Michael Ehlers
Analyst · Terence Flynn with Goldman Sachs. Your line is open
Thanks for the question. So just to reiterate, we're very pleased with the performance of SPINRAZA, both in the U.S. and outside the U.S. and think it has a very strong growth profile. It was up 60% year-over-year although down a little bit sequentially. As I mentioned, really there are three factors that drove the sequential decline and that was; one, a shift from loading to maintenance doses in some of the more mature markets in Europe, the timing of shipments in certain distributor markets which are hard to predict, and then pricing dynamics including unfavorable country mix. So as we look forward in 2019, we expect for that franchise to resume growth. We expect that to come from several sources. Number one, in the mature markets, just like we saw the dynamic of the shift in the U.S., we expect some of these larger markets to return to growth in 2019. Second, although the IPM, or International Partner Markets, will continue to be lumpy, they are a good source of growth for us, so we expect that to grow as well. And then if you look at new markets, either entry into new markets for expansion into markets that we've just recently entered, there's a number of kind of interesting things that are happening. If we look at Europe first, we expect to enter the U.K. at some point in 2019 which would be a good size opportunity. In Turkey, we've been very successful in Type 1. We expect to kind of get Type 2 and Type 3. Saudi Arabia, Poland, and Portugal are all markets we expect to enter as well from a European perspective. Moving around the world, Canada, we just recently got approval in the fourth quarter of 2018. We expect that to be a good growth opportunity for us and a good market. And then, if you look across the rest of the world, in Asia Pacific, South Korea, we expect to get reimbursement in that market in 2019. Taiwan is another good sized market, Hong Kong. And then, in China we expect to get in on a self-pay basis. And then, Latin America, Brazil could be a sizable country. Today it's on a one-off approval basis. We expect to get reimbursement from the epidemiology is in the thousands in Brazil. So there's ample opportunity for us to grow. It's diversified regionally and by country. That's a real testament to both the effectiveness and reception of SPINRAZA worldwide.