Galderma's Impact on Dermatology | CEO Dr. Flemming Ørnskov

Oh, thank you very much for your kind words and thanks for having me on your podcast.

So, I had the opportunity to work with the owners at looking at the business when it became for sale. It was part of Nestlé. So I started as CEO in October 2019, but before that I spent a significant amount of time traveling the world to understand specifically Galderma but also understand dermatology. I'm a physician by training, so I did know a little bit about it, but my area was pediatrics, so of course we also touched on dermatology in that sense. But the more I got to know about the business, the more I got to know about the specialty, the more I got to know about Galderma, the more excited I became. And that's why I said yes to take this really fantastic opportunity. And together with a really great team, we are building the world's most important, the most significant, and hopefully also the leading in all aspects dermatology company. And yes, we have multiple businesses and we have a clear purpose: we want to advance dermatology for every skin story. And the way we want to do that is through innovation. Maybe not surprising when you're a physician. And we built a very integrated, fast-growing platform that, as you stated in your introduction, spans multiple very exciting, fast-growing parts of dermatology.

Yeah, I think the most important, and you learn that when you travel the world and as I did starting in 2019 talking to a lot of dermatologists or other professionals working in this space, it's for them the first thing almost out of all of them when they talk about Galderma is, 'Oh, you've been around for a long time, you're dedicated to this space, we really are pleased with that because there were other players that have left the space.' And I'm of course building on what predecessors and other teams before me have done. But I think what I see is that focusing on the dermatologist or healthcare professionals that work in this space, providing them with superior services, truly innovative product, having a broad portfolio servicing their needs so they can serve the needs of the customers and patients that they serve. And what I see is that's much more cross-fertilization, much more cross-selling than I had ever seen. When I watch how many samples we hand out, 220,000 samples in the US alone last year handed out to practitioners in this space. So we cover a lot of offices, a lot of customers. And when I look at the product range we have, there's a lot of overlap, there's a lot of synergies. And the more this space is getting digitalized, and the more e-commerce there is, the more blatantly in front of you you see all of the integration. And I think what I've seen is by creating an integrating innovation system, we can develop prescription product, we can develop consumer type of products, we can develop OTC products, and we can develop aesthetic products, because a lot of the similarities - what the product should be able to do, how you develop the product, the texture of the product, the mechanism - all of that, whether we talk about itch, whether we talk about a moisturizer, whether we talk about atopic dermatitis, there's a lot of synergies. And of course, if we take an area like acne, which affects most of us - I have teenagers at home so I see it every single day - I'm really proud that we have a broad portfolio to serve the needs of the many, many people, teenagers, young adults that suffer from acne.

Well, I've had the pleasure to lead companies - the one I led before this became the world leader in rare diseases, again I think a pretty good fit with someone that worked in pediatrics. So we woke up in the morning and we went to bed in the evening and we only had one thought: to develop products for mostly kids with devastating, typically genetically, rare diseases. And here I see what we're focusing on here. We wake up in the morning and go to focusing on dermatology, on skin. What does that do? It focuses the company, it makes us unique, it drives innovation. Everybody is thinking all the time about the same customers, how to expand the product range, what are we hearing, how can we serve not only the customers but also the consumers and the patients in the best way. So lots of cross-selling, lots of opportunities. So I think for me, that gives us a competitive advantage. We don't really have a clear-cut competitor of size in our space. And I think we have a unique strategy: we're focusing on servicing the needs of dermatologists and the customers and patients they serve. We are mostly in the premium segments, we cover as you said 100-plus countries in terms of where our products are available, and we drive the synergies also on the science side. And you'll see that with some of our portfolio products, both already on the market and some of the very exciting things we have in the pipeline.

I don't know how many offices I have had the pleasure of being able to open or being invited as a guest when they have opened the offices. When I started, we were basically focused on around nine countries, nine sizable countries, ranging from US, Brazil, many in Germany. We were not really big in Asia Pacific, we were not big in other places in Latin America. And what I see now is we almost quarterly open new offices, we enter into new markets. So today we span the globe. And if I look at our growth, a lot of our growth is coming out of these new areas for us, which is Asia Pacific, Japan, areas outside Brazil in Latin America, Eastern Europe. And what is really exciting for me is that we take our portfolio, we work on getting the registrations, getting access, many times we have to buy out the distributors so our products become available around the globe. Because we live in a global world, the digitalization - the customers in Korea and the customers in the US and the customer in Europe they know our products, they can watch them online. So being in all these markets, being available both retail and e-commerce, to understand what the customers want and also sometimes adapt our products a bit to special needs in special parts of the world. And today, most of our growth - not all of our growth because we still grow very fast in US and in Europe - but a lot of our growth is coming out of Asia Pacific, out of Latin America. And I think that's super exciting because we want to build a truly global platform where we service customers with dermatological needs around the globe, not only online but actually in the countries.

