I think your referring to the GILD announcement to market last week right? I haven't seen any SBS segment btw
I've posted re same here in recent days, I'm assuming this is what MM was referring to in webinar when she mentioned shifting market place
I see it as a net positive due to the below. Having said that I assume you imagine it can obviously impact on CAGR ( and I agree) but with the success and structure of these trails, in reality we are positioned in a very large, distinct, price inelastic (west at least) market.
Key points
- We could be a (HIV) cure with extended duration/ tweak-age - NK as yet. Cure is different proposition right?
- We could be a functional cure or simply reduce viral load/ inflammation per 10s data faster than CART alone - different proposition and market right?
- We are demonstrably broadspectrum
- What they have developed already exists in non injectable forms
CAGR ... The existing market wont be impacted by the preventable injectable right? Its not a cure. Current Growth (from memory) is what 4-5%? Per above, I gather this is simply a more convenient delivery method for product utilised for a similar purpose, that is currently in market. So, whilst I'm not sure if it how much more effective it is, I gather it is more effective, either due to drug efficacy or behavioural reasons (they don't forget, or are less likely to)
Timing .... From announcement, I gather there's iterative trials to come in different segments. All in all, over say what 3-5 years can we expect CAGR to drop to say 2% ceteris paribus ? DYOR. I cant see it at 0% with these medications for decades until it lasts for a decades or so like a hep or tetanus shot, not months.
Relevance to BIT ... I don't think that many people realise how tailored these trails are. Its not just a matter of prevention vs cure. Obviously if we come out with a demonstrable cure its never a bad thing to achieve with a trail, but the 10/11s have been imo designed to specifically target management. Cure is upside.
10s ...The 10's expedite viral load reduction (presumably from clearance of reservoirs) hence better enabling the use of the injectables which I gather must (at least currently) have lower efficacy like for like with the pill format according to AI. Although this most recent trail may equalise that in time. So... what better way to prepare someone for injectables than offering them 12 or 26 weeks of BIT225 to reduce load so they can migrate off the pill to an injection quickly? Equally if someone needs to remain on medication 225 per study reduces load, inflammation theoretically comorbidities etc as a result. It doesn't matter that much whether the CART is a pill or injectable form a BIT 225 perspective
11s ... Equally in the 11s in terms of I suppose you'd say were pulling them back from the brink as well as I guess ultimately getting them to a point of being able to take a longer term convenient injection current injectables ie reducing load? (we haven't really seen data yet so a little licence there). Don't forget a lot of the issue with this space is the resistance concern, so I gather we also have the potential to reduce potential for resistance by reducing viral "head count" given our low risk of resistance... reminds me of a project I'm working on
.
Resistance / Last resort ...Also I suppose there is a role for BIT in potentially addressing situations where people have become resistant to all CART products - again a potentially life saving proposition. I suspect this is the space we may see if it can work stand alone in time. In fairness this may be reduced by broader adoption of injectables for treatment. But as I say, nothing in market currently, price inelastic.
Price inelasticity - The severity mitigated and "value added" in the above implies to me as I say we are not price sensitive. I think I mentioned a former colleague who had leukaemia earlier this year. Drug that nearly saved him set the federal government back some $250K+ .. I'm sure lots of people have these sorts of stories.
Upside ...- what if as proposed its also broad spectrum, can be directed at cancer etc, made into an injectable like the above.
- Just a thought - If we are the best out there atm, in a way it makes it easier for say a GILD to shape their strategy to market for next period of time, affords CF to segment to buy and further develop our offering, to some extent precludes other entrants.
- As BMD said, early days, as Steven Becker said, we are at the forefront of this segment globally. As MM said... um... "it keeps working". To some degree don't we just need diversity of treatment options? Seems obvious to me with the antibiotic story.
Guesstimation...Value .... Reading between the lines, BP are keen (hopefully you can see why from the above.. if not let me know and Ill ramble on some more
) but they want to see whatever external verification was referenced in call. If they buy and develop this successfully, our current MC is probably a days or a weeks sales revenue.
CAGR ...So to your core point there's still (IMO) a ridiculous amount of upside here even if HIV CAGR say halves over 10 years. Even with an approval in time, what's the rollout and adoption timeline ? Population growth, behavioural changes over same period.
ST Prevention vs Cure Vs LT Vaccine... What if we shape this into a cure over time? Get it to be an injectable also ? Will that take precedence over a ST preventative? Will people want to be on a preventative indefinitely? Would they not just take an injection of this if they are infected? So the GILD breakthrough whilst good is a an
in between step really. ie its not a cure and its not a LT term vaccine.
Breadth ... Then there's the front line hypothetical WW3 soldiers who could take BIT as a preventative bcs its broad-spectrum not single indication
... ie this ultimately should have more demonstrated potential than the GILD offering ... do people want to take one or many injections if they have the choice?
Sales process ...As I said, I also very much liked how they highlighted the breadth of conversations they are having. MERK, GSK? ... and "of course" GILD. If I had a sales guy selling specialised widgets, I'd be happy if they'd shaped their pitch like that. Obvious buyer with something to lose vs new eager entrants.... tell everyone you telling everyone.
Trick is to get out of the valley and onto the shelf in some sense, its harder because its the first one out of the "shop", once this is in market and we have revenue the subsequent ones will relatively easy.
Bring on COVID!!!!
So in short, I don't believe the CAGR impact your essentially referencing is material or near term. Pricing is sufficiently inelastic, market is large enough and we ultimately have more to offer with success.
I will be in legitimate trouble for staying up and writing this, but unlike WB there's correlation in view and position
DYOR
(20min delay)