SpringWorks Therapeutics Inc

NASDAQ:SWTX

Earnings Call Analysis

SpringWorks Therapeutics Reports Strong Q2 Performance and Positive Drug Developments

In Q2 2024, SpringWorks Therapeutics reported robust growth with $40.2 million in net product revenue from OGSIVEO, their FDA-approved treatment for desmoid tumors. This marked rapid adoption and high physician and patient satisfaction. Additionally, the company completed its NDA submission for mirdametinib, aimed at treating neurofibromatosis type 1-associated plexiform neurofibromas (NF1-PN), expecting FDA approval by 2025. Mirdametinib has shown significant promise with a manageable safety profile and substantial symptom relief. CEO Saqib Islam emphasized the strong market opportunity for both drugs, driven by significant unmet medical needs and positive early feedback.

Strong Launch Momentum for OGSIVEO

SpringWorks Therapeutics has reported robust performance in its second quarter of 2024, with net product revenue from OGSIVEO reaching $40.2 million. This marks a significant increase, bringing the year-to-date total to $61.2 million. OGSIVEO, the first FDA-approved treatment for adults with desmoid tumors, is quickly gaining traction as the standard of care, supported by high demand from both patients and healthcare providers. Since its launch in November 2023, OGSIVEO has been hailed for its transformative clinical benefits, including rapid and significant symptom relief. The company expects continued growth as it reaches an estimated 7,000 actively managed desmoid tumor patients in the U.S.

Innovations to Enhance Patient Experience

Enhancements in the patient experience have been a notable focus for SpringWorks. The recent introduction of new tablet strengths (150mg and 100mg) in convenient blister packaging has been particularly successful, contributing to improved adherence and patient satisfaction. The strong early uptake of these formats verifies the positive impact of these innovations on treatment compliance and overall patient experience.

Positive Feedback and Adoption Rates

Feedback from the medical community has been overwhelmingly positive, with 95% of oncologists expressing satisfaction with OGSIVEO. Notably, a significant majority of prescribers indicated a strong preference for OGSIVEO over rival treatments. The adoption rate is promising, with a high likelihood of this drug being used as the frontline therapy. Such factors position OGSIVEO favorably within the treatment landscape, reinforcing its credibility as a leading systemic therapy for desmoid tumors.

Regulatory Developments for Mirdametinib

In addition to OGSIVEO's performance, SpringWorks is advancing its pipeline, particularly the investigational MEK inhibitor, mirdametinib. The company has completed its New Drug Application (NDA) submission to the FDA for mirdametinib, targeting children and adults with neurofibromatosis type 1 plexiform neurofibromas (NF1-PN). This approval process could culminate in a launch in 2025, tapping into a sizeable market of approximately 40,000 patients in the U.S., many of whom currently lack approved treatment options.

Strategic Focus on Education and Outreach

SpringWorks is committed to enhancing awareness of OGSIVEO among both patients and healthcare providers. Their strategy includes educational programs aimed at improving understanding of desmoid tumors and the exclusive role of OGSIVEO as the systemic treatment of choice. This initiative is expected to facilitate quicker treatment decisions for patients currently under surveillance, reducing the time they remain untreated.

Financial Health and Future Growth Prospects

Despite an increase in operating expenses due to aggressive commercial efforts, SpringWorks maintains a robust financial position with $522 million in cash and equivalents, giving it ample runway to fund future development and operational activities. The company anticipates its clear path to profitability, reinforced by strong incoming revenues from OGSIVEO and expected contributions from mirdametinib in the coming year.

Looking Ahead: Growth and Investor Opportunities

The forecasts for the remainder of 2024 appear optimistic, with expectations for continued growth driven by OGSIVEO's established position in the market and the anticipated launch of mirdametinib. With steady patient adoption and proven clinical benefits of its therapies, SpringWorks is poised to expand its reach, enhancing shareholder value. As the company continually improves upon its offerings and patient care capabilities, it seems well-equipped to meet the evolving needs within the rare cancer community.

Earnings Call Transcript 2024-Q2

[Operator]

Good morning. My name is Gigi, and I'll be your conference operator today. I would like to welcome everyone to the SpringWorks Therapeutics Second Quarter 2024 Earnings Conference Call.

