Showing posts with label Rituxan. Show all posts
Showing posts with label Rituxan. Show all posts

Tuesday, March 15, 2011

Biogen Idec PML Test Approved in Europe, Changing Tysabri Outlook

For all the publicity about multiple sclerosis drug Tysabri, investors tend to forget that the real breadwinner so far for Biogen Idec continues to be Avonex, also for multiple sclerosis (MS). Avonex revenues in Q4 2010 were $654 million; Tysabri revenues were $242 million.

Tysabri is the more effective drug, but it has been held back by the risk of PML, progressive multifocal leukoencephalopathy. This is in turn caused by JCV, a virus often quietly, apparently harmlessly residing in human brains. MS is an immune disorder; its treatments involve dialing down the immune system. In about 1 in 1000 patients, JCV wakes up, and instead of being taken care of by the immune system, causes serious damage or even death.

As a result, despite its effectiveness many patients and doctors have only used Tysabri as a last resort.

Now that score should change. The new test will let physicians know which MS patients have JCV and which don't. Presumably, those that don't have JCV could take Tysabri without fear. It is believed that about one-half of potential patients in the U.S. and Europe have JCV, although it is more common in cultures with poor sewage systems.

Those who have JCV can still take Tysabri, but would be closely monitored. So far PML incidents have occurred in patients taking Tysabri for a period longer than 1 year.

New MS therapies are also being developed or marketed, notably Gilenya by Novartis, which is the first oral treatment for the disease, but which was not as effective as Tysabri in clinical trials.
Meanwhile, Biogen is narrowing the scope of its development program, eliminating oncology and cardiovascular candidates to focus on immunology. This should reduce costs in the short run.

Since the quarter ended Fampyra for mobility for MS patients was rejected by the European Medicines Agency (EMA), but Biogen is appealing the decision. Fampyra is approved in the United States. The FDA also approved Rituxan as a maintenance treatment for advanced follicular lymphoma. In the quarter Rituxan generated $258 million.

Because Tysabri can now be "risk stratified," Biogen has stopped enrolling patients in the long-term Surpass trial, which is designed to show off its superior efficacy.

Going forward, Biogen has a lot riding on the questions of whether doctors and patients can put the PML scare behind them, and on whether they will prefer an easy to administer oral drug to the more effective, but harder to administer Tysabri.

See also http://www.biogenidec.com/

Monday, February 15, 2010

Biogen Idec (BIIB) Revenue Lull

Biogen Idec (BIIB) reported Q4 2009 financial results and held its quarterly analysts conference last week. I used Biogen as an example in my Choosing a Biotech Stock series, and later chose to buy some myself, which I still own.

Biogen is in an interesting phase. Its revenue growth has slowed from the high levels of the past few years, to just 6% from the year-earlier quarter. At the same time, year over year, net income for the fourth quarter rose 48% to $305.6 million (GAAP).

So what is going on? The flat revenue is because Rituxan for rheumatoid arthritis revenues are expiring outside the U.S. Biogen will continue to sell Rituxan inside the U.S.

Compensating for that drop, we still have ramping sales of Tysabri for Multiple Sclerosis, which had revenues jump 39% from year-earlier. Tysabri is still being introduced internationally. It is something of a miracle drug for MS. Tysabri has very good profit margins. Biogen's older MS therapy, Avonex, had revenues up only 5% y/y. Tysabri had scared investors because of cases of PML associated with it, but recently the FDA announced that with Biogen's monitoring program for PML, the benfits of Tysabri outweigh any danger. Biogen is continuing to work to reduce the possibility of PML.

Biogen has an extensive pipeline of drugs that, if approved, could significantly increase its revenues and profits over the next decade. The first possible revenue boost would be from Fampridine for MS. Unlike Tysabri and Avonex, which work by suppressing the immune response that causes MS, Fampridine works by strengthening the signaling of intact nerve cells. It can give patients temporary control of their movements. This is likely to be very attractive to MS victims.

I continue to like Biogen, but its main value is over a long time from of 2 years or more. In the meantime I hope they either use the cash they are generating to pay a dividend or to acquire more quality drug candidates for development.

Analyst conferences coming up this week:

Applied Materials (AMAT) Wednesday
NVIDIA (NVDA) Wednesday

See also:
Q4 2009 Biogen Idec analyst conference summary
http://www.biogenidec.com/

Monday, October 27, 2008

Biogen Idec (BIIB) Growth Accelerating

Biogen Idec just keeps growing revenues and profits. At a time when the entire stock market is melting down, smart people can make money (in the long run) by buying almost anything, but there is a lot of insurance in buying cash rich, rapidly growing companies like Biogen.

Biogen has a lot of cash (and marketable securities), over $2 billion at the end of Q3. Its non-GAAP (cash) net income was $288 million in Q3.

Aside from truly apocalyptic scenarios, I see no reason why profits should not continue to grow rapidly for the foreseeable future. 3rd quarter revenues were up 10% from the second quarter and up 38% from Q3 in 2007. GAAP net income was sequentially flat, but up 73% from $119 million last year, with GAAP EPS at $0.70.

