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Actually Monk I've been buying AMRN. Last purchase
North. Unless AMRN gets some relief from the courts in the US ( reversal of judge Du's decision , restraining generic infringement etc ) ...the US market is going nowhere. Break even at best because AMRN will be very unlikely to spend $ expanding this market .
So that leaves the EU where we now have patent protection until 2039 ( from memory ) One approach to gain access to Germany , Italy and France is to engage those Health Depts in a short trial for a specific sub group where the economic benefits of risk reduction can easily be quantified.
Consider that " out to lunch " if you like but in the mean time what your ideas for gaining market share in these 3 key EU markets ...the same ol same ol ?
Kiwi
Capt. I linked data from the supplemental section of the Revasc analysis but it didn't format easily ....If you look you will see a dramatic reduction in needing a repeat revascularisation for those on Vascepa
Kiwi
Capt https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050276
The risk reduction ( and therefore potential cost savings ) in this subgroup is dramatic .
The event lines separate very early and separation is very evident at the 3 yr pt.
Yes we would need buy end to some extent from the Health Depts in Germany , France and Italy.
My understanding is that CAD patients are a lot more adherent to taking their meds after being admitted for a CV event .
Recruiting should be a lot easier and quicker then R-IT since theres a lot of followup with these patients in the first months following a PCI
Analysis Event (%) Rate/1000 pt-yr
Event (%) Rate/1000 pt-yr
Coronary Revascularization
1st occurrence event 376 (9.20) 22.50
544 (13.30) 33.67
2nd occurrence event 66 (1.61) 3.77
3rd occurrence event 14 (0.34) 0.80
130 (3.18) 7.57
38 (0.93) 2.19
Kiwi
Capt. I was thinking of a short trial for a specific subgroup recruiting recent PCI patients in Germany , France and Italy.
This would require the co operation of the health depts of those 3 countries . Say 1,000 patients in Germany with 500 each from France and Italy . .
Unless theres a change in the US regarding generic infringement ...reversal of Judge Du's decision etc the US market is break even at best .
Because of the patent extension in the EU ...it's IMHO the only market we should spend $ developing at this time.
To do that we need a buy in from the 3 major EU health dept markets mentioned above.
Why focus on Revasc rates following a PCI ?
Because it's one of the sub groups with the largest risk reduction and the economic benefit of this risk reduction is easily quantified.
Example ... assume there are 20,000 revasc cases following a PCI each year in Germany , Italy and France combined ...at an average cost 10,000 Euros each case ( less expensive then in the US ) = 200m Euros each year in cost to these 3 healthcare systems combined.
If SOC plus Vascepa reduces that event rate by 25% vs SOC alone in this patient population thats a savings of 50m Euro's .
Would this 50m Euros savings cover the cost of providing all PCI patients with Vazkepa following their initial PCI procedure ?
I don't know ...I'm just using this as an example of how AMRN could use a small focused trial like this to gain access to these markets ...assuming there was at least a 25% risk reduction in revasc rates
I'm not thinking of a rerun of the Reduce It trial . Simply a small focused trial in the 3 EU markets we need access to .
JMO
Kiwi
RMB as a follow up re acquisitions . Acquisitions happen for several different reasons.
Some Co's may have excellent P 2 trial results but are unable to fund a final pivotal trial(s ) needed for FDA approval or simply receive an offer to good to refuse from a larger Co. ...recent sales of Co's developing drugs for IgaN ( kidney disease ) for instance
Other Co's like UNCY are not set up to launch the sales of their drug and will almost certainly look for a buyer if their final trial succeeds....same with TLPH .
AMRN is an economies of scale situation ...as presented in Denners sales pitch .
NVS has the economies of scale
Kiwi
RMB. Denner's argument is economies of scale . A pervious poster had linked the pages in their presentation .
NVS has economies of scale because they already have a sales force in the EU promoting Inclisiran ( their PCSK9 ) for CAD patients .
IMHO the ideal combination for CAD patients is Inclisiran plus Vascepa .I wish Kaiser would allow me to do it .
Inclisiran is 3 shots for the first yr and 2 shots per year after that ...dramatically lowers LDL cholesterol ...done in a clinic. .
First shot would be at annual physical so after that its just getting the patient back 6 mths later for their second shot .
Likely far better adherence
The problem with Statins is that roughly 50% drop them after the first year ( so adherence is poor ) and theres an increased risk for diabetes.
