Amgen Inc. (AMGN) Morgan Stanley 21st Annual Global Healthcare Conference 2023 (Transcript)

Amgen Inc. (NASDAQ:AMGN) Morgan Stanley 21st Annual Global Healthcare Conference 2023 September 12, 2023 8:50 AM ET

Company Participants

Robert Bradway – Chairman and Chief Executive Officer

Conference Call Participants

Terence Flynn – Morgan Stanley

Terence Flynn

Great. Good morning, everybody. Thanks for joining us. I’m Terence Flynn, the US biopharma analyst here at Morgan Stanley. We’re very pleased to be hosting Amgen. Today from the company, we had Bob Bradway, who’s the company’s Chairman and CEO.

Before we get started for important disclosures, please see the Morgan Stanley research disclosure website at www.morganstanley.com/researchdisclosures. If you have any questions, please reach out to your Morgan Stanley sales representative.

Bob, before we launch into my questions, I’ll turn it over to you for some opening remarks. But thanks so much for your time today.

Robert Bradway

Thank you, Terrence. Thanks for having us. And thank you all for joining us. Perhaps before we get started, I might just say a word or two about Horizon. I know Terence Flynn probably won’t be in a position to ask questions about that. So let me just briefly update you on where we are, which is that we’re excited now to have a path forward to close and we expect to close shortly after the Irish sanctions hearings, which should mean no later than the middle of October we’ll be closing the transaction.

And it’s not a transaction that the biopharma analysts that cover us – or it’s not a company rather that they’re all that familiar with. So let me just say a few words about why we felt Horizon was such a great strategic fit for us.

First, our strategy on research and development and the way we like to allocate capital for innovation is to focus on medicines that are innovative, first-in-class, make a really big difference for the patients who benefit from them and address serious diseases. And that’s exactly what Horizon’s recently launched molecules do. They’re novel, first-in-class, make a very big difference for the patients suffering from the diseases that the molecules were developed to treat and, again, with molecules treat very serious diseases. So, really good overlap in terms of the strategy, the high level, why we thought these were attractive – this is an attractive company with attractive opportunities for us.

In addition, the molecules that are at an early stage of their lifecycle and molecules that we think still have tremendous growth potential are biologics. And we’re a world leader in biologics, as you know. And so, we’re excited about the things that we think we can do through time with the Horizon portfolio and process development, new formulation development, other forms of lifecycle management, so we see molecules that are still at an early enough stage in their lifecycle that we can influence them, and we can influence them not just with our sales and marketing capabilities, but also with our protein sciences.

We talked some time about our desire to globalize our biologics business. We’re now operating 102 countries around the world. I think Horizon have 10 people outside of the United States. So we have an opportunity to take their medicines globally, which we’re excited about doing. They now have registration in a couple of international markets, for example, and our teams outside of the US are really excited to be having the opportunity to work with those, beginning in the month of October. So it fits well with our international strategy as well.

And then, finally, I would say that it fits well with our recent commitment to rare diseases. We acquired TAVNEOS, some of you may know, which is a molecule designed to treat patients who suffer from a rare form of vasculitis. And we think the capabilities that Horizon has built for helping manage rare disease patient populations is world class. And we look forward to doing everything we can to learn about that and to try to assimilate that in our business and continue to look for other opportunities through time to allocate capital to medicines that, again, can make a big difference even if the number of patients afflicted with the disease is few in number. So, we’re excited about Horizon. We see a clear path forward and, again, expect that transaction to close by the middle of October.

Beyond Horizon, the month of – the autumn anyway will be an exciting time for us. There’ll be data on a number of our pipeline projects. And I want to just quickly highlight four from the oncology portfolio because there’ll be a fair amount of information in a short period of time on them.

