$SGYP Trulance launch details will be key on 2Q17
New vs. switching patient detail interesting for Trulance
Trulance use in a meaningful percentage of new vs. switching CIC patients could suggest
better long-term uptake than expected; thus, we await details, potentially on 2Q17 SGYP
earnings. We will focus on launch details rather than consensus for 2Q17, since we look
for information on longer-term launch trends. We believe the simple, real-world reality for
CIC is that Trulance does not have the diarrhea concerns of Linzess, and that Trulance
can be taken with or without food.
Linzess still best indicator for Trulance, watch inventory levels
We look for commentary on the 2Q17 Ironwood call regarding inventory changes for
Linzess, as well as any changes to discounts, rebates, or sampling, which could indicate
pressure from Trulance. Linzess weekly TRx counts have recovered from a ~7.5% drop
in early January 2017 vs. late December 2016, but we wonder if additional discounts or
other measures have been utilized.
Retreatment data suggest seamless integration for Trulance
We expect Trulance efficacy and safety to be the same regardless of usage before or
after Linzess, based on Linzess retreatment data from 2014. Ironwood and Forest
showed in Trial 31 that patients who received Linzess for 12 weeks, then placebo
for 4 weeks, followed by a return to Linzess afterwards showed high satisfaction. We
believe this shows that patients who may "switch" from Linzess to Trulance are likely
to experience good efficacy, even after a treatment break. Interestingly, Linzess data
actually showed that after returning to Linzess, patients showed a higher satisfaction
score than before they had stopped.
Maintain BUY, $13 PT
We maintain our BUY rating and $13 PT based on our view that Trulance differentiation
on safety and ease of use will result in a successful long-term launch. We recognize
that Allergan / Ironwood's Linzess is embedded in the market with strong salesforce
support, but we believe that Trulance is simply easier for doctors to give and for patients
to tolerate.


Reply · Report Post