Good day, ladies and gentlemen, and thank you for standing by. Welcome to the Heron Therapeutics conference call to discuss the FDA approval of APONVIE. As a reminder, this conference is being recorded. I would now like to turn the call over to David Szekeres, Executive Vice President, Chief Operating Officer. Please proceed.
Thank you, Mandeep. Good afternoon, everyone, and thank you for joining us. With me today from Heron are Barry Quart, Chief Executive Officer and Chairman, John Poyhonen, President and Chief Commercial Officer, Kimberly Manhard, Executive Vice President, Drug Development and Board Director, and Chris Storgard, Senior Vice President, Chief Medical Officer. For those of you participating via conference call, the slides are made available via webcast and can also be accessed by going to the investor relations page of our website following conclusion of today's call. Barry will provide introductory remarks and offer context around the recent approval of APONVIE, the trade name for HTX-019, for prevention of postoperative nausea and vomiting, and will review the approved indication and important clinical data. John will discuss our commercial plans for ZYNRELEF before opening the call for your questions.
Before we begin, I would like to remind you that this call will contain forward-looking statements concerning Heron's future expectations, plans, prospects, corporate strategy, and performance, which constitute forward-looking statements for the purposes of the Safe Harbor provision under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including those discussed in our filings with the SEC. In addition, any forward-looking statements represent our views only as of the date of this webcast and should not be relied upon as representing our views as of any subsequent date. We specifically disclaim any obligations to update such statements. Now, I'll turn the call over to Barry.
Thank you, David. Welcome, everyone. Thank you for joining us. I'm extraordinarily pleased to report that last Friday, the FDA approved APONVIE for the prevention of postoperative nausea and vomiting. I've included our pipeline slide in the presentation today, not only because I'm excited to show the APONVIE bar all the way to the right, showing approval, but I also wanted a reminder today that we are celebrating our fourth U.S. FDA approval, with 2 in the last 16 months. You will hear shortly how we are putting to use all the experience gained from our prior launches, including what's gone right as well as what hasn't. To lay the groundwork for a successful APONVIE launch. APONVIE is indicated for the prevention of postoperative nausea and vomiting, or known as PONV, in adults.
APONVIE is available as a very convenient, room temperature stable, ready-to-use 32 milligram single-dose vial for direct administration as a 30-second intravenous injection prior to induction of anesthesia. APONVIE was approved based on the results from 2 large randomized controlled trials of oral aprepitant against the standard of care ondansetron in patients undergoing open abdominal surgery. Focusing on the most objective endpoint, vomiting. In study one, shown on slide 5, aprepitant produced an absolute difference in the proportion of patients vomiting after surgery of over 15%. To put that into perspective, more than twice as many patients receiving ondansetron for prophylaxis vomited through 48 hours post-surgery compared to those who received aprepitant. 38.3% versus only 18.5% for aprepitant. The results in study 2 are almost identical, with an almost 18% absolute difference in vomiting through 48 hours.
More than twice as many patients vomiting after receiving ondansetron for prophylaxis. 33.1% versus only 15.4% for aprepitant. Adding to the body of data available on the use of aprepitant for PONV is a 2020 Cochrane Database of Systematic Reviews meta-analysis on drugs for preventing postoperative nausea and vomiting in adults after general anesthesia. This meta-analysis included 282 studies with 50,812 participants and covered a large number of single agents and drug combinations. The table on slide 7 highlights the relative risk for vomiting versus placebo and the number of patients vomiting out of 1,000 for a select group of single agents.
Oral aprepitant was found to be the most effective single agent for prevention of vomiting for the first 24 hours after surgery, as well as in the first 6 hours or in the PACU. Oral aprepitant and its IV prodrug provided similar or better reductions in vomiting compared to drug combinations evaluated, with aprepitant plus a 5-HT3 antagonist found to be the most effective 2 drug combination. Oral aprepitant also had a favorable safety profile versus placebo. It's not surprising that the small amount of published data with the IV aprepitant prodrug, fosaprepitant, shows even better efficacy than the oral formulation. Comparing drug levels achieved with oral aprepitant formulation versus IV administration of APONVIE showed that with IV administration of aprepitant, Cmax is 4 times higher than with the equivalent oral dose and is achieved in minutes versus hours for the oral.