[Operator Instructions] I would now like to hand the conference over to Samantha Sandler, Senior Director of Investor Relations at SpringWorks Therapeutics. Samantha, you may now begin the conference.

[Samantha Sandler, executive]

Thank you and good morning, everyone. Welcome to SpringWorks Therapeutics Second Quarter 2024 Earnings Conference Call. This morning, we issued a press release, which outlines our financial and operational results for the second quarter. You can access the press release as well as the slides that we will be presenting today by going to the Investors & Media section of our website at www.springworkstx.com.

Joining me today are Saqib Islam, Chief Executive Officer; Bhavesh Ashar, Chief Commercial Officer; Dr. Jim Cassidy, Chief Medical Officer; Francis Perier, Chief Financial Officer; and Dr. Badreddin Edris, Chief Operating Officer.

Before we begin, I would like to remind you that some of the statements made during the call today are forward-looking statements that are subject to a number of risks and uncertainties. This may cause our actual results to differ materially, including those described in our reports filed with the SEC. You are cautioned not to place any undue reliance on these forward-looking statements and SpringWorks disclaims any obligation to update such statements. I will now turn the call over to Saqib.

[Saqib Islam, executive]

Thank you, Sam, and thank you all for joining this morning. I'm pleased to share our second quarter results and how we are delivering on our objective to make a profound impact on the lives of patients with devastating diseases.

Starting with OGSIVEO for patients with desmoid tumors, we are encouraged by the strong momentum of our U.S. launch. In the second quarter of 2024, we reported $40.2 million in net product revenue. This robust and continued growth is driven by the transformative clinical benefits from OGSIVEO, high demand from patients and physicians across treatment settings and strong commercial execution.

Since our FDA approval last November, OGSIVEO has rapidly become the standard of care systemic therapy for patients with desmoid tumors. As Bhavesh will discuss in more detail, we are seeing steady growth in new patient starts as well as strong persistence from those, who previously initiated OGSIVEO therapy. Importantly, patients are reporting rapid and meaningful symptomatic relieves, which is contributing to their overall improved quality of life and their enthusiasm for OGSIVEO for their treatment.

We are pleased with our early launch experience and believe that we have only reached a small proportion of people with desmoid tumors, who can benefit from OGSIVEO. Our confidence in the overall patient population has continued to increase as we have gained further insights from the launch and from emerging desmoid tumor-specific claims data. Our conviction remains high in the opportunity we have in front of us to serve an increasing number of desmoid tumor patients.

Turning to our investigational MEK inhibitor, mirdametinib. In the second quarter, we completed our NDA submission to the FDA for the treatment of children and adults with neurofibromatosis type 1 associated plexiform neurofibromas, or NF1-PN. Our NDA submission is based on positive data from our pivotal Phase IIb ReNeu trial which support the potential for mirdametinib to be a best-in-class therapy for both children and adults living with these devastating lifelong tumors.

There is a substantial unmet need for the approximately 40,000 people living with NF1-PN in the United States alone, 30,000 of whom were adults and 10,000 are pediatric patients. Challenges with administration and tolerability limit the use of currently available options for children, and there are no FDA-approved therapies for adults.

We look forward to working with the FDA throughout our NDA review process and to advancing our commercial preparations in anticipation of our second medicine introduced to patients in 2025. We are also excited about the opportunities in our emerging portfolio. We have several important efforts in development to serve additional patient populations with high unmet needs, including patients with ovarian granulosa cell tumors, multiple myeloma and MAPK mutant solid tumors.

In addition, we recently began enrollment in our Phase I study of our investigational TEAD inhibitor SW-682, in Hippo mutant solid tumors, which represent up to 10% of cancers. Finally, we have durable IP protections for our lead molecules and a robust balance sheet that we expect to fund us through profitability. I'll now hand the call to Bhavesh to discuss our progress with OGSIVEO for patients with desmoid tumors. Bhavesh?

[Bhavesh Ashar, executive]

Thank you, Saqib. I'm happy to share an update on the U.S. launch of OGSIVEO. 2 full quarters into our launch, OGSIVEO is already the most prescribed systemic therapies for adults with desmoid tumors. As Saqib highlighted, in the second quarter of 2024, we generated $40.2 million in net product revenue, driven by strong demand for OGSIVEO by patients and physicians across treatment sites, real-world experience of OGSIVEO meaningful benefits and focused commercial execution in delivering the first and only FDA-approved medicine to the desmoid tumor community.

