`_____________________
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`BEFORE THE PATENT TRIAL AND APPEAL BOARD
`_____________________
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`PAR PHARMACEUTICAL, INC.,
`Petitioner,
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`v.
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`HORIZON THERAPEUTICS, LLC,
`Patent Owner.
`
`_____________________
`
`Case IPR2017-01769
`Patent 9,326,966
`_____________________
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`REPLY DECLARATION OF NEAL SONDHEIMER, M.D., Ph.D.
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`EXHIBIT 1028
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`TABLE OF CONTENTS
`Introduction ...................................................................................................... 1
` Qualifications ........................................................................................ 1
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`Scope of Work ....................................................................................... 1
` Ground 1 of Par’s Petition Renders the Challenged Claims
`Obvious. ........................................................................................................... 2
` A POSA Would Have Increased Drug Doses for
`Patients Having “Normal” Ammonia Levels. ....................................... 3
` A POSA Would Have Used Fasting Plasma Ammonia
`Levels to Determine Dosing .................................................................. 4
` Dr. Enns Exaggerates the Risk of Overdosing ...................................... 6
` Grounds 2 and 3 of Par’s Petition Renders the Challenged
`Claims Obvious. .............................................................................................. 7
` The Prior Art Does Not Teach Away from the Challenged
`Claims .............................................................................................................. 8
`Conclusion ..................................................................................................... 12
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`i
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`I, Neal Sondheimer, do hereby declare as follows:
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`INTRODUCTION
` Qualifications
`1. My background and qualifications are described in Section II of my
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`initial declaration submitted in the proceeding on July 13, 2017 (“Initial
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`Declaration”) (EX1002, ¶¶7-13). I incorporate those qualifications by reference
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`here. I am being compensated as set forth in my Initial Declaration (EX1002, ¶2),
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`and I continue to have no personal or financial interest in Par or in the outcome of
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`this proceeding.
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`2.
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`Scope of Work
`For this declaration, I was asked to review and discuss the declaration
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`of Dr. Gregory M. Enns (“the Enns Declaration”). (EX2006.) I have also
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`reviewed the Horizon’s Patent Owner Response (Paper 22) (“Horizon’s POR”).
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`Nothing in the Enns Declaration or Horizon’s POR alters or changes my opinions
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`set forth in my Initial Declaration.
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`3.
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`This declaration is a statement of my additional opinions in this matter
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`and the basis and reasons for those opinions. In forming the opinions expressed in
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`this declaration, I have relied upon my education, experience, and knowledge of
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`the subject matter discussed. In addition to my Initial Declaration and the
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`materials identified therein, I have also reviewed, considered, or relied upon
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`documents and other materials, which are cited in the table below:
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`1
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
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`Exhibit
`No.
`2012
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`2013
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`2015
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`2018
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`2019
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`2025
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`2031
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`2032
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`2046
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`Description
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`U.S. Patent Publication No. 2012/0022157, filed August 27, 2009,
`published January 26, 2012
`Tuchman & Batshaw, Management of Inherited Disorders of
`Ureagenesis, 12 The Endocrinologist 99–109 (2002). (“Tuchman”).
`Broomfield & Grunewald, How to Use Serum Ammonia, 97 Arch.
`Dis. Child Educ. Pract. Ed. 72-77 (2011)
`Kasumov et al., New Secondary Metabolites of Phenylbutyrate in
`Humans and Rats, 32 Drug Metabolism and Disposition 10-19
`(2004)
`Häberle et al., Suggested Guidelines for the Diagnosis and
`Management of Urea Cycle Disorders, 7 Orphanet J. Rare Diseases
`1-30 (2012)
`Colloquium, Consensus Statement from a Conference for the
`Management of Patients with Urea Cycle Disorders, 138 J.
`Pediatrics S1-S5 (2001)
`Cheson et al., Novel Therapeutic Agents for the Treatment of
`Myelodysplastic Syndromes, 27 Seminars in Oncology 560-77 (John
`W. Yarbro, et al. eds., 2000)
`Scaglia et al., Effect of Alternative Pathway Therapy on Branched
`Chain Amino Acid Metabolism in Urea Cycle Disorder Patients, 81
`Molecular Genetics and Metabolism, Supplement 1 S79-S85 (2004)
`Transcript of the Deposition of Dr. Neal Sondheimer, taken April
`19, 2018
`
` GROUND 1 OF PAR’S PETITION
`RENDERS THE CHALLENGED CLAIMS OBVIOUS.
`4.
