Otonomy OTO-313 — Treatment of Tinnitus

Presumably if these results are good they would then (as it would be in their best interests financially of course) to test their drug on cases of over a year in?
If I recall the podcast conversation accurately, they will push treatment to market as soon as it's approved and it can be approved on the basis of these study cohorts (obviously why they're doing them), and subsequent Phase 3. The idea is that it is simply easier to prove out on nascent cases.
 
The market started running the sell stops when that H4 candle (26th July @ 16:00) pinned the low that is situated to the left in that circled area.

As far as we tinnitus sufferers are concerned that could be good or bad news. If I were to try and put a positive spin on this, the market could be running retail stops in order to accumulate on them at low prices.

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Keeping with the positive note, something to consider on the Monthly chart.

As we're approaching the end of July we're about to witness the close of this month's candle. If the July candle does close bearish (looking more or less like it does now) then it will have produced a bearish engulfing pattern (over June's bull candle, having opened slightly above it yet closing below).

Many trading commentators punt this out as a sign for even lower prices, however, *if* August's candle were to close above July's, therefore reverse engulfing the engulfing candle, this *can* be a sign in this context of a major market reversal, especially at the end of a long move down.

So even though August's close is pivotal for me (a close above $2.10 would be ideal) I'll be watching this one herein on the H4/H1 for signs of accumulation.

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The stock is dropping big time. Does that mean bad news is on the way?
Maybe, the volume has been high. Lots of people are clearly heading for the exit. Though then again, it could be a self fulfilling prophecy. Everyone is on edge, someone decides to sell out and other people see them do that and think they know something so they sell out too, and it creates a cascading effect. It could also be some shenanigans. Someone big sells a lot to trigger a sell off and then picks things up cheaply after everyone has panic sold. That would be kind of risky though.

It could also be people were unhappy with Dr. Weber's answer about what they were doing for the Placebo effect. That's my biggest concern. The closest thing to OTO-313 is AM-101, and the data that's been released for AM-101 shows that there was around a 35-65% placebo effect in the PGIC (patient global impression of change). That's a lot bigger than what Otonomy saw in its TFI (13% placebo effect). Yeah, that's not apples to apples, but its close. Why was the placebo effect so huge for AM-101 and so small for OTO-313?

I have confidence in the drug though, after all the reading I've done I lean heavily toward it having a real effect. I think we'll see a higher placebo effect in this trial, but the effect affects both groups, so I imagine we'll see something like 30% of the placebo group seeing a benefit and 60% of the treated group seeing a benefit.
 
The closest thing to OTO-313 is AM-101, and the data that's been released for AM-101 shows that there was around a 35-65% placebo effect in the PGIC (patient global impression of change). That's a lot bigger than what Otonomy saw in its TFI (13% placebo effect). Yeah, that's not apples to apples, but its close. Why was the placebo effect so huge for AM-101 and so small for OTO-313?
The PGIC and TFI are different. The PGIC is not a primary marker of efficacy that Otonomy are using anyway. I would think it is HIGHLY unlikely you will see anything near a 60% clinically meaningful responder rate, given that they have included more chronic cases in this and an overall much larger cohort of patients.
 
The stock is dropping big time. Does that mean bad news is on the way?
Most probably I'm afraid. It feels like it's always the same with those "promising" tinnitus treatments. You get some hope and after a while it shows that the treatment has no effect and your hope is killed and you realise that you will have to live with this noise forever. I'm sorry if I'm pessimistic, but it sucks when the hope is killed over and over again.
 
The PGIC and TFI are different. The PGIC is not a primary marker of efficacy that Otonomy are using anyway.
I was about to argue with you that they're highly correlated, but that may not be the case. I looked up the data for the PGIC in Phase 1/2:
Three (3) of 15 patients who received OTO-313 reported their symptoms were very much improved on the PGIC at Week 8 compared with no patients in the placebo group at any visit (Baseline, Weeks 1, 2, 4 or 8). A higher percentage of patients in the placebo group reported their symptoms unchanged at Week 1 (10/16, 62.5%), Week 2 (9/16, 56.3%), Week 4 (7/15, 43.8%), and Week 8 (10/16, 62.5%) compared with those in the OTO-313 group at Weeks 1 and 2 (7/15, 46.7%), Week 4 (4/15, 26.7%), and Week 8 (5/15, 33.3%). Of the 6 OTO-313 TFI responders, 5/6 (83.3%) patients scored much improved or minimally improved on the PGIC at Week 4. Similarly, at Week 8, 5/6 patients (83.3%) scored very much improved, much improved, or minimally improved on the PGIC.
It's possible the placebo group had positive PGIC responders who had weak TFI scores. They don't tell us if the 40% non-unchanged participants were positive or negative. If negative, it could be that the slow release gel causes some irritation. That could dampen any placebo effect.
I would think it is HIGHLY unlikely you will see anything near a 60% clinically meaningful responder rate, given that they have included more chronic cases in this and an overall much larger cohort of patients.
We shall see. I don't think there will be any difference between the subgroups.