PCSK9's like Repatha that I'm on ...require a trip to the hospital pharmacy once a month ( can't be shipped as its refrigerated ) and relies on my rather poor ability to self inject myself ( sub Q ) every 2 weeks.
So replace Statins and the other PCSK9's with Inclisiran and Vascepa ...both sold by NVS. .
But NVS will want AMRN to get full EU reimbursement in place first ...which so far AMRN has failed to do .....and we await details on Wed as to any plans they may have in that area to be divulged .
Kiwi
So AMRN sees no benefit in even doing a fairly short ...say 3 yr revascularisation trial like the following ..especially in light of the EU patent extension.
Irishpaddy ...well at least we have one thing in common .....I worked in sheep shearing gang in my youth .
Hope U sold a big chunk of your AMRN after posting this
Irishhpaddy
Irshpaddy ...I expect the share buyback to go through . As regards UK regulators concerns ,a simple search would have shown you the following
Here are some key points on how UK regulators view share repurchases:
Thx Jas .Saw the Eagles live just after Hotel California was released in Ca . Best live concerts ( at least very memorable ones ) ...to date myself ...early Led Zeppelin ( Royal Alpert Hall London ) ..early Rolling Stones in NZ
Kiwi
Capt. excellent work
thx
Kiwi
JR. I assume you have a background in business .
So how do you think AMRN can get reimbursement for Vascepa in Germany , France and Italy . Without such reimbursements in place I doubt any Big EU Pharma is interested .
Kiwi
Dar. I have very limited understanding on the differences in buy backs in the UK vs the US ..
I think UK regulators take the view that Mgt and insiders are the ones who benefit most from share buybacks . Banks are often against them as it reduces working capital . The idea of using share buybacks as a way to boost a low stock price ( which is what the aim appears to be here ) is frowned upon in the UK.
Mgt and insiders can't buy back stock in a period before earnings release ...so if Sarissa is buying more stock they would need to wait a week .
Above is just a quick review of UK regulations
Short term ( as a trade ) I hope it goes thru .
Long term ( as an investor ) I think it's a dumb idea . The $50m would be better spent on doing whatever it takes to get reimbursements under way in Germany , France and Italy especially now that we have EU patent protection out an additional 8 yrs ( from memory )
Kiwi
CBB. No EU pharma co is buying AMRN without a realistic plan to get reimbursement in Germany , France and Italy.
So far AMRN has failed to detail such a plan .
Maybe they will at the May earnings report.
NVS is the most obvious EU Pharma ...especially now that the EU patent life has been extended .
So can Sarissa buy more shares before the buyback ? Doesn't this have to be approved by UK ? regulators first and therefore wouldn't they have inside knowledge of those proceedings ???
Kiwi
The benefits of diversification
I have positions in UNCY , RZLT ( sold half recently up 100% ) and TLPH ...plus a little AMRN cos I'm an idiot and take their drug Vascepa
So the gain in TLPH today outweighs the loss in RZLT and UNCY .
Now if I could just get all 3 heading higher ...:--)
Kiwi
Well they may have finally got their pivotal trial underway ( was delayed due to hospital site admin delays ) ...stock up on heavy vol
Kiwi
Unfortunately this has turned into one ugly chart for a Co about to release results of an Open Label trial .
I still hold a small position ...ala bet only what you're ok with losing .....but not as gung - ho as I once was.
Kiwi
Well Capt I'll be interested to see what mgt says during the earning release CC on their plans to gain reimbursement in Germany , France and Italy .
Hopefully they will provide details and a time table .
Thx for your charts etc . They clearly demonstrate the risk reduction especially in certain sub groups .
When you look at the cost of revascularisation following a PCI .....The savings to health depts would be substantial even if you reduced RR by only 25% ( to allow for possible overstatement of benefit due to placebo used in R-IT)
Well since you have an email relationship with Denner ...ask him why Germany is not onboard .
Kiwi
RMB. This is what Germany wants
Ram. I agree that we are very unlikely to see another EPA trial the size and length of R-IT .
A trial of a high risk sub group ...say 2,000 PCI patients followed for 3 yrs for rate of re vascularization ? What's the patent life in the EU now with the new extension ?
If thats what it takes to get reimbursement in Germany and France it might be worth it . At least more / larger RWE studies.
Well the quick answer is that those EU health depts that wasted tax euros reimbursing a drug with no CV benefit ( Omacor /Lovaza ) came under a lot of criticism .
