Operator: Our next question today comes from Mike Ulz from Morgan Stanley.
Unidentified Analyst: This is Rohan on from Mike. Can you just talk about the breakdown of your 2024 guidance? How much do you attribute to ASM versus ISM? And then can you talk about any trends you’re seeing thus far for 2024?
Kate Haviland: Yes, Christy, do you want to take the guide? I mean, the one thing I’ll say about 2024 is that we’re a few weeks in here where — this is our first experience with the Q1 dynamics that Christy mentioned. You see often in pharma with ISM. So we’re just — teams working through that well to see how that plays out. But really the underlying demand from both new and existing patients appears very strong this year and very early days. Christy, do you want to talk about the guidance?
Christy Rossi: Sure. So as you all have heard us say many times, we don’t break out revenue by indication. However, ISM is clearly driving our revenue growth, right? We’ve seen that clear inflection upon the first two quarters of launch and I think if you look at the revenue trajectory Rohan, it’s obviously that growth is coming from ISM. Philina shared that more than 70% of our new starts are coming at the 25 milligram dose, which is an imperfect sort of way of looking at ISM. But I think it’s a relevant data point that again, just highlights that we’re really seeing the growth coming from ISM and would expect that to continue well into the future, as we capitalize on this $2 billion opportunity for AYVAKIT. As Kate said, we are early in Q1.
The one thing I would highlight is we were really pleased to hit the thousand patient marks in January. So I think that speaks to certainly the continued demand that we’re seeing in terms of new patient starts, et cetera. That we’re seeing. There’s other dynamics in Q1 that I wouldn’t be surprised if we faced our first quarter of launch. Certainly in my previous experience, especially in these types of chronic immunology markets, you do often see hits around compliance, growth to net and copay dynamics, et cetera. So we’re only part of the way through the quarter, obviously. We’ll see how that all plays out. But Q1 is often more of a challenging one. Just if you look at quarter-on-quarter dynamics of the year,
Operator: Our next question comes from Matt Biegler from Oppenheimer.
Matt Biegler : Congrats from us as well. Can you give us more granularity on the prescriber mix? I think last quarter, we saw around 25% of new scripts from allergists, like has that figure continued to increase? And also what’s the contribution of dermatologists and GI docs as well?
Kate Haviland: I’ll hand that Philina. I mean we’ve been really pleased to see that contribution from allergist immunology, which is a key prescriber target for us has continued to grow. Philina, do you want to talk more about that?
Philina Lee: We do continue to see the allergist contribution grow. It’s now over 30% probably in the mid-30s. I think we had talked about 20%, 25% previously. We’re really excited to be motivating this prescriber base among allergists. It’s also adoption among the academic as well as the community setting. They’re finding AYVAKIT easy. They’re obviously very attuned to the symptom management and the quality of life impacts of ISM on these patients and are motivated to try a disease modifying option. Among derm and GI, in our experience derm and GI it’s really much more of a referring specialty, whereas allergist immunologists and hematologist, oncologists are the primary prescribing specialties. And that really has been our focus to date from a promotional standpoint.
For example, when you look at the top 400 treaters that is completely dominated by hemoc and AI, and that continues to be our primary focus to drive the adoption where we’re most likely to see repeat prescribing. When it comes to derm and GI, I would say, they do play an important role in diagnosis and multidisciplinary care and so we do have other sort of arms of educating to help these specialties identify patients.
Kate Haviland: And just to add to that, our medical team has done a really great job here actually, and they’ve been focusing on some of these other specialties to Philina’s point, but making sure we’re finding kind of the right medical dermatologist, who actually have an interest in SM, CSM patients and tend to be kind of part of those patient’s journeys. And it’s a full group effort here but as the allergy, immunology and hematology, oncology are going to be the drivers of this opportunity for the foreseeable future.
Operator: Our next question comes from Ami Fadia from Needham.
