Frequency Therapeutics — Hearing Loss Regeneration
- Thread starter RB2014
- Start date
Keith Handy
Member
- Jan 5, 2021
- 302
- Tinnitus Since
- 11/2020
- Cause of Tinnitus
- Stress + sleep deprivation + noise
I was just the other day thinking of making a video where I dress up as an ENT and pretend to have said person as a patient... and nearly offer the FX-322, for an affordable cost, but then retract it on the basis that tinnitus is character forming, and that most likely if said person had said treatment, he would probably go and listen to headphones—even at a low volume—and that would be the worst thing said person could possibly do.
Member- May 7, 2015
- 1,050
- Tinnitus Since
- 29.09/2014
- Cause of Tinnitus
- Acoustic trauma using headphones
- Aug 5, 2019
- 1,852
- Tinnitus Since
- 05/2019
- Cause of Tinnitus
- Autoimmune hyperacusis from Sjogren's Syndrome
Haha, I'm completely talking out of my ass with the theory of turbulent perilymph via vibrations pushing it deeper. Probably the most efficient method is something boring like getting in the right position and letting gravity work.
- May 27, 2020
- 556
- Tinnitus Since
- 2007
- Cause of Tinnitus
- Loud music/headphones/concerts - Hyperacusis from motorbike
Haha, I was mindful of not derailing the thread but at the same time I could feel everyone's anxiety starting to creep through with results any day now. I don't mind some memes as a break from all the technical discussion and to help lighten the mood, but it appears we've started something we can't stop now lol. I actually loved your first one, it resonated with me on so many levels!
It just feels like we're all sitting patiently outside the Sistine Chapel now, waiting for the white smoke to come out of the chimney.
Haha, Yeah probably! but nothing is for sure with this experiments with the cochlea.
- Aug 5, 2019
- 1,852
- Tinnitus Since
- 05/2019
- Cause of Tinnitus
- Autoimmune hyperacusis from Sjogren's Syndrome
This thread is amusing, as it's all over the place. Some investor talk; some venting over fears; some memes; some theories; some of you, FGG, and Diesel mapping the human genome in real time on the thread; Bobb world; some freak-out over scheduled SEC exchanges from the executive team; some "how do you like me now" talk towards Leigh and TRT; some talk about study participants learning how to ace word tests; some history lessons; some ELI5 science lessons; etc.
- Feb 14, 2020
- 1,630
- Tinnitus Since
- 1-2019
- Cause of Tinnitus
- 20+ Years of Live Music, Motorcycles, and Power Tools
You're not kidding. The FX-322 thread is literally the cultural hub of Tinnitus Talk.
- May 7, 2015
- 1,050
- Tinnitus Since
- 29.09/2014
- Cause of Tinnitus
- Acoustic trauma using headphones
Yeah, these are crazy times.
Not a day has gone by, since I first heard of Frequency Therapeutics, without thinking about them and if their, in theory, ingenious method will help us.
After buying a healthy amount of stock in the company as well, the obsession hasn't really diminished.
It feels good that there are clearly so many of us that share the same anticipation for the days to come.
I can't remember being this expectant since I was a twelve year old the day before X-mas eve.
I just hope I/we don't end up with a pair of socks as that would suck the life out of me!
Just prepare for all possibilities - as most here all know too well, nothing in life is guaranteed. Hope for the best and prepare for the worst as they say!
A decent result on tinnitus would be pretty exciting though...
A decent result on tinnitus would be pretty exciting though...
- Feb 14, 2020
- 1,630
- Tinnitus Since
- 1-2019
- Cause of Tinnitus
- 20+ Years of Live Music, Motorcycles, and Power Tools
Now that we've got a lot more viewers, reposting this with some changes... to be clear... ANY of these outcomes are positive and would still lead to a pivotal phase. I am pretty optimistic FX-322 will end up approved, but there still may be work to do for a "2.0" version.
The Worst Case: Multi-Dosing doesn't have any significant effect. It becomes a "bigger" Phase 1/2.
Description:
The data shows that all 3 dose cohorts basically reproduce what we saw in the single dose Phase 1/2, except with 72 patients instead of 15.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Similar improvement rate at 8 kHz + on audiogram, but nothing lower.
The Okay:
Tinnitus scores (TFI) show improvement trend, but is not significant amongst cohorts
EHF audiogram shows improvement but not significant.
Word-in-Noise score shows improvement, but slightly more significant.
The Bad:
No improvement below 8 kHz on audiogram.
Multi-dosing didn't work.
What this may indicate: Need to change delivery method or formulation for an FX-322 "2.0" to work with multiple doses, or get enough to reach the apex of the cochlea. FX-322 will come out, but will require many to return to ENT for the "2.0".