The drug levels achieved almost immediately with APONVIE are associated with greater than or equal to 97% receptor occupancy, and therapeutic drug levels are maintained for over 48 hours. Given the extraordinary efficacy observed in a small number of foreign studies with the aprepitant prodrug fosaprepitant, it's reasonable to wonder why this product is not used for PONV. Well, 1 obvious reason is that it's never been approved for PONV, but the real reason is related to its poor tolerability and inconvenient preparation and administration. Fosaprepitant, which contains polysorbate 80 as a synthetic surfactant, is poorly tolerated when administered through peripheral veins with up to 40% infusion site reactions. In cancer patients, fosaprepitant is administered through a central line and is still associated with significant side effects. But through a small peripheral vein used in surgical patients, the pain and irritation would just be too great.
This poor tolerability profile, combined with the need for reconstitution in an IV bag with 150 mL of sodium chloride and administration as a 20- to 30-minute infusion, makes fosaprepitant a non-starter for PONV. Conversely, the emulsion formulation used with APONVIE is much better tolerated and is given as a 30-second IV injection, also known as an IV push, without these tolerability issues. With that brief overview as to why we believe that APONVIE is the most effective agent for preventing vomiting after surgery, I will now turn the call over to John Poyhonen, our Chief Commercial Officer. John.
Thank you, Barry. From a commercial perspective, we are absolutely thrilled with the approval of APONVIE and adding a second product to our acute care portfolio that's focused on addressing the 2 most concerning side effects for patients undergoing surgery, postoperative pain and postoperative nausea and vomiting. Today, my presentation will focus on the market opportunity, APONVIE's significant differentiation from the competition, and why we believe APONVIE will establish a sizable market share in PONV while growing the market. We have a comprehensive go-to-market strategy and plan. Today I will not be sharing specific details ahead of our launch in the Q1 of 2023 to prevent potential competitive responses. We truly believe that APONVIE and the PONV market is the next big opportunity at Heron. Let's start with the name, APONVIE. It conveys aprepitant for PONV.
The market research on the brand name was extremely positive from healthcare providers, and importantly differentiates this lower dosage offering of aprepitant emulsion from CINVANTI, our highly successful product for CINV. We estimate the total market to be about 69 million procedures in 2023. Of course, not all procedures receive prophylaxis for PONV, and I'll share the size of our target market in later slides. Importantly, the market research identifies a number of significant unmet needs in the current market, including a more convenient product with faster onset, which APONVIE meets with a 30-second IV push and 97% receptor occupancy within 5 minutes, also bypassing first pass metabolism. A more effective product, as Barry shows, aprepitant is the most effective product for PONV prevention, alone or in combination. Finally, longer lasting treatment, with APONVIE providing PONV prevention for up to 48 hours.
The last unmet need is especially important with the growth in outpatient surgeries and patients being discharged hours after surgery. In short, APONVIE is clearly differentiated in this market and positioned for success. APONVIE is also the perfect strategic fit for Heron based on the synergies with our commercial organization. It starts with tremendous overlap of accounts we are already targeting for ZYNRELEF. We have existing trusted relationships with anesthesia and pharmacy, which are critical for formulary access and usage. In addition, about 65% of our CINVANTI business comes from the hospital market. The existing positive experiences at major hospitals and IDNs should help us jumpstart APONVIE access and usage. We conducted 3 comprehensive market research studies through a leading third-party firm to assess the PONV market and aprepitant demand. The results from all 3 studies were remarkably consistent based on a large cross-section of PONV healthcare providers.
