Posts Tagged afib

Delivering Drugs Straight to the Heart – InCarda’s Acute Atrial Arrhythmia Treatment

Narsi Rangachari, co-founder of InCarda Therapeutics talked about InCarda’s novel approach to delivering drugs straight to the heart.

Scheme of atrial fibrillation (top) and sinus ...

Scheme of atrial fibrillation (top) and sinus rhythm (bottom). The purple arrow indicates a P wave, which is lost in atrial fibrillation. (Photo credit: Wikipedia)

Approximately 20 million patients a year in the US, experience one or more forms of acute cardiac conditions. Current therapies to treat acute conditions are not optimal. They are slow, have not effective presenting higher risk. Current therapies also seem to cause a great deal of patient discomfort, resulting sometimes in poor quality of life, frequent and continuing ER visits, and extended hospital stay. Cardiac conditions add a tremendous burden to the overall healthcare costs. Cardiac arrhythmias rank as number 7 among the top 10 reasons for hospitalizations. There are little to no acute interventions in treating patients with atrial arrhythmias.

Atrial Fibrillation (also called Afib or AF) is a serious but non-life threatening condition that causes irregular and often-rapid heartbeats and many a time where the patient experiences debilitating symptoms. Global prevalence of AF is over 34 million and growing, with more than 5 million Americans estimated to suffering from the disease. Oral tablets approved for chronic treatment of AF are 30-50% effective, have very slow onset and are generally not suited for acute intervention. Few of the new drugs have made it to the market and these have not proven to be safe and effective. Ablation is an expensive and invasive procedure requiring repeat procedures, require hospital stays and are often associated with serious adverse events.

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InCarda’s patented technology focuses on targeting the drugs to the heart via the lungs, said Rangachari. He spoke about a variety of technologies available to deliver drugs to and through the lungs. These included portable nebulizers, dry powder aerosols and breath controlled pulmonary delivery. The benefit of inhalation in treating atrial arrhythmias is that it delivers a “first pass” to cardiac tissue, delivering a bolus of drug directly to regions of the heart where stimuli for acute atrial arrhythmias arise. This permits rapid onset, lower off-target tissue exposure of the drug and – importantly – can be self-administered by the patient. InRhythm currently under development to treat widespread symptomatic atrial arrhythmia conditions like paroxysmal atrial fibrillation (PAF) uses approved drugs in a new dosing paradigm. InCarda has developed a de-risked approach by employing well studied, first line drugs, with long histories of efficacy and safety. In addition, the Company is using validated endpoints with established clinical assays and using commercially available inhalation devices for clinical evaluation. It was a very interesting talk and was followed by Q&A.

PS – See similar article on Pearl Therapeutics , a tiny company that focused on inhalation drug delivery for conditions like asthma and COPD and was bought by Astra Zeneca for $1.15 Billion.

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2013 J P Morgan Healthcare Conference – Pharmaceutical & Biotech Company Presentations

2013 J P Morgan Healthcare Conference – Pharmaceutical & Biotech Company Presentations 

Disclaimer – Below is my best attempt to capture highlights from company presentations, at 2013 J. P. Morgan Healthcare Conference, in San Francisco, CA.  Please check details against more authentic sources, before making any financial decisions.  My writeup on the overview of the conference can be found at this link – .  My article on the highlights from some of the medical device company presentations can be found at this link – .  Big Pharma industry historically enjoyed growth rates in double digits and 20% operating margins with growing demand and big profits.  But times are changing for big pharma with challenging healthcare environment, cost pressures, and patent expirations.  Many firms responded to initial challenges by investing heavily in next-generation drugs, often based on biotechnology.  Though promise of biotech has not panned out, many pharma companies have done restructuring, initiated serious cost containment and have nurtured the pipeline by investing in some promising molecules.  See below, highlights from some of these companies.


Amgen – 2011 & 2012 were solid years and advanced pipeline offers promise for 2013

Both 2011 and 2012 were solid years for Amgen, with revenue growth of 11%, said COO and CEO elect, Bob Bradway.  He credited the growth largely to the newly launched products, particularly denosumab franchise that include XGEVA and Prolia.  In first year in market, Amgen has recouped over $500M of revenues from this new franchise.  Amgen has returned 36% back to the shareholders.  Prolia accounts for $1B in sales in the US.