The "Meh" Case 1: Multi-Dosing works, but didn't go deeper per cohort.
Description:
Data shows that multi-dosing does have a stratified effect, but stays concentrated in the EHF (8 kHz+).
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement (20 dB+, 30 dB+, etc).
The Okay:
4-dose show more improvements at 8 kHz (10 dB+, 20 dB+, etc) + on audiogram, but nothing lower in frequency.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No improvement below 8 kHz on audiogram.
What this may indicate: Dosing may need to be larger in concentration or closer together to increase diffusion per dose in the cochlea.
The "Meh" Case 2: Multi-Dosing works, goes deeper, but underwhelming response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, but the improvements are minor.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
The Okay:
Word-in-Noise score shows improvement, but slightly more significant.
EHF audiogram shows improvement, but isn't groundbreaking (10-20 dB, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz), but the gains don't get above 10 dB.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No significant improvement in dB on normal audiogram above 10 dB at any given frequency.
Issues point to synaptopathy being a greater issue than anticipated (need PIPE-505, OTO-413).
What this may indicate: Similar to the above. Possibly more doses beyond 4x, and closer together in time.
The Ideal Outcome: Multi-Dosing goes deeper + significant response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, and the improvements are significant.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement from baseline(20 dB+, 30 dB+, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz, 2 kHz), and show clear improvement per band: +30 dB @ 8 kHz, +20 dB @ 6 kHz, +10 dB @ 4 kHz.
Tinnitus scores (TFI) significant improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Okay:
Obviously doesn't go deeper into cochlea.
Hearing isn't restored to "like new" after 4 doses.
FX-322 is still many years from product.
What this may indicate: Enough FX-322 is sticking around so that more doses should continue to go deeper into the cochlea.
The Worst Case: Multi-Dosing doesn't have any significant effect. It becomes a "bigger" Phase 1/2.
Description:
The data shows that all 3 dose cohorts basically reproduce what we saw in the single dose Phase 1/2, except with 72 patients instead of 15.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Similar improvement rate at 8 kHz + on audiogram, but nothing lower.
The Okay:
Tinnitus scores (TFI) show improvement trend, but is not significant amongst cohorts
EHF audiogram shows improvement but not significant.
Word-in-Noise score shows improvement, but slightly more significant.
The Bad:
No improvement below 8 kHz on audiogram.
Multi-dosing didn't work.
What this may indicate: Need to change delivery method or formulation for an FX-322 "2.0" to work with multiple doses, or get enough to reach the apex of the cochlea. FX-322 will come out, but will require many to return to ENT for the "2.0".
The "Meh" Case 1: Multi-Dosing works, but didn't go deeper per cohort.
Description:
Data shows that multi-dosing does have a stratified effect, but stays concentrated in the EHF (8 kHz+).
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement (20 dB+, 30 dB+, etc).
The Okay:
4-dose show more improvements at 8 kHz (10 dB+, 20 dB+, etc) + on audiogram, but nothing lower in frequency.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No improvement below 8 kHz on audiogram.
What this may indicate: Dosing may need to be larger in concentration or closer together to increase diffusion per dose in the cochlea.
The "Meh" Case 2: Multi-Dosing works, goes deeper, but underwhelming response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, but the improvements are minor.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
The Okay:
Word-in-Noise score shows improvement, but slightly more significant.
EHF audiogram shows improvement, but isn't groundbreaking (10-20 dB, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz), but the gains don't get above 10 dB.
Tinnitus scores (TFI) show improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Bad:
No significant improvement in dB on normal audiogram above 10 dB at any given frequency.
Issues point to synaptopathy being a greater issue than anticipated (need PIPE-505, OTO-413).
What this may indicate: Similar to the above. Possibly more doses beyond 4x, and closer together in time.
The Ideal Outcome: Multi-Dosing goes deeper + significant response.
Description:
Data shows that multi-dosing does have a stratified effect in terms of depth, and the improvements are significant.
The Good:
Word score improvements continue to be clinically meaningful / statistically significant.
Word-in-Noise score shows improvement that is clinically meaningful / statistically significant.
EHF audiogram shows significant improvement from baseline(20 dB+, 30 dB+, etc).
4-dose improvements go below 8 kHz on audiogram (6 kHz, 4 kHz, 2 kHz), and show clear improvement per band: +30 dB @ 8 kHz, +20 dB @ 6 kHz, +10 dB @ 4 kHz.
Tinnitus scores (TFI) significant improvement trend, and is stratified at each cohort level (more doses, lower TFI).
The Okay:
Obviously doesn't go deeper into cochlea.
Hearing isn't restored to "like new" after 4 doses.
FX-322 is still many years from product.