`From my review of the Enns Declaration and Horizon’s POR, I
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`understand Horizon to only argue that the prior art does not teach (1) adjusting
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`doses in patients who have plasma ammonia levels between one-half the ULN and
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`the ULN; and (2) using “fasting” plasma ammonia levels in making decisions
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`2
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`about drug dosing, with respect to Horizon’s challenge to Ground 1 of Par’s
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`Petition. I disagree.
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` A POSA Would Have Increased Drug Doses
`for Patients Having “Normal” Ammonia Levels.
`Dr. Enns states “Fernandes only suggests that plasma ammonia levels
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`5.
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`at emergency levels (i.e., >120 μmol/L) warrant dosage increases.” (EX2006,
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`¶67.) And he states that “Fernandes defines the normal range for plasma ammonia
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`as <50 μmol/L,” not the <80µmol/L presented in Ferdandes’s Figure 17.2. (Id. at
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`¶65.) But as I stated in my Initial Declaration, Fernandes clearly advises
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`increasing the dosage of medication in patients with plasma ammonia levels
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`<80µmol/L. (EX1002, ¶63.) And while Fernandes discloses 50μmol/L as one
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`ULN, Fernandes also expressly discloses that “[h]ealthy neonates have slightly
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`higher values.” (EX1015, 217-18.) To that end, Blau describes hyperammonemia
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`as being “plasma ammonia >80 in newborns or >50 µmol/L after 28 days
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`postnatally.” (EX1006, 5.) A POSA would understand that 80µmol/L in Figure
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`17.2, therefore, is a reasonable ULN for some UCD patients, for example,
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`newborns.
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`6.
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`Fernandes’s Figure 17.2 is reproduced below with a red box
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`highlighting the branch of the treatment protocol for patients having a “normal”
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`plasma ammonia:
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`3
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
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`(EX1015, Fig. 17.2 (annotated).) Fernandes teaches in Figure 17.2 that in patients
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`with plasma ammonia levels <80µmol/L, and in consideration of biomarkers such
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`as plasma glutamine and essential amino acids (“EAAs”), medicine doses should
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`be increased. Fernandes expressly shows, therefore, that patients with plasma
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`ammonia levels below the ULN may require an increased dosage of nitrogen
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`scavenging drug.
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` A POSA Would Have Used Fasting
`Plasma Ammonia Levels to Determine Dosing.
`As I noted in my Initial Declaration, Fernandes teaches that protein
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`7.
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`intake affects plasma ammonia levels. (EX1002, ¶58.) Likewise, the
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`’859 Publication teaches that dietary protein affects plasma ammonia levels.
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`4
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`(EX1004, [0003].) Also as I noted in my Initial Declaration, Blau, Simell, and Lee
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`each describes measuring fasting plasma ammonia levels. (EX1002, ¶¶77-78, 80.)
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`8.
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`In view of these disclosures, I stated in my Initial Declaration that a
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`POSA would have known that fasting plasma ammonia levels should be used to
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`avoid the variability in ammonia levels that were caused by food and other daily
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`activities. (EX1002, ¶¶94-95, 99, 101.) Dr. Enns’s and Horizon’s arguments that
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`the prior art does not teach using fasting plasma ammonia levels do not change my
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`opinion.
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`9.
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`For instance, as I noted in my Initial Declaration, Lee teaches that
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`only 27.0% of ammonia values exceeded ULN while patients were taking GPB, in
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`contrast to 39.6% while on PBA. (EX1002, ¶106-107; EX1010, 224.) Lee states
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`that “[t]hese differences were attributable to lower ‘overnight’ ammonia levels
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`(12-24 h)....” (EX1002, ¶107; EX1010, 224 (emphasis added).)
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`10.
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`I also disagree with Dr. Enns’s and Horizon’s argument that fasting
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`ammonia levels are the lowest during the day, because, in Lee’s Figure 2, the
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`plasma ammonia value at t=30 minutes is lower than at t=0 minutes. (EX2006,
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`¶121; Paper 22, 41-42.) Dr. Enns and Horizon ignore that protein is not
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`instantaneously absorbed and metabolized such that there is a lag before dietary
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`protein is reflected in the body as plasma ammonia. I explained as much during
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`my deposition by explaining that there is a bioavailability issue that explains the
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`5
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`lag after eating before plasma ammonia levels begin to rise. (EX2046, 49:18-
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`50:8.) The effect of the GPB administered at t=0 on plasma ammonia levels is,
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`consequently, reflected at t=30 minutes. (EX1010, Fig. 2.) Furthermore, the
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`lowest plasma ammonia level occurs at t=24 hours, which is a fasting plasma
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`ammonia level. (Id.)
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`11.