Well, I think the first thing to keep in mind is that Galderma historically was more in the consumer part of the business and in the small molecule part of the business, whether it was in our therapeutic dermatology part or in our dermatological skincare part. And of course, in the biological part, we went into aesthetics with neuromodulators, so we had some experience. But to get into the biologic space in the therapeutic dermatology took a very big investment. We had to hire a lot of people with expertise in that area. And there's a lot of things I'm proud of. But if I think where we've taken nemolizumab, which is an interleukin-31, it attacks that pathway. What we've done in terms of getting publications in major journals like New England Journal of Medicine, if I look at how both phase 2 and now phase 3 has progressed extremely well, the results we have - we have two indications that we are very advanced with and a third that's a little bit behind. So the two major ones is prurigo nodularis, about a billion-dollar market, and then atopic dermatitis, about an 18-billion-dollar market. And both of them have significant unmet need. We think that nemolizumab, by attacking the cascade of IL-31, is uniquely positioned because it's upstream and it has a lot of effects on not only skin lesions, beneficial effects on the itch, but as you can see from our clinical trials, it also impacts not only well-being but also people's ability to sleep. So we think it's really exciting. We are completing phase 3 and we'll soon be going to the regulatory pathways to get it approved. And if you look at the product, not only what we think it's differentiated because it's not the only one but it's the most advanced IL-31-based medication. If I look at the fact that the FDA in 2019 gave us a breakthrough therapy designation for prurigo nodularis, and it was reconfirmed in 2023 when there was actually another product on the market or close to being on the market, I think people see that as a truly differentiated molecule that has a lot of benefits, whether it's with skin lesions, whether it's with itch where it has a very strong impact, or it's overall on people's well-being like their ability to sleep.

Well, if I look at the actual expansion we've had on R&D, it has multifold since we started in 2019. We had a small team in 2019, very dedicated with great expertise mostly in areas outside biologics, and we had never developed our own neuromodulator, we had just licensed in one at that time. So we had to build that expertise. For nemolizumab we just talked about, I think the team has done a phenomenal job during COVID, keeping the clinical trials going, and basically with minor delays now entering the phase where we could soon submit for regulatory approval around the world. And the data, which are well published also recently at EADV, you will see that the team has done a really good job. Many of them are new, they have expertise, they develop other products in that area. So that was one big challenge we took on. We also decided to take on, one could say maybe an even bigger challenge, which is more or less from scratch to develop a new neuromodulator. It's a real botulinum toxin A, it's called QM-1114, where we basically from scratch developed a new neuromodulator that we think has a lot of benefits in addition to being fully liquidized, but also in terms of its therapeutic profile. And again, here we did not only have to do all the clinical trials, we had to develop it from scratch and we had to develop our own manufacturing site, all of which took a lot of investment, a lot of expertise. I'm really with those two biologic agents being very advanced, and I think we've really proven we can do that. But it was also very important for me that we continue to drive innovation in areas like acne. So we've launched a number of new products at CLE, we have other products, we've looked at combination agents. We recently in the UK launched a patch which is another area of interest in acne growing very fast. And we acquired a company called Alastin Skincare in 2022 because we saw that segment - physician-prescribed products that are adjunct to many aesthetic interventions - we saw that as a very fast-growing area that supplemented our aesthetics business but also was a good link to our consumer business. So all of this makes me feel that we have increased our investment, we have become much more skilled in developing biologics. I think we've been fairly successful, and we continue to look for new areas and new innovations. And if I take a product like Cetaphil, we've had multiple new ranges coming out and new SKUs for that. So we innovate around all of our businesses.

Well, having worked in this field also in pediatrics and also having kids at home that have acne, I think that there are multiple modalities given the manifestation and severity. There is significant unmet need still with scarring. So I think having the number one portfolio in the world, being available in so many countries as we are, whether it's with different Epiduo, for a CLE, Twyneo, for some people they may take the cynical view and say there's some overlap, maybe why is it not just one product? But I think we see that there's different regimens, different needs, different degrees of severity. And for us, it's having the broadest possible portfolio because untreated or suboptimally treated, I think we all notice some of the devastating scarring that can happen. So we want to be at the forefront on continuing to develop, whether it's single agent or multi-agent combination products, so that basically we have the broadest portfolio. And a lot of people have stopped innovating in this area, and we continue to bring out new stuff and innovate. And I think I mentioned to you as well, we know that some patients, particularly teenagers, also like patches. So we just rolled out a patch in the UK and plan to expand beyond the UK. So I think we are really proud of being number one, the one with most brands, whether they require prescription or they are OTC, because it's still an area that affects most teenagers and many young adults. There's significant unmet need and it is something that we need to be dedicated to. It's 80% of adolescents and young adults, and if it's left untreated or suboptimally treated, we know that there are meaningful side effects or scarring that can happen.