We're seeing robust adoption with broad use aligned with our FDA-approved label including in newly diagnosed patients and in those seeking their next line of therapy after unsatisfactory outcomes with previous interventions. Physicians at centers of excellence with strong early adopters of OGSIVEO, the majority of them have now treated multiple patients and continue to add new patients. We're also pleased with the continued uptake amongst physicians and other academic and community centers, where we are also seeing steady new patient starts.

In addition, we've received consistent feedback from both patients and physicians on OGSIVEO's life altering impact. Patients are experiencing rapid and significant symptom relief, notably pain reduction, helping them to get back to their daily lives. Enhancing the patient experience with OGSIVEO has been an area of focus this quarter. We're pleased with the successful introduction of the 150-milligram and 100-milligram strength OGSIVEO tablets in convenient blister packaging. The new product format has seen strong adoption to date, validating the importance of this innovation for patients.

Patients prescribed OGSIVEO continue to have broad access with reimbursement across payers. Commercial and government insurers are broadly reimbursing OGSIVEO and formal coverage policies are in place for over 90% of commercially covered lives. Across the payer landscape, there is clear recognition of the clinical value of our medicine as an NCCN category 1 preferred treatment.

And in June, the Desmoid Tumor Working Group guidelines were published in JAMA Oncology, highlighting OGSIVEO's incorporation into the treatment algorithm as the first and only approved drug for desmoid tumors. In just 7 months on market, OGSIVEO has become the systemic standard of care for desmoid tumors based on our analysis of prescription data and we're excited to leverage this position of strength to reach many more patients with this disease.

We've also continued to receive highly positive feedback from prescribers and patients on their experiences with OGSIVEO. In a recent survey of 110 oncologists, 95% of OGSIVEO prescribers expressed satisfaction with their experience. More than 85% of prescribers prefer it over off-label systemics, which are known to have inconsistent efficacy and tolerability challenges, further supporting OGSIVEO's position as a systemic therapy of choice.

In addition, most physicians said that they are likely to use OGSIVEO as a frontline treatment, indicating treatment with OGSIVEO at the earliest opportunity for their adult patients. Further, we're hearing consistent feedback from patients of profound symptom relief on OGSIVEO, including patients experiencing rapid and meaningful improvements in pain within days of initiating treatment. The strength of the real-world feedback which is consistent with our clinical trial experience, we'll continue to solidify OGSIVEO as the standard of care systemic treatment for patients with desmoid tumors.

Turning now to the opportunity we see ahead of us. There are up to 1,650 newly diagnosed patients annually. Our market research supports that the vast majority of physicians are likely to use OGSIVEO as a frontline treatment and we're already seeing uptake of OGSIVEO as the first intervention. Our research has previously pointed to up to 7,000 actively managed patients in the U.S. each year. Our early launch results as well as desmoid tumor specific ICD-10 claims data have continued to validate the size of this currently addressable patient pool, and we now view this estimate as conservative.

The role of systemic therapy is continuing to increase among patients who require active treatment with surgery being deprioritized in treatment guidelines. With OGSIVEO as the first choice systemic, we're confident that there continues to be a substantial opportunity for growth in this patient population. In addition, there's a sizable diagnosed prevalent population of 30,000 people overall. We know that the majority of desmoid tumor patients receive active intervention over the course of their disease and hence, a meaningful proportion of these patients who, are currently on the sidelines, could potentially be addressed with a new treatment option.

We have seen robust adoption to date and continue to have strong conviction in the sizable opportunity ahead of us to continue serving adults with desmoid tumors at all stages of treatment. Our success thus far positions us well for continued momentum in the second half of the year and beyond. We're gratified to have earned the advocacy of Desmoid tumor experts through their collaboration in the DeFi study as well as engagement following the approval of OGSIVEO.

Our commercial efforts aim to amplify their voices to educate and improve outcomes for patients. This comes in the form of providing opportunities for these leaders to educate the broader desmoid tumor community including physicians, nurses, advocates, patients and caregivers on guideline recommended treatment approaches.

