NS...Questcor's emerging HOCKEY STICK (formation)...As I have predicted for MONTHS!!!
Let me start with nephrology, which is now our largest market, with estimated sales in the quarter of between $70 million and $75 million, or very roughly 45% of Acthar net sales. Recall that only five quarters ago, following a small pilot effort, we launched our sales force in nephrology with 28 reps. At that time, the MS market was our largest source of revenue by a wide margin, but due to rapid growth, nephrology is now our largest market and the main driver of our revenue growth.
In fact, Acthar net revenue from nephrology is now substantially more than from MS, as prescriptions for nephrotic syndrome reached record levels in the fourth quarter, and have continued to grow into Q1. We believe this growth is due to nephrologists’ recognizing the need for additional treatment options in nephrotic syndrome patients, particularly those who have already tried first line therapy and are in need of another FDA approved treatment alternative.
Nephrotic syndrome can often lead to loss of kidney function and ultimately end-stage renal disease, which requires a kidney transplant or much more commonly requires lifelong renal dialysis. Patients on dialysis frequently suffer from multiple other associated medical problems, including serious infections and hospitalizations, as well as a substantially reduced quality of life and life expectancy.
Because of this, nephrologists work hard to successfully treat their nephrotic syndrome patients, despite there being few effective therapies available. For their part, insurers typically support these efforts, because of the high inherent healthcare costs and poor health outcomes resulting from deterioration of kidney function and the onset of end-stage renal disease.
With Acthar, the commonly recommended treatment regimen based on published, clinical experience is a full course of therapy averaging 10 vials over 6 months. In actual practice, we believe an average prescription consists of about 7.5 to 8 vials, dispensed over a several month period.