ekekeg, how do you check your account to see if your share is borrowed?

What is the primary stent that XIENCE V / PROMOUS replaced in your lab?

 

 Cypher          41.83 %

  Taxus           50.72 %

 

  Endeavor      5.16 %

 

  BMS              2.29 %

I suppose this poll is for physicians who intends to use the new Xience DES. Looks like newer DES with better efficacy and safety profile may overtake the older generation DES. This is an inevitable trend, which goes for any product out there, in the medical world.

: Credit Suisse Report:

Biosensors International Group Ltd. -----------------------------------Maintain OUTPERFORM

1Q09 review: strong ramp up of Biormatrix sales EPS: ▲ TP: ◄►

 

Jinsong Du / Research Analyst / 852 2101 6589 / jinsong.du@credit-suisse.com Justin Liu / Research Analyst / 852 2101 7350 / justin.liu@credit-suisse.com

 

● Biosensors announced 1Q09 (quarter ended in Jun 09) results

 

yesterday. With the accounting treatment change to recognise the

 

US$40 mn one-time payment of licensing fee, 1Q09 revenue grew

 

303% QoQ to US$58 mn. Without this change, revenue was

 

US$20 mn. The BioMatrix stent generated US$7.2 mn in 1Q09,

 

exceeding Credit Suisse estimates.

 

● The smaller than expected reoccurring licensing revenue,

 

however, raised concerns on the future contribution from the

 

revenue-sharing with Terumo. Since this was only Terumo first

 

quarter of selling Nobori stent, we remain confident on our

 

estimates and will closely monitor the progress.

 

● We have been assuming the JWMS deal in China would be

 

rejected by the Chinese government, and both Biosensors and

 

Shandong Weigao confirmed that yesterday. Our revenue

 

estimates now DO NOT consolidate JWMS sales any more.

 

● Biosensors stay very confident on the upcoming LEADERS trial

 

results, which is scheduled to release by end Aug and could serve

 

as a near-term catalyst. Maintain OUTPERFORM.

 

US$40 mn payment from Terumo recognised in 1Q09

 

On 22 April 2008, the company announced that it signed a

 

modification to the licence agreement with Terumo (4543 JP, ￥6,170,

 

Not Rated), under which the company is to receive US$40 mn in

 

exchange for a reduction of the revenue sharing provisions applicable

 

to sales of the Nobori drug-eluting stent (DES) outside of Japan. The

 

company initially stated that this US$40 mn revenue would be

 

recognised over five year. However, the company now believes that it

 

is more appropriate from the accounting perspective to recognise this

 

US$40 mn now.

 

Stronger-than-expected BioMatrix ramp-up, but licensing

 

revenue implies minimal revenue sharing from Terumo

 

BioMatrix was commercially launched in April 2008. With positive early

 

market acceptance in Germany, Latin America, the Middle East and

 

some European counties, the sales momentum of BioMatrix was

 

stronger than expected, and recorded US7.2 mn in 1Q09. (US$1.7 mn

 

in pre-launch sales in 4Q08).

 

The smaller than expected reoccurring licensing revenue, however,

 

may imply a minimal revenue sharing from Terumo’s Nobori stent and

 

have raised concerns among investors on the future contribution from

 

the revenue-sharing with Terumo. Since this was only Terumo first

 

quarter of selling Nobori stent, we remain confident on our estimates

 

and will closely monitor the progress.

 

Restructuring on track and should improve margins in the

 

long run

 

Biosensors’ gross margin improved to 53.3% in 1Q09 from 39.3% in

 

1Q08, thanks to the sales of higher margin BioMatrix, which

 

accounted for 39% of total product revenue in 1Q09.

 

The company confirmed that the closedowns of facilities in the U.S.

 

and the Netherlands are on track. Although the near-term costs have

 

a negative impact on the bottom line, the company is confident that

 

long-term margins should improve after the completion of the

 

restructuring process. Staff downsizing in the US is to be completed

 

by 2Q09 with an additional US$1.5-2 mn expenditure. Our estimates

 

of the restructuring expenses were detailed in our last quarter’s review

 

notes.

 

Upcoming LEADERS trial results – a positive catalyst

 

Biosensors plans to release the Leaders trial results during the

 

European Society of Cardiology (ESC) Congress (from 30 Aug. to 3

 

Sep.). Potentially positive trial results may serve as a near-term

 

catalyst for the share price, in our view.

