Go Big or Go Home – Pt.3 (3) – Imetelstat’s Potential Market Size - MF

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Go Big or Go Home – Pt.3 (3) – Imetelstat’s Potential Market Size - MF

Post by kmall » Mon Jun 01, 2020 4:48 am

MF - Myelofibrosis Market Size

Myelofibrosis market will exceed $1 billion by 2025
https://www.chemdiv.com/myelofibrosis-m ... lobaldata/

Myelofibrosis treatment market will reach USD $971.5 Million By 2024
https://www.globenewswire.com/news-rele ... earch.html

“North America is the developed regional market for myelofibrosis treatment market and is expected to grow rapidly over the forecast period.”

“Europe is the second largest market for myelofibrosis treatment and is expected to grow significantly over the forecast period.”

“The Asia Pacific is the third largest region for the myelofibrosis treatment market and it is expected to grow significantly over the forecast period.”

……..starting to detect a “growing significantly” pattern here?

As I stated earlier, my past research had centered mainly on MDS with the then upcoming IMerge P3 clinical trial last year, however, with the recently announced commencement of P3 IMbark and an ever-expanding patient population in this indication as well, I’ll try my best to draw conclusions on this indication.

The link below places a global MF patient population at 1 per 100,000 or approx. 80,000*
https://www.wikidoc.org/index.php/Myelo ... mographics
*2020 World population: 8 Billion

As we can see MF has a much lower patient population then MDS and AML. With that said, it wouldn’t surprise me to see the 1 per 100k ratio being somewhat inaccurate. Coming across patient discrepancies for MDS, we could very well form similar conclusions in MF. Being a much rarer disease than MDS, the numbers are most likely less extreme, but as you can see from this Bristol-Meyers fact sheet in the link below, “Global estimates of prevalence and incidence vary widely.”

https://www.bms.com/assets/bms/us/en-us ... -sheet.pdf
This BMS fact sheet places the global MF patient population at 1.5 per 100,000 or approx. 120,00……….a 50% increase! That is quite a dramatic leap - as would be the numbers for a Global MF market size when adding 50% - $1.5 Billion approx. – according to the above projection.

I know that we’re in the middle of talking about the MF marketplace, but let’s rewind to last Thursdays CC for a moment.

We all know that MF has a fairly “dismal” prognosis as far as the patients are concerned. I’m putting “dismal” in quotations since that is the term Dr. Scarlett attached to it during the 2019 Needham Healthcare Conference. With that said, great emphasis was placed on OS (overall survival) as a primary endpoint for the P3 portion of the IMbark trial Thursday by our CMO Dr. Rizo.

“the primary end point for the trial is planned to be overall survival. And we believe this is the first trial in refractory myelofibrosis to use overall survival as a primary end point.” – Dr. Aleksandra Rizo

As well as the quote everyone has been talking about…….”a paradigm shift”

“Maybe I can just reinforce, Chip. I mean, we love the fact that we have a drug that can improve overall survival in this relapsed/refractory setting as there's no other drug, as you mentioned, that has shown that. And as you know, right, other drugs are having primary end points that are addressing the symptom of the disease, whether that's a spleen or a symptom response or an anemia improvement or a combination of the above, right?”

“So, what we have here is an overall survival. And I think that we have the possibility or the chance to have a paradigm shift in the thinking of how you approach treatment with myelofibrosis.” - Dr. Aleksandra Rizo

…….This elicited our “It's the go big or go home approach.” response - Chad Messer

So back to the Market potential of Imetelstat. The only other treatment for MF as of now as we all know is JAKafi. Imetelstat is almost 3x as efficient as JAKafi from the P2 data revealed so far. Again, many of you are far superior than me in this regard, so I’ll just leave it at that.

This 2016 report below (Pg. 16) from AHIP (America’s Health Insurance Plans) clearly shows the cost associated with JAKafi – mind you these are 2016 dollars.
https://www.ahip.org/wp-content/uploads ... Report.pdf

Jakafi’s cost ranges from $91,621 per patient / year to $143,808…………..it’s clear to see why Incyte would be threatened by Imetelstats approval; something that we have known all too well as long term investors. AA in MF for Imetelstat would be a major “paradigm shift” for Incyte in the wrong direction.

Jakafi (drug) Incyte (manufacturer) Myelofibrosis (indication)

$91,621 – (FSS) Federal Supply Schedule

$119,844 – (WAC) Wholesale Acquisition Cost

$143,808 – (AWP) Average Wholesale Price

Now do the math on the low side of our numbers. The US - MF patient population is approx. 16,000 – 18,500.*
*https://www.bms.com/assets/bms/us/en-us ... -sheet.pdf (from the BMS fact sheet above)

Let’s multiply 16,000 with the JAKafi (FSS) price - $91,621 = $1,465,936,000.00………….or almost $1.5 Billion (these are 2016 dollars)

Obviously Incyte isn’t getting 100% of that number, but 50% or even 25% is plausible. Remember this is on the low end of known figures from 4+ years ago and this only encompasses the US market.

Once again, I think that the $1 - $1.5 Billion annual Global market size for MF is vastly underestimated. By how much is anyone’s guess.

In conclusion, from the 3 indications mentioned here we can now project anywhere from a $5.7 - $15.6 Billion or more annual Global market. I would feel comfortable placing this estimate roughly in the middle at around $8 - $10 Billion. As stated earlier, how much of this can be carved out for Imetelstat is still shrouded in mystery, however, if the enthusiasm reflected in last Thursdays CC is any indication – I would stake my claim that it’s quite a fair share.

I would like to thank any of you who had the patience and fortitude to read through this series and many of these findings for doing so. All of the information provided has been gathered from extensive research and I do appreciate anyone who is as interested as myself in details that some would consider mundane. I’ve also speckled in a fair bit of speculation and guess work; so, to all of you hardline fact finders; my apologies. Hence, why I have provided so many links. You can see for yourself where this information has been culled from. It’s kind of hard not to speculate on certain details since many of these findings fluctuate from one end of the spectrum to the next. All 3 of these Hematologic malignancies are still being researched and treatments are constantly evolving as we all know too well.

A special thanks to Andrew-bp (the boards moderator), all members of the Imetelchat community, Team Geron and especially all of those patients in past, present and future clinical trials of Imetelstat. Without them, those of us as investors and anyone who has a keen interest in the science of this drug would fail to have any skin in this game what so ever. Let us never forget the sacrifice they have made and continue to make on a daily basis to propel this drug and its possibilities towards heights we all hope will come to fruition someday. All the best. -Kmall

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