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I've watched quite a few of these presentations over the years but have never seen an analyst (Ken C. of Cowen) so enthusiastic. Makes me worried that his company is getting some business soon.
I did a little looking but found nothing more than there are a LOT of the HLA types. Seriously though, it appears HLA-A*0201 is probably way more common (and still less than half - my guess) in HBV patients of European descent. Much less so in Asia/Africa.
You can go search pubmed (what I did) and see if you get the same impression.
DTIL: Not me, but something prompted me to look it over a few months back when I bought a little as a reminder to investigate further. Otherwise, I would forget about these little bios. I hope my instinct was right.
I know that should do a lot more homework before I waste your time on this discussion. Can you go right to NASH without tagging NAFLD? Would you call nascent NAFLD a treatable disease, with appropriate lifestyle modification?
I agree that once you have advanced fibrosis, lifestyle changes will probably do little to nothing for it.
I appreciate what ENTA has been able to do in virology. I like that they have other programs ongoing as well. But I have concerns that a lot of money is going to be wasted, across the pharma/biotech landscape, going after NASH. When I look at a list of drugs currently in trials for NASH, my mind swims with the variety of approaches being pursued (at least 15, maybe 20 or more). It tells me that there's no great consensus about the class of drug(s - for combinations) of the eventual king(s) of the hill.
Philosophically, what would patients do if you told most of them that they could get positive resolution of a cancer diagnosis by changing diet and exercise habits (maybe relatively radically)? I think they would do that. I think society has a right to ask people to do that, first. We'll have to make difficult $ allocation decisions in healthcare in the not-to-distant future. Why do all of these drug companies think that you and I will always be there to pay dearly for a disease that has other ways of mitigating/resolving it (in many cases)?
I'm sure this type of discussion will bring me some heat. I'm not trying to start a discussion about personal responsibility, but venting about the assumption that the money trough will always be open for pharma to treat lifestyle (NAFLD->NASH only fits partly) diseases.
So, I'm not happy that ENTA is starting over on this expensive quest for a possible sip at that trough in the distant future.
Do these insurance co's typically trade at such a discount to book?
How do you reconcile the multiple you pay for that growth compared to competitors? There's no argument that it's loved by the "street."
I'm curious as to what metric makes this stock cheap in your eyes. Thanks, Dew.
Way too simplistic in my opinion. Let's just entertain that's all I care about. Why shouldn't I expect to hear a rationale from management about why it makes sense to develop this drug?
I love to see drug dev companies err on the side of cutting off potential dead ends too early.
ENTA: Unless they can lay out a solid argument/scenario for success, given the other potential (and further along) NASH therapies on the market, then they really need to do what's right for shareholders and drop this effort. The stock immediately recovers 10 points at least.
I love biotech on days like today :)
Glad they are building the projects. However, the idea of developing electricity projects, without concern for fairness in a regulated energy market, is bothersome. Dominion Energy gives them opportunities (Walmart, Google, etc as well) to play mini independent merchant generator that it doesn't give others. Heck, it then probably resells that power to Dominion customers with a green premium to how it nets out AWS electricity bills.
Also, if you really want to act like you've got a big brain in there AMZN, then you need to match the daily shape of this power production to the shape of your demand. Not just be a contributor to the shape mismatch problem.
I'm pretty sure that you don't believe that would be a smart use of capital.
I guess it makes sense, more than a dividend would, given there isn't the organic cash flow to sustain a decent dividend past the three year term of the buyback. I just hope they see it as the best available investment and not some share price or EPS strategy.
FGEN subject to remaining overhang of doubt regarding MACE data (+adcom). Then on the business side, it remains to be seen 1) if FGEN can access the NDD patient population and 2) if/how China will cover roxa for patients. Just my quick thoughts.
After looking at the news, I figured some trading desk fat fingered the symbol and put a huge order in via algo- fire and forget. I couldn't figure out what symbol they might have intended, however.
Isn't Davita one of Buffet's trading heir-apparent's favorites? I think it's Ted Wexler or something.
I just got around to reading through this deck, DD. Lots of familiar things, but I was still wowed. Very clear, non-promotional, and leaves you feeling that you can buy their pipeline for free practically.
Feel free to answer none of these questions, I realize that maybe you've covered them dozens of times.
Why can't RSV development go faster? There have to be plenty of potential trial participants, and the trials should be short, no?
Just thinking off the top of my head, the economic case for 938 should be easy to make if it can reduce hospitalization in a meaningful way.
Looking forward to NASH results, although they are only measuring ALT. Can you remind me why they went from NAFLD to NASH for P2?
LGND: Yeah, the cash to mkt cap ratio is pretty amazing for a company that generates decent earnings. You typically see that in companies that haven't sniffed a positive EPS.
I have a personal experience (grandfather) with the deleterious effects of contrast agents, given our healthcare system's overuse of imaging (since it's incented). He had kidney impairment due to multiple administrations of contrast agent over the years. Had a fall off a ladder, broken elbow and pelvis, emergency room docs imaged for bleeds. Would have recovered if non-damaging contrast agent available years earlier or doc's had held off on contrast that time. Ended up in ICU for kidneys, eventually on dialysis, infection, gone.
Stock bounced off upper 80's back in 2015/16 and has never been that low since. Seems to earn double what it did back then, too.
I forgot to ask the board last time if anyone knew this Lemelson Capital that seems to have an axe to grind with LGND. Checked out their website and "unprofessional" is the nicest way I can describe them.
