Q2 2023 United Therapeutics Corp Earnings Call
Good morning, and welcome to the United Therapeutics Corporation second quarter 2023 earnings webcast.
My name is Danielle and I will be your conference operator today.
All participants on the call portion of this webcast will be in listen only mode until the question and answer portion of this earnings call.
If you would like to ask a question during that time.
Simply press Star then the number one on your telephone keypad.
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Please note this call is being recorded.
I'll now turn the webcast over to Dewey Steadman head of Investor Relations at United Therapeutics.
Thanks, Danielle and good morning, It's my pleasure to welcome you to the United Therapeutics.
Therapeutics Corporation second quarter 2023 earnings webcast.
With me on today's webcast, our Dr. Martine Rothblatt, our chairperson and Chief Executive Officer, Michael Beckwith, Our President and Chief Operating Officer, James <unk>, Our Chief Financial Officer, and Treasurer, Pat 45, our executive Vice President of technical operations and Dr. Leigh Peterson, our senior Vice President of product development.
Please note that remarks today will include forward looking statements, representing our expectations or beliefs regarding future events.
These statements involve risks and uncertainties that may cause actual results to differ materially.
Our latest SEC filings, including forms 10-K, and 10-Q contain additional information on these risks and uncertainties and we assume no obligation to update these forward looking statements.
Today's remarks also may discuss the progress and results of clinical trials or other developments with respect to our products. These remarks are intended solely to educate investors and are not intended to serve as the basis for medical decision, making or to suggest that any products are safe and effective for any unapproved or investigational uses remember full prescribing information for our products.
Available on our website.
Note that Pat to find out is we will be participating in one on one meetings at the 2023 Wedbush <unk> Healthcare conference on August eight.
Then Michael Biggs, what James Edwin and I will participate in a fireside chat and one on one meetings at the Morgan Stanley 20, <unk> annual Global Healthcare Conference on September 11th. In addition, we will present data at the European Society of Cardiology and Amsterdam in August the European respiratory Society in Milan in September and a chest.
Annual meeting in Hawaii in October .
Now I will turn the webcast over to Dr. Rothblatt for an overview of our second quarter 2023 financial results and the business activities of United Therapeutics Martine.
Thank you Dewey.
I'm thrilled that United Therapeutics continues to report double digit revenue growth and our highest quarterly revenue ever.
We expect this growth trajectory to continue with our current business as we expect to reach a 4 billion dollar annual revenue run rate by mid decade.
Beyond that we expect continued waves of growth with an additional doubling of our revenue from the potential launch of <unk>. So in pulmonary fibrosis and have relented pegged in pulmonary arterial hypertension, and then yet another doubling up of revenues with the potential for an unlimited supply of tolerable transplantable.
Oregon in the next decade.
Let me now drive a little bit deeper into some of these you know absolutely fantastic results that we are pleased to report this quarter.
As mentioned the total revenues are at a $596 million for the three months, but it's interesting to compare that with the matching three months of last year, which were just about $467 million. So that's a percentage.
Growth rate of 28% and I'm very much in line with the type of growth rate that we have previously indicated.
We expect to achieve in order to achieve that 4 billion dollar revenue run rate by mid decade.
Another deeper level to look at is the company's net income for the past quarter. We are reported over a quarter of a billion dollars in net income and again, it's instructive to compare that with the quarter matching quarter in 2022.
When we reported $116 million and net income.
Percentage change of 123%.
Very comparable numbers can be obtained if you defied the net income into the outstanding shares and in fact, we're pretty proud that as compared to peers. We have a relatively low number of shares outstanding which helps drive those some fantastic.
Salt.
Now, let's dive a even deeper into some of the results on the products Tavy, so $319 million up 59% from last year, where module and $127 million down about <unk> five.
$5 million from the matching quarter last year, a rent a tram $95 million up 20% from the matching quarter last year unit toxin $44 million essentially flat from the matching quarter last year, we don't really talk that much about.
Using the toxin, but I, probably should stop and and for people, who are perhaps new or to United Therapeutics remind everyone that this is a treatment for neuroblastoma pediatric cancer with a very high rate of mortality.
And for the based on the several years that our units Hudson has been used by doctors to treat that cancer.
Approximately 50% of the kids treated with unit toxin.