Besides growth in its core franchise and advanced footprint, Amgen also has exhibited strong commercial execution with solid performance in the US and international markets, said Barclay.  Sales of Neulasta grew and 40% of patients receive it during first chemo.  Enbrel is Amgen’s leading molecule in rheumatoid arthritis and psoriasis space and is steadily growing.  Sensipar, Nplate, and Vectibix also have strong and steady momentum. There was 18% growth in 2011 on these new products.

Additionally, there is a late stage pipeline emerging that looks promising.  It includes, molecules AMG 145, an antibody PCS K9 for hyperlipidemia for high cholesterol, AMG 785 antibody for post menopausal osteoporosis, AMG 827 (in collaboration with Astra Zeneca) for psoriasis, AMG 416 for secondary hypothyroidism, and several oncology molecules, including AMG 102 for gastric cancer and AMG 386 for ovarian cancer.

Amgen will continue collaborations with other significant players.  Recent acquisitions that are advancing its pipeline include Micromet, decode, and finally Mustafa Nevzat to help establish a presence in Turkey, an emerging market for Amgen.  Amgen will continue to return significant capital to shareholders and in 2013, Amgen will focus on growing revenue, operating efficiencies, advance its pipeline, and focus on ROI.

Bristol Myers Squibb – will its promising portfolio deliver in 2013?

While 2012 was a year of transition, BMS is now poised to deliver by driving growth of key brands, executing on new product launches, and driving late stage pipeline said, CEO, Lamberto Andreotti.

BMS’s diversified portfolio includes key brands Eliquis, Yervoy, forxiga, Orencia, Sprycel and so on.  Acquisition of Eliquis for stroke prevention and systemic embolism for Afib, offered a significant global opportunity and it was launched in Europe, US, Canada, and Japan.  BMS has a broad portfolio targeting diabetes, in partnership with Astra Zeneca and it includes Amylin, onglyza, forxiga, and Byetta.  A robust late stage portfolio targeting HCV includes some promising molecules.  Finally, immuno-oncology continues to remain an exciting portfolio.  Yervoy is showing encouraging 5 year survival data for melanoma patients, Nivolumab is in broad stage III program, and Elotuzumab phast III studies are looking promising, said Andreotti.

BMS is committed to 3% increase in dividend for 2013 versus 2012, has completed initial $3B share repurchase program and has announced additional $3B share repurchase program, and will continue to focus on business development through licensing, acquisition, and partnerships.  BMS is well poised to deliver with improved decision making, more efficient operations, and greater collaboration, said Andreotti.

Merck – Exciting Pipeline & Plans to Expand Geographic Footprint

Celebrating first year as a combined company, following the merger of Schering-Plough and Merck, the company is well poised to outperform the broader healthcare market, said Ken Frazier, President & CEO of Merck.  Its broad portfolio includes market leading medicines and vaccines, Merck has expanded geographic footprint in key markets, and has a strong exciting late stage pipeline.

While sales force was reduced in the US by 10%, in emerging markets like China, Brazil, and Russia, Merck was increasing the presence.  Despite 2012 being a year of maximum disruption, with blending sales forces, training reps on new products etc., the company maintained top line growth with 7 of the top 10 products growing at a steady pace, said Frazier.  The current late stage pipeline includes 55% legacy Merck compounds and 45% legacy Shering-Plough compounds, affirming the scientific productivity of both organizations, said Frazier.  Growth strategy going forward includes plan for geographic expansion in Japan and emerging markets, delivering on the pipeline, and expanding broader portfolio of business that include Merck BioVentures and animal health business. Some significant brands include, Simponi which is launched in 18 countries, with great success.  There are five new drug approvals including Dulera in the US, and Brinavess, Daxas, Elonva and Sycrest in Europe.