Importantly, this includes educating on the role of systemic, the limitations of surgical intervention and the availability of OGSIVEO as an FDA-approved and NCCN Category 1 preferred treatment option. Education and peer-to-peer information and experience sharing are critical avenues to increasing awareness of OGSIVEO and will continue to support increased breadth and depth of prescribing. Continuing to address the needs of patients also remains paramount, and we're highly focused on supporting positive experiences with OGSIVEO.

In mid-May, we successfully introduced our 150-milligram and 100-milligram strength tablets in convenient Bristol packaging. This new product format was developed as an innovation for patients to increase convenience and adherence by reducing the daily pill intake and simplifying morning and evening dosing. We have seen a strong transition to this new format through the second quarter and expect this transition to continue over the next 3 months.

Additionally, we're expanding our educational resources and delivering best-in-class patient services through SpringWorks Care connections to further support the treatment journey with OGSIVEO. We also continue to generate data to support the strong clinical profile of OGSIVEO and are advancing our efforts to expand OGSIVEO into additional geographies. In the second quarter, we presented additional data from our Phase III DeFi trial at ASCO that reinforced the robust efficacy and manageable safety profile of OGSIVEO including in hard-to-treat subgroups, such as patients with characteristics associated with poor prognosis and those with APC mutations, which can be a more aggressive form of the disease.

In an oral presentation at ASCO, the file was also showcased as an exemplar of one of the most comprehensive assessments of ovarian function in an oncology clinical trial to date and a best practice for evaluating a drug's effect on ovarian function for future cancer trials in accordance with ASCO guidelines. This analysis included updated data on investigator-reported resolution of ovarian toxicity and DeFi which further supported the transient nature of ovarian toxicity in both the majority of patients who stay on OGSIVEO therapy and all those who stopped treatment for any reason.

Turning to upcoming milestones. We're working closely with the European regulators as they review our marketing authorization application and we are excited by the potential to receive approval from the European Commission in 2025. We also look forward to sharing long-term follow-up data from DeFi at a medical conference before the end of the year. In our Phase I and Phase II studies, patients remain on OGSIVEO for a median of over 4 years. And at the time of the Phase III DeFi trial data cutoff, median treatment duration was approaching 2 years.

With these long-term follow-up data from DeFi, we plan to provide an update on the continued antitumor activity and overall clinical benefit provided by OGSIVEO with longer durations of treatment. The ability for patients to stay on therapy is critical, given the persistent morbidities associated with this disease and we believe these longer-term results from DeFi will further support the potential for extended treatment durations.

I'll now turn it over to Dr. Jim Cassidy, our Chief Medical Officer, to discuss the progress we're making with our MEK inhibitor, mirdametinib with children and adults with NF1-PN. Jim?

[James Cassidy, executive]

Thanks, Bhavesh. I'm glad to provide an update on our progress developing mirdametinib as a potentially best-in-class therapy for patients with NF1-PN, which is a highly morbid and lifelong disease that affects both children and adults. To start, there is a significant opportunity to improve outcomes for these patients that are approximately 100,000 people in the United States living with NFI. These individuals have a 30% to 50% lifetime risk of developing Plexiform Neurofibromas, which are tumors that grow along peripheral nerve sheaths and can cause severe disfigurement, pain and functional impairment.

We estimate that there are approximately 40,000 patients with NF1-PN in the U.S. today. The majority of them are adults who currently do not have an approved therapy. As there is no specific demographic win for this disease, we estimate that there are a proportionate number of people living with NF1-PN outside of the United States as well.

While systemic therapies or treatment of choice and MEK inhibitors have been clinically validated as a class in this indication, there are no formal treatment guidelines and our market research shows that only a small portion of NF1-PN patients have been treated with a targeted therapy. We have done considerable work to understand the disease state, current treatment paradigm and physician and patient preferences and taken as a whole, our research supports that patients are in need of new options. This is illustrated by a highly fragmented treatment landscape with significant use of off-label therapies even in pediatric patients for whom there is an approved medicine.

People living with NF1-PN have substantial needs that are not met by current options and bringing to market a new systemic therapy could allow many more patients to be treated. As we'll discuss, the positive results from our pivotal Phase IIb ReNeu support mirdametinib's to be a first-in-class therapy for adults with in NF1-PN and the best-in-class option for pediatric patients. The new results were presented at 3 medical conferences in the second quarter, including during an oral session at ASCO.

