Neurocrine Biosciences reported that its VMAT2 inhibitor, INGREZZA (valbenazine), achieved a least‑squares mean target occupancy of 76.5 % in a head‑to‑head positron emission tomography study, compared with 38.3 % for Teva’s extended‑release formulation, AUSTEDO XR. The study, presented at the 64th Annual Meeting of the American College of Neuropsychopharmacology in the Bahamas, involved eight participants who each completed four PET visits. Occupancy estimates were 83 % for a 40‑mg dose and 92 % for an 80‑mg dose of INGREZZA, versus 54 % for a 24‑mg dose and 70 % for a 48‑mg dose of AUSTEDO XR.
The markedly higher occupancy suggests that INGREZZA engages the VMAT2 transporter more fully at therapeutic doses, potentially translating into stronger and more durable dopamine modulation for patients with tardive dyskinesia and Huntington’s disease chorea. In a market where both drugs are approved for the same indications, a two‑fold difference in target engagement can be a decisive factor in payer negotiations and clinical decision‑making, especially as payers increasingly demand evidence of superior efficacy to justify premium pricing.
Neurocrine’s chief medical officer, Sanjay Keswani, noted that the data reinforce the company’s established pharmacodynamic profile and support the robust early and sustained clinical efficacy observed in previous trials. He added that the high occupancy may contribute to the drug’s favorable safety and tolerability profile, which has been a key differentiator in the competitive landscape. The company plans to incorporate these findings into upcoming phase III studies and to use the data to strengthen its value‑based pricing arguments with payers.
While the study itself was not the primary driver of market reaction on January 15, analysts’ commentary that day reflected a broader view of Neurocrine’s pipeline. Morgan Stanley downgraded the stock, citing limited clinical catalysts until 2027, and UBS lowered its price target over concerns about competition for the company’s obesity candidate. Conversely, H.C. Wainwright raised its target, citing the new obesity program, and TD Cowen maintained a buy rating, highlighting the diversified pipeline. The mixed analyst sentiment underscores that, although the PET data are positive, investors are weighing the company’s overall strategic trajectory and competitive risks.
The study’s implications extend beyond clinical data. By demonstrating superior target engagement, Neurocrine strengthens its bargaining position with payers, potentially enabling higher reimbursement rates and broader market access. The company’s strategy to leverage this data in payer discussions aligns with its broader goal of establishing INGREZZA as the preferred VMAT2 inhibitor in both tardive dyskinesia and Huntington’s disease markets, where the addressable market is projected to grow to $4.5 billion by 2030. The data also support ongoing discussions with payers about the value proposition of INGREZZA, as higher target engagement can be used to justify premium pricing and reimbursement rates.
Neurocrine will use the occupancy data to inform future clinical trials and payer negotiations, reinforcing its competitive advantage in a market where Teva’s AUSTEDO XR has recently entered. The company’s focus on robust clinical evidence, combined with its diversified pipeline, positions it to navigate competitive pressures while pursuing growth in both established and emerging indications.
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