As well as the other on concomitant therapies used their cancer is wiped out it does not return even five years later when they're when they're checked the cancer has not returned in about half of the patients I I find that you know truly remarkable and.
Just a a miracle of biotechnology.
And one of the many blessings to be here at United Therapeutics that so many kids can live with cancer free life after getting that devastating diagnosis in there tender years. So in any event because that our drug is so a well used by the pediatric on.
Colleges are.
We're now looking at them on a annualized basis I'm, you know, it's getting close to $200 million a year.
Now in addition to those top line revenues and profit figures, let's dive a little bit into the spending section and here, we break out our our spending in large categories in terms of external research in.
Development internal research and development and then the general administrative and sales and marketing categories with a few miscellaneous rose put in their according to us GAAP standards.
So the external research and development is what we spend on on other companies assisting us with our research and development.
The lion's share of that money goes to conducting our worldwide clinical trials. So we've got quite a few clinical trials going on right now and most of them are in the phase three our stage of development, which is the largest and the most costly phase of development.
But we have the to Teton one in Teton, two phase III trials for idiopathic pulmonary fibrosis and then we have this new Teton three or also called a P. P F AR.
Type of pulmonary fibrosis, which is another phase III trial, just starting up this year, we have the ongoing worldwide rolin of peg clinical trials covering you know countries you know in almost every continent and that is a more expensive clinical.
Trial, because that clinical trials aiming for an endpoint to show that we reduce deaths.
And morbidity in patients with pulmonary hypertension. So we have to both enroll more patients in and keep the study going longer until we get a statistically significant difference.
And the death rates, but then we look at that and and hope to achieve statistical significance with respect to the treated or active group.
We also I'm still are ongoing with the gene therapy trial and so all of these trials combined they they end up costing us more than $100 million a year just in spending outside of the company and that's not even a talking about the the level of spending.
Inside of the company.
Now inside of the company, we've got our our great team of clinical drug developers are ultimately led by Doctor Peterson, who joins me on the call today and she has just been doing an amazing amazing job of running all of these phase III trials are simultaneously Ed.
And it really it takes a humongous amount of effort to get drug labeled translated ship to these countries all over the world constantly be monitoring those centers sending people. There every month to make sure that the protocol is being complied with I cannot begin to tell you how long the checklist.
Is to conduct these are clinical trials. So it's it's not surprising that you know there is another more than $100 million a year spent on internal research and development now.
Now under the internal research and development category. We also cover the development activities for the Oregon manufacturing efforts that I described in at the beginning of the call and there. We've got the the lead program are our Zeno transplantation efforts.
And there in accordance with the F D a guidance, which we received in our interact meetings with the F. D. A both for the Zeno kidney and for the Zeno Heart, we are proceeding with the pivotal preclinical studies necessary to enable.
And opening of an I N D four zeno kidney and see no heart.
We are doing our best to hopefully be able to open at the high end D. As soon as possible, it's not really possible to predict exactly.
When the F D. A would feel that it was the appropriate time to do that but I would say that the timeframe for that F. D. A decision kind of you know reasonable case is a 24 25 time frame a more pessimistic case could be at $25.
96 timeframe, but any way you look at it is you know literally around the corner and drug development speak and that's an additional area of.
A significant spend we also are continuing to spend heavily on our laboratory based lung manufacturing activities, both with our allogeneic as well as with autologous cellular they shouldn't and that too is a really a trail.
Our leasing effort, where people are many of them are one patients who have been treated with our medicines for pulmonary hypertension, but in the event that their disease progresses, which is usually the case with pulmonary hypertension and for that matter pulmonary fibrosis.
CIS as well and of course, many other lung diseases.
You progressed to the point of needing a lung transplant.
And we are doing our best to be able to have laboratory manufactured lungs, two satisfies those patients' needs for lung transplant, but in the meantime, we have a really remarkable program.
Which we call one bioengineering and of this program, we we take lungs from organ donors, who for various reasons. The transplant surgeons feel they are not quite ready or certain.
That they want to use that donor lung for to put into a very very sick person who needs that long.
So they ask the organ procurement organizations to fly those lungs to one of our two lung bioengineering centers are one is in silver spring, Maryland across the street from our headquarters and the others in Jacksonville, Florida on the campus of the mail.