These presentations are improving awareness and building enthusiasm for our positive results amongst the physician community. The FCC data across both adult and pediatric cohorts and ReNeu showed significant reductions in the size of NF1-PN tumors with robust objective response rate confirmed by blinded independent central review. In addition, we saw very deep responses that have not been seen before in published studies of this disease. The majority of patients with a confirmed object of response experienced a tumor reduction of greater than 50% and reductions of up to 90% were seen in both cohorts.

This is particularly significant when you consider the hard-to-treat patients that were enrolled in our study. Importantly, physician feedback suggests that these are unprecedented data and have the potential to be a meaningful differentiator. In both children and adults [ mirdametinib ] demonstrated a manageable safety profile with low rates of grade 3 adverse events and low discontinuation rates due to AEs. We believe mirdametinib tolerability profile supports the potential for extended treatment duration, which is important in a current disease like NF1-PN, where there are high rates of cure after stopping therapy.

In ReNeu across both cohorts, -- the median time on treatment was approaching 2 years with some patients on mirdametinib therapy for nearly 4 years at the time of the primary analysis. Nearly all patients that completed the treatment phase continued on therapy in the long-term follow-up portion of the study. The potential for mirdametinib to enhance patient quality of life is also very meaningful.

Pain is a common symptom in NF1-PN and current clinical practice recommendations indicate that this is a critical factor in treatment initiation decisions. Further, in many cases, the primary goal of treatment is improvement of such PN associated mobilities. Pain was the most commonly reported baseline mobility in the ReNeu trial, so significant both adults and children, including those with the most ability taking pain, reported early sustained and [indiscernible] significant reductions in pain severity and pain interference over the course of mirdametinib's treatment.

Lastly, we believe that mirdametinib convenient dosing regimen, which provides treatment of holiday and a pediatric-friendly dispersible formulation to further optimize the patient experience and potentially enhance compliance. And ReNeu children and [indiscernible] reports were highly positive in this regard with maximum acceptability scores for ease of slowing and willingness to continue to take the dispersible tablet.

The totality of the ReNeu data reinforces our belief that mirdametinib can address strong desire amongst both physicians and patients for our new therapy that offers robust tumor and symptomatic control, a manageable safety profile and convenient dosing regimen, all of which, we expect will enable patients to remain on therapy for an extended period of time.

Looking ahead, we are making meaningful progress advancing mirdametinib towards potential regulatory approval in 2025. Mirdametinib was granted orphan drug designation by both the FDA and the European Commission. And the FDA also granted fast track and rare pediatric disease designations for NF1-PN. We completed our NDA submission to the FDA at the end of June, and we anticipate announcing our PDUFA date in the coming weeks.

We're also on track to complete the submission of our European marketing authorization within this half. In addition, that our new results will continue to be showcased at upcoming medical congresses and we expect the results to be published in our peer review journal later this year. And now Frank Perier, our Chief Financial Officer, will discuss our second quarter financial results. Frank?

[Francis Perier, executive]

Thank you, Jim. I'll now summarize a few highlights from our second quarter 2024 financial results. Starting with revenues. We recorded $40.2 million of OGSIVEO net product revenue in the second quarter. This brings our 2024 year-to-date OGSIVEO net product revenue to $61.2 million.

Our total operating expenses increased compared to the second quarter and the first half of 2023, driven by the commercial activities to support the U.S. launch of OGSIVEO and the anticipated U.S. launch of mirdametinib in both adults and children with NF1-PN. We have a strong balance sheet supporting our clear path to profitability with $522 million in cash, cash equivalents and marketable securities as of the end of the second quarter.

Lastly, we have a durable operating plan designed to fund multiple global product launches and to enable the continued investment in expansion opportunities across our pipeline. With that, I'll hand the call back over to Saqib.

[Saqib Islam, executive]

Thank you, Frank. As we've discussed this morning, we are very pleased with the continued strong momentum of our U.S. launch of OGSIVEO for adults with desmoid tumors and are working with urgency to bring mirdametinib to children and adults with NF1-PN.