Well, if I look at our portfolio, the neuromodulator segment is one of our fastest-growing segments. So there's significant unmet need. There's also markets we're not in today where we either don't have the rights or haven't entered the market or have distributors. So we have significant opportunity around the globe. And we already today have multiple products. We have, for instance, in Europe in many countries, we have both a powder form of a neuromodulator, Dysport or Azzalure, and we also have a liquidized form of Azzalure called Alluzience. So we see that different customers and different doctors like different modalities. So coming out with what we think is a really innovative new fully liquidized neuromodulator that is different than anything else on the market, because if you look at onset, duration, and convenience, there are still significant unmet needs. It's a fast-growing segment. So I think, if approved, that this will have a very important role to play in this very fast-growing segment of neuromodulators in aesthetics. And for us, it's very important we have Restylane, we have Sculptra which is a collagen-stimulating product, one of our fastest-growing. And what we see is that there are different needs for different consumers or patients and doctors, and we just want to have the broadest possible injectable portfolio of high-quality, differentiated products.

Well, so in the clinical trials, what we have seen is, of course, that the convenience and the ease of use is very attractive to the physicians and healthcare practitioners that were exposed to the product in the clinical trials. And as I said, I think both in terms of consistency, not having any challenges in which dose to apply, and also the easy way to understand which way to apply and which dose to apply, and as I mentioned, onset and duration are still significant unmet needs. But you know, as we have seen with other neuromodulators being launched recently, it all comes down of course to the clinical data but what is the real-world experience that the practitioners will have, and what are the outcomes that the consumers are getting when they get injected.

So, well, it's a different formulation, so they would have to do a lot of research. As I mentioned, we have developed this from scratch. It's totally unique. It's a unique botulinum toxin A, different strain, and it has unique manufacturing ways. And so I think overall it's a totally differentiated. I cannot comment on what other people will do, but I think the feedback, and as the results all become available to people, I think you will see this is a differentiated neuromodulator that at least addresses some of the unmet needs that are in the marketplace, on top of the convenience of not having to reconstitute.

Well, as we mentioned about research and development, the key thing is to be thorough, to be innovative, to focus on fewer things and do them extremely well. And I think if you go back to our conversations about nemolizumab and about QM-1114, I think we've been very thorough, very comprehensive. Both of them have some of the largest programs. And I think with nemolizumab, both in prurigo nodularis and in atopic dermatitis, we have some of the largest programs ever. And so we want to be very thorough to do it the right way and ideally come out with really differentiated results. And we took the same approach to applying artificial intelligence to this space. So working with an AI company based in Switzerland, we developed something called Face by Galderma, which is truly innovative. It allows aesthetic professionals and patients basically to see before they get treated what the after picture would be, so the after before so to speak. And the feedback has been, 'Wow, go before I see basically the after effect.' And I think that is really something that has been, I don't want to use the word revolutionary, but it's certainly given a lot of buzz among practitioners that you basically have a view into what it could look like once you get your treatment. So I think more of those tools will be available. I think we're the first ones. We've also for Cetaphil we have an AI skin analysis tool that also gives a personalized report that also uses AI elements. Of course, in manufacturing and decision-making in the company and other aspects, this is something we will look at. So it is part of our strategy. But for me, Face by Galderma is a good example: we did a lot of testing, we were very thorough, we worked with a company that developed the technology, we incorporated it into our commercial strategy, we did a lot of testing, we rolled it out in certain countries. So again, the same principle we apply when we do clinical trials: be thorough, test it, get the feedback, adapt, and then make sure that when it gets rolled out to physicians and patients, they really say, 'Wow, this is really something innovative.'

Yeah, I know in many ways 2019 feels like a long time ago, but to me it almost feels like yesterday. I think we just got started. We had, like anyone else, we had to adapt with COVID and other things, and the economic crisis. So there's many things have happened along the way. But the most important thing we have been able to control has been to build the world's leading platform in dermatology and to be a leading player in this field. I think we made really good progress. I'm not going to say that we can declare victory, but I feel really good about the progress we've made. But I still see so much more that we can do. You said we've just started with two biologics, which I think are really intriguing biologics and will be very significant commercial successes, I'm absolutely assured of that. But we have many other things in the pipeline, and many other things we want to drive through innovation. So building the great platform, there's a few more countries we would like to get into, building our portfolio fully out in all of those countries, continue to be seen as the leader in innovation in all the parts that we're in, whether it's in dermatological skincare, therapeutic dermatology, or injectable aesthetics, that people really say, 'Wow, they continue to come out with really innovative.' And one thing we haven't really spoken a lot about is for us it's not just about the product, it's also about the service we provide. We do an enormous amount of training. We want to make sure that our products also come with great training, that they're used in the best possible way and the safest way, so it's safe for the consumers and patients that we serve through the practitioner. So there's a lot of things with our unique integrated strategy that I still want to work on. But A, B, and C is we need to continue to be innovative, bring out differentiated product, be seen by the customers as having great service, but also innovative service like what you've seen with Face by Galderma.

Well, thank you so much and thanks for having me.