Ami Fadia : Let me add my congratulations on the strong quarter and guidance. But I had a follow-up on guidance and I’m trying to square away what are some of the variables, as I think about what the guidance implies, it seems to be that in fourth quarter you had added more than 200 patients and guidance implies roughly a little over a 100 patient ads per quarter. So what are some of the other variables we should be thinking about? What’s your assumption with regards to discontinuation of patients from the thousand patients that you have — and had in January? And then how should we think about duration of treatment? And is there any other sort of important variables we should be thinking about?
Kate Haviland : Christy, do you want to dive into guidance a bit?
Christy Rossi : Sure. Ami, I would say the guidance does not imply that and I would — I know Mark asked a similar question earlier. There’s a range of assumptions on each of these variables that you can kind of think about to get into that guidance range. We’re obviously thinking about a number of inputs here. So, new patients prescribed discontinuation rates. Both of those things kind of impact net patient ads on a quarter, factors like compliance, what our percent of free drug looks like, et cetera, and then we talked about the international launch. You could probably get to more than a thousand scenarios, if you play with those variables depending on the assumptions. And I think there’s some people at Blueprint that have probably done that.
But what’s safe to say is that our first couple of quarters of launch and our experience there really set the foundation for sort of what are the key assumptions that we’re taking forward. And certainly one of those is that we’re continuing — we’re going to continue to have very steady, consistent, new patient starts and discontinuation rates that are very much in line with what we’ve been seeing, which support extended durations of therapy that we think could be multiple years. That is sort of the forms of foundation of our assumptions based on the last two quarters of experience. That was where we started. And then you kind of think about reasonable ranges and assumptions around each of those things. And that really informed how we got to the guidance range.
Operator: Our next question comes from Peter Lawson from Barclays.
Peter Lawson : Thanks for the update and guidance and all the details. Was there anything that happened during 4Q or the PnL of 1Q that kind of changes the view that GS and SM revenues should essentially be flat in ‘24?
Kate Haviland : I mean, the answer is no, but I know if you have any more color, I mean, we’ve been very just as consistent. I mean, we have said for maybe 18 months now that just, it contributes about $8, $9 a quarter. That is steady Eddie. That is been very, very consistent quarter-over-quarter for a long period of time. Now, SM continues to have growth in it, it’s just not the same growth rate as ISM. And Christy do you want to talk about that?
Christy Rossi : Yes. The he short answer, Peter, is no. The launch is not flattening. I think that our guidance is the clearest signal of that with over 80% of growth at the midpoint and all leading indicators being very positive.
Operator: Our next question comes from Colleen Kusy from Baird.
Colleen Kusy : Congrats on the progress and thanks for taking our questions. So I think you talked about 20% of the top 400 docs based on volume have prescribed AYVAKIT. So is those 80% of docs that haven’t, can you explain, again, what’s been the hurdle for them and what might convince them to start prescribing AYVAKIT?
Kate Haviland : Yes, so Philina, you should dive in here. Just to be clear that’s been since the ISM approval. Just to be clear, we’re trying to track here like physicians who see FM generally, but we’re looking at the — we can’t, as Christy has said, Philina, we can’t really distinguish between advanced SM and ISM all the time based on diagnosis codes. We do look at the dosage 25 milligram as an imperfect proxy for that. So this is really looking at the physicians who have been prescribing since Q3 and Q4, right? So, I don’t know Philina, if you want to talk?
Philina Lee: This is a market where the cadence, the timing of patient visits is a really critical factor in when they’re able to engage and have that conversation about indolent SM with their providers. And so, I would say at this point, this early in the launch, we’re actually really excited to have had penetration into 20% of this group, with room to grow the adoption both within that group as well as broadening beyond to those who haven’t. I would say awareness among this group is very strong. They are all having personally engaged a number of these providers, they’re all motivated, they are excited about AYVAKIT’s benefit risk profile, and they’re waiting for those next patients to come in and have that conversation.
Operator: We are coming up on the hour and going to end the call. Ms. Haviland, I turn the call back over to you.
Kate Haviland: Thank you, operator. And I want to thank you all for taking the time to join us today and thank you for your questions. And you know, we look forward to seeing you in the near-term here, many of you at AAAAI in Washington DC and so, have a great day and we’ll see you soon.
Operator: That concludes today’s call. You may now disconnect your line.