Our most recent study included over 700 HCPs and served to define the market opportunity and key insights on antiemetic usage to support our segmentation strategy. The studies indicated HCP preference share and formulary access, allowing us to develop our pricing strategy and sales forecast. The APONVIE target market opportunity includes patients at moderate to high risk for PONV, which equates to 36 million procedures. The table on the left of the slide shows a simplified form of the PONV risk factors, including female gender, non-smokers, history of PONV and/or motion sickness, along with postoperative opioid usage. The table on the right shows the Apfel risk score that utilizes these risk factors to establish 3 levels of risk for patients, low, moderate, and high.
The pie chart in the middle summarizes the percentage of patients in each risk category, with 19 million moderate risk patients at 2 risk factors and 17 million high risk at 3 or more. Market research indicates that only 56% of addressable market procedures or 38 million patients receive prophylaxis for PONV. Importantly, about 12 million high to moderate risk patients are currently not receiving any prophylaxis at all, which creates a significant opportunity to grow the market. Only 75% of high-risk patients and 61% of moderate risk patients receive prophylaxis for PONV. This situation is analogous to our launch of SUSTOL for CINV. By focusing on cancer patients that were not receiving both a 5-HT3 and an NK1, we were able to grow the NK1 market by 33% in the first year of launch.
We expect to also grow the NK1 market in PONV by utilizing the 2020 consensus guidelines that I'll speak about on the next slide. Finally, even with 38 million patients receiving prophylaxis for PONV, there are almost 21 million annual administrations of rescue treatment for PONV. This clearly demonstrates that existing PONV prophylaxis is not working and establishes a significant unmet need for APONVIE. Next, I would like to review the key opportunities based on the fourth and most current consensus guidelines for the management of postoperative nausea and vomiting published in 2020. As you can see in the bar chart, as patient risk factors increase, the incidence of PONV also increases dramatically.
In fact, a direct quote from the updated guidelines is, "In this iteration of the PONV guideline, one of the most major changes is that we now recommend the use of multimodal prophylaxis in patients with 1 or more risk factors." In short, multimodal means use of more than 1 agent with a different mechanism of action for the majority of patients. The recommendations on adult PONV drug management shown on the right starts with the identification of risk factors and risk mitigation strategies. Based on risk stratification in section 3, 2 antiemetic agents are recommended for patients with 1-2 risk factors, which represents a major change in the 2020 PONV guidelines. In addition, for high-risk patients with 3 or more risk factors, the guidelines recommend 3-4 antiemetics based on the current consensus. Recommendations for multimodal PONV therapy creates a huge opportunity for APONVIE.
Section 4 provides PONV drug classes. As you can see, the guidelines already include NK1 receptor antagonist, which includes aprepitant, the active ingredient in APONVIE. Based on market research and advisory board feedback, we believe that APONVIE will rapidly become the NK1 of choice due to the convenient 30-second IV push and rapid onset of action within 5 minutes. APONVIE's message is simple and memorable. 1 Push to prevent PONV. We will focus on 5 key attributes that significantly differentiate APONVIE. APONVIE is the first and only formulation of an NK1 approved for the prevention of PONV. Second, superior vomiting prevention versus the current standard of care of ondansetron through 48 hours. Longer-lasting treatment is a significant unmet need to prevent post-discharge nausea and vomiting, which will help reduce patient callbacks in the growing outpatient surgery market.
Our third key attribute is APONVIE is administered through a single 30-second IV push. This breakthrough formulation is a major improvement over oral aprepitant, which was taken 1-3 hours prior to induction of general anesthesia in clinical trials and takes 3 hours or more to reach maximum receptor occupancy. Safety is always a key consideration in the selection of therapy. Aprepitant has a comparable safety profile to IV ondansetron, the current standard of care. Also, aprepitant is not associated with QT prolongation or instances of serotonin syndrome. Finally, aprepitant reaches plasma concentrations associated with greater than or equal to 97% receptor occupancy within 5 minutes. This rapid onset of action was viewed by HCPs as one of the most important benefits. Slide 17. This slide summarizes the market research after showing the APONVIE product profile.
