This speaks of systemic-naive patients which are patients

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Haschwald_Zimmer sox0407 #29903
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This speaks of systemic-naive patients which are patients who have not had continuous exposure to Methotrexate and therefore have not built up a resistance to it's efficacy, correct?

Patients for which Methotrexate is no longer working well can likely switch to Otezla (or Prurisol) for a significant benefit.

So the way I see it there are two scenarios:

1. If Prurisol shows solid improvement with 300MG on mod-severe it will be a clear winner against both MTX and Otezla. This would be very bad for Otezla because patients would first use Prurisol as it is oral and has greater efficacy. If Prurisol does not work well on a patient, they would then likely have to try MTX due to much lower cost prior to Otezla.

2. If Prurisol does not show improvement with 300MG on mod-severe it will be ranked equivalently to Otezla. It would then come down to price I would think. P would have to be sold somewhat competitively to MTX (some premium for oral – 2-4K/treatment) to be first line. Otherwise it will be fighting for second-string with Otezla (at 22K/treatement) for patients who do not respond well to MTX.

If the second scenario, would it be better to sell Prurisol at much lower margins (2-4K/treatment) or duke it out with Otezla at much higher margins (22K/treatment). There is probably some midpoint where Prurisol is significantly cheaper than Otezla but still highly profitable.

Is the above the correct takeaway from this blog?

If Prurisol 2B does not perform better than in phase 2A, isn't it at similar risk of becoming a second-line treatment much like Otezla unless it is competitively price with MTX (again with a premium for convenience)?

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