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Bristol Myers, Bayer forecast blockbuster future for rival blood thinners

Bristol Myers Squibb and Bayer this week said they expect rival blood thinners they’re each developing could exceed $5 billion in peak annual sales later this decade, if clinical testing shows them to be better than current top-selling treatments.

The forecasts are indicative of the companies’ confidence in the experimental drugs. Known as Factor XIa inhibitors, they are meant to have lower risk of bleeding than Factor Xa-targeting medicines like Eliquis and Xarelto, but have shown mixed results in mid-stage trials.

The companies are looking ahead to late-stage trials to prove the potential of the drugs, which act on a different part of the body’s clotting mechanism than current treatments.

Speaking at the J.P. Morgan Healthcare Conference Monday, Bristol Myers’ chief commercial officer Chris Boerner said they plan to advance the experimental drug milvexian they are developing with Johnson & Johnson into Phase 3 testing soon.

“Based on all of the data we’ve seen from our monotherapy as well as our combination studies, we think it has the potential to be a very important next-generation antithrombotic with an excess of $5 billion of potential across three indications” for secondary stroke prevention, atrial fibrillation and acute coronary syndrome, he said.

Factor Xa inhibitors are strongly effective in preventing strokes in patients with atrial fibrillation, but “from our experience with Eliquis … upwards of 40% of patients either don’t get a Factor Xa or are undertreated primarily because of a concern of bleeding,” Boerner said. Bristol Myers sells Eliquis in partnership with Pfizer.

Meanwhile, Bayer on Tuesday forecast sales of more than 5 billion euros, or $5.4 billion, for its Factor XIa inhibitor asundexian. Bayer started Phase 3 study of the drug in August.

Data from its study in atrial fibrillation could be released by the second half of 2025, Morgan Stanley analyst James Quigley wrote in a note to clients Tuesday. “Following the Phase 2 data, we remain optimistic about the commercial potential of asundexian, despite the pullback in the shares” caused by the study’s technical failure when it missed its goal to reduce covert brain infarctions, Quigley wrote.

Asundexian was one of four drugs Bayer predicts could add more than 12 billion euros in additional peak sales, including the cardio-renal drug Kerendia.

The new blood thinners are important for both Bristol Myers and for Bayer, as the companies need to replace revenue for Eliquis and Xarelto, respectively, when those medicines lose patent protection later this decade.