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`In sum, Dr. Enns’s testimony about the prior art does not change my
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`conclusions regarding the ’966 patent claims. Therefore, it remains my opinion
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`that a POSA would have successfully arrived at a method of treating a UCD using
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`the claimed methods.
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` Dr. Enns Exaggerates the Risk of Overdosing.
`12. Dr. Enns claims that a POSA “would have been reluctant to increase
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`the dosage of nitrogen scavengers when a patient already had a normal fasting
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`plasma ammonia level due to concerns about the potentially harmful effects of
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`over-treatment.” (EX2006, ¶103; see also Paper 22, 33-34.) I disagree.
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`13. First, Dr. Enns relies on adverse events that occurred with drugs other
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`than GPB. (See EX1006, 262 (phenylbutyrate); EX2013, 105 (phenylacetate,
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`phenylbutyrate); EX2018, 10 (phenylbutyrate); EX2019, Table 4 (phenylacetate,
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`phenylbutyrate); EX2031, 564 (phenylbutyrate); EX2032, S79 (phenylacetate and
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`phenylbutyrate).) GPB was well-known to be better tolerated than the drugs on
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`which Dr. Enns relies. (EX1004, [0086].)
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`6
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`14. Second, I understand the challenged claims to encompass
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`administering any amount of initial dosage or adjusted dosage. Consequently, Dr.
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`Enns ignores that an increase in dose may not cause the concerns he espouses.
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`Additionally, if a patient’s treatment is initiated with a dose of GPB below the
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`maximum recommended dose, an increased dose would remain within the range of
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`FDA-approved dosing for safety and efficacy.
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`15. For example, in Lee, “8 of 10 patients were being prescribed lower
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`NaPBA doses than currently recommended in the approved product labeling.”
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`(EX1010, 226.) These patients could receive an increase in dosing – indeed, Lee
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`recommended doing so (id.) – and still remain within the approved dosing range.
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`None of these are relevant to or would constitute a “massive over-dosage,” as
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`described by Dr. Enns (EX.2006, ¶104).
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` GROUNDS 2 AND 3 OF PAR’S PETITION
`RENDERS THE CHALLENGED CLAIMS OBVIOUS.
`16. Horizon argues that the prior art is “completely silent” regarding “any
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`particular ammonia level within the normal range let alone the claimed target.”
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`(Paper 22, 52.) I disagree.
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`17. The ’859 Publication reports that “a plasma ammonia level of less
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`than about 40 µmol/L, or of not greater than 35 µmol/L would indicate the
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`treatment was effective.” (EX1004, [0074].) Likewise, Fernandes discloses that
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`“[t]he aim [of treatment] is to keep plasma ammonia levels below 80 µmol/l....”
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`7
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`(EX1015, 219.) The prior art, therefore, repeatedly teaches that maintaining
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`plasma ammonia levels below the ULN is desirable.
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`18. Further, a POSA would have understood from the teachings of the
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`’859 Publication and Lichter-Konecki that further improvements in plasma
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`ammonia control were still possible for patients having “normal” fasted plasma
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`ammonia levels. For instance, Lichter-Konecki notes GPB’s non-inferiority
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`compared to NaPBA because it decreased the frequency of excursions above ULN.
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`(EX1017, 326.) And the ’859 Publication states that “the mean percentage of
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`normal ammonia values increased from 58% after sodium PBA treatment to 83%
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`after HPN-100 treatment.... Based on preliminary results, HPN-100 also provides
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`more stable ammonia levels, and reduces risk of hyperammonemia.” (EX1004,
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`[0201-0202].) Consequently, a POSA would have understood that getting fasted
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`plasma ammonia levels in the normal range would have been significant, as well as
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`decreasing the frequency at which patients’ plasma ammonia levels exceeded
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`ULN.
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` THE PRIOR ART DOES NOT TEACH
`AWAY FROM THE CHALLENGED CLAIMS.
`19.
`I understand that the prior art is considered to teach away from the
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`claimed invention when a POSA, upon reading the reference, would be
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`discouraged from following the path set out in the reference, or would be led in a
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`direction divergent from the path that was taken by the patentee.
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`8
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`20. Horizon and Dr. Enns allege that a POSA would be discouraged from
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`relying on normal plasma ammonia levels to make dosage adjustments because of
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`the known variability in ammonia levels. (Paper 22, 35-40; EX2006, ¶¶105-116.)
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`I have reviewed the references cited by Horizon and Dr. Enns and do not find them
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`to discourage using normal plasma ammonia levels to make dose adjustments.
