RE:CYDY Presentation - see chart on page 11The link on page 11 takes you to this paper
https://academic.oup.com/cid/article/48/7/979/327496 Table 1 in that paper has data about 2/3 resistance levels in their cohort (towards bottom of table). Presumably they extrapolate from thrse numbers. The papers cohort is Swiss from 1999. This was the type of approach I did last year to get my own estimates, there are a few (very few) similar papers to this that have similar numbers. There are clearly limitations to this approach, there have been differences in many metrics between European and US populations, and this data is getting on for 20 years old, but in my mind its a fair way of getting an approximation. To that extent I wouldnt consider their number being different to Thera's if error ranges had been included with either of those numbers.
WRT the 70,000 on page 12. That seems to be the number of patients with virological failure per year (from the 232,000 population), so seems they estimate roughly 1/3 of their target population undergoes VF each year, I think that compares with thera's estimate of 1/2. The curious thing on page 12 is that it looks like they might go on to target the whole population, seems to suggest they'll become a first line treatment, i.e. not waiting until patients undergo VF. There is a logic to that in my mind, Trogarzo should be open to all, waiting for VF seems like a dangerous game to play. But given Trogarzo's label its hard to see them getting that. Unless they do follow on studies.
Finally are they suggesting a price of $24,000? Or is that just the average spend for a patient on ART drugs?
SPCEO1 wrote: Here is a link to a presentation CYDY just made this week - please take a look at page 11 which highlights an estimate of those with HIV and how many there are with 1, 2 or 3 classes of resistance.
Now, I know nothing about how they put these numbers together and whether it was a sensible process. But it does confirm the data TH has come up with on the size of the MDR patient group (3 class resistant). Actually, they have more patients in the MDR group than TH has suggested. They also have the decline rate int hat population being faster than had envisaged (I am assuming they have the MDR patient groopu dying off because of old age or perhaps because of HIV and the data does not contemplate the success Trogarzo will have in keeping these people alive.
Relative to my own forecasts, If I used this data it would lead me to increase my estimate of the number of patients between now and 2025 for Trogarzo because its starting point in terms of number of patients is higher and that is more impactful than the faster decline rate than I assumed. So, if I incorprated this info into my model, I would end up with a higher NPV and forecasted EPS for TH.
Also interesting is the fact that the chart shows the 2 class resistant market continuing to increase. Anyone have any theories on why 2 class resistance would continue to increase while three calls resistance would continue to fall?
CYDY on the next slide claims their combo therapy would cover 70% of 70,000 2 class resistance patients. Since the chart on the previous slide indicated there are 232,291 2 class resistant patients in 2018, I am not sure where they pulled the 70,000 patients from. Perhaps this 70,000 is a subset of the larger number and include their estimate of the number of those with 2 class resisitance and limited other options, which is how their phase III trial protocol read. Does that 70,000 include the 20-25,000 that TH talks about? So, in CYDY's mind, are there 49,000 patients they can treat (although Trogarzo can treat those patients as well) and 21,000 who only Trogarzo can treat among the 70,000? Inquiring minds would love to know exactly how these numbers were derived and whether there are any credibility to them. At a minimum, however, CYDY is saying that there are 21,000 of the 70,000 patients they identify that only Trogarzo can treat due to the strain (or tropic) of HIV those patients have. And that basically lines up with TH's market size estimates. Now, the label for Trogarzo allowed for it to dip into the market outside that which the company has long identified (the 3 class resistant patients). Assuming CYDY is right about there being 70,000 patients with 2 class resistance and limited ther options, then there certainly is some meaningful upside for Trogarzo sales beyond the 20-25,000 the company has focused on. Assuming the near broke CYDY can survive and get PRO 140 approved and commercialized, that will not happen until mid-2020 at the earliest. And, if you have been keeping an eye on CYDY, you know nothing ever happens at the earliest possible time. So, TH has a chance of getting a lot of those 2 class resisstant with limited options patients on Trogarzo before PRO 140 ever makes it to commercialization, if it ever does. Morever, if it does, CYDY is going to need a marketing partner and TH is the best option for them.
So, the chart leads to some interesting possibilities for TH and tells us the market size estimate TH came up with for the 3 class resistance market was on the low side.
For any that might be worried about the falling number of patients in the MDR market post 2025, remember there is a good chance TH will be marketing one or more of Taimed's other products to a much larger HIV population than just the MDR market by that point. Also, it is a long ways away and the market is not going to care about that for several years yet.