Additionally, the more severe cases responded better so they upped the bar for this trial. Theoretically that means we should see a response rate better than 46%. I don't think 60% is out of the question. However, Otonomy said in their call that they view a 40% response rate as a win. If that's the case I hope they can keep the placebo effect down.
 
Most probably I'm afraid. It feels like it's always the same with those "promising" tinnitus treatments. You get some hope and after a while it shows that the treatment has no effect and your hope is killed and you realise that you will have to live with this noise forever. I'm sorry if I'm pessimistic, but it sucks when the hope is killed over and over again.
One difference with the new technology versus the old:

Regeneration tech isn't a hearing aid or a device attempting to assist, fool, or reset the brain/ear. The goal is turning back your clock as much as possible by regenerating your body to its complete function.

Sensory regeneration seems to be a final frontier on a foundational level in regenerative science. They have the early foundations for muscle generation. Diseases are being cured/edited out of people such as Sickle Cell Anemia.

The breakthrough has just begun, and it's moving faster and faster every year. The speed in which regeneration is being studied and tested, the millennias-long wait for true help is coming to an end. It won't take 40 years with what regenerative medicine can do to fix sensory injuries.

Hang in there.
 
Stocks right now are so weird that I don't hold much faith in the share price reflecting the efficacy of OTO-313. If there is a problem with the drug in this trial, there must be a reason behind it.
 
Stocks right now are so weird that I don't hold much faith in the share price reflecting the efficacy of OTO-313. If there is a problem with the drug in this trial, there must be a reason behind it.
Agreed. I've completely separated share price/performance from trial/pipeline data.
 
I think as per usual some manipulation and underhand tactics going off on the stocks. From anecdotal reports it does not match up!
Yep. What's really important now is for peeps not to get screwed over again like some did buying FREQ stock the last time things hotted up round here prior to the publication of trial data.

Back then it was too late for me to add my 'tuppence worth' as the buying had already started. But the price was clearly too high and parabolic at that point in time and due a pullback. The aftermath has been painful to witness, particularly because our community gets screwed over enough, without having the market shifters screw us over too.

Difference with Otonomy is that the price is very low, and as per the chart I posted above, we could *potentially* be in for a market reversal. In these situations, the main thing I always tell myself is, the price charts don't lie. In fact, price data and action is the only thing 'they' can't hide from us.

Over the course of the next month things could get quite interesting with this *cheap* stock. Let's wait and see.
 
I think as per usual some manipulation and underhand tactics going off on the stocks. From anecdotal reports it does not match up!
Placebo effect, or even worse, someone saying something to pump the stock. Take anything you read online with a grain of salt. There were several good anecdotes about FX-322, and that flopped pretty hard (when compared to placebo).

That said, the results aren't in. Right now the stock price is all we have to go on, and to me it looks like panic selling. Someone dumped their shares at 1.2 this morning (pre-market). That's basically throwing money away - even if you knew something, it would have been much smarter to wait until the market opened. That looks like fear to me - or even worse, like you said, manipulation.

Volume is starting to come down. I really think this was spurred by someone not liking what they heard in the earnings call and dumping their shares. People saw this and followed suit.

Otonomy released the results of Otividex 11 days after their earnings call last February. I think we're in for a nail biting 2 weeks before we see the actual data.
 
Right now the stock price is all we have to go on, and to me it looks like panic selling. Someone dumped their shares at 1.2 this morning (pre-market). That's basically throwing money away - even if you knew something, it would have been much smarter to wait until the market opened. That looks like fear to me - or even worse, like you said, manipulation.

Volume is starting to come down. I really think this was spurred by someone not liking what they heard in the earnings call and dumping their shares. People saw this and followed suit.
@patorjk, it could be many things. I find it hard to believe that even big investors have knowledge or tip offs before the company has the data. Leak is not impossible, however, it is doubtful.

I didn't listen to the financial review and instead read the poorly written, illiterate transcript.

I would expect the strong signals in Phase 1 for <6 months to roughly translate.

Whether the data from >6 months was not as good, dragging down the % of responders closer to placebo is possible. This was not asked by any investor though.
 
