Pinned straw:
I have just waded through a bunch of previous posts but can't find what Im looking for.
Im pretty sure that someone somewhere mentioned a drug as competition. I am also pretty sure it was Methenamin or Antihydral
It has taken me an embarrassingly long time to twig to this, but I use Antihydral. And so do a significant percentage of Rockclimbers.
Not only does it increase friction by reducing hand perspiration, if applied daily for a week or so before going on a climbing trip - it really toughens the pads of your fingers. This allows you to keep climbing, as you don't lose all the finger off your fingertips - the dreaded "Day-four-skin". After 3 days of over excited climbing you wake up on Day four to discover your pads are bleeding and you can't climb anymore.
So what?
Well, firstly, I just thought it was a cool little nugget that would interest people.
But, secondly, there is clearly a percentage, who knows how large, of baseline uptake of Antihydral that is not by patients suffering from hyperhidrosis. There are approximately 10 million rock climbers in the USA. I reckon 5-10% would get through a tube a year. That is a wild guess. Most of us only use it prior to a climbing trip (holiday) to make sure we can keep climbing.
@mikebrisy does this alter the assumptions and spreadsheets?
HELD IRL
@Chagsy the short answer is that it doesn't impact my growth assumptions.
That said, my growth assumptions are certainly higher than the market is pricing, but are still very modest in the context of the scale of the US axillary hyperhidrosis (AHh) market. This is for several reasons:
- Ecclock progress in Japan provides one reference
- Expectations are damped by the fact that Qbrexa, the only other approved anticholinergic indicated for the condition, has only achieved modest US sales
- SOFDRA will be a relatively expensive treatment, and so most users will require payor funding, indicating off-label use will likely be limited
- Eventually, the potential emergence of competition, means we'll eventually see sales decline from peak - as with every drug (when 5, 10, 15 years?)
Management at $BOT have, if I recall correctly, commented in the past on the potential for SOFDRA to be used beyond its now approved indication. But without approval, a customer would have to fund this themselves. So I think that reduces the "rock climbing" market opportunity, although I had no idea there are that many rock climers in the US! Given uptake assumptions for SOFDRA are so low, it would only take experiments by a tiny fraction of the rock-climing community to make an impact. That's said as SOFDRA is prescription-only, I'm not sure how they'd access it.
Methenamin (Antihyrdal) is, as I understand, approved for recurrent UTIs, and there is some data indicating it is effective in plantar and palmar Hh, but I am not aware of any studies in AHh, nor is it approved for that indication - as far as I am aware. That said, it not unreasonable to think some customers might try it out for AHh. This is particulary given that it is a relatively cheap treatment.
There are a couple of more general points here: 1) companies will continue to study the effects beyond the initial approved indications and 2) for a condition like hyperhidrosis, given that it manifests itself on different parts of the body (axillary, palmar, plantar), there is likely to be experimentation (both in formal clinical development or informally by users) with applying a product approved in one area to another.
Regarding competition, Qbrexa is the only other anticholinergic approved for AHh. Another product, THVD-102 (more recently redesignated RVT-504) doesn't seem to be progressing.
Given the potential for other anticholinergics to emerge or indeed other products, the long term success of $BOT is to continue to develop other products of which several are in the pipeline, but likely still 5-10 years away. However, $BOT management are already talking in general terms about leveraging their telehealth "platform", and so, if it proves successful and $BOT gets cashed up, you'd expect them to do additional licencing deals.
Bottom line,... swings and roundabouts.... so where I have landed in my assumptions is that the range of market uncertainty for primary AHh significantly exceeds the added uncertainties arising from the other items discussed. Prior to your straw, I wasn't aware of the rock-climbing opportunity or threat, but having now considered it, I don't think it changes my assumptions.