Deerfielders Weigh in on a Safe Return to Work Policy Amid Covid-19 Crisis

Antibody testing provides a data-driven path to getting people back into the economy

The availability of point of care antibody testing—also known as serological testing—may provide a feasible roadmap for getting people back to work safely following the COVID-19 crisis, according to an editorial published in the journal Contemporary Clinical Trials Communications.

“You can’t stop the economy forever,” asserted Governor Cuomo in a recent news conference, according to STAT. “So we have to start to think about, does everyone stay out of work? Should young people go back to work sooner? Can we test for those who had the virus, resolved, and are now immune, and can they start to go back to work?”

Regardless of whether they already have immunity to the virus, millions of Americans may try to return to work, potentially undoing all the benefits of the shutdown, suggests the editorial. 

Antibody testing, the authors argue, could clarify a person’s status quickly in real-time and reveal whether they have been exposed to COVID-19. Accordingly, a person who mounts an IgG positive response (suggesting the presence of immunoglobulin G antibodies) would most likely now be immune to the virus and an IgM positive result would point to the process of developing immunity in someone who more recently became infected.

“Unlike the PCR tests (a measure of virus material), the immediate results and unconstrained supply of antibody tests could fundamentally change the way we manage this epidemic,” says Robert Jackson, MD, a co-author of the paper. “And from an economic perspective, it could lead to a tractable path for people to return to work. Collecting the data and tracking individuals longitudinally, in order to confirm the hypothesis, will be necessary.”

And barring any HIPAA concerns, the authors propose that persons with positive antibody tests during periods of social distancing could get a bracelet, which indicates that they are immune-protected and can return to work. Those without a bracelet would still be asked to practice social-distancing and not yet resume their normal activities. But this approach could potentially get at least some portion of the economy back running again, suggests the authors.

According to the authors, the antibody tests are cheap, easy to administer, and could be made available at every hospital.

“Broad testing is in society’s best interest,” says Alex Karnal, a co-author of the editorial. “Until we make serological tests available in a robust way, it’s as if we are flying a plane without navigation.”

Authors of the editorial, titled, “Let’s Get Americans Back to Work Again,” are: Alex Karnal, Partner and Managing Director; Robert Jackson, MD, Partner and Chief Science Officer; and Joe Pearlberg, MD, PhD, Vice President of Scientific Affairs, all at Deerfield; and Amitabh Chandra, PhD, McCance Family Professor at Harvard Business School and Weiner Professor at the Harvard Kennedy School.

Deerfield Management Brings Together Scientists, Entrepreneurs and Leading Companies to Form the New York-Based Healthcare Innovation Campus

$635 million in real estate and multi-disciplinary laboratory infrastructure will combine with multi-billion dollar investments in research to transform the battle against disease

NEW YORK, NY, September 26, 2019—In a major move, Deerfield Management Company, L.P.  is investing $635 million to create a transformative life sciences campus in New York City, designed to integrate the capabilities of innovators from academia, government, industry and the not-for-profit sectors to tackle unmet needs in healthcare. Deerfield additionally announced that it intends to commit more than $2 billion in research and seed funding by 2030 to develop much-needed new and innovative medicines and treatment solutions.  Deerfield expects this world-class infrastructure and funding to contribute to the prevention, cure or management of dozens of still deadly and debilitating diseases.  

As the foundation of this bold undertaking, Deerfield has acquired the 345 Park Avenue South property, which boasts more than 300,000 square feet. The site, designated a NYCLifeSci campus, will bring together scientists, entrepreneurs and leading organizations from around the world to work shoulder-to-shoulder to conceive of and develop new treatments and better ways to prevent and defeat disease. The campus will provide turnkey laboratories, and engineering and computing space, as well as other amenities and supportive services.  

“We are proud to be part of a community of people in New York who strive to save and extend lives. Creating an environment in which innovative thinking, ground-breaking advances in scientific discovery and where the development of new paradigms of patient care will occur every day is tremendously exciting,” said James Flynn, Managing Partner of Deerfield.  

“We are thrilled that our partnership with Deerfield will not only create quality jobs for New Yorkers but will also help provide a home for emerging companies to develop breakthrough scientific discoveries. New York City already has the best research institutions in the world. By investing in this Life Sciences campus to bring new lab space and programming for healthcare and early-stage biotech companies, we can strengthen the City’s position as a global leader in life sciences,” said NYCEDC President & CEO James Patchett.

The $540 million in financing for the acquisition and renovation of this world-class facility was led by Blackstone Real Estate, which has been a strong supporter of life sciences.  

Nadeem Meghji, Senior Managing Director, Head of Real Estate Americas at Blackstone said, “We are thrilled to finance this important project, which will advance life sciences research in New York City. With our investment in BioMed Realty, and elsewhere across our businesses, life sciences is among our highest priority investment sectors. We look forward to continuing to support the growing demand for research and innovation.”

