BMY thinks Milvexian can become a $4B drug by the end of the decade, according to today’s webcast and slide presentation (#msg-166786099). Milvexian has potential in both venous and arterial anticoagulation, which is something the FXa inhibitors, such as Eliquis, do not have.
Milvexian is an oral inhibitor of Factor XIa being co-developed by BMY and JNJ (#msg-140083631). For BMY specifically, Milvexian is the company’s hope for replacing Eliquis revenue when Eliquis goes off-patent in 2028.
In the trial reported today, Milvexian + Plavix/aspirin was compared to Plavix/aspirin alone at five different Milvexian doses. Despite the lackluster results, which include a flat dose response, BMY/JNJ have committed to a phase-3 program for Milvexian in three indications: secondary stroke prevention; ACS; and primary stroke prevention in patients with AF. The phase-3 trials are slated to start by year-end 2022 (see slide #13). Curiously, the three phase-3 indications do not include either of the indications tested in phase-2, which are treatment of acute ischemic stroke (see above) and VTE prevention (#msg-166773814).
The main competition for Milvexian is Bayer’s Asundexian, another oral FXIa inhibitor that just started phase-3 trials in AF/stroke prevention and treatment of acute ischemic stroke (https://www.businesswire.com/news/home/20220828005030/en ).
BMY has pegged Milvexian is a $5B+ opportunity (not risk adjusted—see slide #20), but this seems optimistic in light of the dataset released today.