While strongly focusing on internal innovation, Merck has also signed 46 significant outside deals with external partners including most recently the SmartCells deal in diabetes.  Merck has over 20 drugs in Phase III incuding Vorapaxar, Tredaptive, Anacetrapib, and Odanacatib.  Merck will continue to remain committed to cardiovascular space, with currently over 100,000 patients in outcome studies and though costly now, the eventual aim is that these will lead to drugs that will reduce cardiovascular events, heart attacks, and strokes.  Vorapaxar is the largest study with 40,000 patiens and Tredaptive has 25,000 patients. While Merck is number two pharmaceutical company, globally, it is number five in emerging markets and going forward, plans to expand presence in these markets from current 18% total sales to 25% by 2013, said Frazier.  The plan is to grow the current portfolio in oral antibiotics and vaccines, as well as in women’s health.  Additionally, given the rise in chronic diseases, Merck plans to grow in respiratory, cardiac, and diabetes space.  Januvia is already number one oral diabetic product in emerging markets.   Merck acknowledges that countries like China are surrounded by strong science and innovation in those markets can be a huge contributor.  Merck aims to grow through value creating partnerships in those markets that would help in issues like pricing, reimbursement, market access, and low cost manufacturing.

Gilead – In addition to targeting Hep C, also continues to grow & remain a Leader in HIV Treatment

2012 has been a busy year for Gilead, said Chairman and CEO, John Martin.  Gilead’s current commercial portfolio includes HIV, liver, respiratory, cardiovascular and other areas.  The biggest part of revenue generation has been HIV.  Truvada, the single regimen pill is steadily growing and is made available in low and middle income countries at steeply discounted prices or through generic licensing partners.  In 2012, Gilead launched single table regimens, Atripla and Completera for HIV, distributed through join ventures with Merck and Janssen Therapeutics.  Also in 2011, Gilead extended licenses to Indian partners to grant them future rights to produce generic versions of single table regimen, Stribild.  Stribild was approved by US FDA, in August, 2012 and approval in Europe is expected in 2013.

Gilead’s pipeline includes Tenofovir, delivered directly to lymph nodes and showing greater efficacy, Sofosbuvir for Hep C, and Simtuzumab targeting Ideopathic Pulmonary Fibrosis.  While much of the focus in 2012 had been on Gilead’s Hep C pipeline, it seems the company’s HIV franchise may emerge as a strong growth driver, than previously anticipated.  The number of people in developing countries receiving Gilead antiretroviral therapy has increased from less than 30,000 in 2006 to over 3 million in 2012 and one-third of people treated for HIV in developing countries receive Gilead medicines.  

Eli Lilly – Poised to deliver with 13 molecules in Phase 3, and 20 molecules in phase 2

Chairman, President, and CO John Lechleiter shared that Lilly’s total revenue is over $20B, with gross margin of revenue, approximately 78%, $3 billion in net income with at least $4 billion in operating cash flow.  Lilly will continue to stay the course and implement the strategy that includes, replenishing and advancing the pipeline, driving growth in countercyclical growth areas, and increasing productivity to fund R&D.

In 2008, Lilly made the largest acquisition in Lilly’s history, by acquiring ImClone, to advance its oncology pipeline.  In 2012, Lilly launched Amyvid in US, got approval for Erbitux and Jentadueto.  Cymbalta and Zyprexa are approved for new indications in Japan and Cialis is approved in Europe for once daily use for BPH.    Some of the setbacks included slower emerging market growth, due to patent expirations.   Growth is expected from dulaglutide in collaboration with Boehringer Ingelheim to target diabetes, launch of Tradjenta in 30+ markets, and from Lilly’s animal health division Elanco’s acquisition of Janssen Pharmaceuticals animal health business.  Lilly is poised to deliver with rich pipeline that includes 13 molecules in Phase 3, and 20 molecules in phase 2, said Lechleiter.

Glaxo Smith Kline –  Refocused on Science & Revamped R&D Engine

Patrick Vallance, President of Pharmaceutical R&D opened the presentation  with assurances that GSK has re-engineered its drug discovery organization, has built a late stage pipeline, restructured its commercial and manufacturing to support the pipeline and will deliver value.  Given where GSK was a year ago, there seemed to be a marked progress in terms of its late stage pipeline.