The building construction and programming is being backed by the New York City Economic Development Corporation and Industrial Development Agency. It is expected to be in move-in ready condition for Deerfield and other innovators in healthcare by early 2021.

Due to obstacles, including a lack of capital and siloed approaches, promising new therapies and improvements in care management frequently fail to make it to patients. In addition to leveraging the value of public and private organizations in developing solutions, the Deerfield innovation campus will pursue all forms of technology, including digital, medical device and biotherapeutic approaches.  

“Many leaders have come together to build this incredible ecosystem, capable of accelerating the fight against disease. This campus should create the ideal backdrop to advance innovation,” said Alex Karnal, Partner and Portfolio Manager at Deerfield. “We are grateful to our partners, including the New York City Economic Development Corporation and Blackstone, as without them, this ambitious project might not have been possible.”

Having proven its ability to mobilize innovators in this space, MATTER, a healthcare focused incubator, in collaboration with Deerfield, will be supporting startups of all stages within the innovation campus.  MATTER has developed extensive specialized programs to train C-suite executives in the early stages of their career and to introduce young companies to established organizations for mentorship, collaboration and potential acquisition.  Combined with Deerfield’s operating support capabilities which extends to legal, finance, information technology, human resources, and market research, among other skillsets, companies formed within the campus will have unparalleled access to capabilities of the highest quality at low cost.

“Deerfield’s expertise and resources, combined with MATTER’s capabilities and experience, will create a healthcare and life sciences campus unlike any other,” said MATTER CEO Steven Collens. “We are thrilled to be a part of this endeavor to help entrepreneurs and innovators develop technologies and solutions that will improve the healthcare experience.”

Along with new educational programming being developed—and to complement the services provided by MATTER—Deerfield also announced that it will be growing its existing Deerfield LifeSci NYC Fellows and Break into the Boardroom programs. Deerfield additionally introduced a new initiative, Women in Science, focused on training women on how to commercialize their potentially lifesaving discoveries and create companies. The investment company has a rich history of developing and leading programs supporting diversity.

About Deerfield

Deerfield is an investment management firm committed to advancing healthcare through investment, information and philanthropy.

For more information, please visit www.deerfield.com

Contacts

Deerfield Management Company
Karen Heidelberger, 212-551-1600
[email protected]

Duchenne Muscular Dystrophy Prevalence Increases, While Incidence Remains Steady

Uptick attributed to improved treatments and longevity

New York, NY, May 23, 2019—In the first study of its kind involving Duchenne Muscular Dystrophy (DMD) in the U.S., researchers from the Deerfield Institute found that while the number of new cases has remained stable, there has been an uptick in prevalence—largely attributed to enhanced treatments and longevity. The study, which is titled “Duchenne Muscular Dystrophy Prevalence in the U.S.: A Novel Incidence-Based Modeling Approach Using System Dynamics”, was featured in a recent poster session at the ISPOR 2019 annual meeting in New Orleans.

DMD, a genetic disorder characterized by progressive muscle degeneration and weakness, is caused by an absence of Dystrophin, a protein that helps keep muscle cells intact. Symptom onset is in early childhood, typically between ages 3 and 5. The disease primarily affects boys, but in rare cases it can affect girls.

Using a triangular distribution of incidence rates identified in the literature2,3, a sensitivity analysis was run to estimate the diagnosed incidence of DMD in the U.S. at 17.24 per 100,000 live male births, corresponding to approximately 362 incident cases in 2019; diagnosed prevalence was found to be 6.09 per 100,000 male population across all age groups, corresponding to about 10,015 prevalent cases in 2019.

The Deerfield Institute researchers found that while the majority (64.5%) of DMD patients are under the age of 20, there is a significant number of older DMD patients up to 45 years of age that were excluded from previous prevalence estimates. 4 The prevalence of DMD among males, aged 45 or younger, was found to be 10.0 per 100,000 vs previously estimated prevalence estimates of 1.38 per 10,000 among males 5 to 24 years of age.  

“We hypothesized that the prevalence of DMD has increased over the past few decades, due predominantly to improvements in treatment and care” said Emma Giegerich, MPH, an epidemiologist with the Deerfield Institute and co-author of the study. “Our incidence-to-prevalence model was built using system dynamics principles and birth-cohort-specific survival curves to get the most accurate picture of the disease landscape and its current burden. The results indicate that there is a larger than expected patient population that may benefit from novel treatment interventions, such as targeted gene therapies, potentially improving the viability of current or future drug development programs.”

The study was co-authored by Mark Stuntz, MPH, a former Deerfield Institute investigator.

