Jacobus and Catalyst Continue to Race for Approval of LEMS Drug

By Dalia Deak

The latest development in the race for approval between Jacobus Pharmaceutical Company and Catalyst Pharmaceuticals is a ‘refuse to file’ letter that the FDA issued to Catalyst indicating that Catalyst’s New Drug Application for Firdapse was incomplete. Both companies are competing for approval of slightly modified forms of a drug—3,4-diaminopyridine, or 3,4-DAP— to treat Lambert-Eaton myasthenic syndrome (LEMS). The winner will receive 7 years of exclusive marketing rights to the drug.

LEMS is an autoimmune disorder that affects an estimated 3,000 people in the United States. It is a rare, debilitating disorder that is marked by progressive weakening of the muscles that often begins in young adulthood. The drug in question was initially discovered in the 1970s in Scotland, with researchers in Sweden demonstrating its use in LEMS patients in the 1980s. Jacobus Pharmaceutical Company has been providing a free base form of the drug to patients with a LEMS diagnosis since the early 1990s at no cost (with the exception of postage), though the drug had never received FDA approval.

This distribution was done through the company’s compassionate use program. Compassionate use, or expanded access, is a mechanism by which an investigational drug (i.e., one that has not been approved) is made available for use outside of a clinical trial. This often requires that certain doctors fill out a great deal of paperwork for each patient, a process that can sometimes necessitate patients travel extensively to reach doctors willing to do so or familiar with the process. Alternately, patients diagnosed with LEMS can obtain the drug through a compounding pharmacy, though there are challenges associated with that as well.

That is, this was the case until Catalyst Pharmaceuticals came on the scene. Catalyst applied for approval of a modified version of the drug that does not require refrigeration. Additionally, Catalyst also applied for and received orphan drug status and was granted breakthrough designation. In addition to the 7-year market exclusivity, orphan drug status affords tax credits on clinical research, exemption/waivers on filing fees, and assistance throughout the process. A breakthrough designation indicates that the FDA will expedite the development and review of such drug.

In a presentation to investors, Catalyst indicated that it hopes to generate between $300 and $900 million per year from the drug for treatment of patients with LEMS, and potentially congenital myasthenic syndrome (CMS). The dramatic price increase that this would require (with some estimating that the drug could cost $100,000) has patients and providers worried, so much so that a group of neuromuscular doctors penned an editorial arguing that Catalyst is seeking profits from mostly old medical research. Others have argued that approval of the product, which Catalyst has sought to spend the time and money doing, will allow for doctors everywhere to be able to write prescriptions. It is important to note that the FDA does not take price into account when making decisions regarding the approval of drugs, though some have argued that it should.

It seems that this week’s letter could be a setback for Catalyst, though it is not yet clear how much of an edge it will give Jacobus. Importantly, as the issue of drug pricing continues to be a prominent one during this election cycle, the race to approval for this old drug, and the subsequent price that the winning company sets, may have important implications on a larger scale.


At the end of her fellowship year, Dalia Deak had completed a MPH in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and was accepted Harvard Law School as a JD candidate ('19). She received her BS in biomedical engineering from the University of Virginia, where she focused primarily on computer science in biomedical engineering and issues at the intersection of technology, health policy, and public health. After receiving her undergraduate education, Dalia joined the Brookings Institution as a Research Assistant where she worked on their medical device evidence and innovation portfolio. While at Brookings, Dalia co-authored a report for the U.S. Food and Drug Administration on the implementation of a unique device identification system that would support postmarket surveillance and enhance patient safety. Dalia’s research interests lay at the intersection of medical device and drug policy and public health law, and her fellowship research paper was entitled "Repurposing Transformative Drugs: Public Health, Policy, and Legal Issues."

One thought to “Jacobus and Catalyst Continue to Race for Approval of LEMS Drug”

  1. Thank you for posting this! I have been trying to find Dalia Deak’s email address, as I’d like to share the important news that the unscrupulous, predatory Catalyst Pharmaceutical did unfortunately obtain fast track and orphan drug approval from the FDA for Firdapse in late November 2018 and 13 days later announced the astounding price of $350,000 per patient per year!!!!!! This more than unscrupulous event needs to be made public, as it not only affects LEMS patients, but also the cost of healthcare and health insurance in general.

    This is WORSE than the Epipen fiasco. Please help me bring this to the National press.
    Thank You,
    Lore Wilkinson

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