Replies to post #248435 on Biotech Values

[WorstLuck]

Thanks for the post, very informative. Appreciate the detail.

Some of your points and jbog's snooping raise a question related to the cosmetic side, which I will raise here because it ties into your commentary and not because of your practice.

jbog reported about 50% favorable online. My hypothesis is that is probably not too far off what should be expected given the combination of patient expectation of a duration that in clinical trial is only reached by the median participant, combined with the psychological, so it is not unreasonable to see up to 50% unfavorable comments.

[DewDiligence]

A couple of my migraine Botox patients do great for 10 weeks and poorly the last 2 - real or imagined?

This effect is undoubtedly real insofar as there is a mechanistic explanation for what these patients are reporting. For most patients, the physical connections blocked by Botox begin the process of reconstituting themselves after about 10 weeks.

[vinmantoo]

Doc328,

Thanks for your knowledgable first-hand comments. They reinforce my view that the Q2 numbers aren't that important. What matters is how Daxxify will be taken up with time, and how approval in the CD indication affects uptake in that market.

Given the numbers you cited, does that mean your practice overall isn't very dependent on toxins for patient population and revenues?

[DewDiligence]

Has Revance ever commented about Daxi in migraine? My understanding is that Allergan/Abbvie still has an enforceable patent for that use.

RVNC is nominally working on migraine, but the program has been on the back burner for some time. ABBV’s migraine patent pertains to the injection protocol, so it wouldn’t impede RVNC’s use of a different injection protocol, which is something RVNC claims to be developing.

If it were up to me, RVNC would pass on migraine. The cost of running two phase-3 trials in migraine is pretty high because the sample sizes needed to overcome the placebo effect would be quite large. Moreover, the CGRP meds—especially the oral ones—present formidable competition. I’d rather see RVNC settle for whatever (modest) share of the migraine market they can get off-label than go all in.