Idiot bears will be mauled by Arikayce lion
Expert Call (with Notes) Suggests Potential for
We spoke to a Pulmonologist who has prescribed Arikayce to ~12 patients to
date. Key highlights from the call include:
o Arikayce Sales Likely to Continue Climbing Near Term. We have
received a number of calls lately inquiring whether we think Arikayce sales
will level off this year as new starts are offset by patients discontinuing
treatment due to side effects or lack of response (bears assume duration of
treatment of ~6 months for patients that don’t culture convert; ~70% of
patients in the Ph3 did not culture convert by month 6). Our recent expert call is consistent with feedback from our Q2 Arikayce survey, which suggests this
bearish scenario does not appear to be playing out. The KOL has ~12
patients on drug today and plans to start at least 6 more patients in 2H19,
supportive of continued strong uptake of the drug. In addition, he expects
patients will remain on therapy at least 12-18 months. Interestingly, he plans
to use Arikayce as long as needed/indefinitely in patients that do not culture convert in the first 6 months, provided the drug is well tolerated. From his experience, the drug has had a reasonable safety profile and only 1 patient has discontinued treatment (the discontinuation was not related to safety or lack of efficacy; this is another datapoint supporting our view that Arikayce has been much better tolerated in clinical practice relative to the Ph3 trial experience). He does not expect reimbursement of the drug for LT treatment
will be an issue, citing Arikayce access has been much better than expected.
o Arikayce Could be a More Chronic Drug Than Expected. Our expert
indicated that, in his view, there is no such thing as a ‘cure’ for NTM MAC.
Many patients have scarred lungs, which makes them prone to infection;
even if patients culture convert, the disease likely will recur as the pathogen
is ubiquitous and patients’ original lung damage makes them susceptible.
Once treated, patients do not often leave the treatment loop, which could result in Arikayce sales exceeding our and Street consensus over time