Tuesday, July 29, 2014

AEGR CC, Two Elephants in the Room: AntiPCSK9 and DOJ investigation

Amgen's 2015 PCSK9 and the DOJ investigation: Aegerion runs out of road

The two biggest threats to Aegerion's growth narrative got no respect in Aegerion's 2nd Quarter conference call.
 
  • Amgen is set to submit its cheaper and safer Anti-PCSK9 drug for regulatory approval this next quarter: Q3 2014. It will compete for Aegerion's patients.
  • It is highly probable that most of Aegerion's patients are off-label, despite a very strict REMS ETASU specifically designed to prevent off-label sales.  The Department of Justice is investigating Aegerion for marketing practices.  This scrutiny, and perhaps action, could slow down, if not reverse, Aegerion's sales at some point in the near future.
 
AMGN's new blockbuster to stunt AEGR's growth and lower its price multiple

It is possible that Amgen's new drug could be available in 2015. It is much safer and cheaper than Aegerion's $300,000 drug.  Additionally, what Aegerion has been selling off-label, Amgen will be able to sell on-label.

This gives Aegerion a two-year limit to its current addressable market.  Given this serious threat in the future by a drug promising to be a blockbuster, how can Aegerion close the gap between its small revenue and the price that investors are paying for the whole company?
 

AEGR's true market is off-label non-HoFH patients

AntiPCSK9 poses a serious threat to Aegerion's market … which is not just the HoFH population. Contrary to popular belief, the greater part of Aegerion's market is probably non-HoFH, severe victims of high cholesterol. Of course, Aegerion's drug is supposed to be restricted to HoFH patients only and the FDA has required Aegerion to undergo the very strict REMS ETASU to guard against marketing abuses.

REMS ETASU stands for Risk Evaluation Mitigation Strategy with Elements to Assure Safe Use. In Aegerion's case it was put in place with the explicit purpose of restricting Aegerion's drug to HoFH patients, only. In fact, Doctors must sign an attestation with each prescription that the patient's diagnosis is consistent with HoFH. That attestation is faxed to Aegerion. This increases both Aegerion's and Doctors' liabilities.  

The probability however that Aegerion is thumbing its nose at FDA procedure follows from a deduction based upon credible premises:

  • AEGR's commercial management has been telling investors that there can be 3,000 HoFH patients in the United States.
  • AEGR's own science team and Nobel Prize winners say that there are only 300.
  • Aegerion's med team even left oral testimony with German regulators as recently as April 2014, stating that the prevalence rate for HoFH was 1:1,000,000 -- which would equate to 300 patients in the US.
  • Conclusion: If one accepts that the scientists are correct and that AEGR management is incentivized to  inflate the count, then AEGR's proactive attempt and success in surpassing the number 300 implies that AEGR is engaging in illegal off-label marketing.

Aegerion has been touting studies that claim a higher patient population for HoFH than has been traditionally held. First, the study they tout was funded by themselves and others in the industry which have a financial interest in finding a more expansive patient population. And second, the study does not find more HoFH, it proposes lowering the standard of diagnosis ... recommending that Doctors use a more lenient scoring system.  It would be an interesting case: Does funding and proposing lower standards of diagnosis which guarantee a higher proportion of off-label patients constitute off-label marketing in the eyes of regulators?  Similarly, we have already seen Aegerion prefer to focus on cardiologists rather than the lipidologists, who have the higher expertise in this area. 
 
Aegerion has taken credit for its marketing efforts.  How could there be an effective marketing effort, in excess of the 300 HoFH patients, without Aegerion being responsible for the off-label sales?  Ironically, beyond the patient population, the more sales they make the greater the risk to patients and investors that off-label sales are taking place.
 
It all adds up to the probability that Aegerion is marketing its drug off-label.  Indeed, the Department of Justice is currently investigating Aegerion's sales, marketing, and promotion practices. The DOJ has subpoenaed AEGR for documents in this matter.  There must be a reason for this investigation.

In fact, the percentage of Aegerion's patients who are not HoFH may exceed 90%.

If we accept the scientific community's number of 300 HoFH patients in the US, then we still must subtract from this total: 

  1. Those who are under 18.
  2. Those who opt for ISIS rival drug, "Kynamro" -- which is preferred and made a prerequisite by some insurers.
  3. Those who are presently enrolled in PCSK9 trials.
  4. Those who cannot tolerate the drug. The drop-out rate has been somewhere between 10 and 15%
  5. Those who test for liver toxicity.
  6. Those with statin interactions who prefer to stick with statins. 

