Biotech Values

[DewDiligence]

Re: Migraine market for botulinum toxin

But not in efficacy.

Well, that’s where the heterogeneity of migraine comes into play. What constitutes insufficient efficacy for some people may be sufficient for others. Migraine is a large enough market that there’s room for drugs with multiple MoAs to garner meaningful sales.

Where I tend to agree with you is on the technical difficulty—and cost—of running two successful phase-3 trials, and this is why I’d prefer that RVNC leave this indication alone and simply take whatever off-label sales they can muster.

There is some argument that Botox…works via decreasing CGRP, and if that is correct I'm not sure there will be patients that fail a CGRP and work with a Botox-type drug.

Due to its lower cost relative to CGRPs, botulinum toxin will likely continue to be a first-line option for most patients who use it, so the presumed lack of efficacy in the second-line setting won’t matter much from a business standpoint.