And I want to start with tarlatamab, which is our bispecific T cell engaging molecule, which addresses small cell lung cancer. And just picking up on a theme that I’ve already introduced. small cell lung cancer is a very serious disease. There have been very few innovative medicines that are proven safe and effective in that setting. And we think we have a medicine that looks very attractive. And we announced earlier in the year that the results that we’ve seen from our Phase 2 data, we think they’re very encouraging from both a safety and efficacy standpoint, much stronger even than what we saw in our Phase 1 trial. So we’re very rapidly advancing what we think will be a completely novel way of addressing the needs of small cell lung cancer patients.

And one of the reasons we’re particularly excited about this, not just because it’s novel and the data look very encouraging, but it builds on what we’ve been doing in the area of T cell engagement now for a while. And in particular, it follows on the success that we’re experiencing with BLINCYTO. And so, in many ways, we see BLINCYTO as being a model for what we can do with tarlatamab and other bispecific medicines.

And let me just briefly summarize for you BLINCYTO. You probably have observed that the product is growing very rapidly at the moment, with high double-digit growth rates, reflecting the fact that it’s now being used more and more – at more and more early stages of the acute lymphoblastic leukemia disease.

And when, of course, we launched BLINCYTO, it was in late stage refractory relapsed patients, just as we would expect to launch tarlatamab in third line small cell lung cancer. But we very rapidly have been able to move forward in the leukemia settings to earlier and earlier lines of therapy and, in fact, recently helped generate data that shows we were able to more than double the overall survival versus standard of care for patients who have early stages of acute lymphoblastic leukemia.

In particular, we achieved that with patients who were, what we call, minimal residual disease negative. In other words, these are patients where there was no molecular evidence of a presence of the leukemia cells. And those patients were randomized in one arm to receive BLINCYTO and then the other to stay on standard of care. And again, the superior results were achieved by BLINCYTO, demonstrating that even when the cancer is not detectable, it has the potential to evade the assays and is still there and can return. And that’s where BLINCYTO has been so effective in eliminating the disease.

So just as that shows great promise in starting in late stages and moving to early stages, we think we can – we will be seeking to repeat that with tarlatamab. So, we’ll enter very likely in third line disease where 65,000, 70,000 patients a year in the world’s major markets that have small cell lung cancer that we think would be addressable with a therapy like tarlatamab. So we’re at the early stages of what should be a very exciting new opportunity for us.

Then I would also mention that this is the first time a T cell engaging therapy has been shown to work in solid tumors, and we hope to follow it very quickly with others. And the one that’s getting most attention perhaps at the moment is prostate cancer medicine, directed at Amgen known as STEAP1, a medicine called xaluritamig. And again, we’re very encouraged as we have said a few times during the course of the year by the data that we see for that molecule. We expect to be sharing some of that in the autumn, and so we’re excited for you to be able to see that and begin to form your own point of view.

And then, in addition, there are two other cancer medicines from our portfolio that you’ll be seeing information on. And that, of course, includes our LUMAKRAS data where we demonstrated successful clinical responses in combination with Vectibix and chemotherapy in colorectal cancer. So that’s very encouraging.

And then I also want to mention a novel approach to treating tumors which overexpress PRMT5 and are MTAP null. We think that on the order of 10% to 15% of all large tumors fit that profile, demonstrated with a medicine that we’ve designed as part of our – you’ve heard us talk about the Inducible Proximity Platform, but it’s the idea that multispecific drugs, we think, can be very effective in addressing targets that have been challenging, like the PRMT5 expressing tumors.

So we’ve demonstrated some data there that we’re very encouraged by, and we’ll be expecting that to become public as well in the autumn. So, four different molecules that are moving quickly through the pipeline, for which there’ll be new information available to you shortly. So that’ll be exciting.

There are other things, of course – other Phase 3 programs like our FGFR2b program in gastric cancer, but I wanted to just highlight the ones where data are imminent.

I’m sure, Terence, you may want to talk about some of the other pipeline molecules, but a lot of attention obviously has been focused on our obesity portfolio and on our cardiovascular portfolio, where, again, we think we have differentiated and novel medicines addressing big important opportunities.

