And we’re also doing that I should say in a very resource effective way based on our deep knowledge of where these patients are going to look for information, learn about the disease and engage with providers.
Kate Haviland: And one thing I would just add to that is, you know, nothing is as impactful to patients as hearing from other patients who’ve been on the therapy. And now that as we see here today where we’re over a thousand patients, estimate a thousand patients in the U.S. and we see patients who are on therapy sharing those experiences in chat rooms and online. And we’re also have some more formalized programming around that where we can connect patients who are on AYVAKIT, with patients who are considering it as a therapy, which I think is going to be very impactful this year. Christy, do you want to talk about the CDK2?
Christy Rossi: Sure. So as you said, we have a significant amount of strategic interest in the target, right? I think the target is clearly now one that’s going to be incredibly important to any company that wants to be a player in the breast cancer market going forward. The focus of conversation from a BD perspective has been on 222 certainly. We have a next generation asset that could be a part of those conversations we’re exploring and open to different possibilities there. But I think there’s also a lot of interest in our degrader platform broadly. And we really look at that as essentially a different modality and approach to addressing this target. So, we’ll see how these conversations evolve. Certainly open to different collaboration structures, but our overall goal is really maximizing the value of the franchise in totality.
Laura Prendergast : And just when can we expect to see more information on this degrader platform?
Kate Haviland: Suad, do you want to talk a little bit more about that?
Suad Namouni : We are very happy with the variety of the progress that we made on our degrader platform. As you may remember, we started this a little bit more than two years ago. And today we have a number of degraders in development. We mentioned CDK2 degraders in the cyclin dependent kinase space, but this is only the tip of the iceberg that we and that Kate shared at the JP Morgan conference. I think down the road, you will see some good degraders CDK2 clearly other targets are our key targets in the treatment of cancer. And we will really give more timeline and guidance as we get closer and ready to share that type of information.
Kate Haviland: And I think one other thing to mention too is, and I know we said it in our press release, I mean, we’re also doing quite a bit of work in the mast cell and looking at other mast cell driven targets as well. And so stay tuned on that as we move forward.
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?
