Merck’s cough project breathes life into Bellus

Welcome to the newest cult biotech stock: Bellus Health, a Canadian group with a long history of reinvention, closed up 45% yesterday after Merck & Co highlighted the phase III chronic cough project gefapixant at its R&D day. The connection is that gefapixant shares its mechanism of action, purinergic receptor P2X3 antagonism, with Bellus’s BLU-5937. That asset became Bellus’s lead after the pivotal failure in 2016 of eprodisate in AA amyloidosis, an event that came some years after a US complete response letter and the earlier phase III blow-up of the Alzheimer’s disease project tramiprosate. Back then the group was known as Neurochem, and the tramiprosate prodrug BLU8499/ALZ-801 is now in development by Alzheon. Meanwhile, the rationale behind BLU-5937 and gefapixant is that P2X3 receptors might be implicated in respiratory disorders; but chronic cough could have a variety of underlying causes, including asthma, infection, gastrointestinal conditions and drug side effects, so designing a robust trial with a relevant endpoint will be problematic. Still, even after yesterday’s surge Bellus’s valuation only just breached $300m, which in the current climate might make it worth a punt.

Industry P2X3 antagonist pipeline
Project Company Status
Gefapixant Merck & Co (ex Afferent/Roche) Phase III (NCT03696108)
S-600918 Shionogi Phase II (Japan)
BLU-5937 Bellus Health (ex Astrazeneca) Phase II (NCT03979638)
BAY1902607 Bayer Phase I/II (NCT03535168)
BAY1817080 Bayer/Evotec Phase I/II (NCT03310645)
ASN009 Asana BioSciences Likely discontinued
Source: EvaluatePharma &

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