So if AEGR has {fill-in-your-estimate} patients, and only {fill-in-your-estimate} are truly HoFH, what percentage off-label does this leave you? How serious are regulators with the REMS ETASU imposed upon Aegerion?  It was specifically designed to prevent off-label abuse.


AMGN to send AEGR to the dugout

Nonetheless, Amgen is poised to take away the off-label share of Aegerion's market.

Amgen's PCSK9 is safer and is better tolerated.

Amgen's drug will be cheaper … much cheaper.

Amgen will probably have a wider indication and thus will be able to legally market and promote to the extreme end of the HeFH population, unlike Aegerion.

Insurers are more likely to prefer that patients try PCSK9, as many do Kynamro, before trying AEGR's lomitapide.

Doctors will have less regulatory hurdles in prescribing the PCSK9 drugs than they currently do with AEGR's lomitapide. 

AEGR's Dr. Sumeray admitted that the company's patients would most likely try PCSK9. 

Even if Amgen's Evolocumab fails approval, which seems unlikely, or is significantly delayed, there are other anti-PCSK9 drugs in the works and thus there will be many swings at the plate … and it only takes one base hit to score at Aegerion's expense.  A simple web or news search for "PCSK9" will quickly bring up a host of studies and announcements about this highly regarded cholesterol treatment.

What this means is that there are two serious points of failure to Aegerion's growth narrative, one present and one future.  This will most likely crush Aegerion's price.

Aegerion has forecasted as much as $200 million in revenue for 2014. There are many obstacles to this goal; however, the two most serious are the current DOJ scrutiny and the oncoming competition with Amgen's potentially blockbuster anti-PCSK9. 

Why would Aegerion be valued higher than Amgen? Aegerion only has a single drug and no pipeline. Just one drug. AEGR is a binary event. If this one link in the chain breaks, AEGR  is finished. It has DOJ scrutiny precisely for its sales practices and investors have not yet received closure regarding the FDA warning.  There is strong evidence that investors have been lied to in a very big way in regards to the actual patient population of HoFH.  What's more Amgen is readying a potential blockbuster drug whose official indication will most likely extend all the way through both AEGR's off-label and on-label market.  And it is the loss of AEGR's off-label market that will hurt AEGR the most.

Compare this to Amgen which has multiple drugs, three of them very promising. Anti-PCSK9 is getting a lot of attention both from the press and from the scientific community. It is a direct and very credible threat to Aegerion's on and off-label markets.  So why would Amgen -- having the brighter future -- not have also a superior price-to-sales ratio indicative of future prospects?

Certainly the higher multiple should belong to the one with the greater prospects. 

This is a choice between purchasing $1 in revenue for $9 and purchasing $1 in revenue for $5, where the $5 purchase was the most likely to succeed in marketing and least likely to get caught up in the court system and where contrary to expectation, the more expensive stock was less likely to succeed.

All this spells out the fact that AEGR investors were misled and the price had been inflated with unrealistic presentations of Aegerion's addressable market.  

Friday, July 11, 2014

Response to Todd Campbell's The Motley Fool Article

Campbell: "With a market cap of just $850 million, shares are trading at between four and five times sales and, while that's not cheap, it's not out-of-control expensive either."
AEGR's price to sales is 11.4, not "4 or 5."
The article also fails to mention factors behind Aegerion's crash:
… The patient population contradictions between the CEO and the scientists that work on AEGR's drug, which is key to understanding the price drop. The CEO says there can be 3,000 HoFH patients in the US, while Dr. Sumeray of AEGR just left testimony in Germany that there are only 300. Dr. Rader and Dr. Cuchel -- both worked on AEGR's drug -- also use the number 300. With AEGR reporting +450 patients, there is a risk that many of these patients are off-label, despite a very strict REMS ETASU in place that was specifically designed to prevent off-label prescriptions.
… Indeed, the DOJ is conducting an investigation into AEGR's marketing practices.
… Another omission from this article: AMGN's antiPCSK9 drug threatens to upset AEGR's narrative later this year.
 