For details of Biogen's Q3, see my Biogen Idec Analyst Conference Summary, Q3 2008.

There are three mostly-independent components to Biogen Idec's future growth. Its main revenue generators include two drugs for Multiple Sclerosis (MS), Avonex ($573 million Q3 sales) and Tysabri ($173 million Q3 sales). Avonex is the older drug, approved and marketed in the U.S., Europe, and many other countries. Tysabri, the newer, even more effective drug, is still in the global approval process. When MS patients switch to a new drug, they switch often switch to Tysabri. In terms of revenue, however, the main component at present is international expansion. It will take years for Tysabri to be approved and for sale in all the world's major markets. MS is a life-long disease at present; you can't stop taking your therapies without it starting to progress, though Tysabri seems to actually cause the disease to regress in many cases.

The second revenue and profit building leg is expanded indications for existing drugs. Rituxan, which had sales of $299 million in the quarter, has been approved for Non-Hodgkin's Lymphoma (NHL) and is in Phase III for Chronic Lymphocytic Leukemia (CLL). Tysabri is in a Phase I trial for multiple myeloma and was recently approved for treatment of Crohn's Disease.

The third leg is the pipeline, which is impressive. There are drugs in every stage of development from pre-clinical to Phase III, and Biogen has the cash to buy rights to promising therapies as well. There are five novel compounds in late stage (Phase III) registrational trials (BG-12, Lumiliximab, Galiximab, Lixivaptan, Adentri).

For those who don't following biotech batting averages, only a relatively few of the drugs that are tried in Phase I trials eventually get good Phase III results and are profitably brought to market. As with any other biotechnology or pharmaceutical company, BIIB will see drugs that don't live up to their early promise. That said, BIIB has a rather exceptional record in actually developing drugs that help patients enough to become revenue blockbusters. Some of BIIBs pipeline candidates will be approved and turn into profit engines in the future.

Every company's stock is risky. Drug candidates can fail, and even successful drugs can be driven off the market by rivals. BIIB should be bought only as part of a portfolio that makes sense to you.

The main risk that remains in BIIB (though I think it has already led to a discount in the stock price) is from the known adverse event associated with Tysabri, PML (Progressive Multifocal Leukoencephalopathy). This was a little-known disease until HIV infections became widespread, resulting in a large pool of people with suppressed immune systems. It is an opportunistic infection, rare even in immune-suppressed patients. There have been several PML cases in patients being treated with Tysabri. Doctors are warned to watch for PML symptoms when they prescribe Tysabri. PML can be deadly.

You might think that would kill sales of Tysabri, but it has not, because doctors and patients, or enough of them, are looking at the bigger picture. MS is an auto-immune disorder. Stopping it involves keying down the immune system. With the choice being between watching MS symptoms progress and taking a drug that stops the progression, most patients are going to want to take the drug. PML is a risk, but a small one, and if detected in time can be survivable. It is sad to have to make choices like that, but when you know you have MS, and what its progress will be if untreated, it is still the best choice for most people.

I hope you have some cash to buy stocks during this giant Wall Street Geniuses' fire sale, but in any case ...

Keep diversified.

More data:

Biogen Idec home page

Monday, September 1, 2008

Biogen Idec: Will it Recover?

Biogen Idec has a remarkably low PE (price to earnings) ratio of 15.9 (per Nasdaq BIIB summary page, which uses non-GAAP numbers) for a biotechnology stock. The reason is simple: it was announced on July 31, 2008, that two patients taking Tysabri for Multiple Sclerosis (MS) had developed PML (progressive multifocal leukoencephalopathy). In 2005 Tysabri had been taken off the market after it was associated with 3 previous cases of PML. It was allowed back on the market in 2006 with a warning about PML in its label.

Tysabri accounted for $147 million out of $993 million total Q2 2008 revenues for Biogen Idec [See my summary of Biogen Idec Q2 2008 analyst conference]. In addition, it had the fastest growing revenues, up 210% from year earlier.

In a market where there are thousands of undervalued stocks to choose from, it is easy to understand a rapid exit from a stock based on any bad news, especially if the extent of the damage is unknown. But did that leave the stock fairly priced?

What is the downside from the new PML cases? First, more PML cases were expected when Tysabri was re-introducted to the market. No PML at all would have been the surprise. There is a warning about PML on the Tysabri label, and a monitoring program in place to catch PML early if it occurs. Which is exactly what happened. However, if there are a lot more PML cases, this still could cause the FDA to take the drug off the market.

Why has the FDA even allowed Tysabri to continue? Because it is remarkably effective in treating MS compared to other available treatments. Many patients and doctors feel this increased effectiveness makes it worth the risk of PML.

So far, the risk of PML, while undeniable, is minimal. There are currently about 30,000 Tysabri patients, and 2 got PML, and both have been improving since they were diagnosed (PML can cause death).

Biogen continues to work with the FDA to make the drug label clear. Without a doubt some doctors and patients will decide the benefits are not worth the known risks. However, that is against a backdrop of rapid switching to Tysabri from less effective therapies.

