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Biotech / Medical : Biotech Valuation -- Ignore unavailable to you. Want to Upgrade?

To: software salesperson who wrote (5766)	2/27/2002 8:09:41 PM
From: Biotech Jim	Respond to of 52153

Though MTX is a toxic drug with a nasty label, one should not underestimate that it is a standard of care for the rheumatologist AND that they know how to use it. Very few primary care physicians treat RA or psoriatic RA patients. Although I am a believer in Enbrel and loaded up on IMNX when it was in the low teens, Enbrel IMO will not be that easy to switch over for more than 1/4 to 1/2 of the MTX patients. However, one must also factor into this the observation that many rheumatologists now have a business in the drug infusion arena. BJ

To: software salesperson who wrote (5766)	2/27/2002 8:33:10 PM
From: scaram(o)uche	Read Replies (3) \| Respond to of 52153

Really good stuff, thanks. You're certainly correct to focus on safety, and enbrel is looking pretty good. If a patient is P plus PA, a physician certainly could prescribe a new biologic that was only approved for P. >> solution: enbrel << My bias is that an effective agent that acts "centrally" (i.e., removes or otherwise neutralizes the effector cell) will -- all other issues equal, particularly tox issues -- be the better therapeutic over time. Penetration against enbrel might be tough, and it would take a couple of years to get the long-term perspective, but it's a battle worth engaging. I wouldn't assume that AMGN has a lock. >> solution: enbrel + new biologics << I see no reason why this can't be "new biologic", period. >> a homogenous 500,000 US moderate/severe << So, from your information, we can assume approximately a heterogeneous million, worldwide? Was the $2-3 billion estimate for U.S. only?

To: software salesperson who wrote (5766)	2/27/2002 11:16:28 PM
From: Biomaven	Read Replies (2) \| Respond to of 52153

sales, Interesting points. Do you know what the numbers breakdown is between pure P and PA? We still don't know what the long-term tox issues with Enbrel/Remicade are. I wouldn't be at all surprised to see some new issues crop up with long term treatment. (Of course the same can be said for the new biologics). Part of the issue with mtx is that many patients refuse the liver biopsies that they are supposed to have. Here's a comment from a doctor responding to another doctor whose patient refused the biopsy: Unfortunately, the dilemma concerning what to do when a patient refuses liver biopsy is one that is common in all practices that use MTX. We are truly between the " devil and the deep blue sea ", and coming from a state in which the surfeit of attorneys approaches the absurd, I would probably vote to stop the MTX despite whatever you find out about blood tests. Believe me, the patient will not remember any of your warnings when her attorney serves you with papers. Another approach would be to refer her to the nearest medical center where they can take the responsibility. I know that some of you feel differently, and that the patient may suffer in this scenario. So be it. We didn't create the system. Speaking of mtx, I was quite surprised to see that the SCIO p38 RA trial announced today is a combo trial with mtx. I don't understand their reasoning, but I doubt it can be good news. (Note that the abandoned VRTX effort that showed efficacy in an oral P38 inhibitor was a monotherapy trial.) Peter