Most probably I'm afraid. It feels like it's always the same with those "promising" tinnitus treatments. You get some hope and after a while it shows that the treatment has no effect and your hope is killed and you realise that you will have to live with this noise forever. I'm sorry if I'm pessimistic, but it sucks when the hope is killed over and over again.
We all fear the same thing, what if we get our hopes up and get crushed? I do agree that everything is always a letdown with the hearing community.

What other drugs were this close besides AM-101? There really wasn't anything else promising. We get a lot of hope but most things don't even get to Phase 2 or it's just over hype for something that's barely in trials.

Besides AM-101, I truly can't think of anything that sounded this promising this close to market. I mean we always get promises that something is coming soon, then it never happens.

OTO-313 is the second tinnitus intratympanic injection drug.

The biggest letdown I experienced was FX-322. I'm pretty sure that was a big letdown for all of us, but I don't truly count it as a failure. Desperate people ruin things and lie on their hearing tests. Bad trial design ruins things too. The drug works too.

So truly our letdowns have not been horrible, but the lack of interest for hearing damage, and everything moving at a snail pace is definitely what I agree on for a let down. If all the regenerative drugs fail, I will probably be mostly homebound for the rest of my life. Nobody wants these to pass more than me.

So until Phase 2 results are in, let's all chill out on the pessimism.

And for the stock tanking, it could be insider trades but I'm pretty sure it's just because of the recession that's starting up, so many stocks are taking big hits, even ones that have been steadily increasing for years. Or could be investors getting skiddish like other people are saying. I sold my shares after the first break on the support and realized there's better stocks to invest my money in.
 
I was cautiously optimistic until 5 days ago. Cautious due to Phase 1 characteristics:

1) Small group size
2) Only tested on acute tinnitus

However, I have let the market dramatically dampen my optimism, yet I openly admit I know very little about stock markets.
 
I was cautiously optimistic until 5 days ago. Cautious due to Phase 1 characteristics:

1) Small group size
2) Only tested on acute tinnitus

However, I have let the market dramatically dampen my optimism, yet I openly admit I know very little about stock markets.
Tried and true saying - don't watch the stock, watch the business.
 
I did invest a lot in their stocks, I hope I didn't do a big mistake.

I know people whose tinnitus improved thanks to this medication, so I had high hopes.
 
Yep, bad news.
  • OTO-313 demonstrated no clinically meaningful improvement versus placebo for primary and secondary endpoints across all timepoints
  • Company to discontinue development of OTO-313 and implement other measures to extend its cash runway
  • Clinical focus shifts to OTO-413 following positive Phase 2a results in April 2022; top-line results for evaluation of higher dosing still expected in fourth quarter of 2022
 
The problem was the placebo effect:
"These results were unexpected with a much higher placebo response than observed in the prior Phase 1/2 study," said David A. Weber, Ph.D., president and CEO of Otonomy. "In addition to this trial, we have also reviewed preliminary top-line results for the one-month safety evaluation of higher and bilateral dosing of OTO-313 and did not observe a treatment benefit that is convincing in light of the Phase 2 results. Therefore, we must make the difficult decision for all stakeholders including patients and clinicians who were highly supportive of this trial to discontinue further work on OTO-313. We also intend to implement other measures to extend our cash runway."
It sounds like the higher dose trial did better, but the placebo effect was just too discouraging in the Phase 2 trial. I get the feeling we may be doomed until there's a better way of measuring tinnitus.
 
OTO-313 was definitely not on my list to look out for - I'd stay away from injections trough the eardrum personally.

Do not give up hope, Dr. Susan Shore theoretically completed their Phase 2 in July. You see how fast results can be published? We will have positive news within a few months for sure.

Don't forget we have results of Dr. Hamid Djalilian, Dr. Susan Shore, the Oxytocin trial and others to look out for, and we have XEN1101 going in Phase 3 and SPI-1005 already started the Phase 3. Besides that research on repurposing drugs such as Etanercept, Zoledronate.

One candidate less but plenty still in the race. OTO-313 wouldn't have been first to market either way.
 
Don't forget we have results of Dr. Hamid Djalilian, Dr. Susan Shore, the Oxytocin trial and others to look out for, and we have XEN1101 going in Phase 3 and SPI-1005 already started the Phase 3. Besides that research on repurposing drugs such as Etanercept, Zoledronate.
All of those could fail miserably, maybe with the exception of Dr. Shore, but it could also be yet another Lenire with an inflated 80% "success rate".

It's best to be pessimistic with these things, then be happily surprised if something will ever work.
 

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