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DR.
MILLER: I have a question about the efficacy frontal versus
vertex. It appears that the vertex--it was clearly more efficacious
on the vertex if you took hair counts. I think it was 107, and
the difference in the frontal area was 59. You have fewer patients
with the frontal evaluations, and yet, when patients present,
the vast majority present with frontal hair loss, the vertex
is a problem but not nearly the problem that the frontal loss
is. So, I'd ask you why the difference in response between vertex
and frontal and then, why your emphasis on vertex when the frontal
is really the area that's more important.
DR. KAUFMAN: The question has to do with the relative efficacy
demonstrated in the frontal hair loss study compared with the
efficacy in the vertex studies. I think that the hair count
data in the frontal study, as you commented, does show less
of an increase from baseline or less of a large treatment effect
compared with the vertex studies. But it's worth recalling that
the area sampled in the frontal hair loss study is within the
frontal thinning area. It is not at the anterior leading edge
of active hair loss, as in the vertex study. So, there may be
a sampling bias related to those two studies that impacts on
the change from baseline and hair counts.
In addition, the actual baseline hair count in the frontal hair
loss study was greater than it was in the vertex studies, and
the data do support that the lower the hair count at baseline,
the higher the increase from baseline. Now, an additional point
is that we did evaluate the frontal area in all patients in
the vertex pivotal study. So, all 1,553 patients participating
in the pivotal vertex studies also had photographs of their
scalp taken using that superior frontal view that was used,
and in that analysis, using the same expert panel that reviewed
vertex photographs, the efficacy in the frontal area was essentially
the same in the 1,553 vertex patients as it was in the vertex
area. So, I think in answer to your question, when you look
at all of the data from all three trials, there is overwhelming
evidence that there is efficacy in both the frontal and the
vertex patients and that the vertex patients, when reviewed
from the front by the global panel, demonstrate efficacy nearly
equivalent to that in the vertex. And I showed you one example
of that in the last patient in the vertex series at one year,
where the second photograph of that patient demonstrated the
efficacy seen in the frontal area, and that efficacy in the
frontal area in the vertex studies was essentially the same
as seen in the vertex area in those patients.
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