So many now want independent confirming data
Kiwi
Ram Why do I have problem with the buyback . Short term its a win , long term a waste of $
So my plan is to accumulate under $1 ...if the buyback pushes the PPS over $1.50 ...I"ll sell ( 50% return ) unless I see them making concrete plans to increase the level of evidence that Germany and France will likely want before reimbursing.
Why risk a trial ( even a small one in a select subgroup ) and risk a different result ...because without that independent trial many in the Cardiology community remain unconvinced.
There were at least 13 independent trials confirming risk reduction of Statins
At least 3 for PCSK9's ...
Germany has always wanted independent placebo controlled trials before reimbursing CV drugs ...at least in recent years . If you aware of a CV drug reimbursed in Germany based on 1 double blinded trial , please post it
Kiwi
RMB. I think it was this trial. The results of the
So here's an example of what these AMRN guys / girls are getting
RE your view
Re
Nope. High TG's with high LDL was a known risk factor . Lovaza was the go to, to lower high TG's . Problem was it raised LDL levels significantly for some.
HeFH patients such as myself often also have mixed D ( High TG with low HDL ) . I couldn't take Lovaza because my LDL was still around 180mg/dl in max dose Lipitor .
My TG's in the low 200's .
So ...back in the day of the Anchor SPA ...we were waiting for AMR 101 ( now Vascepa ) to be approved for reducing high TG's without raising LDL cholesterol .
I think it was a Co called Reliant that developed Lovaza and sold it to GSK ....this is before we found Lovaza did not reduce CV events .
So if the Anchor indication had been approved ...AMRN would have existed as an alternative for those that couldn't take Lovaza.
Omacor ( Lovaza in the EU ) was big business in many EU countries , especially Spain that reimbursed generously for it .
Kiwi
I posted this on biotech values board last week
We are up 189% over the last 3 mths . To reduce exposure after this run is simply good risk management .
A large enough sell order to reduce exposure ,can trigger a cascade of stop loss orders .
Market will be looking at near term P2 DME data as next major catalyst .
JMO
Kiwi
LS. as a follow up . Renvela is also swallowed but most require 2 pills ( fairly large ) with each meal.
OLC ( Lanthanum ) is far more effective at lowering serum pho
https://unicycive.com/wp-content/uploads/2023/05/Renazorb-Phosphate-Binders-Daily-Medication-Volume-Poster.pdf
Kiwi
LS. good question
My wife prescribes a lot of Sevelamer (Renvela® or Renagel®) largely because its what the issuers will cover . Her patients hate the drug and most are nowhere near serum pho goal .
Those who absolutely refuse Sevelamer , she will go thru the prior authorization hurdles for them to get Fosrenol ( which I believe costs more ) .
If a brand pho binder that patients will take ...1 small pill with meals , swallowed , is approved and the copay is affordable , the thinking is that more Nephrologists and patients will push for it.
The current SOC re pho binders is a failure . 85% of the roughly 400,000 US dialysis patients on these SOC binders are nowhere near pho goal because of pill burden and taste .
Note ...the existing Fosrenol generic is CHEWED ( or in powder form ) Patients hate the taste. The OLC bio equivalent is SWALLOWED .
I don't have a clear idea on pricing , rebates etc except they need to make the copay affordable ...something ARDX did not do with their Xphazoh.
But first they need their final " tolerability " trial to succeed.
Kiwi
Ram. interesting pt of view .
Mine is summed up as follows
UNCY ...my pitch
First this is a risk only what you can afford to lose spec. Trial failure ...to many dropping OLC due to side effects especially nausea and PPS will be at least cut in half ...JMO
Upside potential ...for what it's worth
Disagree re reminiscent of Statins .
I've been on them all since late 1986 ( the first Mevacor was approved in 1987 )
In 1986 I was a " Lab rat " at UCSF ...denied health insurance due to family history of heart attacks .
UCSF provided some coverage provided I'd be in their CV trials ...was on the first statin for about 6 mths as part of a safety study before approval .
Back then AST /ALT Liver tests very mth .
Biggest change was the introduction of Lipitor. ....first high intensity Statin
Kiwi
Todays action is what I'm looking for ahead of trial results .
Upside swing on increased vol .
I added back some this AM
From Piper earlier in the mth
RMB. OLC is the bioequivlent of Fosrenol ( Lanthanum Carbonate ). . My wife has a few patients on Fosrenol .
The history with Lanthanum is roughly as follows ...from a large trial in China