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Expert Interview

Slingshot members are talking to an expert! The topic is:

Evaluating the current treatment landscape in Tardive Dyskinesia post Ingrezza and Austedo approval

Ticker(s): NBIX, TEVA

Who's the expert?

Name: Dr Joseph Jankovic - MD

Institution: Baylor College of Medicine 

  • Professor of Neurology, Distinguished Chair in Movement Disorders, Founder & Director of the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor.
  • Currently has 5 of 250 patients with Tardive Dyskinesia on Ingrezza.
  • Participated in the pivotal Huntington's Disease trial for Austedo.

Interview Questions

Please tell us about your clinical practice, background in treating Tardive Dyskinesia and research in the space. How many patients do you treat, and what is the first line of choice?

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How much of a need for new treatments is still there? Which drug is becoming the golden standard?

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What % of patients with tardive dyskinesia don’t have as good a response under Austedo or Ingrezza as you would expect?

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What is the clinical significance of inhibiting vesicular monoamine transporter 2/VMAT2 with a drug like Ingrezza or Austedo?

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Have there been any serious cases of Drug-induced QT prolongation in patients using Ingrezza or Austedo post approval?

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How does Ingrezza’s ~30% Reduction in TD Severity at 6 Weeks compare to other drugs on the market, and to Austedo more specifically?

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What percent of the patient population has both Huntington’s disease chorea and TD, and is Austedo always the treatment of choice in those cases, as its label would imply?

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Do they view their patients as mild, moderate, severe, or “just TD” – does it matter severity for who starts and when? NBIX says it does not.

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 Is VMAT2 an important mechanism for other neuro conditions, if so, which ones?

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How is access? Payors now aware that this is becoming a big drug and may restrict access going forward…

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What is your current share of Ingrezza vs. Austedo? How has it changed overtime and how do you expect it to change in the future?

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What is compliance? Duration on therapy?

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Does it help that NBIX has a specialty distribution network that calls you 10 days before Rx runs out? Does Teva do this?

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What are the differences in marketing for the Neurocrine team vs Teva’s team?

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Why use Ingrezza vs. Austedo and why?

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 Is Ingrezza’s dosing advantage (no titration schedule) meaningful when deciding between the two therapies?

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Neurocrine cited an issue at the beginning of this year with insurance reauthorizations – that cause a good portion of patients to not receive their first Rx of 2019 until February, did you have any similar issues with your patients this year? If so, can you talk through that dynamic?

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How large is the addressable TD market? The companies estimate the prevalence may be at least 500,000 in the US but realistically what % of these patients will ultimately be diagnosed and treated?

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What are the off label indications you have treated with Ingrezza or Austedo and did you see a response?

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