIO Inc. (RGNX). The FDA cited concerns about that drug's study criteria and its surrogate endpoint. Denali's clear path to approval right after a competitor's setback highlights the high-stakes, binary nature of drug development.
Analysts are taking note of the commercial opportunity. William Blair wrote that "Denali is well-positioned and capitalized with line-of-sight to the underappreciated launch." Analyst Myles Minter added that Avlayah, combined with Denali's follow-on product for another rare disease, positions the company to build "a more-than-$1-billion sales franchise." The firm reiterated its Outperform rating on Denali shares.
In early trading Thursday, Denali Therapeutics shares were down 1.65% at $22.10. Sometimes the market takes a breath even on good news, but the long-term story here is about a company that just solved a major scientific puzzle and opened a new frontier in treating neurological disease.
