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Questcor Pharmaceuticals, Inc. (QCOR) Message Board

  • mclim73 mclim73 Mar 28, 2013 2:44 PM Flag

    will MS trend go down 50 percent from here?

    i know RA and NS will more than make up for MS decline that we all expect, but somehow i think opposite will happen.

    We barely touched the baseline penetration into MS imo. With the recent pulse therpy data, im sure more doctors will look into Acthar.


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    • Mclim--
      I tend to agree on all points. Looks like Tecfidera is a good drug for MS as others have posted, but not a perfect solution. In one trial, 27% of patients relapsed compared to 40% with placebo; and in the second trial, 22% relapsed, compared to 40% in placebo. Another 5% discontinued treatment due to side effects, primarily gastric distress. The mechanism of action is unknown--which probably means treatment will be trial and error.

      For 70-75% of patients, Tecfidera will make a difference and sometimes a significant difference--if trial results are reflected by clinical experience. For 25-30% of patients, it will be ineffective or intolerable--and that is a significant population (100,000+ ?) to be potentially treated with Acthar.

      Also, a significant percentage of patients in the trials were not the most refractory relapse patients--it was a mix ranging from patients with potential to relapse on one end, to patients with systematic and aggressive relapses.

      I see Tecfidera replacing prednisolone and other MS drugs for a significant number of patients as a first line
      treatment. Second line or last resort--no prediction from me--but I think Acthar MS scripts will decline incrementally and over time if at all, and ultimately may depend on uptake of pulse therapy as you suggest.

      Sentiment: Strong Buy

      • 5 Replies to pharmaman58
      • bump

      • Tecfidera is a chronic therapy that will compete with the interferons, copaxone, and other oral MS agents (e.g. Gilenya). It's main advantage over the injectables is that it is oral. It's advantage over the other orals is it's efficacy.

        When one of the above therapies fails...i.e. there is an acute exacerbation of MS then prednisolone or Acthar is needed. Thus, Tecfidera does not directly compete with either other than the fact that if it's efficacy is improved relative to alternatives it will reduce the need for acute exacerbation drugs. The first line choice of drug for an an acute exacerbation is usually prednisolone. Acthar would be a reasonable alternative if it's cost wasn't insanely higher $1000's vs. pennies.

        The recent abstract presented at the AAN suggested Acthar was associated with 1/10 the relapse rate going forward relative to prednisolone and fewer psychiatric effects. That was a small study but is very provocative. Acthar will stay as a last resort type of MS therapy due to the extreme cost but if a larger study confirms these differences that could change - esp. if it also showed a decrease in long term disability. If such a large pool were opened up hopefully it would make sense for QCOR to lower costs into a sane range so that MS patients could benefit from the start.

      • it's the population my friend, still far from the last of them,
        haven't heard of this mend, we're nowhere near the end.

      • pharma: what might be interesting is the extent of OVERLAP between patients who do and do not respond to prednisolone and patients who do and do not respond to Tecfidera.

        Assuming that patients who reacted unsatisfactorily to the one, are now put on the other, INSTEAD of then being tried out with Acthar, then there is at best (for us) a DELAY in revenues (ie. until BOTH treatments have proved unsatisfactory, and then Acthar is prescribed).

        The worst case (for us) would be if ALL the patients who do not respond to the one (prednisolone or Tecfidera) DO respond to the other. THEN, there would be a sustained drop in the rate of Acthar usage for MS for a steady-state population (ie. no increase in overall MS diagnoses).

        Now, I have no understanding of the bio-chemistry underlying the treatment paths of prednisolone and Tecfidera, so I cannot estimate whether Acthar usage for MS will merely be delayed by the introduction, into the picture, of Tecfidera, or actually reduced substantially - but I bet there are those here that would have more of a clue predicting that.

      • that's wasn't the question
        the question was WILL QCOR earnings be impacted by BIIB BG12 ?
        YES OR NO, instead you started with a story that you sleep too much and eat too much...

89.99+0.02(+0.02%)Aug 1 4:00 PMEDT

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