Thread by @bmgallagherjr

Given yesterdays news of $AMGN buying $HZN for $28B I’ve been asked to give color to the Tepezza history by a few people in a Tweet Thread. So here it goes. It’s my fist so be kind.

Researchers Terry Smith and Ray Douglas at the time of University of Michigan (#GoBlue) had been studying the role of IGF-1R in a condition affecting a subset of Graves’ patients called Graves Orbitopathy or Thyroid Eye Disease (TED)

A top notch team of entrepreneurs/drug developers Dave Madden, Guido Magni, and Richard Woodward had recently founded Narrow River Management with the philosophy that drugs could be developed much more efficiently than the industry currently was

Terry and Ray’s work came to the attention of NRM and being as insightful as they are they saw a potential path to a drug for which patients had no options. Steroids failed in TED and patients were left with debilitating eye issues and invasive decompression surgeries

There were a lot of shelved IGF-1R mAb’s in Pharma (incl $AMGN if memory serves me correctly) as it had historically been a hot target for oncology but proved repeatedly to not work. The NRM team diligences all of them and chose Teprotumumab from Roche as the best profile

TBH it also helped that Guido had been CMO at Roche and therefore had hands on experience with the molecule. But this was 2011 and financings of a newco were very challenging even with such and experienced group of execs (sound familiar?)

I knew Dave from the board of $DRNA and he approached me to lead the Series A. We did a lot of diligence & ultimately totally backed the story. The key was making sure the clinical trial design would give us an unambiguous answer to the question of does the MOA impact TED

Syndication was challenging! We wanted a 3 handed deal but ended up closing the Series A with SR One and Lundbeckfonden in 2012 with a license for Tepro from Roche and even some GMP material to kick off the Ph2 trial in 84 patients (NB FDA allowed this to be 1 of the reg trials)

The trial was a slog. Enrollment was tough. Very few companies had run TED trials despite the clinical need. But the team persevered and got it fully enrolled. During the course we heard anecdotes about possible responses but it was blinded and we had all been burned before

Halfway thru the trial the BoD and management made the decision (and not an easy one) to change the primary endpoint to proptosis AND CAS (it had been “or”) this creating an even higher bar for success. It worked.

Spring of 2017 the study readout and was unblinded. The results were unambiguous and remarkable and ended up being published in NEJM nejm.org/doi/full/10.10…

The team ran a dual sale and Series B process using Stifel which culminated in the sale to $HZNP in May 2017. The NRM team helped Horizon run the confirmatory trial and Tepezza was available to patients to start 2020.

River Vision did the whole thing on $35M from 2 investors. Investors monetized down streams but still made 8x. NRM had proven that drugs could be developed more efficiently. More importantly TED patients now have an effect drug to treat their condition

The NRM team is at it again with two renal newco’s. Don’t bother trying to find out much online. They aren’t interested in fame or recognition. They only care about delivering life changing medicines. (Sorry if this was too long)