Nancy J. Wysenski
Analyst · Sanford Bernstein
Thanks again and good evening, everyone. For the next few minutes, I'd like to review with you certain aspects about the launch of INCIVEK, as well as provide some insight into our thoughts in the evolution of hepatitis C treatment. Let's start first with the launch. I'd like to thank the hundreds of people at Vertex who contributed to the development, distribution and launch of INCIVEK. It's amazing that a group could produce such a phenomenal launch having never worked together in this capacity before. Physicians have been able to prescribe INCIVEK combination therapy to more than 17,000 patients during the first 5 months following approval. The rapid acceptance by physicians and patients is evidenced in the high market share of INCIVEK. INCIVEK profile is compelling for both people with hepatitis C and their doctors. People initiating treatment with INCIVEK include those new to treatment, as well as those previously treated with pegylated-interferon and ribavirin. Our research indicates that 60% to 70% of INCIVEK prescriptions written today represent patients who are new to treatments and many are also fairly early in the course of their disease. Consistent with the specialist-driven nature of the hepatitis C market, adoption of INCIVEK is highest among gastroenterologists, hepatologist and infectious disease specialists, and the nurse practitioners and physician assistants who work within these practices. However, I would point out that we're also seeing a number of additional prescribers who had not recently been prescribing pegylated-interferon and ribavirin. This is another encouraging sign of acceptance and broadening of the prescriber base. In terms of payors, we're in the process of contracting with various commercial and government plans and we're pleased with the progress so far. Through recent favorable formulary decisions, our co-pay assistance in 3 drug programs, we continue to ensure broad patient access to INCIVEK. To date, INCIVEK is available on formulary in healthcare plans that represent more than 180 million covered lives in the U.S., following formal drug utilization reviews. That means that more than half the population in the U.S. now has approved access to INCIVEK post-formulary review. Most other patients also have access to INCIVEK but their plans have not yet reviewed the protease inhibitor class of medicines. Now allow me to dig into some of the specifics of the launch. First, I'd like to briefly describe for you our way of thinking about the hepatitis C market. A common way of understanding treatment behavior is by grouping physicians into deciles or 10 groups based upon how many prescriptions they write. Since the highest prescribers write many more prescriptions, there are far fewer of them in this top decile. For example, historically, there were less than 100 physicians in the top decile who were producing 10% of all hepatitis C prescriptions. On the other hand in the lowest decile, there were more than 2,500 physicians, who wrote the same number of hepatitis C-related prescriptions as those 100 prescribers at the top. Key opinion leaders, many of whom are also involved in clinical trials, typically see the greatest number of people with hepatitis C and are well represented within the top few deciles. Naturally, these physicians possess high awareness of medicines before they launch and this was no different with INCIVEK. Through their understanding of INCIVEK, bolstered by our commercial support after launch, this group of physicians rapidly accept the therapy at a level that has been unprecedented in the treatment of hepatitis C. INCIVEK, therefore, achieved significant penetration in this segment and have built a strong base of prescriptions moving forward. Based on our research, we believe the high adoption rates and market share in this segment could result in greater acceptance by the other prescribers. As physician behavior in the top decile tend to influence the broader prescribing base. At this time, there are thousands of doctors in the mid to lower deciles who have not yet prescribed any direct acting antiviral and represent future opportunity. Our goal is to continue to educate and engage healthcare providers, who are already prescribing INCIVEK, as well as those in deeper decile. We already have a solid base as INCIVEK performs more strongly than any other PI in each of the 10 deciles. In fact, based on the most recent data, INCIVEK commands more than 70% market share in any decile of prescribers. Now I'd like to make a comment on how we've seen the launch of INCIVEK progressed from a sales perspective over the past few months using some of our internally-derived data and metrics. I'll refer you to the graph on Slide #24 in our webcast slide deck, which plots our monthly ex-factory sales of INCIVEK through September, together with data that describes wholesale inventory level. I'll make the comment that we've seen continued strong demand so far in October. Following our launch, we saw an extremely rapid take of uptake -- sorry, a rapid uptake of INCIVEK. In fact, for the first few months, it is not only faster than any other medicine launched within the hepatitis C market, it may be one of the strongest launches within pharma in this time frame. In addition, wholesale inventory levels have remained fairly constant at 2.5 weeks since the start of the third quarter. This slide is not intended as a forecast or guidance, and we won't necessarily be providing this level of detail in future quarterly calls. But we