Into the unknown: Tarsus’ CEO on its launch strategies in a new disease category

Patients with the eyelid disease demodex blepharitis frequently follow a similar treatment journey — one Dr. Bobak Azamian, CEO of Tarsus Pharmaceuticals, witnessed up close when his mother started having problems with her eyes.

It all started with a stye, a common and painful red bump on the eyelid. After a round of antibiotics and over-the-counter meds, some symptoms persisted. For many patients the story would have ended there, without a clear diagnosis or options for further treatment. But it just so happened Tarsus was closing in on an approval for Xdemvy, the first-ever drug for demodex blepharitis, the root cause of demodex mites that can fester in eye lashes.

Sure enough, Azamian’s own mother was ultimately diagnosed with the condition. After Xdemvy got the FDA nod July 25 last year, she became an early patient prescribed a six-week course of the medication.

“My mom’s case is seared in my mind,” Azamian said. “The No. 1 challenge with demodex blepharitis is that a lot of patients aren’t diagnosed.”

 Xdemvy marked a breakthrough for the indication and for Tarsus as its first drug to cross the regulatory finish line. But as a first-in-class therapy in a disease category with low diagnosis rates and no other treatments, it also presented the company, headed by a physician CEO who’d never led a product launch in pharma, with commercialization challenges. To get the drug into the hands of an estimated patient population that includes 25 million Americans, the company had to blaze its own trail.

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“We are creating this market, so we are launching and educating at the same time.”

Dr. Bobak Azamian

CEO, Tarsus Pharmaceuticals

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So far, the strategy, which includes a mix of educational campaigns and direct doctor outreach by a growing sales force, has paid off. In its latest earnings update, Tarsus reported fourth quarter revenue north of $13 million — exceeding forecasts of $7 million — and total year sales for Xdemvy of $14.7 million.

The company is also busy in the clinic studying Xdemvy for meibomian gland dysfunction, another eye condition with no other FDA-approved treatments that, coincidentally, Azamian’s mom was also diagnosed with. Tarsus is also testing another treatment, TP-05, as a Lyme disease prophylactic and TP-04, a potential therapy for rosacea.

“The connection between these indications is a unique molecule called lotilaner with the chemistry of an antiparasitic treatment,” Azamian said. “It’s part of a new class of safe and effective medicines that inhibit gamma-aminobutyric acid-gated chloride channels.”

And although the treatments in the company’s pipeline are based on Tarsus’ antiparasitic technology, Azamian said the long-term goal is to mature into an ophthalmology focused company and tap into a global market Market Research predicts will be worth $61 billion by 2028.

For now though, Tarsus has to execute on its Xdemvy launch. Here, Azamian, a 2022 PharmaVoice 100, discusses the company’s commercialization strategies, unforeseen challenges and how the company is leveraging tech along the way.

This interview has been edited for brevity and style.

PHARMAVOICE: What has been your broad commercialization strategy with this new drug in a new market?

DR. BOBAK AZAMIAN: We are doing all the commercialization efforts in house. What we realized is that we are creating a new category, and we need to have a high-touch approach.

We needed to create a pharmacy channel that makes it easy for patients to get the treatment, and we’ve [got it at] four pharmacies that deliver, including CVS and Walgreens. Doctors have to know about it too and do prior authorizations. So that’s been a success so far.

And obviously the sales rep is the customer-facing part of our operation. We [have] reps for each territory, which feeds back into the marketing and commercialization efforts. In hindsight this has been the right decision.

There’s been a lot of talk in the industry about on-the-ground sales forces shrinking, but your sales staff grew 183% last year. Why has this part of the strategy been so important for launching Xdemvy?

The eyecare space is different — eye doctors like the one-on-one interactions. So we have 85 reps calling on thousands of doctors, and [they] are considering whether to call on them more frequently because the more we can get in front of them and ask about examining eyelids, the more we hear they didn’t realize there were that many patients [with this condition], and they want to give patients a good solution. 

Our target is 15,000 doctors and we’ve already worked with 6,000 doctors. And now that many patients have completed six weeks on the medication, doctors are seeing results and prescribing it more because they see it works.

But we know [reaching] the next 9,000 doctors is going to be more work.