Replies to post #171587 on Biotech Values

[JohnWayne]

I don't have the share numbers, but a good analog to consider would be Tasigna (bid) vs. Sprycel (qd) in second line CML. The biggest problem with this analog is that, IIRC, Tasigna launched substantially after Sprycel.

A more fundamental problem with looking for an analog, which I think Dew has spoken to before, is that we're talking about, in the scheme of things, a very short treatment duration, while compliance is usually thought of more on terms of chronic diseases. So while compliance might logically be worse for ABBV/ENTA, I don't know how important this will be to prescribers or payers, especially given how hard it would be to actually prove a difference in compliance between regimens.

[biomaven0]

>>unknown is how to model it

Obviously we are missing two key unknowns - how much impact there is on SVR with reduced compliance and just how much there would actually be in the way of non-compliance. The latter depends a lot on population I would think. In general attempts that I am aware of to try to show QD produces significantly better compliance than BID have failed - in fact I am aware of a trial of a beta blocker where compliance with BID was actually numerically better than with QD.

In CML, the dramatically different outcomes between trials and "real-life" show that long-term compliance is indeed a significant issue. But in that case we are talking years rather than weeks. Transplant patients typically manage around 90% compliance over long periods.

So maybe in reality the crucial issue is whether doctors will believe (whether accurately or not) that the pill burden will affect compliance.

When there are multiple pills to be taken with different frequencies then the opportunity for screw-ups is obviously greater. If Abbvie were smart they would do a Z-Pack type packaging - blister packs with what pills you have to take when marked on them by day.

Peter