Clinic and there are highly skilled highly trained technicians. They work on the lung like a person would like the doctor would work on a on a patient or a search and we'd work on a patient and they do everything that they can to render that lung suitable for transplantation.
And quite to me is as a person who's actually never done the procedure I'm like blowing away that half of the time, they succeed and the one that was not going to be used to save a person's life is in fact able to be used to save a person's life and to date we have.
Saved over 300 peoples our lives with these lung bioengineering products.
I'll also mention just kind of coincidentally.
That when we are not able to use the lung to save a person's life. We are often times able to use the cells from the lung to assist in our efforts to manufacture hello genetically cellular rise lungs in our laboratories. So it's.
Of everything all fits together here at United Therapeutics.
I know I've I've talked on for quite a while here, but there is just so many exciting things going on at United Therapeutics, We have been able to build up a.
Our substantial cash balance and we are targeting that for three main.
Areas of deployment.
First and foremost is to invest in all of the internal projects that we have going here at United Therapeutics, and I've mentioned several of them.
My remarks today, you may recall, just a last quarter, we talked about a half a billion dollars being allocated to the production of a dedicated Taipei. So D. P. I production facility on our campus in researched.
Parc North Carolina.
So that is a in a recognition of the you know very excellent take up that the typeface. So DPI product has seen among physicians patients and their families all supporting the patients in that regard.
And then another area of capital deployment would be to probe too build the G. M. P equivalent production facilities for these you know kidneys and Zeno Hearts that I've mentioned previously and of course, the FDA wants to see.
And we would also want to see that those Zeno kidneys Zeno Hearts are manufactured in a totally clinically appropriate fashion, which requires the animal equivalent of a GMP facility.
The technical name for it is a designated pathogen free facility. So capital is also a targeted for that in addition, we have a very a robust.
Our business development group.
Led by a doctor Betsy Eades of our company.
And she is frequently.
Bringing to us often very compelling candidates for a potential either investment or outright acquisition and we need to retained adequate capital for those opportunities you may recall that.
I think you know probably the next biggest impact drug that we could have in pulmonary hypertension relented peg was acquired through our business development efforts for about $1 billion. So these type of opportunities are regularly are being reviewed.
With my Doctor eats and then <unk>.
And then third is to repurchase.
<unk> shares to the extent that there is excess capital that can't be deployed for internal business development or external business development of course, the next up would be to engage in share repurchases and we have repurchased lots of shares overtime.
In fact, I mentioned earlier that our outstanding share count is relatively modest compared to peers and that is because in no small part of our previous our share repurchases.
So with those introductory remarks, I'd now like to turn the phone over to Michael banker with our President and Chief operating Officer Mike.
Thanks Martine.
Good morning, everyone. As Martine said, we had a phenomenal second quarter from a revenue standpoint, setting revenue records for 14 days, so our rent a tram and totaled coprostanol and I want to begin by publicly thanking and congratulating all of our commercial and medical affairs teams at United Therapeutics for their hard work and achievements during the quarter.
As usual I'll provide some color on what we're seeing with respect to Taipei, So a renter trim and remodeling.
So I'll start with where I want to highlight several things I should also mention that for purposes of these comments queso refers to the combined nebulizer and DPI unless I otherwise note.
So first as I just mentioned, we posted not posted the highest quarterly revenues ever for Friday, So which reflects increasing physician and patient demand in both the P. H N ph ILD indications as well as the type of title V. So DPI inventory build of about $30 million in the quarter at the specialty pharmacies.
Our underlying demand metrics that as referrals, which is what we call prescriptions, new patient starts and that patient adds remained very strong and roughly in line with the last few quarters.
New patient starts are trending around a 70 30 split between DPI the nebulizer, respectively. The.
The transitioning of long term existing <unk> patients to today. So DPI has largely played out at this point at least until the part D redesign provisions of the inflation reduction that begin to go into effect over the next two years.
<unk> Nebulizer high base of referrals and starts have trended upward over the last few months, we do expect that there'll be some basal level of transitioning between the neighborhood nebulizer and DPI going forward as physicians optimize to which delivery device is best suited to each of their patients.
We also continue to make great progress growing the Taipei, So prescriber base and prescribing depth within that base.