We asked surgeons and anesthesiologists what percentage of the low, moderate, and high risk PONV procedures would you currently, in which you currently prescribe an antiemetic for prophylaxis, would you anticipate ultimately using APONVIE for prophylaxis? Not surprisingly, as risk increased, so did APONVIE preference share. While APONVIE's preference share was high across all surgical specialties, we were extremely pleased to see a preference share with anesthesiologists, the primary decision-maker for PONV antiemetics. In fact, in our target market of moderate to high-risk patients, their preference was higher for APONVIE than the overall average. Our initial target accounts for APONVIE are those using oral aprepitant for PONV, with over 500,000 capsules expected to be used this year. The rapid growth of oral aprepitant in key is a key indicator that HCPs view the drug positively for PONV.
The growth is not surprising given the effectiveness of aprepitant, but it is a bit surprising considering the lack of commercial promotion and the WAC price of about $88 per capsule. Although the actual cost to customers is less. With this in mind, our initial goal will be to become the NK1 leader for PONV. APONVIE is differentiated with a 30-second IV push with therapeutic levels associated with 97% receptor occupancy achieved within 5 minutes and lasts for 48 hours. On the other hand, oral aprepitant was taken 1-3 hours prior to the induction of general anesthesia in clinical trials and does not reach the maximum concentration until 3 hours after administration. APONVIE is the clear winner based on convenience of the IV formulation and the rapid onset of action. In summary, APONVIE is the ideal strategic fit for Heron.
PONV is a very large market with 36 million high to moderate risk patients. We will utilize the PONV consensus guidelines to grow the market opportunity with 12 million high to moderate risk patients currently not receiving prophylaxis. There is a significant unmet need for more effective and longer-lasting PONV prevention with 21 million annual administrations of rescue treatment. APONVIE is perfectly positioned to meet those needs, with aprepitant being the most effective approved antiemetic, alone or in combination for prevention of vomiting through a single 30-second IV push with a rapid onset of action within 5 minutes. When we decided to develop APONVIE, the synergies with our existing commercial organization was a key benefit. Our acute care team is already calling on hospitals and ASCs with anesthesiologists and surgeons as our target audience, so minimal new investment is required for the launch.
In addition, 65% of our CINVANTI business for CINV comes from the hospital market. Many large integrated delivery networks and hospitals are already familiar with the aprepitant emulsion and the operational benefits of the IV push. The growing oral aprepitant market is the perfect initial target, with 500,000 annual units to jumpstart APONVIE based on its more convenient 30-second push and rapid onset of action. Finally, we will leverage our existing CINVANTI manufacturing capabilities to meet our COGS target for APONVIE. That concludes my prepared remarks, and I'll now turn the call back over to Barry. Barry?
Thank you, John.
As you've heard, with the approval of APONVIE, we now have an acute care portfolio of 2 best-in-class products addressing unmet needs in the 2 areas patients are concerned about most after surgery, pain and nausea and vomiting. The next 2 slides contain important safety information about APONVIE and can be found on our website. I will now turn the call over to the operator and open it for questions. Operator, we will now take questions.
The floor is now open for your questions. To ask a question at this time, please press star 1 on your telephone keypad. If at any point you would like to withdraw from the queue, please press star 1 again. We will take a moment to render our roster. Our first question comes from the line of Brandon Folkes from Cantor Fitzgerald. Please proceed.
Hi, thanks for taking my questions, and congratulations on the approval. Maybe just 2 from me. Can you help us understand, in practice, are these hospitals consistently using the risk factor analysis you showed us today in terms of classifying patients ahead of surgery, or is there some level of subjectivity or variability from institution to institution? Maybe do you have some work to drive institutions to use this framework consistently? Then maybe just a follow-on. Do you expect a different uptake in the outpatient setting versus inpatient? Where is the majority of the oral being used currently? Thank you.