Six new drugs that completed phase III studies in 2012 include dabrafenib and trametinib in oncology, albiglutide targeting diabetes, dolutegravir targeting HIV and Relvar and UMEC/VI for respiratory diseases.  In oncology, combination therapy with both molecules is indicating more complete blockade of critical pathway and ability to prevent or delay emergence of resistance.  For type II diabetes, albiglutide, first once-weekly fully humanized GLP-1RA regimen that can be administered with a pen device, is indicating opportunity to delay use of basal insulin and no weight gain.  For HIV, current trials indicate dolutegravir to be statistically superior to Atripla at week 48.  GSK has a broad portfolio targeting respiratory diseases.  Relvar/Breo for asthma and COPD, appears well tolerated and efficacious at lower doses and shows significant improvement in lung functions compared to FF or FP.  UMEC/VI for COPD, once daily, is potentially first in class in the US and indicates statistically significant improvement over placebo.  GSK has more advanced portfolio in respiratory disease space.  GSK has reengineered to deliver sustainable pipeline flow with visible multiple waves of pipeline delivery, said Vallance.  It seems that GSK has refocused on science and has revamped its R&D engine.  Will it deliver?

Baxter – Diverse Core Portfolio, Robust R&D Pipeline, Targeted Acquisitions – (stock worth watching)

Baxter CFO, Robert Hombach began the presentation with a reminder that this $38 billion healthcare company is one of the most diversified companies presenting at this conference.  Baxter focuses on acute and critical care business and on treatment of chronic diseases.  Emerging markets account for 20% of sales.  Baxter has a diverse core portfolio, a robust R&D pipeline, and engages in targeted acquisitions.

BioScience accounts for $6.1 billion business and represents vaccines, bio surgery and hemophilia.  Baxter is advancing pipeline of novel recombinant proteins.  Bio surgery business continues to be double digit growth driver.  Advate, a targeted therapy for hemophilia A, which affects approximately 1 in 5,000 males, is also a strong growth driver, showing to be very safe and efficacious and remains a gold standard of therapy. Investors believe Advate sales will continue higher, on account of FDA’s recent approved a higher dosage strength of the drug, in 2012. The higher dose allows patients to be treated only once every three days, which is a first in the hemophilia market and gives Baxter a sustainable advantage.  Medical products business account for $7.8 billion in sales in 2011.  Its key renal business accounted for 32%.  Baxter acquired Swedish-based Gambro, a kidney and liver dialysis company, for $4 billion, in late 2012, to integrate end stage renal market and enhance worldwide reach.

Baxter’s late stage product pipeline in 2012, includes 18 molecules in phase 3.  SubQ self-administration therapy of Gamnagard Liquid for Primary Immunodeficiency is showing favorable tolerability pipeline including low infusion site reaction and is advancing label indications.  A possible future blockbuster drug, Baxter has multiple data releases of Gamnagard for Alzheimer’s disease this year.  There is a probability that Baxter receives FDA approval for Gammagard Liquid in mild/moderate Alzheimer’s in coming years.  Baxter’s expanding portfolio to new therapeutic areas include, CD34+ stem cells as a possible treatment for chronic myocardial ischemia, anti-MIF antibody targeting MIF protein that influences tumor growth, and Rigosertib, a novel targeted anti-cancer compound.  Baxter has partnered with Momenta Pharmaceuticals, in a $452 million deal, to tap into the biosimilars market.   Baxter is continuing the innovation in home dialysis, with over 30 new products in the pipeline and has potential to contribute up to $250 million to its top line.  This is one of the richest pipeline in Baxter’s history, said Hombach.

Abbott – New Diversified Healthcare Company with Focus on Nutrition, Established Pharma, and Medical Devices

Abbott is a large cap diversified healthcare company and is now separate from new company, abbvie, a large cap biopharmaceutical company, said CEO, Miles White.  The new Abbott Laboratories is strongly position with $5.9 billion sales in medical devices and $5.4 billion in sales in established pharma market, in 2011.  Diagnostics accounted for an additional $4.2 billion in sales and nutrition accounted for $6 billion in sales, in 2011.  There is an increasing emerging market presence with sales targeted to approach 50%, by 2015.