1 Retrieved from https://www.mda.org/disease/duchenne-muscular-dystrophy.
2 Dooley J, Gordon EK, Dodds L, MacSween J. Duchenne muscular dystrophy: a 30-year population-based incidence study. Clinical Pediatrics 2010;49(2):177-179.
3 Mendell JR, Shilling C, Leslie ND, Flanigan KM, al-Dahhak R, Gastier-Foster J, Kneile K, Dunn DM, Duval B, Aoyagi A, Hamil C, Mahmoud M, Roush K, Bird L, Rankin C, Lilly H, Street N, Chandrasekar R, Weiss RB. Evidence-based path to newborn screening for Duchenne muscular dystrophy. Ann Neurol 2012;71:304-313. 
4 Romitti PA, Zhu Y, Puzhankara S, James KA, Nabukera SK, Zamba GK, Ciafaloni E, Cunniff C, Druschel CM, Mathews KD, Matthews DJ, Meaney FJ, Andrews JG, Conway KM, Fox DJ, Street N, Adams MM, Bolen J, STARnet MD. Prevalence of Duchenne and Becker muscular dystrophies in the United States. Pediatrics. 2015;135(3):513–21.

About the Deerfield Institute

The Deerfield Institute is the research division of Deerfield Management, a health care investment management firm committed to advancing health care through investment, information and philanthropy.

Contacts

Karen Heidelberger, [email protected], 212-551-1600

Predictors of laparoscopic hysterectomy for leiomyoma surgical removal in the United States

Objectives

Leiomyomas (uterine fibroids) are benign tumors that are prevalent among women of reproductive age and affect approximately 80% of premenopausal women. Hysterectomy is one of the most common surgical procedures for removal of uterine fibroids. Laparoscopic hysterectomy (LH) has increasingly been used as an alternative to the open surgical hysterectomy (OSH). The purpose of this study was to identify predictors of LH procedures among leiomyoma patients.

Methods

The National Inpatient Sample (NIS) is the largest publicly available inpatient healthcare database in the US, containing a 20% stratified systematic random sample of all US community hospital discharges. Thirteen years of available data, 2002–2014, were used for this analysis. International Classification of Diseases 9th revision (ICD-9) codes were used to identify all records of women with primary discharge diagnosis of uterine leiomyoma who had undergone either LH or OSH. Multivariate logistic regression analysis was conducted to identify significant predictors of LH. Population sampling weights were used to extrapolate results to national estimates.

Results

There were 310,150 leiomyoma LH procedures from 2002 to 2014, corresponding to 22.5% of the total number of leiomyoma hysterectomy procedures. The mean age of patients undergoing LH was significantly higher than those undergoing OSH (45.69 years vs 43.29 years; p<0.001). After adjusting for covariates, significant predictors of LH procedures included age > 50 years (OR=3.18; 95% CI=3.57-4.07), hospital location in the West (OR=1.46; 95% CI=1.38-1.86), and hospital urban non-teaching status (OR=1.20; 95% CI=1.04-1.38).

Conclusions

The study shows that despite the advances in surgical technologies, there are very few predictors of non-conventional laparoscopic approach to leiomyoma hysterectomy. Our findings suggest that there is a differential access to LH procedures among the US population which may be, in part, a result of racial and socioeconomic differences and centralization of laparoscopy services in urban areas.

Trends in isolated mitral valve surgery: the changing risk profile of patients and outcomes

Abstract 00357: Open surgical repair has historically been the only corrective procedure for mitral regurgitation. There are few contemporary data examining evolving patient characteristics and surgical outcomes of mitral valve surgery. We sought to characterize trends in patient characteristics and outcomes after isolated mitral valve repair surgery over the past decade in the United States

The importance of emerging transcatheter mitral valve technologies in cost-effectiveness and post-procedure outcomes

Abstract 00165: Mitral intervention has historically been open surgical and has been limited to a small subset of patients who could tolerate surgery and where there was perceived clinical benefit. With the emergence of transcatheter mitral interventions, we sought to compare the types of patients undergoing surgical and transcatheter mitral interventions. Moreover, we sought to determine if there were any major differences in adverse events, length of stay (LOS), and cost to the healthcare system

Deerfield Discovers Gender Affects Treatment and Outcome in Abdominal Aortic Aneurysm

New York, NY – December 21, 2017 – Deerfield announced today the publication of “Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations” in the journal Scientific Reports. Scientific Reports is a peer-reviewed, open-access journal from Nature Research. This is one of 12 articles written by Deerfield this year that has been published in peer reviewed journals.