On the <unk> DPI supply side, our partner mankind completed their production expansion and process improvement efforts during the quarter, which we expect will increase production capacity by about 250% going forward. We started to benefit from these enhancements at the end of June when as I mentioned, our specialty pharmacies were able to build.
About $30 million.
A DPI inventory.
Specialty pharmacy inventory levels on the last day of the quarter actually reached their contractual arrange based on historical demand.
However, this could fluctuate through the remainder of the year as Televisa DPI demand grows and until mankind has a few more months of production with the additional capacity.
We anticipate that specialty pharmacies, maybe able to get into the regular ordering patterns for today. So DPI.
Sometime either later this year or the first half of 'twenty four.
As a reminder, mannkind is also undertaking work to further expand production capacity even beyond these most recent improvements, which we expect will come online in 2024.
I should also note that the nebulizer destocking that we highlighted in the fourth quarter of last year and first quarter of this year. It did in fact conclude in the first quarter.
Second quarter Nebulizer orders were in line with specialty pharmacy contractual inventory levels and patient demand.
So to wrap up the <unk> story, we're extremely pleased with the progress we've made and the opportunity that lies ahead of us our focus and efforts in the second half of this year and into 'twenty four.
At our four main areas first is increasing production of supply tightness at Epi in partnership with Mannkind second is increasing physician screening for ph ILD and their ILD patient population.
Third is growing the prescribing breadth and driving depth to three plus patients as I've mentioned on prior calls and then fourth is continuing to increase patient retention on Taipei. So while we've made very good progress on each of these items. Thus far there's still more we can do and to this end, we recently realigned product promotional responsibilities with our.
Within our existing commercial head count and are in the middle of the head count expansion, including themselves to drive these efforts.
Turning to our module and this business continues to be incredibly resilient, even though it is facing.
Face generic competition for almost four years now.
A trend that started last quarter, we saw a near record number of referrals in the second quarter and active or module on patients remain at pre generic levels remunerative continues to gain traction in the market. It is as it is the only subcutaneous pump.
Widely available for new room remodel and patient starts.
Finally, our Renaissance had another record quarter with the highest revenue in patients on therapy since its launch our 90 day titration kit launch during the first quarter has continued to receive positive patient and physician feedback.
We're also very excited that data from the expedite trial, which is our rapid or module and titration and transitioned to a rent a trend study has now been published in two medical journals. We look forward to disseminating this important information to clinicians and appropriate forums over the balance of this year and into next.
So to wrap up we're very pleased with the overall <unk> business led by the incredible incredible demand for a high base of DPI and we believe we're on our way to hitting our goal of a $4 billion annual revenue run rate by the middle of the decade with that I'll turn the call back over to you Martin.
That was an amazing awesome wrap up thank you. So much how do you stay on top of so many details blows my mind perfect Wow.
We have the best and the precedent. Thank you Mike Okay.
Operator, please open up the lines for any questions and like all forward them amongst Mike Pat and Dr. Peterson.
Thank you.
The question and answer session to ask a question you May Press Star then one on your touch sensors.
If youre using a speakerphone please pick up your handset before pressing the keys.
Your question. Please press Star then two.
The first question comes from Ash Verma of UBS. Please go ahead.
Hi, Thanks, good morning, and congrats for the strong quarter here I have two questions one just on timing.
So wanted to ask what's your level of conviction.
Yeah.
The pilot study should benefit in D E E.
But even if he done studying you're studying idea all comers.
And then second one can you provide some color on the patient asked me how much of the new patient adds is coming from P. H P.
And do you expect the patient adds per quarter, just talk does it go faster in the coming quarters and years.
Thank you for your question and thanks for the congratulations we have so many colors into Q I'm, just gonna have to limit it to one question per caller. So we will take your first question about pulmonary fibrosis and Dr. Peterson could you kindly respond to ask this question yes.
Yes sure. Thanks for the question. So as you mentioned that we had data from increase right.
In P. H I P S subpopulation of increase that exhibited.
Our improvement in S E, which is.
A marker that that indicate.
Korean anti fibrotic activity I know.
This in addition to.
Right.
Many many publications on also a mechanism for how do they sell which is anti fibrotic.
Confident that it will also work in the population of two karn, one and two countries, which are IPF idiopathic pulmonary fibrosis as well as our new study in P. P M.
Which is progressive pulmonary fibrosis.