Abbott enjoyed leadership position in large markets in several industry sectors.  In diagnostics, Abbott hold number 1 place in immunoassay diagnostics and in blood screening and has a leading point of care platform.  In nutrition, it is number 1 in adult and pediatric nutrition and is a leading science based nutrition company.  In medical devices, Abbott is number 1 in DES, BMS, BVS, and number 1 in Lasik and number 2 in cataract, said White.  Diabetes and vision care is driving growth in emerging markets.   Abbott also has robust vascular pipeline and in 2012, launched Absorb, a bioresorbable vascular scaffold for treatment of CAD, in Europe, Asia, and Latin America.  In established pharmaceuticals, Abbott is a leader in branded generics, with a broad portfolio that includes, 500+ branded generics, a strong development pipeline, and 60% presence in emerging markets.

AbbVie – Will other products pick up slack from Humira’s patent expiration for more agile new company?

AbbVie is the new spinoff company, from Abbott Laboratories, focused on “research-based pharmaceuticals.”   It is a global biopharma company, with focus and agility of a biotech, said CFO, Bill Chase.  AbbVie has revenues of about $18 billion and Humira, a prescription drug for rheumatoid arthritis, is its best asset.   Humira is a huge product, generating about $9 billion in sales.  There is a concern with Humira’s pending patent expiration in 2016, but Chase outlined some future plans.  AbbVie will focus on achieving Humira’s full potential through new indications, maximizing product portfolio, advancing pipeline, and leveraging global footprint.

Humira has recently been approved for ulcerative colitis.  Beyond Humira, other growth brands and durable performers include, Andro Gel, leading in testosterone replacement, Lupron, Synagis1, Creon, Synthroid, Kaletra, Norvir and Zemplar.  Humira faces stiff competition, in addition to patent expiration.  Will AbbVie’s other products easily take up the slack?

Bausch & Lomb – Only Global Company Focused on Eye Care Focused on Future Growth & New Products

B&L is the only global company found on caring for the eyes, said, President & CEO Brent Saunders.  B&L is an iconic brand with 160 year history.  The company manufactures and markets eye health products that include contact lenses and lens care products for Astigmatism, Presbyopia, Nearsighted/Farsighted, and cataract patients.  The company also provides intraocular lenses and delivery systems, ophthalmic surgical devices and instruments, and ophthalmic pharmaceuticals; vision shaping treatment products; dry eye products; allergy/redness relief products; eye wash products; eye vitamins and so on.  Three important worldwide trends, the aging population, higher diabetes prevalence, and emerging middle class more interested in eye care, will lead to increased demand, said Saunders.

At B&L, 80% of business is in cash market.  Some of the upcoming B&L products to watch are, BioTrue, one day lenses made from a next generation, bioinspired material called HyperGel, Victus Fentosecond Laser platform for enhanced performance across cataract and corneal procedures, and enVista, new glistening free, hydrophobic acrylic IOLs.  What is in its future?  Will there be a buyer willing to offer multi-billion dollar deal or will this private equity firm turn to an initial public offering (IPO)?  Following the company presentation, Saunders mentioned that the company is focused on future growth and also “aspiring to return to public markets”.

Cerulean Pharma – Private Company with Nanoparticle Based, Dynamic, Targeted Drug Delivery Platform

Cerulean Pharma develops and markets novel, intelligently designed, nanoparticle based technology to target tumor agents, in fight against cancer, said CEO Oliver Fetzer.  Tumor is targeted via leaky vasculature, used at entry portals into the tumor tissue.  Cerulean nanoparticles are are small enough to penetrate these tumor blood vessels but are too large to enter health tissue.  These nanoparticles are transported through the tumor tissue up into tumor cells and then the drug is gradually released within tumor cells. The drug is covalently bound and dynamically releases within tumor cells and the nanoparticles eventually disintegrate over time.