LGND - I'm not sure what to make of their business model. Clearly, it's carried a higher multiple in the past than it does today. It's not a roll-up operation (ugghh), but it does seek success in more numerous ways than typical biotech. Way less capital intensive ways it appears. However, the very early stage investments, with wildly uncertain payouts, make it difficult for an investor to try to value it.
I'm intrigued because I recognize my own predilection to swing for the fence, and I'm discouraged because there's no homer possible in the near term.
Anyone else thought much about LGND?
Dew, I must have misread what CoolTone does. I thought it was the equivalent of one of those old muscle stim via electrodes, for inducing increased muscle "tone". I didn't think it had anything to do with fat reduction.
Thanks for taking the time to share all of those thoughts. I'll confess that I had never internalized how sick folks are with eGFR < 15. Your predictions make a lot of sense in that light. Do we know what the average time spent with eGFR <= 15 is, before dialysis is started? Anemia is not your biggest problem at this stage, is it?
Anyway, am I wrong in now concluding that roxa's MACE benefit is right where you would expect (hope) it to be? Prior to kidney failure (15 < eGFR < 60) and also during incident dialysis.
I can't help but come away more positive on roxa after another think through. Maybe I'm forgetting some details of the results presented in early May.
That was dewophile's thesis, not mine. Mine was concern over lack of credibility RVNC has with investors/traders and the possible causes.
I do wish that they weren't spending money on PF trials. I'll be proven right or wrong in time, but why not choose only indications that Botox has had success in before moving on to new territory. Dysport was tried in PF without success and RVNC's 2a was unsuccessful IIRC.
Anyway, I'm long but always wondering if why I don't look like the smart money more often than not.
AGN/RVNC: AGN CEO on Mad Money last night. Cramer had plenty of opportunities to ask about competition from Botox challengers. Instead he wrote them off with a hand wave and a remark like "I just don't see them anywhere [or becoming anything or something]."
Yeah, he's kind of a suck up, but not a total pushover. RVNC's CEO was on MM last year too, so Cramer is familiar with the company. I really don't care what Cramer believes, but clearly he isn't the only one. While the market hasn't liked AGN much in the last couple of years, clearly some participants don't hold out much hope for RVNC either. RVNC started it's descent from the highs much earlier in 2018 than the XBI or IBB so you can't say it's general biotech malaise.
What is the bear thesis? Therapeutic indications, where most of Botox is used/sold, will require much more funding for RVNC? Botox will burn the ship to the water line on price to retain market share in aesthetics to prevent RVNC from funding itself on those sales in the meantime?
Thanks Dew. Wow, 63 study sites recruiting. Trial started 4/2018. Difficulty averaging 2 per site?
Why do you think they opted not to do the biopsy, when other NASH hopefuls are?
Any idea what the size of the NASH study is supposed to be? It's currently running and not set to report until 3Q2019. For a 12 week study, do you think they worry that they might need to enroll up until May or June?
Also, do you know if they're doing biopsies in this study?
Hey DD, have you ever spoken to the difficulty of unseating a very entrenched incumbent (AGN/Botox) with respect to RVNC. I wonder what your thoughts are. I realize that there are a few differences with RT002, as this is a product not paid for by insurance, but can AGN employ tactics that slow RT002 uptake (ala ABBV/Humira and others)? Or are those games enabled by our convoluted drug payment system?
RVNC's valuation seems completely mis-aligned if they can take even moderate market share from Botox.
Or is my thinking off base on this? Thanks.
Disclosure: Long RVNC
Results as early as July or late as Sept 2019. Is it difficult to enroll for this type of trial?
Maybe I'm just eager for more news flow, but what takes so long in this trial? Thanks!
I think AMGN reported sales of $1.2-1.3B for EPO in 2017 on total sales of ~23B. So, a gradual 5% total sales bleed starting next year maybe. Probably will be lost in the noise.
The reporting is weird but no dose response evident in log HBsAg reduction. Haven't we seen similar (if not better) results over the years that don't pan out?
But hey, I'm an amateur at this.
Re: RVNC PF
Advancement to a 2b is the absolute wrong goal for shareholders in the long run. A successful outcome of a well designed trial is my preferred goal.
As I've said before, I've never liked the PF indication for RVNC's drug (or any drug for that matter). Too difficult to diagnose correctly.
RVNC: If that happens, I would hypothesize that at least one of the results is less than hoped. PF is an infuriating condition to treat.
10% growth before price increases?
It's a tough condition to diagnose in my n=1 experience. Many visits to specialists who were convinced it was PF, only to have it be tarsal tunnel syndrome (I think).
I wonder how much risk there is related to getting the correct diagnosis for inclusion in these studies?
So the analyst who wrote this "report" (ahem) receives compensation based on the volume of trading in this security at his firm. Glad I skipped right to the appendix as usual.
Is this index biased towards urban areas? Small/med town and rural Virginia certainly nowhere near those levels.
Was that a jab at me? Hey, I did say public/private partnerships. :)
I'd rather the government was the silent/stay-out-of-the-way partner.
Pensions, insurance have problems at 2% and much more as zero approaches. Time for fiscal stimulus is overdue. We need an overheating economy if we can generate it.
What's the flaw in gov't borrowing at these low rates to fund public/private partnerships for infrastructure development? It would seem to me that the money would go to the workers in this country who would spend a good percentage of it.
Thanks Dew. Are P2-like results from the first P3 (readout in Aug16) sufficient for approval in the U.S.? I assume the exploratory studies are for possible market expansion.
It appears pricing is around $3k if I did the math right (big if). It wasn't clear from the slides whether retreatment is likely/possible/necessary.
CT