And then there’s a lot going on our inflammation pipeline as well with our OX40 medicine rapidly advancing in Phase 3 clinical development, TEZSPIRE and a number of additional indications, which are potentially very exciting. And of course, TAVNEOS, which we have already touched on.

So quite a lot going on in our portfolio at the moment. The business is performing well. I think you saw that in the second quarter. We’re excited about the outlook for the balance of the year. And I would simply reiterate that, when it comes to the long term, we feel very encouraged about our ability to deliver long term growth for our shareholders.

And as we said at the time of the announcement of Horizon now all those many months ago, we expect that Horizon will be additive to that long term growth picture that we’ve talked to about.

So, sorry, Terence, took a few moments there, but why don’t we turn it over to you for questions.

Question-and-Answer Session

Q – Terence Flynn

I guess the one segue question is, you talked a lot about the innovation and the investments that the company is making in oncology. Obviously, the IRA is somewhat of a hurdle to the industry. Other companies have talked about maybe pivoting away from oncology because of some of the disincentives that, unfortunately, it creates. So maybe just help us think about how you’re positioning that company for a post IRA world here to continue to innovate and bring new therapies to patients, especially in areas like cancer, but then what that means as you think about the incremental R&D dollar that the company is investing.

Robert Bradway

I think, unfortunately, the Inflation Reduction Act, Terrence, is not good news for patients. And it won’t prove to be good news for innovation, particularly in the area of small molecule research and development and cancer. So I think it is an inescapable consequence of the legislation that capital will be reallocated away from small molecule cancer medicines over time. And that’s unfortunate because we are on the threshold of some really important breakthroughs in cancer. But the nature of that legislation conspires to cut the number of years that are available to innovators to earn a return on the innovation. And without the benefit of a full patent life, it’s going to be very difficult for companies to earn an attractive return.

So I think, particularly in small molecule cancer research, it’s a challenge, Terrence. I don’t know that I would include to the same extent that I would include the large molecules, but the future of cancer research is that you have to start in the late line, relatively small patient populations, and it takes time to move into the earlier lines of therapy. And without the benefit of a full patent life for molecules, that’s a challenging equation to make work.

But we’ll adapt. And the fact that there is price pressure in the US is no surprise to us. I think, again, it’s very unfortunate for patients that it comes in the form of price control by the US government. I don’t think that’s going to wind up being very constructive. I think there were better ways to have met the needs of patients than what this legislation represents. So all in all, I think it’s unfortunate, but we’ll move on, we’ll adapt.

And, again, I think we live in a world where people are getting older and older and as they get older, they’re susceptible to more and more disease and it’s our responsibility to innovate, come up with better ways to prevent those diseases from debilitating people the way they do today. So we still see there being huge demand for what we do. We still think we can innovate prosperously, but let’s not lose sight of the fact that the Inflation Reduction Act is a fundamental change for the industry for sure.

Terence Flynn

One other big picture question is I talked a lot over probably the last decade or so, Amgen was one of the first biotech companies to really make a bigger push into the primary care biologics space with Prolia, which goes back a ways and then Repatha, also CGRP for migraines. And we talked about obesity. You talked about obesity in your opening remarks, again, another primary care type market. So maybe just what have you learned from this experience? And how are you thinking about kind of commercial strategy for some of these newer future launches on the primary care biologics space, where obviously Amgen has a lot of expertise there, and maybe segue that into obesity and how you’re thinking about that market creation?

Robert Bradway

I think you’re right that we were certainly early, if not the first – one of the pioneers in bringing biotech to primary care. And obviously, Prolia has become a very successful drug globally. We’re seeing that repeated now with EVENITY, which is another one of our bone building drugs. We’re very excited about the performance that we’ve seen from EVENITY. And so, I think it demonstrates that physicians are now comfortable with the idea of using monoclonal antibodies in a primary care setting.