While chemo works well in getting the tumor cells, it also harms the healthy tissue.  History of oncology is somewhat gloomy.  With surgery, radiation, combination therapy, chemo, personalized medicine, immunotherapy etc., 5 year survival is still only 50%.  This kind of dynamic tumor targeting has two important benefits.  By focusing on tumors and sparring healthy tissue from unwanted exposure, Cerulean nanopharmaceuticals leads to limited side effects, while also enhancing therapeutic results.  The linker that attached the drug to the nanoparticle is selected to provide optimal intra-tumor drug release, by gradually breaking apart inside the tumor and releasing the drug payload over time.  The current trials indicate significantly lower toxicity and higher effectiveness with drugs with high adverse profile, like Docetaxel, Erlotinib, and Pemetrexed.  Cerulean’s own small molecule oncology product pipeline in trials, includes CRLX101, CRLX301, and siRNA delivery platform.  Cerulean develops products with partners by marrying their molecules, marketed or in development, with their nanopharmaceutical platform.

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2013 JPMorgan Healthcare Conference – Medical Device Company Presentations

Disclaimer – Below is my best attempt to capture highlights from company presentations.  Please check details against more authentic sources, before making any financial decisions.

The overview of the conference can be found at this link – .  In the next few links, I will share some highlights from presentations of big pharmaceutical companies.  The recent global recession with challenges pertaining to price/volume issues, healthcare reforms, more restrictive regulatory environment, medical device taxes, medical reimbursement cuts, and extreme pressure to contain costs have put a lot of pressure on the device industry.  Big Pharma is slightly different.  Historically the industry has enjoyed growth rates in double digits and 20% operating margins with growing demand and big profits.  But times are also changing for big pharma.  Many firms responded to initial challenges by investing heavily in next-generation drugs, often based on biotechnology.  Though promise of biotech has not panned out as expected, there is more fat in big pharma than in device industry.  Below are highlights from some medical device companies.



Medtronic – Looking at returning 50% of capital back to shareholders over next several years


President & CEO, Omar Ishrak talked about the efforts undertaken during the last 18 months to operate more effectively in the changing healthcare environment.  There is tight alignment and the company has made changes in business teams, making them accountable for growth.  Three major US markets, ICDs, Core Spine, and Pacing, have started to stabilize.  Additionally, Medtronic is focusing on multiple high growth platforms, including advanced energy, afib, glucose monitoring, deep brain stimulation and so on.  As opposed to 10% return in 2012, for several coming years, Medtronic is looking at 20% revenue growth, for several years to come, said Ishrak.  Medtronic is expecting to recoup $25B, in next 5 years, mostly from outside the US and is expecting to continue 50% rate of return to the shareholders, that is, $12.5B return to shareholders, over next 5 years.


Medtronic will also focus on generating more cash in the US, through increasing demand, visibility of supply chain, minimizing idle inventory, optimizing supply chain, reducing operating expenses, and finally repatriating cash from outside the US, if the tax policy becomes fair, said Ishrak.   With increasing globalization, there will be continued focus on premium segments in emerging markets, particularly India and China.  Additionally, Medtronic will also focus on value segment and underserved segments through creating infrastructure capability and then aim to bring the innovation back and disrupt developed markets.  Medtronic is quickly adapting to the changing healthcare landscape, and moving from old fee for service model to new pay for value model, said Ishrak.



Stryker – Continued focus on M&A, share buy backs, and cash flow generation


Stryker CEO, Kevin Lobo said the company is focused on innovation, has a robust balance sheet and will continue strong cash flow generation.  In 2012, the total revenue was $8.7B, up 4% from previous year and adjusted earnings per share increased 9%.  Stryker has a very diversified market focus, with no single market representing more than 16%, said Lobo.  US represents 2/3rd of total Stryker sales or 65% of the business.  29% is in Europe and the rest 6% is in emerging markets and Stryker aims to grow in these markets.  Although 2012 was a quieter year from acquisition standpoint, Stryker will continue to focus on M&A and will continue to buy back shares and is looking at strong steady cash flow generation, said Lobo.



