Rajeev Saggar
Analyst · Julian Harrison from BTIG
Thanks, Roger. Thanks, Julian, for the question. So I think what is clear is that -- I've said this before, I think that the community and the centers alike, I think we're experiencing an inhaled renaissance. And I think this is clearly being led by YUTREPIA's product profile. I think that Roger continues to highlight in this call, and that's really that the tolerability of our print formulation has led to the ability to dose higher. And we showed in our ASCENT cohort, especially in PH-ILD that as we go up ever higher, every 8 weeks, that has resulted in notable changes in exercise capacity for these patients to distances and changes that we've not seen in the past. And where this has gone is that practitioners, in our opinion, when we speak to them has realized that especially with this vast armamentarium that's now available in both Group 1 and now also in Group 3, that we're moving more towards making the patient not only clearly wanting to feel better, walk further, live longer, but we need to do that in a way that is extremely tolerable. The construct of using pumps and even oral prostacyclins, especially given their significant GI intolerability, has allowed the market to take a look at YUTREPIA in a different perspective. In particular, what we're realizing is that the oral prostacyclin market has -- in those practitioners, we've seen a large switch over to YUTREPIA. And although the pharmacokinetics are different, I think, again, the fact that we can dose YUTREPIA 1.5 to threefold what has traditionally been used with inhaled treprostinil has really opened their eyes to this fact. And the argument to be made, well, it's 4 times a day, and that's correct. But the advantage of inhaled is that it's directly being administered to the lungs. We can negate all the -- significantly negate many of the off-target systemic side effects that are notable with oral prostacyclins regardless of the dosing frequency of that prostacyclin. And finally, with the use of sotatercept coming on board, I think we're seeing a huge number of practitioners starting to say, why are we putting patients on parenteral therapy and a pump, which obviously had its advantages historically. But now we can lean that pump down, transition that also to YUTREPIA. And I think we'll see some abstracts being presented at ATS highlighting the utility of YUTREPIA in combinatory treatment with sotatercept. And I think from a company's perspective, we realize this is where we need to continue to create the data and show physicians how to also do it from a trial perspective. We've now started recruiting into ASCENT cohort B, which is patients that are inadequately responsive to either Tyvaso nebulizer or Tyvaso DPI and transitioning that to YUTREPIA. We're also planning in the very near future to initiate transitioning from oral selexipag to open-label YUTREPIA. I think that one, of course, we initiated doing that because of, again, what is happening in the community. And finally, just to rehighlight, we need to provide how to actually transition from parenteral therapy on patients on sotatercept and how to transition off the pump directly to YUTREPIA. And that study, we hope to be initiating sometime in 2026, 2027. So hopefully, that provides a detailed response to your question, Julian.