Ahead of the $NEU FY24 Results call in a few minutes, I put in a question to ask CEO Jon to explain why they seemed to move in late 2024 from expecting the progression into a Phase 3 trial for NNZ-2591 could be managed via email with the FDA to requested a Type C meeting, which will be scheduled for April (from memory).
As part of preparing for the call I include here two items:
- Their 20204 highlights
- My analysis of yesterdays $ACAD call, focusing on progress and outlook for DAYBUE
Overall, I am pleased that the overall outlook for DAYBUE has gone from worrisome, as it was in early to mid-2024, to now a more stable outlook, with the prospect of Europe coming into view.
2024 Results -$NEU's Highlights
- Total comprehensive income for shareholders A$166 million, comprising A$142 million profit after tax and A$24 million foreign currency translation gain
- A$222 million cash and short-term investments at 31 December 2024, A$359 million pro-forma cash adjusted to include receipt in Q1 2025 of PRV sale proceeds, sales milestone and Q4 2024 royalty and payment in Q1 2025 of Q4 2024 tax
- A$56 million US royalty income from DAYBUE™ (trofinetide) in 2024 up 110% from A$27 million in 2023, with guidance for growth to between A$62 million and A$67 million in 2025
- A$445 million cumulative income from DAYBUE over 2023 and 2024
- DAYBUE approved in Canada, first sales expected in Q3 2025
- Trofinetide Marketing Authorisation Application for Europe filed, potential for approval in Q1 2026, Acadia planning managed access programs from Q2 2025
- Acadia commencing small clinical study by Q3 2025 to support marketing application for Japan
- NNZ-2591 potential to address core symptoms of diverse neurodevelopmental disorders, independent of the underlying genetics, supported by positive Phase 2 trial results across PhelanMcDermid, Pitt Hopkins and Angelman syndromes, with other indications under evaluation
- Fast Track designation granted by FDA for NNZ-2591 in Pitt Hopkins syndrome and Rare Pediatric Disease designation granted by FDA for all three syndromes
- Type C Meeting with US Food and Drug Administration scheduled for early April 2025 to discuss primary efficacy endpoints for Phase 3 trial in Phelan-McDermid syndrome, with alignment reached on all other key aspects of the program at End of Phase 2 Meeting
- Preparations continuing for planned commencement of Phase 3 trial in mid-year 2025
Summary of yesterday's $ACAD Presentation
Acadia Pharmaceuticals is positioning DAYBUE as a long-term growth driver in the Rett syndrome market, with strong U.S. sales momentum, a stable patient base, and global expansion plans. The company is investing in commercial resources, patient support, and physician education to further penetrate the market, while its regulatory efforts in Europe and Canada aim to establish DAYBUE as a global standard of care for Rett syndrome.
1. Sales and Revenue Performance
- Q4 2024 Sales: $96.7 million (up 11% YoY, 6% sequentially)
- Full-Year 2024 Sales: $348.4 million (up from $177.2 million in 2023, nearly doubling in its first full year on the market)
- Revenue Growth Drivers:
- Increased bottle use per patient as stable patients titrate toward the recommended dose.
- Higher persistency rates, with 62% of patients on therapy for over 12 months.
- Improvement in patient discontinuation rates (15% QoQ decline).
- 2025 Sales Guidance: Expected U.S. sales between $380 million and $405 million, with 9-16% volume growth.
2. Commercial Progress and Market Penetration
- Patient Base Stability:
- 920 unique patients received paid shipments in Q4, stable from Q3.
- About 30% of Rett patients in the U.S. have tried DAYBUE.
- Persistency at 12 months remains around 50%.
- Prescriber Growth:
- 830 HCPs have prescribed DAYBUE (up from ~800 in Q3 2024).
- 35% of patients treated at Rett Centers of Excellence (COEs), while 65% receive treatment in other settings (community and high-volume institutions).
- Penetration: 55% at COEs vs. 25% in community settings, indicating room for growth.
- Sales Force Expansion:
- Acadia is increasing its field force by 30% in 2025 to enhance engagement with physicians outside of COEs and improve patient and caregiver support.
3. Patient Experience and Retention Strategies
- Treatment Uptake and Persistence:
- Over 60% of patients have been on DAYBUE for 12+ months.
- Titration trends indicate improved dosing adherence.
- Discontinuation Rates:
- Improved by 15% QoQ due to proactive support and education initiatives.
- Support Programs:
- Acadia Connect: Dedicated team providing individualized care and treatment navigation.
- New Initiatives: Direct-to-consumer campaigns, peer-to-peer engagement (patients, caregivers, HCPs).
4. Growth Strategies and Expansion Plans
- U.S. Market Growth Initiatives:
- Increase penetration in non-COE settings.
- Expand physician engagement and awareness efforts.
- Drive growth through omnichannel campaigns, real-world data insights, and peer-to-peer engagement.
- International Expansion:
- Europe: Marketing application submitted to the European Medicines Agency (EMA); approval expected in Q1 2026.
- Canada: First DAYBUE sales anticipated in Q3 2025.
- Other Markets: Evaluating broader global expansion through managed access programs.
5. Forward Outlook
- Short-Term Outlook:
- Q1 2025 Expectations: Sequential revenue decline due to Q4 pull-forward dynamics, seasonal factors, and pricing adjustments.
- Revenue expected to increase in Q2 2025 and beyond as commercial efforts gain traction.
- Long-Term Growth Drivers:
- Increased patient penetration in non-COE settings.
- Global market expansion beyond the U.S.
- Improved dose adherence and persistence.
- Real-world evidence from the LOTUS study to reinforce efficacy and long-term benefit.
Disc: Held in RL and SM