Hansen Medical – Maintains Leadership in Intravascular Robotics with Launch of New Products


CEO, Bruce Barclay asserted that Hansen continues to be a global leader in intravascular robotics and sees it as a platform technology in EP (electrophysiology) and vascular space.  Hansen also has a strong pipeline and is developing a full suite of catheters to go with its technology.  Hansen catheters and other flexible robotics have largely known to be used in catheter based interventional medical procedures, particularly for treatment of irregular heart arrhythmias.


In 2012, Hansen launched Magellan (TM) Robotic System in the US that allows Hansen to enter much larger vascular market, on account of greater precision and predictability of the distal tip control.  Hansen has also launched some new products in the EP space.  Artisan Extend catheter was approved in the US, last year and just got approval in the Europe.  Improved procedure predictability of Hansen products offers an opportunity to hospitals for lowering cost and incremental patient turnaround.  Additionally, it is vastly helpful to the physician, who can sit comfortably at a console, does not have to wear lead coat, is away from the radiation field, and has lower risk of orthopedic injuries.  Therefore, this is a good ROI model.


Hansen has had five consecutive quarters of procedure growth on the robotic side and is now approaching 10,000 cases.  Hansen had 14 new patents issued in 2012 and new transaction with Intuitive Surgical added $30M to the balance sheet.  Hansen focuses on early adopters of new technology and on training them well, in this $2B+ medical robotics market, said Barclay.



St. Jude – Poised to deal with challenges and deliver long term growth


Daniel Starks, President, Chairman and CEO of St. Jude reported that preliminary sales for Q4, 2012 were as expected, at approximately $ 1.372 billion.  The company initiated $1B share repurchase program, at the end of 2012, and expects a favorable impact from this in 2013.


Globally ICD market declined 3%, in 2012.  St. Jude’s ICD market share has been stable, with some decline offset by CRT-D and replacement segments.   Most recent data also allays previous market concern about reliability and safety of Durata line of (HV) high voltage leads.  Durata lead survival at 5 years is shown to be 98.7% and compares favorably with MDT line of HV leads.  FDA inspection of SymarCA facility generated form 483.  None of the observations were pertaining to performance of Durata HV leads and all will be remedied with urgency, assured Starks.  HV lead revenue comprises of less than 4% of STJ global sales.


Various cost saving initiatives have generated more than $100 million in cost reductions in 2012 and are expected to generate more than $100 million in additional cost savings in 2013.  These cost savings plus $1B share repurchase will enable STJ to fund incremental R&D investments, expand market share development activities, and absorb the US medical device excise tax.  While sales growth is expected to remain challenging due to macro-economic factors, STJ is well position to deal with the headwinds and deliver long term growth.  Some of the growth drivers in 2013 will be, MediGuide non-fluoroscopic catheter tracking technology with STJ AF platform, LAA and PFO closure to reduce risk of stroke, STJ’s FFR and OCT product lines, STJ next generation EnligHTN renal denervation technology, TAVR and Trifecta tissue valve product lines, and the recovery of STJ neuromodulation franchise, said Starks.



Glaukos –  Private Opthalmic Medical Device Company for management of Glaucoma


Glaukos is a private opthalmic medical device company.  Thomas Burns, CEO and President of the company shared about Glaukos for management of glaucoma.  Glaucoma is a long lasting, permanent condition that does not cause immediate blindness but causes dark patches or areas of blindness.  High pressure caused by excessive fluid produced by the eye, can damage the optic nerve and lead to glaucoma.  Glaukos technology is primarily an infinitesimal titanium stent, iStent, that can be implanted in the eye to drain fluid and thus reduce the pressure that leads to glaucoma.   The iStent is the smallest medical device ever approved the FDA and is placed in the eye during cataract surgery.  It is small enough that the patient will not see or feel it after surgery and post surgery, it continues to work to help reduce eye pressure.  The 2nd generation G2 device is smaller than the first generation device, and can be loaded into a needle and injected at a predictable rate.  Glaukos suprachoroidal stent model G3 device is currently in phase 3 trials.


All products are CE marked and there is great progress in reimbursement, said Burns.  The current number of about 70 million patients in the US is expected to reach 80 M by 2020.  CPT codes are established and currently 4100 stents are implanted to date.

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