What this may indicate: Enough FX-322 is sticking around so that more doses should continue to go deeper into the cochlea.
I think "Meh" Case #2 is the most likely outcome, but the "Ideal" scenario is, of course, ideal.
- Feb 14, 2020
- 1,630
- Tinnitus Since
- 1-2019
- Cause of Tinnitus
- 20+ Years of Live Music, Motorcycles, and Power Tools
Yeah the prevalence of synaptopathy where FX-322 cannot cause regeneration of the new hair cell + synapse may be telling in these results.
HootOwl
Member
I don't have my thoughts organized in quite the same way but what I see:
From Phase 1, the word scores were really impressive. As the vast majority of speech information is below 8000 Hz, I think the gains from a single injection were at least 15 dB in the EHF. My gut tells me it was even more considering that some word scores doubled.
I expect multi dosing to have some further significant effect or I don't think they would have bothered for something they thought would likely make just a 5 dB difference. And the fact that they have a single, double or quadruple dose cohort says that there are likely increasing gains with each treatment, too.
Given this, I strongly suspect the EHF gains will be impressive and much stronger than the Phase 1 results.
I also think multi dosing will reveal greater changes at 8000 Hz.
As for what happens below 8000 Hz, I actually think we would see *some* audiogram changes in the multi dose cohort if they say measured at 7000 Hz but, as the next "rung" down is 4000 Hz, I am not so sure. These would obviously less substantial than in the EHF. It would be nice to know where the drug stops having an effect due diffusion issues/VPA concentration etc and I wish audiograms weren't so limiting. It's unfortunate that Frequency Therapeutics couldn't use custom audiograms with smaller intervals because recruitment depended on stable standard audiogram results. Yet another reason audiograms just suck.
Anyway, regardless, we may get some pleasant surprises but I don't expect changes down to 250 Hz this time around (would love to be wrong here)--maybe with a version 2.0.
Tinnitus data will be tricky. If someone has a 2000 Hz tone, for instance, and the drug doesn't penetrate, it obviously won't affect THI/TFI scores. Without tone matching, it might be extremely hard to interpret the data. I'm glad tinnitus is just an "experimental" end point for that reason.
I thought that was a real thing that someone mentioned a while back. Or I imagined it...
"Local Drug Delivery to the Entire Cochlea without Breaching Its Boundaries"
- May 27, 2020
- 556
- Tinnitus Since
- 2007
- Cause of Tinnitus
- Loud music/headphones/concerts - Hyperacusis from motorbike
Keith Handy
Member
- Jan 5, 2021
- 302
- Tinnitus Since
- 11/2020
- Cause of Tinnitus
- Stress + sleep deprivation + noise
Yep, this is why I was asking about the TFI earlier.
I don't think these scores will adequately reflect how higher-pitched tinnitus might be met with more relief than its lower-pitched variants. Thus a lackluster result here won't be a deal-breaker for me in terms of wanting the treatment, but I worry that the community will be discouraged by a "meh" outcome which will just reflect an average for all cases. I do think the extended audiogram is where the real gold is, and I want to see that really shine; then we simply need advancements in delivery going forward.
Here is a schematic. Not sure if it is exactly to scale but shows an approximation of what you are asking anyway:
- Feb 14, 2020
- 1,630
- Tinnitus Since
- 1-2019
- Cause of Tinnitus
- 20+ Years of Live Music, Motorcycles, and Power Tools
Frequency Therapeutics has a pretty helpful diagram on their investor presentation.
As you can see, the blue shaded area is where the presence of drug has been measured after 1 injection. The belief is that multiple injections might cause more of the drug to diffuse deeper into the cochlea, if concentrations get high enough and deep enough, it may show up as an improvement on the audiogram.
@FGG, I was thinking about your previous comment. It's possible the standard audiogram they are using in the Phase 2A has a 6 kHz band, which might show some gains at the 4x dose group.
I hope it will reach at least partially to my loss (30 dB) of hearing and tinnitus at 3 kHz.
Keith Handy
Member
- Jan 5, 2021
- 302
- Tinnitus Since
- 11/2020
- Cause of Tinnitus
- Stress + sleep deprivation + noise
I was just looking at my own standard audiogram from December and it included 3 kHz and 6 kHz -- eight bands rather than six -- so it's possible.
- Feb 14, 2020
- 1,630
- Tinnitus Since
- 1-2019
- Cause of Tinnitus
- 20+ Years of Live Music, Motorcycles, and Power Tools
Hmm... mine didn't. I wonder how common each type of audiogram is and how that affected recruitment.
Edit: only my last one didn't. Weird. My previous ones did. I wonder if i got a shortened "recheck" one...
If that's the case, my hunch is we will see at least some blip at 6000 Hz. Hopefully a lot more.
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