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`21. Specifically, Fernandes expressly asserts that “[a]ll treatment must be
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`monitored with regular quantitative estimation of plasma ammonia....” (EX1015,
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`219.) Fernandes further states that “[t]he most important diagnostic test in urea
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`cycle disorders is measurement of the plasma ammonia concentration.” (Id., 217.)
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`22. Lee reports that “[c]ontrol of blood ammonia levels is the main
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`objective of both acute and chronic management of UCD patients.” (EX1010,
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`222.)
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`23. Similarly, the ’859 Publication discloses a method having the step of
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`“measuring blood ammonia to determine if the initial dosage is sufficient to control
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`blood ammonia levels, or to establish a suitable average ammonia level,” and then
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`“adjusting the initial dosage of the new drug as needed.” (EX1004, [0098-0099];
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`see also id., [0091].)
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`24. Häberle teaches that “[l]aboratory monitoring must include plasma
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`ammonia determination in venous samples....” (EX2019, 18.)
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`9
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`25. Barsotti emphasizes a need for better methods of measuring ammonia
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`levels, stating that
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`[a]lternative methods are still sought that are noninvasive
`or require a small catheter in a peripheral vein but provide
`a continuous monitor of blood ammonia levels. Such
`methods could alert medical staff to an impending
`hyperammonemic condition and would more easily permit
`earlier
`selection
`and
`regulation
`of
`therapeutic
`interventions.
` Two promising methods…are under
`development....
`(EX1022, S15.) Barsotti’s “Consensus Statement” proposes that “[b]oth the
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`plasma ammonia level and the clinical picture should be considered when choosing
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`therapy” and “[a]n elevated ammonia level during a clinic visit in a patient without
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`symptoms, however, does require adjustment of therapy or better compliance with
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`the recommended treatment regimen.” (EX2025, S3.) Barsotti notes only that
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`“certain centers” are moving away from using plasma ammonia (EX1022, S19),
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`but still describes the continuing importance of plasma ammonia levels.
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`26. While Blau and Broomfield do not specifically discuss drug dosing,
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`they also note the importance of plasma ammonia levels. Broomfield discloses
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`that “[p]lasma ammonia can be used both as part of diagnostic investigations and
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`for monitoring of efficacy of treatment.” (EX2015, 73-75.) Blau provides
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`information on the proper condition for obtaining plasma ammonia levels
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`(EX1006, 268.) and notes the need for “frequent monitoring during treatment.”
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`(Id., 262.)
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`10
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`I also disagree that the ’157 Publication discourages reliance on
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`27.
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`plasma ammonia levels. Indeed, the ’157 Publication discloses an embodiment
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`which includes the step of “adjusting dietary protein and/or drug dosage as
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`appropriate based upon measurement of blood ammonia….” (EX2012, [0134-
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`0137]; see also id., [0127-0131].) The ’157 Publication also has claims directed to
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`improved plasma ammonia control (e.g., claims 19 and 29). (EX2012, 47-48.)
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`28. While Lichter-Konecki states “that random values for blood ammonia
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`are of limited utility,” it goes on to immediately state that “ammonia levels should
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`be drawn at a constant time in relation to meals and medication for monitoring of
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`treatment.” (EX1017, 328.)
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`29. Likewise, Lee notes that variability in plasma ammonia levels over
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`the course of a day but also recognizes the “clinical importance” of plasma
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`ammonia levels. (EX1010, 226.) Further, while Lee states using urinary PAGN is
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`still “preliminary” and “deserves further exploration,” it does not disclose that it is
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`a replacement for plasma ammonia levels. (Id., 226-27.)
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`30.
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`In sum, I do not consider the prior art to teach away from using
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`plasma ammonia for making decisions about dosing nitrogen scavenging drugs,
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`like GPB.
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`11
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
` CONCLUSION
`31.
`In sum, Dr. Enns’s testimony about the prior art does not change my
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`conclusions regarding the ’966 patent claims based on the discussion above and in
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`my Initial Declaration. Therefore, it remains my conclusion that a POSA would
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`have successfully arrived at a method of treating a UCD using the claimed
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`methods.
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`12
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`IPR2017-01769
`Patent No. 9,326,966
`Reply Declaration of Neal Sondheimer, M.D., Ph.D. (Exhibit 1028)
`I hereby declare that all statements made herein of my own knowledge are
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`true and that all statements made on information and belief are believed to be true;
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`and further that these statements were made with the knowledge that willful false
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`statements and the like so made are punishable by fine or imprisonment, or both,
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`under Section 1001 of the Title 18 of the United States Code.
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`Dated: August 15, 2018
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`By: __________________________
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` Dr. Neal Sondheimer, M.D., Ph.D.
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