Some of that has required education of the prescribers as well as the patients and the payers. But I think we’ve made a lot of progress in that regard. And I think the stage is set for future innovative medicines that harness the power of biologics for large patient populations like osteoporosis, where the number of patients at risk of fracture from that disease is measured in the tens of millions. And of course, cardiovascular disease with many tens of millions.

So I think we’re beyond the point of wondering whether it’s possible to take biologics to a large patient audience. I think it’s very clear that we can. And you might ask what are the advantages? Why is that a particularly attractive pathway? Well, the beauty of biologics is they’re very specific. And particularly when it comes to large patient populations, touch wood, the opportunity to rely on specificity and avoid off-target side effects, which often are a problem for small molecules, has proved to be a strength.

And I think the other thing with biologics is, again, the data sets are pretty consistent. And that’s partly a function of the fact that they’re, again, specific, you don’t have the off-target liabilities that come along with small molecules.

So, it’s a strategy that we think has served us well. We also have some small molecules that are performing very well, but, clearly, biologics are and will remain an important part of our future.

Terence Flynn

And as we think about 113 for obesity…

Robert Bradway

133.

Terence Flynn

133, sorry. So 133 for obesity, just as you think about the target profile, maybe help us think about what you’re aiming for here. And when can we expect to see the next set of Phase 2 data? And then again, to kind of pivot back to the prior commentary around primary care biologics, how do you see this obesity market really developing when you have both injectables and orals?

Robert Bradway

Yeah. Terence was asking about our product AMG 133, which is very rapidly enrolling in a large Phase 2 study, where we’ll have an opportunity to ask lots of different questions about how it behaves in these patients. So we’ll be excited to see those data and those data will be available and likely reported next year.

But this is a molecule which has two different components. It’s built on a biologic backbone, and that has the benefit of having it hang around in the body longer than, for example, an oral medicine would or something that was just a peptide would. And so that gives us what we think is a differentiated approach to dosing. So we’re very interested in the prospect of monthly dosing as opposed to other therapies in obesity, which require weekly dosing.

We saw in our early clinical studies very significant rapid weight loss. It’s probably not entirely appropriate to do cross trial comparisons. But I think those who have recognized that the speed at which and the magnitude at which our medicine achieved weight loss was very impressive compared to other agents in the field. And there’s an interesting glimmer of a different profile when the medicine is stopped. So we were able to show some data at the end of the study, under the Phase 1 study where people came off the drug and we didn’t see an immediate rebound in weight.

So anyway, we think we have a molecule that is differentiated from those are in front of us, either in the clinic or in the market and we’re very rapidly advancing, as I said, in Phase 2 studies and look forward to starting what we would expect to be a wide range of Phase 3 studies of that molecule as quickly as possible, as quickly as justified by the Phase 2 data.

But obesity is not going to be a disorder or disease that’s treated by one or two or three molecules. We would expect that this will improve over time to be a heterogeneous disease, and therefore, a disease where many different therapies can play a role. And we at Amgen have a number of different therapies that are in progress, including an oral which is in the clinic. And we have a number of other preclinical projects that we have alluded to, but the only thing we’ve said about those for competitive reasons is that they’re orthogonal to the medicines that are gaining so much attention in the marketplace now. So, orthogonal to the integrin approach, which is what is behind the first two molecules in the market.

And then, just the other thing to note about our AMG 133, based on our belief from analyzing human genetics, we chose to agonize the GLP receptor rather than what our competitors are doing, which is we’re antagonizing and our competitors are agonizing it. So we’ll see, again, in the fullness of time, the data may speak to whether that was an important differentiation or not, but we’re excited about that. I know a number of you are also excited to be at an early stage of development.

Terence Flynn

And if you think about it, you obviously have a lot of internal efforts here on the obesity front. Is this an area as you think about business development where you could potentially bolster capabilities or you feel like you have everything you need internally to really compete that scale in this building market?