 

Collaboration with Shandong Weigao may exist in other

 

forms

 

The company confirmed that they are discussing with Shandong

 

Weigao (8199.HK, HK$11.50, Outperform, TP HK$19.00) on the

 

alternative plan to sell BioMatrix in China, if the proposed deal is

 

rejected by the China government.

 

We believe this is a positive move for Biosensors and Shandong

 

Weigao to continue working together on the SFDA application for

 

BioMatrix and the eventual distribution of Biomatrix in China, even

 

without the proposed deal. The company expected to receive SFDA

 

(Chinese FDA) approval for BioMatrix within the next 12-18 months.

 

We maintain our OUTPERFORM rating and target price of S$0.9.

 

Newspaper questions Boston Scientific stent data

I might as well give some details about this trial - which according to some, PCI (percutaneous Intervention, ie either a Bare metal stent or Balloon angioplasty, or DES) benefits loses its advantage to external drug therapy after 2 years ....

Extract below taken from the www.theheart.org.

Basically, it says that in the trial, the PCI that were done on patients were either bare metal stent or balloon angioplasty, and they were not using a DES, which might have given a better outcome.

Also, the consensus is there PCI and optimal drug therapy goes hand-in-hand, AND NOT that one will REPLACE the other.

FRom  Theheart.org .......

"Bad PCI and unrealistically good medicine"

 PCI didn't surpass OMT more decisively because the trial used "bad PCI and unrealistically good medicine," Dr Dean J Kereiakes (Christ Hospital Heart and Vascular Center, Cincinnati, OH), coauthor of a published critique of the trial's methods [6], told heartwire.

I'm amazed PCI as performed in this trial maintained superiority through two years, because of the extremely high frequency of bare-metal stents, high frequency of standard balloon angioplasty, and the incomplete revascularization in the PCI cohort," Kereiakes said.

According to the trial's primary report, "complete revascularization was performed as clinically appropriate." But it also notes that 69% and 70% of routine-PCI and OMT-only patients, respectively, had two- or three-vessel disease, whereas only 41% of routine-PCI patients received more than one stent [2]. Only 31 patients received DES, which for most of the study had yet to become available, the report notes.

Think of what could have been achieved if more complete PCI had been performed, with optimal technology—that is, with drug-eluting stents. You would have had a more durable benefit of PCI," Kereiakes said.

Excellent medical therapy and a high level of compliance within the confines of the clinical trial also narrowed the outcomes gap between the two patient groups, Kereiakes said. "The level of medication and even the goals achieved, as far as blood-pressure control, cholesterol levels, etc, were truly remarkable in this trial. It's admirable, I think it's inspirational, but it's unrealistic."

In the eye of the beholder

He added, "Patients with objective evidence of ischemia, absolutely, if feasible, should have PCI plus OMT, unless there are mitigating circumstances." PCI wouldn't be required, he said, if medication completely controls both symptoms and objectively documented ischemia, whether symptomatic or silent.

"These data contribute to my enthusiasm for doing PCI better than was done in this trial," Kereiakes said. "Still giving optimal medications to the extent that they're tolerated and the patients are compliant, I have no doubt that a strategy of complete revascularization with optimal technologies would provide a significantly greater gap than was demonstrated to two years in this trial and would extend that benefit beyond two years."

On the latter point, Weiner seemed to agree. If recurrent symptoms after PCI are often due to restenosis and DES can "virtually eliminate" restenosis—both ideas are borne out by the data—and then if DES are used in COURAGE-like patients, "it's not unreasonable to think that the separation between the two groups would be wider, and it would be maintained for a longer period of time," she said.

More conservative about when to perform PCI in COURAGE-like patients, Kaul outlined a scenario he thinks might indicate invasive management. "If on objective assessment you demonstrate a substantial degree of myocardial ischemia in association with reduced LV systolic function, that would be a case where I could justify an initial PCI strategy," he said.

"I would say, high-risk anatomy and a high-risk functional stress test—a large amount of myocardial ischemia and compromised LV function—those would be reasons why I would offer PCI over medical therapy [only]."

Editorialists Peterson and Rumsfeld emphasize that OMT and PCI aren't actually competitors. "The COURAGE trial redefines the contemporary roles of optimal medical therapy and PCI in the management of patients with stable angina. Rather than one victor, COURAGE demonstrates that both treatment strategies can have a profoundly positive effect on patients' health status and suggests complementary roles—optimal medical therapy as first-line therapy, with PCI reserved for patients who do not have a response or who have severe baseline symptoms."