Biotech Values

[WorstLuck]

NVO LLY more to digest on the FLOW trial, FWIW via @Citrini7

Had a great call with one of my two channel checks in endocrinology (who I fully attribute my decision to get long NVO and LLY in 2022 to, he’s turbo smart) regarding novo’s FLOW trial and the effect it may have on CKD/ESRD/dialysis volumes.

His thoughts (completely anecdotal, this is just the opinion of a person who’s got experience in the area):

“Mounjaro/Ozempic are tricky w/ the kidney stuff. On one hand, the effect on DM2 and obesity comorbid HTN obviously is a huge +ve in terms of whether these patients end up in the dialysis funnel, however…

They also significantly dehydrate you, and while that’s manageable for compliant patients who increase their fluid intake, there will be those who don’t & end up taking this for quite a while. Chronic dehydration like that could result in patients who otherwise might not have ended up in the funnel. I’m seeing a lot of patients who already have decided they will be on these drugs forever. So there’s a double edged sword here.

Overall? I think I have to wait to find out more about the FLOW trial but it’s relatively consistent with what I’ve expected. There will be more headlines like this, some will be new discoveries re: direct alteration of disease states and some will just be the kind of obvious secondary and tertiary effects of not being obese (especially in heart health).”

Some other highlights in terms of anecdata:

-Ozempic is significantly more muscle sparing than Mounjaro (he has spoken to NVO about this, they are aware but not marketing on it), expects triple G drugs like Retatrutide will be significantly less muscle sparing than Mounjaro as well
-Some anecdotes about GLP-1s helping with lipodystrophy and cellulite
-Mounjaro is significantly better tolerated by nearly all patients with diabetes and prediabetes
-Very excited for CagriSema and bimagrumab
-Believes there will be a Pharma solution to Gastroparesis issue similar to the way Pharma invented new anti-constipation drugs for chronic pain patients on oxy prone, also believes GH & GHRH are potential pathways to alleviate muscle loss
-Sees CGM demand relatively unchanged, also sees demand from non-DM patients -Has had numerous DM patients w/ a total cessation of short acting insulin use. Very bearish on insulin pumps in general.
-Mounjaro caloric reduction in morbid obesity more significant than in obesity. Sees patients going from 5-6k/d to 700-800. Needs to recommend protein supplementation.
-Most common complaint is GI, although less so with Mounjaro. Telogen effluvium in about 20% of patients - has not seen any pt d/c Tx due to it though. Has seen no Gastroparesis patients, advises patients to stop taking it 4-6 weeks before anaesthesia.
-Believes effect on alcohol consumption is significant; but not on addiction to nicotine/illicit drugs.

If you’re qualified to weigh in, feedback is welcome. (please, for the fucking love of God, ask yourself if you are before you take to that keyboard. no more 27 year old finance bros acting like they understand medicine please, I’ve reached my limit)
12:33 PM · Oct 14, 2023
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