That's excellent. Thank you so much Dr Peterson and operator could you. Please take the next caller.
The next question comes from <unk> Yang from Jefferies. Please go ahead.
Thank you congrats on the great corner that's amazing.
Amazing numbers.
So the question on DPI inventory build of about 30 million in second quarter.
Well did that the inventory levels.
Expected going forward or do you think even with the increase or could there be some draw down in the corner. Thank you great question and so nice to hear your voice. This morning, you and thank you for the congratulations the questions with regards to inventory, we normally ask our chief financial Officer.
Or James hedge fund to handle because he's totally on top of the flow of everything of value in and out of the company. So I'm James could you. Please answer your question.
Yes, Thanks, Marty and good morning, Yoon and thanks for the congrats on the quarter.
Two two parts to the response to Michael talked about the $30 million.
Listen to DPI inventory during the quarter, which was specific to epi inventory build and Michael addressed Nebulize yours inventory as well, which is a pretty much normalized with respect to the demand for DPI for the balance of the year.
As Michael talked about this can really fluctuate going forward.
Through the remainder of the year as we think about patient demand as well as the manufacturing at mine at Mannkind as we work through some of the improvements.
That we've highlighted so going forward there certainly could be a fluctuation in DPI inventory, but I wouldn't want to reiterate what Michael said across the portfolio of products as we completed the quarter, we werent contractual requirements with all the products.
But it is important to highlight the DPI fluctuation going forward based upon demand as well as manufacturing at Mannkind. So thanks for the question Martijn back to you.
James are just excellent answer as always so thank you and you and thanks for asking the question operator can you. Please I'll pull up the next person from the queue.
The next question comes from <unk> Singh from Oppenheimer. Please go ahead.
Oh, great. Thank you for the question and really nice quarter, a really tough comp last year last year at this quarter. So it's really well done.
A question on really in the pack.
Assuming the phase III are successful Martin and team how do you see the products sort of.
We should be used in the.
Treatment paradigm.
Replacement trend.
Well, let me take some of the select some pack patients there could be some generics there, but any thoughts there. Thank you.
Yeah. That's that's a great question and I'm really happy to have it you know I think her touch you've been able to ask a question that kind of transcends two different areas. So unusually I'm going to ask two separate team members to respond to your question with regard to their different levels of involvement in the <unk>.
Frontline treatment for pulmonary hypertension clinical situations and market first of all Mike If you could answer a heart harsh in terms of where you see placing prevent a pack once approved and the and they basically the presentation of.
Treatment options are that would be presented to physicians by by especially by our sales force and then perhaps I'll Lee if after Mike talks you can provide some insight that you're able to share from our clinical trials in terms of how.
Do you see what the protocol calls for in our clinical trials.
And that might also help to shed some light on hard times for his question in terms of where it's being used in the clinical trial.
Outcomes in particular.
Your first name.
Sure and you've got you know all of this is obviously contingent on on how that study reads out of the data and kind of what we see through the.
Through the trucks to the trial, a hard time, but I think generally generally speaking I think we expect that.
You too.
You'll still start with a P. D. Five N E. R E and then at that point as once the disease.
The patient's disease continues to progress the Doctor has has as an option as to what what to add that's why I think.
We're expecting that where a lot of pets sweet spot is going to be right. After the P buys.
At El Rey now yeah for various reasons, depending on where the where the you know where the patient is in their disease journey. It could be maybe they need something stronger. So they go to a rent a trial or maybe they want the convenience of DPI. So they start there and then they kind of transition back and forth, but I really kind of look at it as being sort of.
And that in that sort of area. After PD five E. R. A patient's disease is starting to take a restaurant there.
Yeah, Mike that makes such perfect sense, because you know it would really be to my understanding you know the only once a day.
Prostacyclin.
Category, it's not exactly a prostacyclin analog but it works on that pathway. So the only once a day treatment, which will just be huge for the patients because if you. If you Miss even you know a few doses this diseases in cities and it could just stuck reclaiming territory in your lungs. So comply.
This king and once a day is the emperor.
Type of delivery for compliance I'll leave what kind of insights do you have on her touches question from the outcome of the from the contact of the outcome study.
Yeah, So really with as Michael just said with regard to select the peg I mean of course, we're shooting for a better clinical effect, but also that the fact that Michael just said, it's relented pegged as once daily dosing versus twice.