With Rituxan for NHL (non-Hodgkin Lymphoma) and Avonex for MS both producing more revenue for Biogen than Tysabri does, and with the stock price so low, I think the risk for investors is not particularly great. Avonex revenue grew 14% y/y, and Rituxan grew 21%. While the removal of Tysabri from the market cannot be entirely discounted, that is a risk that has to be weighed against the likelihood that Tysabri will remain on the market, and that Biogen's revenues and profits will continue to grow rapidly with or without Tysabri.

Take into account BIIB's pipeline of drugs in clinical trials, and you have a company that is likely to be much more valuable a few years from now than it is today.

I own Biogen Idec stock and, as a long-term investor, see no reason to sell it. Like all biotech stocks, there is risk involved in this investment.

So keep diversified!

Thursday, July 12, 2007

Genetech's Pipeline

Genetech (DNA) blew past most people's expectations with its Q2 2007 report on July 11th. Pundits feared that a need to add a warning about possible allergic reactions to Xolair, combined with the results of a study saying that a lower dosage of Lucentis may be as effective as the recommended dose, would take the wind out of Genetech's sales. But Xolair sales grew from $111 million in Q1 to $120 million in Q2, and Lucentis sales were only off to $209 million from $211 million in Q1. Overall revenues were up 7% sequentially and an amazing 37% from Q2 2006.

There have also been questions about whether growth can continue without a stronger pipeline. Note that today Genentech's P/E ratio was 33 (per Nasdaq); while typically a company growing revenues at 37% per year would have a higher PE ratio, it still assumes growth will be strong over the next few years. Biotech pipelines are the stuff of long waits: from the beginning of a Phase III trial to first revenues (presuming the drug does not bomb out, which many do) can take years (3 is about the minimum). As to drugs entering Phase I trials, you are looking closer to a decade out.

Genentech, however, has some successful drugs that can generate more revenue through label expansion. Companies often seek very narrow indications for approval, especially of cancer drugs. You don't get approval for "breast cancer;" you get approved for some very narrow subtype of breast cancer, or lung or liver or whatever form of cancer. But once you have that, if it looks like your drug is more broadly applicable, you go back and do trials on closely related indications. In Genentech's case it is seeking label expansion for Herceptin, which is currently approved for "metastatic breast cancer in HER2 overexpressed tumors; as part of a treatment regimen containing doxorubicin, cyclophosphamide, and paclitaxel, for the adjuvant treatment of patients with HER2-positive, node-positive breast cancer." It has completed Phase III trials and has applied to the FDA for approval in "in adjuvant HER2-positive breast cancer," which means in a less specific regimen than the current label. In another Phase III study it was combined with Avastin; and other varieties of Herceptin Phase III studies have been initiated.

Genetech is awaiting FDA action on its submission for Rituxan for Rheumatoid Arthritis (RA) and is preparing a submission for Avastin for first-line metastatic renal cancer and first-line metastatic breast cancer (first line means used as a first therapy; second line means using after a different therapy has failed to halt the progress of the disease). Rituxan already had $582 million in sales in Q2 for the indications it is already approved for.

Such is the size of Genentech's pipeline that this article could become quite a hefty volume if I discussed each pipeline drug in even minimal detail. So instead I will point to a different category: drugs that are not yet generating money for Genentech. These drugs can be anywhere in the clinical trial timeline from Phase I to Phase III. Keep in mind that each phase can take years; ten years from the beginning of a Phase I trial to approval by the FDA is not unusual. Also the field narrows as you go through trial sets; as a general rule you might want four or five candidates entering Phase I to get a single approved, marketable drug.

At the top of the list, in Phase III, we have Ocrelizumab, an anti-CD20 humanized monoclonal antibody. What that means is they are hoping to cure diseases caused by the human immune system attacking the human body. Phase III trials in rheumatoid arthritis have started and Phase III trials in lupus nephritis, systemic lupus erythematosus and relapsing remitting multiple sclerosis (yep, that is what the President had in West Wing) are planned.

At the base of the pyramid we have a slew of Phase I candidates. There's a bunch more anti-CD20 drugs. There are drugs for solid tumors, myelomas and lymphomas, anti-IFN apha for lupus, a variety of cancer therapies with strange designations, PARP inhibitor for malignant melanoma, and a systemic Hedgehog antagonist (Hedgehog is ... well, another time).

The picture I am painting here looks like this to me: a varied and in-depth pipeline covering the spectrum from Phase I to Phase III. Lots of earning potential just from adding to the labels of current successes.

So I think the PE ratio of 30 is a bargain. Genentech management plans to continue to invest heavily in R&D. They are also not shy about buying a drug from another company when they think it has potential. They kept saying they are looking for drugs that will be first in class (the first approved for a disease) or best in class (better than anything already on the market).

I don't own Genentech, but covering the company makes me want to buy some stock. Before you make any decision I suggest, at minimum, you read my summary of the Q2 2007 analyst conference that took place July 11th.

More data:

Genentech Investor relations page
Genentech pipeline page
My Biotechnology Investor Research Help page