Drugs in the brand-new tardive dyskinesia treatment zone—Neurocrine’s Ingrezza, in particular—may have better sales prospects than Wall Street now thinks, if one firm's temperature-taking among doctors proves out in script numbers.
After parsing the results of a survey of 50 doctors—a group comprising 27 neurologists and 23 psychiatrists—Leerink Partners analyst Paul Matteis took his Neurocrine sales expectations above consensus for this year and next. And he now expects Ingrezza to pass the blockbuster benchmark by 2023.
Why? Physicians who have already prescribed Ingrezza or Teva rival Austedo, which regulate dopamine levels by inhibiting the VMAT2 protein, “expect the proportion of TD patients within their practices that are receiving a branded VMAT2 to triple during the next ~24 months," Matteis said in an investor note.
The surveyed doctors also figure that more than half—53%—of TD patients are “candidates” for the new meds, up from the 42% a previous survey tabbed for treatment.
“A glass-half-full take on the survey results would be that physicians have become more sanguine on the VMAT2 category after gaining prescribing experience,” Matteis noted.
An expanding market would be good news for Neurocrine and Teva, which won their TD nods in April and August, respectively. The go-aheads made them the first-ever FDA-approved meds to treat the involuntary movement condition.
But it’s Neurocrine that stands to make bigger gains, if Leerink's numbers are any indication. Surveyed doctors projected a market split in Ingrezza’s favor—66% to Austedo's 34%—once the meds reach peak penetration, Matteis said. For any given survey metric—including efficacy, safety and convenience—about half of the physicians saw no difference between the two meds, but “for those with a preference, Ingrezza was consistently the product of choice,” he added.
When looking only at psychiatrist’s responses, things were even more skewed toward Ingrezza. They forecast an 80-20 market split compared with neurologists’ 56-44 guess; that gap could stem from the fact that neurologists have more experience with Valeant’s Xenazine, a med that's laden with black-box warnings. Austedo competes with that drug in its other indication for chorea associated with Huntington's.
The neurologists “therefore may be more comfortable with the safety of Teva’s Austedo (or less concerned with its black box),” Matteis posited. Meanwhile, he sees an additional reason to feel rosy about Ingrezza, and that’s the med’s prospects in Tourette’s syndrome. While phase 2 trials have delivered “somewhat mixed” results, Matteis is optimistic that Neurocrine’s next study, which could read out later this year, “has a decent shot." He’s pegging the chances of successfully snagging an approval in that disorder at 50%.