In parallel with these commercial efforts, we are enthusiastic about our emerging portfolio. Nirogacestat is being studied in a Phase II trial in ovarian granulosa cell tumors, which is fully enrolled. These tumors account for approximately 5% of all ovarian cancers and like desmoid tumors, this is a meaningful patient population for which there are no FDA-approved therapies.

In multiple myeloma, we've established clinical proof-of-concept for nirogacestat in combination settings with several BCMA-directed agents and are continuing to collaborate with a number of industry and academic partners to further this strategy. We're also pursuing expansion opportunities for mirdametinib in several monotherapy and combination therapy settings, promising data from a Phase I/II study of mirdametinib in pediatric low-grade glioma were recently presented at the International Symposium on Pediatric Neuro-oncology meeting and several combination studies are currently ongoing, including the trial with [ MAP kinase ] binirafenib in advanced colin tumors with MAP kinase mutations and with BeiGene's lifirafenib in NRAS mutant solid tumors.

Brimarafenib is also being explored as a monotherapy in adults with RAF mutant solid tumors. And we're looking to confirm the efficacy signal we reported last year in the dose escalation study in several ongoing dose expansion cohorts.

Additionally, SW-682, our oral TEAD inhibitor is now in the clinic. This program is designed to treat tumors with hippo pathway mutations, which can occur in up to 10% of cancers, including mesothelioma and head and neck cancer. We believe that there is a meaningful opportunity with SW-682 for SpringWorks to develop a novel medicine for these cancers.

Lastly, we are also advancing several internally discovered preclinical stage programs, and we look forward to sharing more about these efforts as they progress. To close, we are very pleased with our accomplishments in the first half of this year and have multiple milestones and data readouts ahead that we look forward to sharing. These include long-term follow-up data from our DeFi trial, which we believe will support the benefits of extended treatment durations with OGSIVEO in desmoid tumors. It also includes initial data from our Phase II trial of nirogacestat in ovarian granulosa cell tumors and we expect the full ReNeu trial results to be published in a peer-reviewed journal.

Our focus for the remainder of the year will be to continue building on OGSIVEO's momentum in the U.S. while working to bring this medicine to patients in Europe and other geographies to advance our regulatory and commercial preparations for mirdametinib and anticipation of serving patients with NF1-PN in the U.S. and Europe, and to progress our diversified emerging portfolio in an efficient manner. We are confident that our strong foundation will support our continued success as we deliver on our mission to change the lives of people suffering from devastating diseases.

As always, I would like to thank the patients and investigators who participated in our clinical trials, our patient advocacy partners and collaborators and our team of SpringWorks workers. We're now happy to take questions. Operator?

[Operator]

[Operator Instructions] Our first question will come from Anupam Rama at JPMorgan.

[Anupam Rama, analyst]

Congrats on all the progress. Just a quick one for me. What are you seeing from both new prescribers and repeat prescribers for OGSIVEO and in the early innings, the wait-and-watch population that's coming in to seek treatment for OGSIVEO?

[Saqib Islam, executive]

Bhavesh, I'll let you take that.

[Bhavesh Ashar, executive]

On the repeat versus new, obviously, we saw a good amount of new prescribers in the initial months of the launch. As you'd expect, we've started to see repos coming in at a regular pace from these initial starts, but supported by continued new patient starts from new patients not being acquired in the second quarter as well.

As you would expect, the total proportion of business coming from existing patients versus new patient starts is increasing over time. And so that's a positive development. From a wait-and-watch perspective, we do know, obviously, that the proportion of the DT patient population there is -- is under active surveillance at any point in time. However, we do know that over 90% of these patients received some active intervention during the course of their disease.

Now with the availability of the first and only FDA-approved treatment, the opportunity ahead of us and supported by treatment guidelines, which favor systemic therapy, supported by the positive experiences that patients and physicians are seeing with OGSIVEO in the early innings of the launch, the opportunity ahead of us is to try and drive faster treatment for these patients under active surveillance. And so we do expect the proportion of active surveillance patients to be dropping over time.

[Operator]

Our next question comes from the line of Yaron Werber from TD Cowen.

[Yaron Werber, analyst]

Right. Congrats also on a nice quarter. Maybe I have a kind of a couple of interrelated questions. One, can you just give us a sense on inventories for the quarter for OGSIVEO and then secondly, just a follow-on Anupam's question. It's -- 1 would imagine that the academic centers are probably the early adopters, and they're moving kind of quickly as patients are coming in to use OGSIVEO. What are you seeing in the community? Maybe just give us a little bit of sense of kind of the breadth of usage.