Thanks, Brandon. Appreciate the questions. I'm gonna turn the questions over to John.
Right. I believe, Brandon, your first question was, do hospitals and ASCs consistently use risk analysis for to categorize their patients? The answer to that would be yes. Some will also focus very heavily on the type of surgical procedure that is being done. For instance, with a neurosurgery, you certainly don't want vomiting post-surgically because of the damage that it could do to the surgical procedure. By and large, there is good consensus in the marketplace on using risk factors for treatment. I'm sorry, your second question regarded outpatient usage. Could you ask that again, please?
Yeah, sure. Just really, where is the majority of that oral aprepitant currently being used?
Yeah. We've got data right now that indicates the amount of it that's being used. We don't have a good mix of what the percentage of outpatient versus inpatient. We know certainly there's been a growing amount of outpatient procedures over the last couple of years, and right now, we're estimating that between outpatient hospital and ASC, it's over 70%, but we don't have the specifics based on claim data for the oral aprepitant at this point in time.
Great. That's very helpful, and congratulations again.
Thank you.
Thank you.
Our next question comes from Boris Peaker from Cowen. Please proceed.
Great. Let me add my congratulations on an approval as well. My first question is on the sales force. Can you comment of how much of the current end user market for APONVIE is your current sales force reaching out, and how much additional commercial investment would you have to make for the APONVIE launch?
John, you wanna take that?
Sure. If you look at our called-upon target audience for us, right now we're reaching 65% of the oral aprepitant market. By adding just 22 accounts, we're able to get to 80% because it's highly concentrated. That would allow us to get 80% of the oral aprepitant. As you would expect, with respect to IV Emend/Zofran, it's being used much more broadly throughout the country. We would expect with our existing sales force that we can get somewhere in the order of 60%-65% of the usage of those accounts.
Got it. Can you also maybe talk a little about the pricing for APONVIE and just the economics that it applies to these practices?
Yeah. You know, that's 1 of the things that we're not going to talk about during this call. I apologize for that, but we've just decided based on the fact that we're not launching until the Q1 of 2023, that it makes no sense for us at this point to signal the competition what we're going to do from a pricing standpoint. We have done 3 very large market research studies to understand what pricing it looks like. We have a very good sense of what price is what we would consider the sweet spot for to maximize not only the access from a formulary standpoint, but preference from anesthesiologist and surgeon standpoint and maximize profitability. I would expect that somewhere around our Q3 conference call, our earnings call, we'll be providing more details on that.
Got it. Thank you very much for taking my question.
Thank you.
Thanks, Boris.
Our next question comes from Carl Byrnes from Northland Capital Markets. Please proceed.
Congratulations on your approval. Just a couple of real quick questions. What do you see as a realistic timeframe in terms of capturing the oral aprepitant market share? I have a follow-up.
John?
It's a great question. I think that we can make a significant dent within the oral aprepitant market within the first year. Obviously, it's going to depend on how quickly we get you know, a therapeutic interchange for a formulation that is much more convenient and has a much more rapid onset of action. You know, I think that we can make a significant dent into the oral aprepitant within the first year. You know, really that will be proven out based on we see how many accounts are willing to do a therapeutic interchange or substitution for oral aprepitant, and we'll get a better sense of what that looks like as we continue our profiling activities.
Great. Thanks. That's very helpful. Unrelated to the approval here, but I'm curious what your interpretation of the recent EXPAREL data on TKA nerve block. Thanks.
Thanks, Carl. I appreciate that. We did receive a lot of inbound questions when that information was published or the press release came out. I mean, first off, I'll point out that there was no actual data in the press release. It was just a P value of less than 0.01 in that TKA study looking at nerve block. We have, as you know, put out data from 2 studies with ZYNRELEF in TKA, and in the first placebo-controlled study, which is analogous to the study that was just recently done with EXPAREL and nerve block. We had, with a smaller subset of patients in our trial, a P value of less than 0.0001.