So.
And that most patients fail that message, but scientifically.
Your question regarding Oh rent a trend now you might remember that that rent a trend or coprostanol actually binds and interacts with multiple prostacyclin receptors versus select taken related to our IP specific.
Activators of the.
The I T only receptor and the <unk>.
And it's thought at least from.
Several non clinical studies that these different risks receptors have different activities.
And so this this could very well translate to the clinic, where we're certain patient do better when they have binding and activation of a.
Multiple prostacyclin receptors and and some patient my might do better with regard to both Tolerability and.
Efficacy, if they and if they simply have a binding and activation of of the IP receptor and so.
So I hope that answers your question as to.
Where we see things, it's not a complete overlap with regard to the mechanisms of action for sure.
Brilliant answer Wow, that's why I'm. So glad we have a scientist on the call and Heartaches I'm. So glad you asked the question because look at all the information that got shared through your question. Thank you operator next question.
The next question comes from parents Flynn of Morgan Stanley . Please go ahead.
Great. Thanks, so much for taking the question congrats on a quarter.
A two part question for me just wondering if you can comment at all on Taipei, So patient start trends in July versus June as well as a breadth of prescriber base, Mike I know you touched on that but any more color. There would be helpful. Thank you. Okay. Thank you Terrence Mike you got it.
Yes.
On the referral and start trends and July versus June I mean, we're continuing you know it's been pretty consistent I think over the first half of the year. That's continuing in July so I think the rate of referrals and starts.
As a consistent level with what we've seen in the first half of the year.
I would say on the prescriber breadth.
Prescriber growth.
I think the rate of growth has been you know I think what I've.
What I've said is that we did last calls that we've roughly doubled the number of prescribers since we've launched.
Month to month quarter to quarter that doesn't necessarily change literally it's just it's a little choppy so.
It has increased marginally above the kind of the doubling.
And the last quarter.
We have seen however continue to maybe stronger growth or higher growth in the last quarter in terms of the depth of three plus prescribers, so which is good I mean.
<unk> said on prior calls we use the analogy that I forget forget the prescribers to three plus to.
To three plus patients you sort of kind of get the flywheel spinning in the other three goes to turn pretty quickly thereafter, so we are making really good progress.
Yeah on that aspect.
Prescribing depth.
And as I said continue to add topline prescribers as well.
Thanks, So much Mike Yeah, that's a great metaphor with the flywheel you could just see how our success compounds once doctors start using our medicine.
Operator, we have time for just two last calls.
The next question comes from Joseph film of T. D. Colin Please go ahead.
Hi, there good morning, and congrats on the quarter and thank you for taking my question.
Maybe just as we think about penetration into the ph L. D market, where do you think you stand now and now that the therapy has been on the market for a couple of years and the indication have your expectations for the size of this market changed at all thank you. Okay. Thank you very much Joe Mike I think you're the best person to answer that.
Sure I think on penetration of the market.
We're in the.
Low single digits.
And I say think because I still you know and this is.
I think a question that was asked earlier that we just didn't have time to ask but around the kind of the mix of the ph of the ph ILD I mean, the data coming out of the referrals is still not it's still a little dirty. So it's still a 100% clean in terms of what's group one of what's what's group three but I think based on kind of what we're seeing it's you know I think it's I think it's fair to say that we're kind of in that low low single.
<unk> digits.
The ph ILD market and then in terms of the size of the market and nothing's really changed in terms of our understanding of what that as you know we kind of started out saying it's at least 30000.
We still we still think that that's that's accurate he can talk to some kols, who think it's significantly higher.
Here that are that may be but you know what.
Set all along with a 30000 I mean, thats still a really good size market for us and so we're really focused on.
Continuing to penetrate in that market and.
You'll get as I said in my my opening remarks, really kind of ramp up the screening of Isle of ILD patients to look for pulmonary hypertension.
Super Thank you Mike so much operator, the last question, we just have time for one more I'm sorry.
And the last question comes from Andreas <unk> from Wedbush. Please go ahead.
Yeah. Thanks, good morning, and thanks for taking my questions I wanted to be the last one year and great quarter.
Another congrats there as well.
So lots and lots of good questions from my colleague once I based on the market evolving and ph going back to the prepared remarks on the potential use of cash how are you thinking about outside investment opportunity is it.