The article, written by Deerfield Institute’s Mark Stuntz, Céline Audibert and Zheng Su, examines the discrepancies between the sexes in outcomes of ruptured abdominal aortic aneurysms (rAAA). Deerfield showed that although the incidence and mortality for rAAA has generally improved over time for both males and females, discrepancies still exist between the male and female population. Its findings revealed that females remain at a higher risk of in-hospital death than males and are less likely to undergo rAAA repair. In fact, even if females did receive surgery, they were more likely to have fatal outcomes. This article is intended to stimulate further exploration of gender based differences in the treatment of abdominal aortic aneurysms with the goal of improving outcomes.

About Deerfield

Deerfield is an investment management firm committed to advancing healthcare through investment, information and philanthropy.

For more information, please visit www.deerfield.com.

Contacts

Deerfield Management Company
Karen Heidelberger, 212-551-1600
[email protected] 

The article can be found at http://www.nature.com/articles/s41598-017-18451-2

Persisting disparities between sexes in outcomes of ruptured abdominal aortic aneurysm hospitalizations

We sought to describe and analyze discrepancies between sexes in the outcomes of patients hospitalized for ruptured abdominal aortic aneurysms (rAAA) by conducting a retrospective analysis of the Nationwide Inpatient Sample. The review included all adult patients (≥18 years old) hospitalized with a primary diagnosis of rAAA between January 2002 and December 2014. In-hospital mortality differences between females and males were analyzed overall and separately among those receiving endovascular AAA repair (EVAR) or open AAA repair (OAR). In-hospital mortality for females declined from 61.0% in 2002 to 49.0% in 2014 (P for trend <0.001), while mortality for males declined from 48.6% in 2002 to 32.2% in 2014 (P for trend <0.001). Among those receiving EVAR, females were significantly more likely to die in the hospital than males (adjusted odds ratio [OR], 1.44; 95% CI, 1.12–1.84). In addition, the odds of mortality among those receiving OAR were higher for females than males (adjusted OR, 1.14; 95% CI: 1.00–1.31). These data provide evidence that despite overall decreasing trends in mortality for both sexes, females remain at higher risk of death compared with males regardless of surgical repair procedure.

Variability in the therapeutic management of advanced ovarian cancer patients: a five-country survey of oncologists

Background

Advanced ovarian cancer patients have a poor prognosis, mainly because the disease is diagnosed at a late stage. A number of therapeutic approaches, such as neoadjuvant and maintenance therapies, have been developed to try to improve treatment outcome. In parallel, the targeted therapies bevacizumab and olaparib have recently been approved for ovarian cancer treatment. The goal of our survey was to provide a comprehensive, global depiction of advanced ovarian cancer treatments across different regions.

Patients and methods

Oncologists from France, Italy, Germany, the UK, and the USA were invited to participate in an online survey. Participants were eligible if they personally managed at least 15 ovarian cancer patients. Quantitative questions addressed the proportion of patients in neoadjuvant, treatment, and maintenance settings; proportion of BRCA-positive patients; and the type of treatment prescribed per setting and per line of therapy, depending on the patient’s BRCA status.

Results

A total of 138 respondents completed our survey in Europe and 132 in the USA. The proportions of patients in treatment, maintenance, and remission were identical across each country and line of treatment at 60%, 20%, and 20%, respectively. The proportion of BRCA-tested patients ranged from 45% in Italy to 73% in the USA, with 10% (UK)–21% (Italy) of tested patients having a positive status. Levels of bevacizumab and olaparib prescriptions differed based on the country, line of treatment, and setting, with a significant share of patients receiving both drugs outside of their approved indications for ovarian cancer treatment.

Conclusion

This survey provides real-world data on how advanced ovarian cancer patients are currently treated: 1) BRCA testing was not performed systematically, which raises concerns regarding access to treatment and 2) absence of consensus regarding which chemotherapeutic regimens or targeted therapy to use in different stages of the disease.

Nationwide trends of clinical characteristics and economic burden of emergency department visits due to acute ischemic stroke

We aimed to provide estimates of the volume and associated charges of acute ischemic stroke (AIS) visits in the US, as well as to assess predictors of patient disposition following an emergency department (ED) visit for AIS. Our study was conducted using the 2010–2013 data from the Nationwide Emergency Department Sample. We identified adult visits with AIS as the primary diagnosis. A generalized linear model was used to calculate mean charges per visit after adjusting for covariates. Multinomial logistic regression was used to assess predictors of patient disposition following an ED visit for AIS. The national incidence did not appreciably change over time, increasing from 26.4 to 27.0 visits per 10,000 adults. Adjusted mean charges per event were highest in the West, increasing from $3,761 in 2010 to $4,575 in 2013. Multinomial logistic regression showed that older age was associated with increased likelihood of both hospital admission and mortality in the ED, while male sex was associated with lower odds of mortality in the ED. Despite improvements in primary and secondary prevention of cardiovascular disease, AIS remains a significant burden on the health care system with a high volume of ED visits and increasing charges for care.