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Working Through the Obese To-Do List in 2011

The year didn't start out too well for Arena Pharmaceuticals (Nasdaq: ARNA  ) with the Food and Drug Administration adding to its to-do list of required actions before the company could resubmit its marketing application for obesity drug lorcaserin.

But the development-stage biotech pressed on and looks like it'll end the year ahead of where it started. Investors seem impressed by Arena's ability to work through the requested items without major incidence.

Arena's tenacity, at least of those still working at the company, should be applauded, but don't be fooled into thinking that an approval is a foregone conclusion if Arena checks all the boxes off its to-do list.

The FDA has three major issues with lorcaserin. None required in-depth clinical trials, but that doesn't mean they're straightforward.

Lorcaserin caused mammary tumors in female rats in a preclinical study. The FDA questioned both the classification of the tumors -- which seems to be resolved -- as well as the mechanism that causes the tumors and whether it's relevant to humans. Studies to solve the latter issue are expected to be finished shortly.

The drug also caused brain cancer in male rats. Arena argues that rats concentrate the drug in their cerebrospinal fluid, which gets into the brain and causes brain cancer. Lorcaserin isn't seen at high levels in human's cerebrospinal fluid, but since the levels in the brain can't be measured, the company can't rule out the possibility that there are high cancer-causing levels of lorcaserin in human brains.

The third area has to do with lorcaserin's potential to cause heart valve problems. The drug is related to fenfluramine -- the fen part of Wyeth's fen-phen. Initial results suggest lorcaserin won't cause heart valve problems because it's different enough from fenfluramine and other drugs that cause the problem. But I don't think this issue should be underestimated. Abbott Labs' (NYSE: ABT  ) obesity drug, Merida, got pulled off the market for heart-related issues, and the FDA is making Orexigen (Nasdaq: OREX  ) run a trial with nearly 10,000 patients to prove that its obesity drug, Contrave, doesn't cause heart problems. VIVUS (Nasdaq: VVUS  ) and Arena think they're off the hook for this requirement, but it's impossible to tell with the FDA.

And that's perhaps the biggest risk with Arena. It could resubmit its application only to find the FDA wants more information about these issues or something entirely new, as Amylin Pharmaceuticals (Nasdaq: AMLN  ) experienced with Bydureon.

With a market cap of about $275 million, Arena is a high-risk, high-reward play. On the high side, a quadruple seems like a very conservative estimate if lorcaserin is approved, but there's a lot of downside risk, too. The company is sitting on $78 million in cash, which will likely be even lower by the time an FDA decision is made. And the cash level might not even be the floor. Beleaguered biotechs have been known to trade for less than their cash. Either way, as the binary events roll in, expect Arena to have a volatile 2012.

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Fool contributor Brian Orelli holds no position in any company mentioned. Click here to see his holdings and a short bio. The Motley Fool owns shares of Abbott Laboratories. Motley Fool newsletter services have recommended buying shares of Abbott Laboratories. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.


Comments from our Foolish Readers

Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On December 30, 2011, at 2:06 PM, uropa1 wrote:

    You are very biased and keep pushimg arena. They have no chance, like a very small snow ball in the hottest hell you can think of, of getting their placebo like drug with all the tumor causing effects to be approved. You have bashed on the other drugs without doing any in depth analysis. As usual, you give a very shallow, un-educated, biased view of the stocks you want to push for some agenda, or mega fund that is paying your salary. You are nothing more than a tool. There should be some oversight for people, and organizations like you and yours to punish you for what injury you cause to the readers and investors that are ultimately hurt.

  • Report this Comment On December 30, 2011, at 3:34 PM, plcfischer wrote:

    You are very biased and keep bashing arena. It is a slam dunk, like an HP CEO getting a golden parachute, that their effective (meets the FDA standard) human tumor free, heart friendly, diabetes friendly weight loss drug will be approved. You have bashed Arena's drug without doing any in depth analysis. As usual, you give a very shallow, un-educated, biased view of the stocks you want to push for some agenda, or mega fund that is paying your salary. You are nothing more than a tool. There should be some oversight for people, and organizations like you and yours to punish you for what injury you cause to the readers and investors that are ultimately hurt.

    OK, I think you gave a very fair report. Full disclosure, I have bought the ARNA lottery ticket. I think the FDA is under pressure to approve a weight loss drug, that Lorcaserin does not cause human cancers or heart valve problems. I hope my bet pays off.

  • Report this Comment On December 30, 2011, at 8:26 PM, PhillyDan wrote:

    Brian:

    1. You forgot to mention that the mammary tumors were not statistically significant compared to the control groups other than the highest dosage of 82x which most rats would get cancer from 82x per day of anything!! That was the case when Arena submitted the rat data in the first NDA.

    The WPG of 5 independent pathologists that re-adjudicated the female rat slides found even better results of the original pre-clinical data. If you are going to report, then get it right.

    There were no statistically significant tumors both benign and malignant in the 7x and 24x dosages.

    Benign tumors that hopefully you know do not progress to malignant tumors.

    Again, report the facts. Lorcaserin caused tumors in male rats but once again, it was not statistically significant. Just like in the female mammary tumors, the control group had more brain tumors than the drug group!!!!

    Do you ever read anything? The FDA asked Arena to do CSF study in humans. The results which you conveniently forgot to mention show that Lorcaserin has a 70x exposure margin for humans. Again, I repeat the brain tumors shown in the male rats was not SS. Again, the male rats were getting much higher dosages of Lorcaserin than any human would get unless they way overdosed.

    Finally there is no heart valve issues shown with Arena in it's phase III studies. Arena did the most significant assessment versus either what Vivus or Orex did with their obesity drugs.

    Furthermore, Lorcaserin was shown to lower BP and heart rate. There were no signals for any heart related issues.

    What about the Bloom-DM study of all T2DM?

    You spent your time throwing out the turds but seemed to forgot the roses. Here is a rose for you to smell on, maybe it will help your brain work better. The average HbA1c level dropped by ~ 1% which is very good. The average FG dropped by 28%. Weight loss in this sub-group and almost everyone knows it is difficult for T2DM patients to lose weight. Yet the weight loss was significant for this group. Recommend you contact Ed Susmann of Medpage who was in the Bloom-DM study and lost about 54 pounds and uses much less diabetic and heart medications. All this without any side effects. Now that would be real reporting.

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