 

Monday, June 9, 2014

RE: thestreet.com's recent article on AEGR

RE:  thestreet.com's article: "Aegerion Stock May See a Resurgence After Hitting Bottom From Ongoing Controveries"

Mr. Spiro: "Estimating the patient population for a rare disease can get tricky."

Which is true and a very good reason for using the most credible sources and facts
that you can find.

On the one hand, the very scientists working on Aegerion's drug have said that there are 300 relevant patients in the US. Nobel Prize winners have said the same. On the other hand, the CEO -- when speaking to investors -- has claimed that there can be 3,000. Who should we believe? And why?

Mr. Spiro: "The stock has plummeted because investors believe Aegerion won't be able to find enough HoFH patients to treat with Juxtapid to reach profitability. I disagree. By the end of 2013, Aegerion was treating 467 patients globally, worth a little over $48.5 million in revenue."

This ignores a glaring possibility. Of those 467 global patients 430 were said to be in the US: "We ended 2013 with over 430 net revenue U.S. patients on therapy, and 37 ex-U.S. net revenue patients on therapy" ~ From "Aegerion Pharmaceuticals Announces Fourth-Quarter and Full-Year 2013 Financial Results"

If the Aegerion science team and the Nobel Prize winners are correct, then the CEO's proactive reach for greater than 300 US patients would present a risk of off-label marketing.

There must be a reason for the DOJ investigation into Aegerion's marketing practices. What could it be? How does this all add up?

The FDA warning is mentioned in Mr. Spiro's article, so why not the DOJ investigation? (or even the Brazilian investigation?) A CNBC report by Dan Mangan mentioned that the DOJ and the FDA issues are probably separate matters. As Aegerion's Investor Rep put it: "I want to be sure you are clear though that we're not certain that the subpoena is related to Marc's statements on 'Fast Money,' and in fact, we believe it likely isn't." ~ CNBC 'Fast Money' faux pas: Firm draws FDA warning, DOJ subpoena  

If the scientists working on Aegerion's drug are correct that there are only 300 US patients, then given the sales results thus far, the more patients that AEGR proactively markets to, the greater the risk of an off-label marketing violation.  This may explain the current DOJ investigation into Aegerion's marketing practices.

Mr. Spiro: "Juxtapid is now approved in Europe and the company's commercial rollout there is well underway."

"… the rollout is well underway." ?? How much revenue is coming in from Europe?
Aegerion's CEO says that Europe "remains a challenging market for establishing reimbursement. Our strategy is to keep European operating expenses low until we have received reimbursement and pricing approvals in each country. We believe that the majority of our revenue in 2014 will still come from the U.S., and to a lesser extent from non-European x U.S. markets, primarily Brazil."

"So when we adjusted our guidance, it was tied really to the slower orders in Brazil and nothing to do with this glitch in Germany. It's just -- we thought even if we succeeded on reimbursement in Germany, the European market is going to be a slower-growing market. They just have, I think, a governor on the growth of orphan products across Europe because of the financial situation in Europe and we had forecasted. That's why we're investing slower and more carefully in all European countries until we get these reimbursements approved."  ~ Q1 2014 CC


Wednesday, May 14, 2014

Why Aegerion's 10% sequential revenue growth disappointed investors


Disclosure: After investigation, I believe that AEGR is grossly overvalued, that its addressable market has been exaggerated by 1,000%, and that its regulatory investigations are not yet reflected in the stock price. Consequently, I am short AEGR. I am not infallible. All claims and references herein should be verified by the reader. All investors must do their own due diligence.  This report is not a recommendation.

If blockbuster rivals – the anti-PCSK9 drugs – arrive at end of 2015, how can AEGR possibly close this gap?

Brazilian regulator – ANVISA – rejected AEGR’s drug. The “named patient option” remains, but requires the patient to take legal action.  Payments have been delayed due to the Brazilian Gov. investigation of AEGR via a new Anti-corruption law (enacted in Jan. 2014).  The law involves bribery. If AEGR sales depended on such, then prior sales numbers will probably not return. The penalty in Brazil is up to 20% of revenue.)

Due to AEGR’s botched dossier, German Regulator -- G-BA – classified the drug as having “no additional benefit.”

Europe is making no significant contributions to revenue, and is not expected to make an impact in the near future.

Japan has required additional study.

The sales force behind rival drug, Kynamro, has been increased by Genzyme and will directly compete with Aegerion’s Juxtapid … at a much cheaper price.