[Saqib Islam, executive]

Bhavesh, I will turn to you again for that.

[Bhavesh Ashar, executive]

So from an inventory standpoint, the overall impact of inventory in the second quarter was minimal. The stocking levels were generally aligned with the demand that we're seeing. And similar to prior quarters, inventory was not a key driver of performance this quarter.

From a community dynamic perspective, first of all, I'll say that from -- as we said in our prepared comments, there is a deeper pool of patients overall than we originally estimated. And we started to break into this aggregate to the patients that are up greater than 7,000 actively managed patients.

We are -- as you highlighted, we are pleased with the update in the Centers of Excellence, we saw breadth of prescribing in the early months of the launch, we saw depth of prescribing in the second quarter. Specifically addressing your question around community, we've started to see good adoption in the community centers, where we continue to drive breadth and -- but we still have an opportunity, right? With the broad pool of patients, we have an opportunity both to continue to drive breadth of prescribing, but also those who experience -- who do prescribe OGSIVEO to drive depth of prescribing.

Now I'll highlight a couple of things in that regard. First of all, our ability to be in the right place at the right time for these community clinics has been significantly enhanced by the availability of the desmoid tumor-specific ICD-10 codes. And so we're able to direct our sales team to be in those clinics when a patient is available for treatment.

And then secondly, the educational efforts that we're driving both around the availability of OGSIVEO as the first and only treatment option for desmoid tumor patients, but also treatment guidelines, which do favor systemic therapy, gives us confidence in the ability for us to drive depth in that community segment as well.

[Operator]

Our next question comes from the line of Corinne Jenkins from Goldman Sachs.

[Corinne Jenkins, analyst]

You've talked a little bit about having some more visibility on this patient population given the ICD-10 codes and potentially as you kind of move to these blister packs going forward, I guess, as you look at that, where have you identified the pockets where you see kind of the greatest opportunity for near and intermediate-term growth and what are you doing tactically to reach that patient population and keep them on therapy?

And then I did want to ask also on mirdametinib, maybe with the launch next year, where do you see kind of like the low-hanging fruit with respect to initial adoption and how should we think about the trajectory of the early launch compared to what you've accomplished here with OGSIVEO?

[Saqib Islam, executive]

For the series of questions, but we're going to try and answer all of them. I think as we think of mirdametinib, we view that opportunity is actually quite meaningful. And as I think of low-hanging fruit, I think we're very comfortable saying that this is an opportunity that is actually at least as large as what we see in desmoid tumors. And that's driven by a number of factors. One, by the size of the patient population, right? We talked about 40,000 patients in the U.S. and a proportionate number outside the U.S. And 1/3 of those are -- excuse me, 1/4 of those are pediatric and 3/4 of those are adults. So the opportunity for us to have a best-in-class treatment for pediatric and a first-in-class treatment for adults, we think gives us a meaningful target.

Second, the physicians in this space actually themselves, even in the pediatric setting, believe that their patients are not being served as broadly as they could be. And so we think there's an opportunity there. And third, you can use Koselugo revenues, which now run rate just in the pediatric setting of about $500 million annually as a proxy for the opportunity just in that 1 quarter of the market.

And as you know, we're filing for both adults and Teads. So we think the opportunity beyond, I think, the low hanging fruit implies that it's all easy. None of it is, but you've got a medicine that people are waiting for, an opportunity that is sizable and data that we believe supports a potentially best-in-class profile for mirdametinib for distance.

Bhavesh, I'll turn to you talk about OGSIVEO

[Bhavesh Ashar, executive]

Yes. No, I'd just reiterate a couple of the points. First and foremost, we're fortunate to have with OGSIVEO to be in a position of delivering a drug with transformative benefit to desmoid tumor patients, right? That is the foundation for the high awareness we have, the high satisfaction that we shared in the prepared comments as well as the strong preference that we see amongst prescribers and patients supported by broad access by the payer community.