Robert Bradway

I think this is going to be a competitive marketplace. So, I think we’re going to have to invest at scale in order to do well in this marketplace. And so, that’s what we’re focusing on. We’re focusing on making sure we understand what it will mean to invest in scale for the obesity program. And I say program, it’s probably not just a single molecule. And again, our growing belief, partly based on genetics, partly based on the clinical data that’s emerging in the field, is that obesity is causal, not just associated with, but causal in a number of other important chronic diseases. And so, we’re going to want to study AMG 133 in rigorous Phase 3 studies to see whether we can prevent some of those diseases that we think are caused by the excess of adipose tissues, obesity. And so, this is going to be an exciting opportunity for us. But cancer would obviously entail significant investment over time.

Terence Flynn

Maybe we’ll pivot to biosimilars and then segue to immunology. On biosimilars, just curious, how this opportunity – has it evolved in the US comparable to your expectations as you initially set out to move into this area? And then, as we think about the implications for RA/immunology, how do you see this playing out over kind of the near to medium term here as we now have biosimilars Humira, you have your own biosimilar Humira, we have a biosimilar Stelara coming in 2025, which, obviously, is going to shape some of these markets. Maybe you could talk about biosimilars as an investment for Amgen, but then what does that mean for immunology and how you think about that from a commercial opportunity?

Robert Bradway

Well, as an investment, again, we continue to think it’s an attractive way for us to earn a return for our investors. So we think that our internal rates of return on our biosimilar investments are exceeding by a very comfortable margin, our cost of capital, so we think we’re creating value with our biosimilars.

What I would say is, of course, that, first, we’re capitalizing on economies of scope, which means we are leveraging the many decades of experience we have in biologics, and that’s experience in process development of biologic molecules, manufacturing, clinical development, quality, safety, and so forth. So we have the infrastructure in place and we’re leveraging that globally to earn what we think will prove to be attractive returns.

I would say I think your question was focused particularly on the US. The market in the US is segmenting into physician and clinic administered medicines on the one hand and then pharmacy medicines on the other. I’d say the physician and hospital based biosimilar market is evolving very much consistent with what we expected. And when you look at the five medicines that we will be launching between now and the end of the decade, obviously the bulk of those are hospital – physician and hospital based medicine. So, we feel pretty confident about what the path looks like there.

We’re still in the early stages on the pharmacy side – pharmacy biosimilar side where our AMGEVITA was the first medicine in the market. We’ll see. I think it’s a little bit early to know for sure how that will evolve.

I would also add that one of the likely unfortunate consequences of the Inflation Reduction Act is that it will disrupt both the biosimilar and probably the generic market in ways that are hard to predict right now. So I think we’re all going to have to keep a close eye on how the implementation of the Inflation Reduction Act affects the market in the US. But, globally, again, continues to be very attractive, and the fact that we have several more launches coming gives us comfort that this should be a source of attractive growth and, therefore, capital return for our investors.

Terence Flynn

Maybe the immunology piece, as you think about implications for the immunology market broadly, obviously, you are one of the pioneers there with EMBREL in terms of building that RA and psoriasis market, continue to innovate with OTEZLA and oral option. You said biosimilar AMGEVITA. So, again, as we think about that market and the implications of some of these legacy drugs going off patent, what does that mean in terms of how you think about scaling that business and investing in that business?

Robert Bradway

Well, I would be careful not to broaden from what’s happening in the TNF sequestering market to all of them from inflammation or immunology. So inflammation remains a very attractive and important marketplace for us. We see that with the great success that we’re enjoying TEZSPIRE in an early stage of its launch. And it’s an area, again, where I think there’s going to be tremendous innovation, and there’s still enormous unmet patient needs. So in our case, TEZSPIRE, TAVNEOS, two recently launched medicines that address autoimmune disorders. And then, of course, we’ve talked about, in the Horizon context, Tepezza, Uplizna, Krystexxa are also, obviously, immunology based medicines designed for autoimmune disorders.

So I think there’s no question that that remains a very attractive area and an area of ongoing investment for us and others in the field. Obviously, OTEZLA as well represents an attractive ongoing, we believe, market for us. And there’s still a lot of unmet need for patients generally in that area.