Management’s version of the addressable market is at odds with the very scientists working on its drug by 1,000%. Risk of off-label promotion.

The scientists on AEGR’s drug claim that there are approx. 300 US HoFH patients in the USA; commercial management claims there can be 3,000.  Even Nobel Prize winners use the number 300 when speaking of USA HoFH sufferers.

If the scientists are correct, and management incorrect, then AEGR’s proactive reach for more than 300 presents a serious risk of off-label marketing.
In fact, the Department of Justice is currently investigating Aegerion for its marketing and sales practices.
If sales depended on off-label promotion, then present scrutiny and a return to compliance could seriously reduce sales.
There has been no investor closure with the FDA Warning. If scrutiny is ongoing, sales efforts may be curtailed to insure compliance.

Aegerion Pharmaceuticals, Inc.
SEC 10-Q 1st Qtr 2014
Aegerion's addressable market at odds by 1,000%
Brazil Passes Landmark Anti-Bribery Law - Compliance Week
Sanofi/Genzyme planning to add more sales representatives




Friday, May 2, 2014

AEGR Problems



See slide at http://1drv.ms/1fMYNS1

What are the problems with AEGR?
RE: Aegerion Pharmaceuticals, Inc.

DOJ Investigation into AEGR sales and promotion practices

No closure with recent FDA warning

AEGR IR says FDA and DOJ problems are probably different

Shareholder lawsuit: "False and misleading statements"

Brazilian government investigation through anti-corruption law

If Brazil investigation yields evidence, threat of additional SEC/DOJ action via Foreign Corrupt Practices act

Straight-up sales practices?  Only Brazil and the US are making meaningful contributions to revenue, yet precisely these two are subject to Government investigations

Intense regulatory scrutiny may force AEGR to pull back current sales practices, reducing revenue

If sales flatten out or decrease, the stock price has a very long way to fall.
AEGR claims a USA patient population of 3,000, while the very scientists on their drug say there are only 300. Nobel Prize winners also say there are only 300.  If the scientists are correct, then AEGR's promotional attempt at more than 300 could constitute off-label marketing and could explain the current DOJ investigation.
European sales have yet to deliver any meaningful revenue.
“The non-U.S. patents directed to the composition of matter of lomitapide issued in Canada, Israel, Japan, and certain EU countries are scheduled to expire in 2016.” ~ AEGR SEC 10-K
The sales team and effort behind rival drug, Kynamro, has recently been increased -- perhaps to take advantage of AEGR's regulatory entanglements and the damage done to AEGR's reputation.
AMGN, REGN, PFE, etc. are showing good results with a possible new blockbuster rival: the anti-PCSK9 drug class.
AEGR claims that its commercial team has been managing drop out rates -- which ought to be subject to medical discipline, not commercial interests.



Wednesday, February 26, 2014

(AEGR) Aegerion and the Department of Justice Subpoena

(AEGR) Aegerion and the Department of Justice Subpoena


  • The DOJ investigation is probably not about the FDA warning
  • First Possibility: Aegerion’s addressable market is at odds by 1,000%
  • Second Possibility: Commercial team influences medical decisions

The two possibilities, in Greater Detail
  • An attempt at 3,000 US patients for Juxtapid raises suspicion of off-label marketing.
  • Commercial interference with Medical Decisions
 

(AEGR) Aegerion Pharmaceuticals Inc. and the Department of Justice Subpoena


Brief Review: In November 2013, Aegerion received an FDA Warning regarding the CEO’s appearance on CNBC’s ‘Fast Money.’  The CEO was accused of claiming “new uses” for its drug and for not including warnings about the dangers associated with its drug. In January the Department of Justice stepped in with a subpoena, seeking information regarding Aegerion’s marketing practices.

The DOJ investigation is probably not about the FDA warning


Because Aegerion received the FDA warning before investors learned of the DOJ subpoena, some assume that the statements made on CNBC Fast Money are the underlying reason for the subpoena.  Indeed many articles mentioned the subpoena alongside the FDA Warning as if there were an implicit connection.  It could of course be true, so we list the CNBC interview as a possibility. However it is unlikely.

