Peter Greenleaf: Well, I think there’s a couple of things you got to factor in, right? We’ve never said nor will we say that new patient starts aren’t important to look at. But in the first couple of years of the launch is always a question of how long will patients stay on drug over time, what will the persistency look like? And when patients do eventually come off a drug, do they come back to drug? And we’re now starting to understand those dynamics better. So, when you look at overall patient growth and when you look at that relative to new patients coming in, I think for us, it’s somewhat of — it’s a forecasting dynamic, right? Like it’s the persistency that we’ve seen and as reported in this quarter, we’ve seen improvements in 12-month persistency, now above 55% or 56%.
And interestingly, when you get to 18 and then 24 months, we’ve seen at least up to this point, sort of a flattening out of the curve. And I guess I would point to a couple of things. new EULAR and KDIGO guidelines emphasize very clearly that patients should be on medications. And this is irregardless of what medication for three to five years. That hasn’t been historically how physicians have treated this disease. So, although guidelines have been pushing it, it’s been treating episodic sort of flares of proteinuria. And I think those guidelines are helpful. Second, in the last 12 to 18 months, we’ve launched different elements of data that have crossed a couple of different key areas. One, three-year data looking at both safety and efficacy of the product.
So, we were first to have data out that far, in particular, looking at EGFR that’s an important safety component of tracking impact to the kidney. And then 18-month biopsy data. So, remember, in first year, obviously, we only had the one-year AURORA study. So. I think all that’s impacting, and I think you got to look at persistency alongside of new patient starts, and we have to be hitting on both.
Unidentified Analyst: Great. Thanks, again.
Operator: Thank you. Our next question comes from the line of Stacy Ku with TD Cowen. Please proceed with your question.
Stacy Ku: Hi. Thanks for taking our question. So we had a few. So I understand that you can’t divulge to too many details, but if we could just strictly follow-up on an earlier question on strategic review. If you could at least self-critique, what do you think could be the best explanation following the strategic review? Do you think it could be related to something like IP, competitors coming, not getting enough traction with patient adds. Just some commentary from yourself would be really helpful. Thank you so much.
Peter Greenleaf: So I’m going to repeat myself, but because of the confidential nature of the strategic review process, there’s a limit to the details that we can provide, particularly when it comes to other parties business decisions and how they saw things. So we can’t speak to the other party’s behalf as the information could be material to their business.
Stacy Ku: Okay. Understood. And then as you talk about kind of these patient restarts, as you think about kind of long-term, do you think this could really help improvements in retention. And then a quick follow-up on kind of your – kind of conversion rates for this year and next year. Do you expect to stick around that 85% to 90% level? Or do you think that could continue to improve? Thank you.
Peter Greenleaf: Starting with the last question first. I think the 85% has been fairly consistent. While we’ve seen quarter-to-quarter a percentage point or two, directionally up or down. It’s been on average, pretty consistent. So I would hold that fairly consistent. In terms of conversions, I still think we have opportunity to continue to increase speed and time to conversion to getting patients on drug. So I do think that’s — that’s one that we can continue to work on, even though we’re at a fairly high level, getting 60% of patients on to north of 60% of patients on the drug within 20 days. And then the persistency thing, if you look at the market research data we have and the claims data that we have internally, they show a pretty wide disconnect between what actually happens with patients in the market and where the guidelines are pushing things to go to in terms of two elements – three actually.
One is diagnosis. We know that SLE patients, a low percentage actually get a 24-hour urine screen when they come into a doc’s office. We need to continue to improve on that. That will grow the market. Second, treating to target is second. So we know from our data that there’s a proportion of physicians actually who only treat to high proteinuria. Above what the current guidelines recommend in terms of proteinuria level that would qualify a patient as having active lupus nephritis. So getting active treatment and treatment to target are key opportunities and goals for us. And then lastly, there’s this element of physicians treating episodic proteinuria versus sticking to guidelines and treating for and keeping those patients in control for at least three to five years, which we think obviously bodes well for continuing to see at least stabilization, if not improvement in our persistency rates out past 12 months and 24 months.
So all of those elements, I think, when you look at the data we have aligned with the guidelines and the market opportunity bodes well for our growth in the future. Thank you.