But as regards the TNF sequester and the treatment of rheumatoid arthritis and ankylosing spondylitis and psoriatic arthritis and psoriasis. Obviously, with patents expiring, the nature that marketplace is changing, I think, over time, it will prove to be like other therapeutic market segments. There’ll be some disruption and there’ll be some new price points established.

But what I would say about EMBREL is that it sets a pretty high safety and efficacy bar. And in order for innovative new medicines to replace EMBREL, they’re going to have to do something pretty special as relates to safety, efficacy, and some other form of clinical performance.

Terence Flynn

Maybe just one additional one on the commercial side is, you mentioned good momentum here back half of the year. Just help us think about any other puts and takes as you work through the balance of 2023. And then the other kind of related question is Amgen has had a very efficient operating margin structure for a while now. And so, as we think about kind of the forward, do you feel like that’s a sustainable level here, given some of the potential headwinds from IRA or other aspects of the business?

Robert Bradway

Well, when you talk about operating margin and IRA, Terence, obviously, the IRA doesn’t really come into effect still for a couple of years. So, I don’t think you’re asking me to give forward operating margin guidance this morning. But we’ve given a perspective for this year on our operating margin. And so, you shouldn’t expect any significant changes in our operating margin.

We take a lot of pride in trying to run the business efficiently. We take pride in having adapted our business to the reality of a price decreasing environment. Prices have been dropping in the US since 2018. And we’ve been making the necessary changes in our business to stay ahead of that. We would expect to continue to do that.

But in terms of the second half of the year, again, the molecules that need to grow in order for us to achieve our long term ambitions are growing very well. So Repatha, again, growing very well, EVENITY growing very well. Prolia continues to perform very well. We’re excited about TEZSPIRE and some of the newly launched molecules that I talked about. I referenced BLINCYTO earlier, performing very well as is the rest of oncology portfolio. So we feel good that the things that need to perform are on track to do that.

In terms of headwinds, obviously, there’s still some headwinds on the pricing side for biosimilars, but that’s not different from what we have expected. And there’s obviously a lot of free drugs still in the psoriasis market. So we continue to think we’re very well positioned with OTEZLA with the benefit of its safety and efficacy record and the fact that we have a label now that enables us to promote this to mild to moderate and effectively to all psoriasis patients.

So we still see that as an attractive longer term opportunity. But there’s probably still headwinds in the second half of year as we work through the ongoing free drug in the marketplace.

Terence Flynn

Maybe pivoting back to the pipeline, I guess on tarlatamab. Thanks for the overview here in small cell. Have you guys met with FDA yet to understand if you’re going to be able to file on those data? I know there’s significant unmet need.

Robert Bradway

And again, I would just encourage you to stay tuned. As I mentioned, Terence, we’ll have an opportunity in the autumn to talk about that and a number of the other programs. And we’ll convene with investors as appropriate around those data and around those events.

Terence Flynn

And the other one you mentioned, obviously, the success of TEZSPIRE commercially in the asthma setting, you’re also looking to push into COPD, Dupixent had some positive Phase 3 data and this indication, is there any read through to the TEZSPIRE program as you think about the likelihood of success here in COPD?

Robert Bradway

We’re obviously very attracted to TEZSPIRE, which is a completely different mechanism of action from the medicine that you referenced. And we, in particular, like the fact that ours is a medicine that looks like it has the potential to be effective in patients irrespective of what their eosinophil level is, which is a biomarker of relevance for people who treat patients with autoimmune disorders, like the respiratory diseases for which we’re studying TEZSPIRE. So it has the potential to be very broad therapy. But COPD remains a really important unmet medical need. And we need the data to tell us whether this would be an effective approach or not. But we’re encouraged. We’re running the trial and we’re hopeful.

Terence Flynn

Great. Well, I think we’re up against time, Bob, but really appreciate your time this morning.

Robert Bradway

Appreciate it. Thank you.