Market Opportunity and Clinical Development Plan in TED
LX-101: TED Patient Populations
Based on published epidemiology data in the literature, TED has an estimated annual incidence of approximately 16 per 100,000 in women and 3 per 100,000 in men, or over 25,000 patients in the U.S. annually. Outside the U.S., the estimated incidence of disease is over 40,000 patients in Europe and 12,000 patients in Japan.
There is currently one approved therapy in the U.S. for patients with TED, Horizon Therapeutics’ Tepezza, which is indicated for the treatment of TED.
Market Segments: TED
Based on the literature, data presented by Horizon and Viridian, as well as our estimates, we believe there is a significant population of patients that could benefit from a new treatment modality.
In the active/acute disease setting, this population includes those patients that are ineligible, or are not candidates, for available therapies; or in areas where Tepezza is not approved. In addition, there is an increasing pool of “post-Tepezza” patients, which includes patients:
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who do not respond to treatment;
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have progressed/failed or otherwise not derived sustained benefit or have residual disease from treatment, including those who relapse after completing treatment;
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who experience a disease flare after treatment; and
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who do not tolerate therapy due to side effects.
We also intend to evaluate LX-101 in patients that could be considered too early in their disease course or with less severe disease to warrant available therapies.
In addition, we also intend to evaluate LX-101 in chronic disease. There are estimated to be over 70,000 patients with chronic TED in the U.S. and over 150,000 patients in Europe. In patients with chronic TED, symptoms, including proptosis and diplopia, can continue to persist.
Notably, in chronic TED, signaling may be reduced, with disease taking the form of expanded fibrotic tissue, theoretically reducing the potential effect of IGF-1R inhibitors that rely on active signaling. However, the expression of IGF-1R in these patients may persist, thereby allowing a payload-bearing agent to potentially be effective in this stage of disease, representing a large market segment.
Overall, we believe any one or more of these segments could offer attractive development pathways as well as significant market potential.
Additionally, there are multiple areas outside of the U.S., e.g., Europe, Australia, Japan, etc., where no IGF-1R targeted agents have been approved and thus may provide additional commercial upside.
Competitive Landscape — TED
Horizon markets the only FDA-approved therapy for patients with TED, Tepezza. Additionally, several companies are developing treatments for patients with TED, including Viridian (VRDN-001, an anti-IGF-1R mAb); Acelyrin (lonigutamab, an anti-IGF-1R mAb); argenx (efgartigimod, an antibody fragment targeting FcRn); Immunovant and Harbour BioMed (IMVT-1402, an anti-RcRn mAb); Tourmaline Bio (TOUR006, an anti-IL-6 antibody); Lassen Therapeutics (LASN01, an anti-IL-11R antibody); and Sling Therapeutics (linsitinib, a small molecule IGF-1R inhibitor). In addition, other therapeutic approaches, such as corticosteroids, methotrexate, surgery, and radiation, have been used to manage patients with TED.
Development Plans: TED
We plan to leverage existing clinical dosing and safety data from the previous clinical trials to advance LX-101 into trials in patients with TED, for signal detection and to establish proof of concept, which we