E Wither Flexion?

As a part-time practicing physician (rheumatology), it has been gratifying to see the advent of effective new therapies for the treatment of many rheumatological disorders such as rheumatoid arthritis, psoriatic arthritis, etc. What is amusing, if that be the correct word, is that the treatment of the most common rheumatologic disease, osteoarthritis, has been relegated to the backwaters of antiquated practice. Not much has changed over the past 30 years. The mainstay of treatment remains pain management with non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, and various equally ineffective intra-articular therapies such as a myriad of hyaluronic acids.

Intra-articular steroids (NOT oral or intravenous) are also commonly used. While steroids offer short term pain control, their long-term safety was always suspect. It has now come into sharp focus, with the publication of a paper in Radiology, the official journal of the Radiology Society of North America. The paper by Kompel et al. demonstrates that injecting all comers of hip and knee OA could actually cause more harm than good, and that patient selection should be methodical, based on individual patient characteristics. This is in marked contrast to the prevalent attitude of rheumatologists and orthopedic surgeons, who never see a joint they don’t like to inject. If patient selection was done carefully, only a fraction of joints would be injected, but with better outcomes.

From an investment point of view, most steroids such as solumedrol are dirt cheap and the companies that make them don’t make much money. The exception is Flexion (FLXN), whose raison d'etre is its intra-articular steroid therapy, Zilretta. In theory, the product is less systemically absorbed and has longer half-life in the joint. So from a safety point of view, it stays in the joint longer, and can have even more devastating effects if administered to a patient who is not a good candidate. If rheumatologists and orthopedic surgeons were to read the paper by Kompel et al and follow its advice, perhaps only a fraction of patients who are estimated by the esteemed analysts to be candidates for Zilretta would actually get it. This would dent the sales of Zilretta, and affect stock price of Flexion considerably.

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Wall St. Wolf 3 months ago Member's comment

I disagree. Zilretta's study supports that usage does not lead to joint deterioration. See here and please respond with your thoughts.


Ketan Desai 3 months ago Author's comment

Are you serious? Only two injections, follow up for only 52 weeks, and you consider that to be adequate long term safety data? Did you bother to read the meta-analysis mentioned in my article? They followed patients for years. If you have not taken the time or the effort to read the article, go back and do so.

Harry Goldstein 3 months ago Member's comment

So $FLXN is essentially a one trick pony? Didn't realize Zilretta was so critical to the companies existence. Do you know what percentage of its profits are tied to this one therapy?

Ketan Desai 3 months ago Author's comment

100% or their revenue come from Zilretta, It is basically a one trick pony, with line extensions and life cycle management. See their "Pipleline" at https://flexiontherapeutics.com/our-pipeline/

Adam Reynolds 3 months ago Member's comment

Sounds like it's time to short! $FLXN