Despite the recent launch of congenital adrenal hyperplasia (CAH) drug Crenessity, Neurocrine Biosciences' disappointing sales forecast for tardive dyskinesia (TD) drug Ingrezza commanded much of the investment community's attention after the company revealed its full-year 2024 results last week.
With $615 million in fourth-quarter sales, the 2017-approved drug missed William Blair's expectations of $621.9 million, the firm's analysts wrote in a Friday note to clients. Furthermore, Neurocrine's lower-than-expected 2025 guidance for Ingrezza—a range of $2.5 billion to $2.6 billion—left investors puzzled and shares spiraling.
By the time Friday trading had ended, investors sent Neurocrine's share price down by about 18.5%.
So, what happened? According to the company, the Ingrezza guidance reflects slower growth expectations heading into 2025 amid new competitive pressures, chief financial officer Matt Abernethy said on the company's conference call. Other factors, such as the “increasingly complex payer environment,” are playing into the situation, as well, according to chief commercial officer Eric Benevich.
Considering Teva’s extended-release version of Austedo won a key approval in 2023, ramped-up competition in 2025 is something the team at Evercore ISI had anticipated. Even so, this year’s first quarter “likely won’t be pretty,” the analysts warned in their own note to clients.
Teva’s Austedo guidance for 2025, at $1.9 billion to $2 billion, currently stands lower than Neurocrine's Ingrezza range. While “both brands are doing quite well,” according to Neurocrine CEO Kyle Gano, Ph.D., the chief exec expects that Ingrezza will continue to clinch the market-leading position despite Teva’s Austedo XR push.
In 2023, Ingrezza won its second indication in chorea associated with Huntington’s disease, putting the rivals on more even shared ground after Austedo’s own nod for the disease in 2017.
Last year, Neurocrine launched a sprinkle formulation of its drug for patients who have difficulty swallowing, bolstering Ingrezza's “strong, clinically differentiated foundation” that can support growth throughout the decade, according to Gano.
With fewer than 10% of the 800,000 TD patients in the U.S. currently treated with VMAT2 inhibitors, Ingrezza still has plenty of room to grow throughout the next 13 years of its market exclusivity, Neurocrine execs stressed.
Efforts to address the competition, boost treatment numbers and educate patients and doctors are already underway through direct-to-consumer advertising and a sales force expansion that should make an impact in the second half of 2025, Abernethy said.
All in all, Ingrezza pulled in $2.3 billion in 2024, making for an “all-time record growth year” for the drug, Benevich noted. Teva's Austedo, meanwhile, collected $1.6 billion in sales last year.
Crenessity launch update
While Neurocrine navigates tough competition for its flagship drug, the company has a new market opportunity to unlock with its newly approved Crenessity.
Crenessity’s market entry marked a breakthrough in CAH treatment, as the drug in December became the first approved therapy for the genetic disorder in over 70 years. Although launching the drug is “not without challenges,” the company is confident that Crenessity can eventually become Nuerocrine’s second blockbuster, Gano said.
There is “significant potential” in the CAH market, but making a billion-dollar product out of Crenessity will require a significant patient and clinician education campaign that will likely take time, William Blair analysts explained. The company is already locked in on this goal and is actively engaging with endocrinologists to help educate the patient community, Benevich noted.
Since its December approval, the drug contributed $2 million to Nuerocrine’s full-year revenue haul of $2.35 billion.