In a later CNBC report,

…. Aegerion spokeswoman Amanda Murphy told a CNBC.com reporter, "I want to be sure you are clear though that we're not certain that the subpoena is related to Marc's statements on 'Fast Money,' and in fact, we believe it likely isn't."  [1]

It makes sense that the DOJ subpoena represents something much deeper than the off-label promotions (IE, “new uses”) made on CNBC.  The DOJ does not need a subpoena to review online video that is available to all of us.  So if the underlying problem which provoked the DOJ subpoena goes deeper than the FDA warning what could that be?

There are two glaring possibilities.

First Possibility: Aegerion’s addressable market is at odds by 1,000%


There has been a serious divide between the CEO’s estimate of the US patient population for HoFH and the estimate by the very scientists working on Aegerion’s drug.  The CEO and some members of the commercial team are claiming that there can be a United States HoFH patient population of 3,000.  The two key scientists working on its drug, and also Nobel Prize winners, put the patient population at 300. If Aegerion’s and Nobel Prize winning scientists are correct and CEO Marc Beer is wrong, then the attempt to market to 3,000 patients could be an attempt to go off-label.  This could have serious consequences, as Aegerion itself noted in its SEC filing:

“In the U.S., violations, including promotion of our products for unapproved (or off-label) uses, are subject to enforcement letters, inquiries and investigations, and civil and criminal sanctions by the FDA.”[2]

Second Possibility: Commercial team influences medical decisions


In Aegerion’s 2nd quarter conference call, the CEO claimed that his commercial team was influencing patient dropout rates in a way that favored the company and investors.  Aegerion’s drug -- “Juxtapid” -- comes with a black box warning for liver toxicity, so any decision for dropouts should be a medical concern and subject to medical discipline.  Any overriding of that discipline by or for financial interests could put patients at risk.

The two possibilities, in Greater Detail


An attempt at 3,000 US patients for Juxtapid raises suspicion of off-label marketing.


To investors, Aegerion's management has been claiming a patient population which exceeds the estimate of its own scientists by 1,000%.[3]   To the FDA and in academic presentations, scientists working on Aegerion's Lomitapide/Juxtapid use a prevalence rate of 1:1,000,000 for the rare disease, HoFH. This comes out to approximately 300 patients in the United States.  If this patient count of 300 is accurate, then Aegerion management’s attempt at 3,000 could involve off-label marketing.  This is not an entirely new suggestion. That Aegerion might have plans to market its product off-label is was suggested in an FDA Advisory Committee meeting (2012, page 229 – emphasis mine, here and throughout).

 "Finally, just concerns with the effectiveness of the proposed risk management strategy. Given the enthusiastic response by Wall Street when these documents came up, and if you add up all the number of people in this country and know that only a small fraction are going to be able to afford it, it is at least likely -- even if the company doesn't intend that because they repeatedly said we're limiting this only to HoFH -- that glowing financial predictions ultimately depend on sales for off-label use to treat elevated cholesterol in the larger number of patients who do not have HoFH." [4]

Even in AEGR's 10-K there are hints of a reach beyond Juxtapid’s indication of HoFH patients, a reach which includes severe HeFH cases. (HeFH patients inherited the disease from only one parent, whereas HoFH patients inherited it from both parents.  Aegerion’s drug indication is restricted to HoFH patients.) The 10-K mentions that its 3,000 US patient estimate included HeFH patients with the HoFH numbers. If Aegerion intended to reach its target of 3,000 US patients by promoting a selection process which would capture a portion of severe HeFH patients, then it could present a serious legal problem for Aegerion.  Here is Aegerion’s explanation as found in its annual 2012 SEC filing.

"Medical literature has historically reported the prevalence rate of genotypic HoFH as one person in a million. ….  In 2010, we commissioned an independent consultant in the healthcare industry to prepare a commercial assessment of the HoFH market for us. In its report, this consultant estimated that the total number of patients likely to seek treatment with symptoms, signs or laboratory findings consistent with HoFH in each of the U.S. and the EU is approximately 3,000 patients. This consultant’s estimates, however, included a segment of severe HeFH patients whose levels of LDL-C are not controlled by current therapies. These patients may be phenotypically indistinct from HoFH patients. JUXTAPID is indicated solely for HoFH. Our prescribing information in the U.S. specifies that the safety and effectiveness of JUXTAPID have not been established in patients with hypercholesterolemia who do not have HoFH. We are not permitted to promote JUXTAPID for any indication other than HoFH. In addition, as part of the prescriber authorization form under our REMS program in the U.S., the prescriber must affirm that the patient has a clinical or laboratory diagnosis consistent with HoFH.  The number of patients with HoFH in the U.S. could actually be significantly lower than we expect, and could be closer to the historically reported rates than to our estimate of 3,000 patients." [5]

 Also in the 10-K, Aegerion uses semantics to define a gap between “promoting off-label” and engaging in “balanced communications.” It will be interesting to see how the Department of Justice might view this fine distinction, even “under certain conditions.”

