Dermavant CEO draws Botox comparison to instill Vtama confidence amid slow psoriasis uptake

Dermavant CEO Todd Zavodnick isn’t concerned with the slow uptake of the hyped plaque psoriasis drug Vtama. He points to another breakthrough treatment which took a while to catch on: Botox.

“No one knew what it was. It was a poison,” Zavodnick said in an interview with Fierce Pharma. “We sit here (thirty) years later and it’s a (multi) billion drug between medical and cosmetic and no one saw it.”

Approved in 1989 for ocular spasms and cross eyes, Botox achieved less than $13 million in sales in its first two full years on the market and in 1991 Allergan acquired the drug and its company, Oculinum, for a mere $9 million. In 2022, Botox generated sales of $2.6 billion for cosmetic uses and $2.7 billion as a therapeutic.

Dermavant hopes for a similar trajectory for Vtama, which was approved in May of last year. As a groundbreaking nonsteroidal topical treatment, it has garnered blockbuster expectations. But sales are scaling slowly—from $13.7 million to $16.7 million to $18.4 million over this year’s first three quarters—compelling some analysts to temper their expectations.

Earlier this month, Leerink Partners slashed its 2032 projection of Vtama sales from $1.4 billion to $407 million. But Zavodnick cites metrics that point to Vtama’s eventual success.

In new patient starts, Vtama is outpacing every competitor in their launch trajectories by a 2 to 1 ratio, Zavodnick said. Vtama also has garnered 13,000 unique prescription writers for 255,000 units. It’s the most successful launch in the space in 20 years, Zavodnick added.

And it’s a space that’s tough to crack, especially compared to Vtama’s future indication for atopic dermatitis (AD), where Dermavant has posted data that virtually guarantees approval. The company expects the AD nod to come before the end of 2024, which will triple Vtama’s eligible patient population. It also will include children age 2 and older as opposed to its psoriasis label which only covers adults.

“Psoriasis was the gateway in our entry into immuno-derm. We know it’s crowded and we’re going to be changing a 50-year habit,” Zavodnick said. “AD is very different. You have children. You have parents that do not want their kid on steroids. They don’t want their kids on a black-box JAK or a black-box product.”

Additionally, with a chronic condition such as psoriasis, patients are less apt to make office visits, typically opting for prescription refills. With an acute disorder like AD, where patients have broken skin or hives, they are much more likely to come to the office as they are seeking immediate relief.

The groundwork the company has already laid, getting dermatologists up to speed on Vtama, will help facilitate its launch in AD.

“It’s not a matter of if, it’s when,” Zavodnick said. “Psoriasis got us to the dance and AD is gonna allow us to unlock the blockbuster, game-changing status.”