Just even in ph and maybe perhaps broadening the company's core focus.
Yeah Andreas.
Deepened interesting question and I think that we are most interested right now in the pulmonary fibrosis a segment in terms of outside investment.
It's not to say that we don't have continued interest in the ph segment, but the ph segment.
Yes, I think almost anybody's estimation pretty crowded marketplace at this point in time.
And by reflection, when we started the company.
There was a there was no oral treatment approved for ph as well.
There was no inhaled treatment approved for P. H in fact, all of it was really available was a printer or a slowdown.
And if you compare that situation with the situation today I.
Honestly I've lost track of how many different drugs and and and versions of drugs and you know generic versions of drugs. There are but it's it's certainly over a dozen so ph is a it's a very crowded marketplace. Despite that a crowding out there seems to be continued since.
G amongst a certain drugs that are in that a crowded field. For example, the P. D. Five inhibitor had circa which can be taken a once daily is something which is often used in combination.
With several of the other drugs.
Less often but still you know frequently and E. T. R. A such as Ampere centre and can be used in combination with the other drugs and increasingly now our own rent a tram is used in combination with those other two kind of you know.
I don't want say weaker, but Oh, I'll say, you know non-pros signal strength drugs.
So.
So there's kind of a combination phenomena means that even though the market is very crowded there are always there's still great opportunity for a new drug in terms of being used as combination therapy.
And that certainly is has Mike bank of which <unk> mentioned in his.
Discussion of prevent a peg, that's our expectation and brilinta pegged that it'll be used in combination.
Thanks for the congrats but one thing that maybe you didn't get enough highlighting on the call. Although Dr. Peterson did talk a bit about it was the a tremendous upswing in growth in our rent a tram and that's no. That's no like coincidence or just something coming out of the blue that's because increasingly.
First of all a rent a tram is being used in combination with the PD fives and eat here as it's a convenient pill and then secondly.
We have another study going on to develop confirmatory data its called the artisan study and this study shows that building on our previous smaller studies that you could rapidly switch a patient from a parenteral drug like printer oral prostacyclin.
Switch coprostanol to rent a tram appealed and if you do that you're able to kind of jump over this valley. When you have the side effects of a rent a town without the efficacy here it'd be the jump over that valley and go directly to the efficacy and you're already kind of at nurse to the side effects are they've been.
By the time you spent on the parental drugs.
So again this is all to say now Paul ph is a crowded area I think that there is strong groom for United Therapeutics to continue to grow.
There hasn't been much discussion on this call about so Tao this up but just to say some of the best data that has been published so far in socal or Sep.
He is in combination with the odd for processing all products. So I think combination therapies are the way to go now kind of exact opposite situation is in pulmonary fibrosis, where you have a comparable.
<unk> size Ah patient population, yet instead of there being a dozen plus approved drugs for it there are really only two and and so it's a very very different situation. Neither of those two are reported to be disease modifying.
In any way are they simply have been shown to slow the rate of progression of the disease, which is good but not as good as being disease modifying.
So I'm very hopeful that we will have something that indicates on disease modifying our capability come out of our Teton studies and are very hopeful that we can do as much in pulmonary fibrosis as we as a company have done in pulmonary hypertension.
I mentioned when I started to answer your question Andreas.
At the beginning of the company there were very few prescribers because all the patients died there was very little hope and United Therapeutics has has enabled a kind of a reinvention of the pulmonary hypertension space that now there's over a dozen drugs and patients.
Instead of dying from pulmonary hypertension, they live with pulmonary hypertension and there are patients living are literally decades, which is amazing a wonderful.
But we would like to be able to do the same thing in pulmonary fibrosis that we've done and are doing in pulmonary hypertension. Some of that will be done with internal R&D such as the great efforts being led by Dr. Peterson that ketone Monte time to Teton Threep and then we are also keenly.
<unk> interested in deploying our capital for business development activities that could build out and expand our portfolio in a pulmonary fibrosis. So that's just one example of a disease area outside of pulmonary hypertension that we plan to tackle.
Andreas Thank you for your question, operator feel free to roll into the wrap up script.
This concludes our question and answer session I would like to turn it back over to Martin for closing remarks.
Okay.
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Yeah.
Yeah.