thought it was important for you to appreciate some of the key metrics we see at this early stage in the launch. Now, some thoughts on how we believe hepatitis C treatment will evolve with different combinations of medicines and new regimens. We believe the advancement of hepatitis C treatment will occur in waves, and we intend to continue to provide new options for patients and physicians as treatment evolve. This will be visible in a number of clinical studies that you'll hear more about at this year's AASLD. The initial wave will be built on expanded indications for interferon-based regimens. A second wave will likely feature more powerful direct acting antiviral combination regimens that still include interferon. And a third wave will hopefully offer all oral or interferon-free regimens. We're excited to be developing medicines that may contribute to these future waves of treatment. Each year, during AASLD and other scientific conferences, we get a glimpse into investigational approaches that may benefit patients in the future and this year is no different. Building upon the strong foundation that the label for INCIVEK already offers, you'll begin to see our plans in the first wave to address patient groups that are considered the most difficult to treat through large, well-controlled randomized trial. One such potential group includes people co-infected with HCV and HIV. Another group is those with recurring hepatitis C, following liver transplantation. Peter will tell you more about this in just a few moments. Relevant to the second wave at this year's double AASLD, we'll show SVR data from the ZENITH trial, investigating our quad regimens. ZENITH explores the use of INCIVEK VX-222 and pegylated-interferon with ribavirin to shorten the duration of therapy for patients even further. In addition to helping people who are new to treatment, this quad regimen could also help patients whose hepatitis C is considered difficult to treat, including null and cirrhotics. You'll also hear about our trial with the INCIVEK, pegylated-interferon and ribavirin in patients with the CC genotype, known as IL28B, who may have the potential for total treatment duration of 12 weeks. These individuals represent approximately 1/3 of the treatment naïve group. But we're not stopping there. As we look further into the future, our strategy is to develop all oral, interferon-free regimens for the third wave in the second half of this decade. Soon, we'll see results from an all-oral regimen of INCIVEK with VX-222 and ribavirin, as well as steps we're making to add our elionukes [ph] into the mix and again, Peter will address this in a moment. Now I'd like to turn your attention to our next commercial program, which is in cystic fibrosis. This is an orphan disease affecting approximately 70,000 children and adults in North America and Europe. Earlier this year, we began building the global infrastructure to prepare for the launch of KALYDECO, previously known as VX-770, including the establishment of our European headquarters in Geneva, Switzerland. We carefully built the commercial team when we launched INCIVEK, focusing on the needs of healthcare providers and people with hepatitis C. Now, we're refining this model to support the launch of KALYDECO, taking into account the unique needs of people with cystic fibrosis. This model will focus on building a long-term relationship with the cystic fibrosis community. In Phase III registration studies, KALYDECO showed rapid, significant and sustained improvements across a variety of disease measures, including lung function in people aged 6 and older with the G551D mutation. KALYDECO was intended to provide patients with a twice daily oral medicine to be used with their current medications. It's the first medicine of its kind to target the underlying cause of CF. Physicians have made great strides over the years in treating CF with the current medicines and they have improved treatment and care for people living with cystic fibrosis. However, these therapies treat only the symptoms of the disease and its complication. We're hopeful that KALYDECO, if approved, will build upon the treatment regimen that physicians are already using to offer a significant benefit for the people with cystic fibrosis. So let's look for a moment at the CF market that we hope to address with KALYDECO. There are approximately 1,000 people in the U.S. and Canada who have the G551D mutation on at least one allele and who are also 6 years old or older. In Europe, we estimate approximately 1,000 people with the G551D or other dating mutation who are 6 years old or older, consistent with our MAA submission. Assuming KALYDECO is approved, we'll be providing financial and other support services in order to help patients and their caregivers before and during treatments. The Vertex team who will lead these efforts will make information about CF as a disease, KALYDECO, reimbursement and support services available to the CF community. I'll share more about these programs following approval. We're in a unique position and feel a great sense of responsibility in launching KALYDECO. There are several areas where we're focusing our attention today to ensure that we get it right. This includes understanding and establishing the value of KALYDECO, as well as focusing on educating the community on the importance of each person knowing their genotype. In this way, we can be sure that KALYDECO can be prescribed for the right patient. We have a lot to do and we'll be ready. Thank you. And I'd now like to turn the call over to Peter.