I think you know, the P values tell me that the magnitude of the effect is much greater in our trials. You know, in the follow-on study that the data we put out where patients received Tylenol and Advil along with HTX-011 or ZYNRELEF, those patients after TKA remained in the mild pain range for the 72 hours after surgery, and we had a sizable number of patients that were opiate-free during that period. You know, from my perspective, not seeing their actual data, the P value would certainly imply that the magnitude of the effect was not very robust. We're anxious to see the actual results.
Exactly. Well, thanks. That's very helpful, and congratulations again.
Thank you. Appreciate it.
Our next question comes from Josh Schimmer from Evercore. Please proceed.
Great. Thanks so much for taking the questions and, as always, a very helpful overview. I guess first question, why would centers not just use oral aprepitant 1-3 hours prior to surgery, depending on how long the surgery is expected to last, so that patients would have adequate drug levels on board when they wake up?
Well, I think, Josh, actually the data indicates that centers are doing that. The fact that a product with zero promotional activity. Remember, the Merck discontinued promotional activity on the oral Emend for PONV probably 7 years ago. So with zero promotional activity, a generic version of oral aprepitant has continued to grow year over year. And what they're doing is exactly as you noted, which is that patients are taking it, you know, at least an hour before surgery or sometimes up to, you know, 3 hours before surgery, depending on the duration of the surgery. The clinical trials done with the product were open abdominal surgery, which certainly is, you know, certainly medium duration surgery, and the product was taken 1-3 hours in advance.
It gives the opportunity to get to, you know, Cmax and, you know, therapeutic drug levels. It's just not the most convenient approach in a patient that's supposed to be NPO to give them pills in advance of surgery. A quick IV push is certainly not only very convenient, but more consistent with not having the patient taking anything by mouth immediately before surgery. Also guarantees consistent drug levels. There's lots of studies showing that when patients go under anesthesia that GI motility obviously is affected. If they haven't absorbed the pill by the beginning of induction of anesthesia, then absorption at that point could be significantly impacted.
It's just a way of eliminating first pass metabolism, any worries about absorption, any concerns about giving the patient oral medication right before surgery. In an outpatient setting, you know, you have to ask the patient to take the pill, I should say, before they come in, you know, if you wanna make sure that they have the drug on board sufficiently.
Got it. I'm sorry if I missed it, what percent of target procedures are inpatient versus outpatient?
Yeah, that was the question that we don't have good clarity on. We're trying to get that information out of claims data. John, I don't know if you have any other information we can share in that regard.
Yeah. Josh, Barry's right. We don't have claims data on the use of oral aprepitant in the surgical setting of care. What we do know, that there's been a major shift to outpatient procedures with, you know, over 70% right now, outpatient procedures, either in the hospital outpatient setting or the ASC. We believe it's significant, but without the claims data, I can't give you the exact percentages.
I get that you're not sharing the price point at this time, but how do you think about the premium that centers would be willing to pay for the convenience benefit of, you know, being able to administer closer to the surgical procedure as opposed to 1-3 hours before and not requiring patients consume a pill prior to surgery? I guess those would seem to be somewhat modest benefits. Can a meaningful premium be placed relative to oral aprepitant?
Yeah. Overall, the $88 oral aprepitant is the WAC price. You know, many accounts are purchasing it for less than that because it is a generic, but because there's only a couple of companies actually selling the generic, you haven't seen the bottom fall out of it like you do in some generic markets. You know, I think that what we've seen very consistently is there is this range that we'll be talking about during our third quarter earnings call, in which you can't go over that, otherwise you just become a very small niche product. If you're under that, then you know, you can pick up a sizable share. That's really how we based our pricing to maximize not only access, but preference and profitability of the product.