"Broadly speaking, a manufacturer may not promote a drug for off-label use, but may engage in non-promotional, balanced communication regarding off-label use under certain conditions."

The second half of the above quote suggests a grey area that Aegerion could attempt to enter – a legal strategy to get around off-label restrictions.

In summary, the scientific community uses the number 300 when referring to estimates of the US HoFH patient population; Aegerion’s investor facing management uses the number 3,000.  If the scientific community's prevalence rate for HoFH is correct and if CEO Beer's is incorrect, this could point toward an attempt to sell beyond the indication for AEGR's Juxtapid – that is, outside of the HoFH patient population.  Such an off-label promotion could be the subject of the DOJ subpoena. 

There is one final hint that the DOJ subpoena may revolve around off-label marketing.  In January 2014 Aegerion made a presentation before investors.  The CEO was asked about the subpoena.  While he would not “talk about specifics,” he felt the need to emphasize the company’s efforts to keep communications “on-label.”  Does such a defense imply that “off-label” marketing had come under suspicion?

TIME 10:45 "While I can't talk about the specifics of the investigation, I can tell you that management is passionate about ensuring we are operating in the best in class way when it comes to compliance, we've been diligent in our efforts to assure that all promotional material, our training of our sales reps, messaging to physicians and [in?] our activities are consistent with on-label promotion and all applicable laws that are related to that compliance."[6]

Commercial interference with Medical Decisions


There is a third possibility for the DOJ subpoena.  Also in the 2nd quarter conference call, the CEO claimed that his commercial team was managing patient dropout rates.  Juxtapid comes with a black box warning for liver toxicity, so any decision for dropouts should be a medical concern and subject to medical discipline, not a marketing goal.

 Conference Call:

 Nicholas Bishop - Cowen and Company, LLC, Research Division

And if I could put in one additional question. On the drop-offs, so you mentioned a less than 10% discontinuation rate. Could you put a little bit of a bar around the -- sort of the timeframe we're talking about? I mean, is there a number of drop-offs after 3 months of therapy or after 6 months? Should we expect the number to rise over time? Just the time element would help.

Aegerion CEO - Marc D. Beer

That's a great question, Nick. I want to remind everybody about this dropout focus because at the JPMorgan Conference, I think I emphasized that I believe that our commercial organization could significantly beat the experience that we had in our Phase III, to the point where I think I made the comment that if Craig Fraser and his team can't beat the Phase III metric of 20% dropout, I'm going to take him out to Springfield, Mass. and shoot him. I just want to emphasize that this dropout is being managed and complianced by a spectacular team of customer-facing people. And it's not without a very concerted effort and programs and execution of those programs that are all in the interest of patient care and keeping these patients on therapy. We can't keep these patients out of harm's way if we can't keep them on the drug.

See also,

_______

Craig E. Fraser

- President of US Commercial & Global Manufacturing and Supply Chain

As Mark discussed, dropout and compliance trends have been well-managed thus far and we believe this to be a direct result of having clear insights into our business and patient status, and by providing the physicians, patients and office staff with the education and support they need to optimize treatment. [7]

In short, the CEO of Aegerion Pharmaceuticals, Inc. has tasked his commercial enterprise with lowering dropout rates for its drug, Lomitapide – a drug which has a black box warning for liver toxicity.

Of course, managing dropout rates should be a medical discipline and not a commercial one.   If these statements to investors are actually translated into medical practice, then patients of Lomitapide could be at risk.  No decision to keep or not to keep a patient on a drug should be influenced by commercial goals, since liver toxicity is an issue entirely independent of encouragement by a commercial team.


 


[2] AEGR SEC 2012 10-K http://www.sec.gov/Archives/edgar/data/1338042/000119312513434859/d592963d10q.htm
[5] AEGR SEC 2012 10-K http://www.sec.gov/Archives/edgar/data/1338042/000119312513434859/d592963d10q.htm
[6] January 2014 Aegerion Investor Presentation