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Revolutionizing RNA therapeutics - Avidity Biosciences

22 min episode · 2 min read
·
Sarah Boyce

Episode

22 min

Read time

2 min

Topics

Productivity, Fundraising & VC, Leadership

AI-Generated Summary

Key Takeaways

  • Antibody-Conjugated RNA Delivery: Avidity uses antibodies to target RNA therapeutics to specific cell types outside the liver, solving a fundamental delivery challenge. The platform enables siRNA delivery to skeletal muscle and cardiac tissue, with three neuromuscular programs in late-stage development for populations of 30,000-40,000 patients each in the US, opening entirely new therapeutic spaces.
  • VHUD Primary Endpoint Strategy: Avidity negotiated with FDA to use Video-recorded Home-based Unified Dystrophy assessment as the primary endpoint for myotonic dystrophy phase 3 trials, with hand grip strength, quantitative muscle testing, and quality of life as key secondaries. The 30-week submission timeline creates an accelerated full approval pathway, establishing precedent for other rare disease programs.
  • Biomarker-Driven Acceleration for FSHD: The FORTITUDE study design includes parallel cohorts: Cohort C uses circulating biomarkers and plasma creatine kinase for potential accelerated approval, while Cohort D runs simultaneously as a functional study for full approval. This dual-track approach minimizes time risk if accelerated pathway fails, with both cohorts enrolling under one umbrella protocol for efficiency.
  • FDA Center Inconsistency Challenge: CDER and CBER apply different standards for rare disease approvals, creating up to one-year market access differences for similar drugs. Congress and Senate appropriations language now addresses this disparity. Platform technology companies can potentially leverage safety and efficacy data across programs, though consistent regulatory frameworks remain under development across centers.
  • Reachable Workspace Clinical Meaningfulness: The endpoint measures arm movement range, directly correlating to daily activities like brushing teeth, washing hair, or reaching cupboards. FSHD patients in their 20s-30s lose these capabilities as the disease progresses. Four-month data showed functional improvements earlier than the anticipated 12-month timeline, with downstream DUX4-regulated genes demonstrating reduced inflammation and cellular apoptosis markers.

What It Covers

Sarah Boyce, CEO of Avidity Biosciences, explains how the company solved RNA delivery to skeletal muscle and cardiac tissue using antibody-conjugated therapeutics. She details clinical development strategies for myotonic dystrophy and FSHD programs, FDA negotiations for accelerated approval pathways, and building a platform technology company targeting rare genetic diseases.

Key Questions Answered

  • Antibody-Conjugated RNA Delivery: Avidity uses antibodies to target RNA therapeutics to specific cell types outside the liver, solving a fundamental delivery challenge. The platform enables siRNA delivery to skeletal muscle and cardiac tissue, with three neuromuscular programs in late-stage development for populations of 30,000-40,000 patients each in the US, opening entirely new therapeutic spaces.
  • VHUD Primary Endpoint Strategy: Avidity negotiated with FDA to use Video-recorded Home-based Unified Dystrophy assessment as the primary endpoint for myotonic dystrophy phase 3 trials, with hand grip strength, quantitative muscle testing, and quality of life as key secondaries. The 30-week submission timeline creates an accelerated full approval pathway, establishing precedent for other rare disease programs.
  • Biomarker-Driven Acceleration for FSHD: The FORTITUDE study design includes parallel cohorts: Cohort C uses circulating biomarkers and plasma creatine kinase for potential accelerated approval, while Cohort D runs simultaneously as a functional study for full approval. This dual-track approach minimizes time risk if accelerated pathway fails, with both cohorts enrolling under one umbrella protocol for efficiency.
  • FDA Center Inconsistency Challenge: CDER and CBER apply different standards for rare disease approvals, creating up to one-year market access differences for similar drugs. Congress and Senate appropriations language now addresses this disparity. Platform technology companies can potentially leverage safety and efficacy data across programs, though consistent regulatory frameworks remain under development across centers.
  • Reachable Workspace Clinical Meaningfulness: The endpoint measures arm movement range, directly correlating to daily activities like brushing teeth, washing hair, or reaching cupboards. FSHD patients in their 20s-30s lose these capabilities as the disease progresses. Four-month data showed functional improvements earlier than the anticipated 12-month timeline, with downstream DUX4-regulated genes demonstrating reduced inflammation and cellular apoptosis markers.

Notable Moment

Boyce describes meeting Avidity's scientific founder at a golf club in San Diego to review preclinical data in secret, given the small biotech community. After seeing nonhuman primate muscle delivery data, she immediately recognized the antibody-conjugated approach as obvious in retrospect, went home that day, and told her husband the perfect CEO role had appeared.

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Episode Transcript

We could not just change the lives of people living with myotonic dystrophy, but we could actually change the whole RNA field. That's pretty ambitious. Welcome to the RTW podcast. I'm your guest host, Piratip Ratoumswan, managing director and research analyst on the RTW asset selection team. Today, I have the privilege of speaking to Sarah Boyce, president and CEO of Avidity Biosciences, a company that is revolutionizing delivery of RNA therapeutics for patients living with debilitating rare genetic conditions. Over five years, Sarah transformed Avidity into a publicly traded leading genetic medicines company with three neuromuscular programs in late stage clinical development. Before that, Sarah was the president of Akcea Therapeutics, where she led the commercialization of oligonucleotide therapies. Sarah, it's great to have you here in New York at RTW's headquarters. Thank you very much for crossing the country to join us today. Thank you, and it's a pleasure to be here. Our audience know a lot about what you do and what Avidity does. But can you tell us a little bit more about Avidity's value proposition? Yeah. Avedi, we're trying to do two things. One is to revolutionize the RNA space, and two is to make a profound impact in people's lives. We have cracked and solved the challenge of delivery of cells and tissue types outside of the liver. Our first franchise is skeletal muscle where we now have three programs in the clinic. Two of those programs are for large rare diseases, population sizes of thirty to forty thousand people living with those diseases in The US. We did it for myotronic dystrophy. We've done the same thing for FSHD, where you really show and you understand biology, you can engage a target with an siRNA, and all the dots connect together from delivery to being able to engage with your genetic target to then being able to see functional changes. We have a franchise in precision cardiology, and, essentially, we are leading the field. We think that you are an optimistic person, and you're incredibly savvy. So what convinced you to join the team and lead Avedi? There was part of me going, what? They can deliver RNA to muscle cells. No one could do that. So I was intrigued. At that point, Avedi was private. We were 20 something people, preclinical. I met with Troy Wilson, and he was like, well, spend time with Art and see the data. Art and I have this very clandestine meeting because San Diego is a very small community. We were inside this golf club to make sure no one saw us, and he took me through the data. And I was like, so you're using an antibody. Like, why has no one thought of that? We all know antibodies are great at targeting certain cells. I've worked at platform technology companies previously and know that one of the great things is when you understand your safety really well, you know how to translate that from …

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