So with just 7 months on the market, we become the systemic standard of care and the most prescribed systemic therapy for adult patients with desmoid tumors. And so the opportunity for us is to continue to drive depth within the centers of excellence as well as drive depth and breadth in the community segment, as I mentioned before.

With the large pool of 7,000 -- more than 7,000 actively managed patients, we do see that we have a significant opportunity ahead of us to see continued growth for OGSIVEO.

[Operator]

Our next question comes from the line of Peter Lawson from Barclays.

[Peter Lawson, analyst]

Great. Thanks for the update and congrats on the progress. First question is really just about the patient trends, how they've been looking at the month and particularly into July and then whether you're seeing any patients discontinuing?

[Saqib Islam, executive]

Thanks for the question, Peter. I think we aren't seeing any exceptional discontinuations. It's what we would have expected from the DeFi study, and I think that gives us confidence going into not just the third quarter, but the fourth quarter as well. So I think that the trend holds well. As Bhavesh highlighted, we think the patient pool is actually deeper than what we had originally estimated. And I think that portends well for the aggregate opportunity here.

Fundamentally, where we are perhaps most excited is the feedback that we're getting, though. You've got patients seeing deep immediate and persistent benefits to their pain, that is causing them to want to get on therapy and want to stay on therapy. So we believe that the opportunity here continues to be sizeable.

[Operator]

Our next question comes from the line of Michael Schmidt from Guggenheim.

[Michael Schmidt, analyst]

Congrats on a strong second quarter result. Just a follow-up on OGSIVEO. As we think about the third quarter here coming up, some other products sometimes experience seasonality over the summer months. Is that something you may expect as well with this OGSIVEO?

And then a follow-up on mirdametinib as we think about the launch next year. Obviously, you have already a product on the market. Do you expect initial switching from Koselugo over to mirdametinib -- or would you expect a predominantly penetration into the currently untreated patients with NF1-PN as we think about that next year?

[Saqib Islam, executive]

Thank you, Michael. So I'll take the OGSIVEO question. I'll ask to Dr. Edris to take the mirdametinib question. I don't think that we're immune from seasonality, I think, as we see in many other products. I would expect to see some seasonality in the summer months. But obviously, as we've said from the outset, we think the pool is deep, and we think the opportunity is significant. Badreddin?

[Badreddin Edris, executive]

So with respect to our opportunity within NF1-PN for mirdametinib, I'll remind you that our NDA filing is for both pediatric and adult patients, the latter of whom represent 3/4 of the market and do not have unapproved therapy. And so we think there's quite a bit of white space there with respect to being able to serve patients who are previously untreated.

Within the pediatric population, I think there will certainly be some patients who have been treatment experience over the years that are seeking their next line of therapy, but our market research shows that, that market is minimally penetrated as well with respect to systemic therapy. So we think there's a significant number of pediatric patients, who are also looking for their first systemic therapy option when mirdametinib becomes available.

[Operator]

Our last question will come from the line of Alec Stranahan from Bank of America.

[Alec Stranahan, analyst]

Congrats from us on the strong print. Any framing you can provide around the focus of the longer-term follow-up data from DeFi later this year? And maybe 1 quick one, if I can sneak it in. Is your expectation that you will receive accelerated review from mirdametinib, just to clarify.

[Saqib Islam, executive]

Thank you, Alex. I'll turn to be the Badreddin.

[Badreddin Edris, executive]

Sure. So with respect to the longer-term follow-up data, Alex, I'll remind you that at the time of our primary analysis, the median time on treatment for patients that were randomized to the nirogacestat arm was just under 2 years. And the majority of those patients were not remaining on therapy. And so what we hope to be able to share an update on later this year. It's certainly a more mature median time on treatment figure for nirogacestat treated patients as well as the trends that we see in terms of responses, how they evolve over time and the benefits that we are seeing with a longer-dated data cut on the patient reported outcomes as well.

So that's what we're gearing up to be able to share. And I'll remind you that in Phase I and Phase II, our median time on treatment was over 4 years in each of those studies. So there's the opportunity to really present longer-term data.

With respect any expectations on review timing and then review designations for the mirdametinib filing, we have not given any guidance on that topic. We'll be in a position to receive the PDUFA date from FDA about 60 days from filing, so that will be some time late in August.

[Operator]

Thank you. This concludes today's call. Thank you for joining. You may now disconnect.