If you look at it, what I would tell you is that $88 actually exceeds, you know, that price point that is a significant risk on becoming just a small niche product. If you look at the number of procedures, you know, one could even say that that's where oral aprepitant currently sits. As, you know, while 500,000 procedures or units is a lot, it's not compared to where we think APONVIE will eventually grow to.
Got it. What product margin are you anticipating?
Ultimately, we would be looking for the kind of standard injectable 80%+ margin. As John noted, the great thing about this product is that we are able to use all of the investment we've put into moving to large scale manufacturing for CINVANTI, which is happening as we speak. In Q4 , we've noted that with CINVANTI, that we're going from around 50% to 75% margin on that product. That will translate into, you know, very substantial improvement in margins very quickly for APONVIE as we go from the current scale rapidly up the learning curve with the work we've already done with CINVANTI.
Got it. Thanks so much for answering the questions.
Of course. Thank you, Josh.
Thanks.
Our next question comes from Rohit Bhasin from Needham & Company. Please proceed.
Hi, this is Rohit on for Serge. Congratulations on the approval. Given its fast onset of action, do you think APONVIE will be used off label as a rescue nausea vomiting treatment? Would you seek approval for the drug as a rescue treatment? Then if so, can you talk about what the clinical trials required would look like? Thanks.
Yeah. Thank you. A great question and obviously, if you talk to anesthesiologists, that's something that will immediately come to their mind, and we get questions about that, you know, very frequently. Clearly, we can't promote the product for treatment. It was just approved for prevention. The opportunity is certainly for the product to be used clinically in patients who have breakthrough, you know, nausea and particularly vomiting with its rapid onset, easy to use, easy to store in the PACU for immediate availability. You know, you would think that this is the obvious place where the product could be used. At this moment, we don't have intentions to conduct any registrational trials in treatment. We have done market research looking at that opportunity.
It does appear to be quite interesting. What we found from anesthesiologists is that they don't really see the difference in prophylaxis versus treatment as the FDA might from a registrational point of view. They look at the data that's available. They understand the molecule. It's highly effective for vomiting and nausea. You know, they make that connection without having clinical trials. You know, again, it's not something that we can promote, but it's a natural use of the product, and we'll see how things play out as the product is launched. My guess is there'll be certainly investigator-initiated trials coming up looking at treatment.
Because we know from talking to anesthesiologists, they've already used aprepitant, the fosaprepitant in rare cases for intractable vomiting with pretty great success.
Great. Thank you.
Our next question comes from Kelly Shi. Please proceed.
Congrats on the progress. My first question is, do you have the information that what is the current market share for NK1 receptor antagonist, the drug class in PONV prophylaxis, and what has been the trend of growth for the past 3 years? Thank you.
Thanks. John, do you wanna take that?
Certainly. Kelly, probably the best way to look at it is the vast majority of NK1 usage currently for prophylaxis has been with oral aprepitant. On slide 18, we show what the growth rate looks like that on units. You know, we're seeing what we believe is 38 million patients actually receive prophylaxis. It's still a very small share compared to, you know, what the opportunity is. You know, as we've talked about throughout the presentation today, I think 1 of the reasons that we're so excited about entering this market now is because of the new consensus guidelines and also the fact that nearly 21 million patients receive rescue therapy.
What they're doing right now from a prophylaxis standpoint has a significant need for improvement, and we think that APONVIE, with its convenient administration and the effectiveness of aprepitant, is the perfect solution to help that multimodal approach.
Okay. Thank you very much.
Thank you.
That does conclude today's questions. I would now like to turn the call over to Dr. Barry Quart for closing remarks.
Thank you. Thank you again for joining us on the call today. We're extremely excited with the approval of APONVIE and look forward to keeping you updated on our launch plans.
Ladies and gentlemen, that concludes today's conference call. Thank you for your participation. You may now disconnect. Goodbye.