Roger G. M. Mills
Analyst · Thomas Wei representing Jefferies
Thank you, Tom, and good afternoon. The first half of 2013 was an exciting period for our pimavanserin program and for all of us here at ACADIA. During the first quarter, Dr. Jeffrey Cummings, who is the director of the Cleveland Clinic Lou Ruvo Center for Brain Health and an internationally renowned clinician, presented detailed results from our -020 Study at the 65th American Academy of Neurology Meeting. The -020 data showed robust and consistent efficacy of pimavanserin across a wide array of study measures. Importantly, regardless of whether the assessments performed by independent blinded raters, site investigators or caregivers, clear benefits of pimavanserin were observed. Consistent with previous studies, pimavanserin was safe and well tolerated in this Phase III study. As Uli mentioned, in April, we met with the FDA. We were delighted the agency agreed that they would accept and review an NDA for PDP based on data from the positive -020 Study, together with supported efficacy and safety data from our other studies. We believe this reflects both the strength of the results demonstrated in our -020 Study, along with supporting efficacy and safety data, and the fact that PDP is a serious unmet medical need without any approved treatment option. With this expedited path, our team has been focused on completing the remaining elements of our pimavanserin PDP development program that are needed for submission of an NDA. This includes final aspects of the CMC development, including stability testing of pimavanserin registration batches and customary supporting studies, including drug-drug interaction studies. We've mentioned previously, CMC development, including stability testing, is a rate-limiting activity in our PDP program. I'm pleased to report that we are well under way with our preparations of manufacturing drug product registration batches and we've completed the development and validation of the necessary analytical method for the drug product. Thus, we remain on track to manufacture the registration batches and place them on stability this year. Meanwhile, we are also conducting supporting studies, which include customary short-term drug-drug interaction studies intended to provide appropriate label guidance for doctors to appropriately treat patients in this elderly population. Given our significant clinical experience with pimavanserin in PDP patients, we do not anticipate concerns in this area. Overall, we are progressing well with these remaining NDA development activities and are on track for planned submission near the end of 2014. We are also continuing to conduct our Phase III PDP open-label safety extension trial, referred to as the -015 study. This study has allowed us to generate a large amount of valuable long-term safety data regarding the use of pimavanserin in patients with PDP. In June, we presented interim data from the -015 Study at the 17th International Congress of Parkinson's Disease and Movement Disorders. The -015 data were based on 458 enrolled subjects from 114 sites in 14 countries. The interim analysis reflected data assembled through March 2013. Importantly, the -015 data suggests that long-term administration of pimavanserin continues to be generally safe and well tolerated in its often elderly and fragile population. Although there are no formal efficacy endpoints in the -015 Study, antipsychotic effect was measured at 1 month using the SAPS-PD scale and is assessed at all visits using the clinical global impression scale to provide the investigator with information on whether patients continue to derive benefit from pimavanserin. These data suggest that the duration of antipsychotic effect may be maintained for longer than the 6 weeks investigated in our pivotal -020 Study. Patients who entered the -015 Study from the 40-milligram treatment arm of the previous 6-week efficacy studies, maintained about the same mean improvement in SAPS-PD scores 1 month later. Those that entered from the placebo arm displayed a marked improvement in the SAPS-PD scores after 1 month in the -015 Study. In addition, long-term CGI data indicate durability of treatment effects in patients remaining in the -015 study. While the study continues to generate long-term safety data, we have already far exceeded ICH guidelines for required 1 year exposures. There are over 200 patients having been treated for 1 year or longer. We also have well over 100 patients who have been treated with pimavanserin for at least 2 years, and through a similar extension study, in connection with our earlier Phase II trial, our longest single patient exposure exceeds 7 years. We believe that the findings from our -015 interim analysis provide further support for the potential of pimavanserin to have significant advantages relative to current antipsychotics used off label for the treatment of PDP. As we continue with the remaining development activities in our PDP program, we intend to request pre-NDA meetings with the FDA later this year to discuss our plans for the NDA submission. As I mentioned earlier, subject to changes that could result from our future interactions with the FDA, or other developments, we remain on track for targeted NDA submission near the end of 2014. Let me now turn to our Alzheimer's disease psychosis, or ADP, program with pimavanserin. Because of its non-dopaminergic mechanism of action and the favorable safety profile observed to date in elderly patients with Parkinson's disease, we believe that pimavanserin can also be ideally suited to address the need for a novel ADP treatment that is safe, effective and well tolerated. We are continuing preparations for our planned initiation of a Phase II feasibility study in ADP patients this year. In this trial, which we refer to as the -019 Study, we expect to enroll about 200 patients who will be randomized on a 1:1 basis between pimavanserin and placebo, and will receive treatment for 12 weeks. We plan to assess multiple endpoints in addition to psychosis, including agitation and aggression and sleep and nighttime behavior to explore the potential benefits of pimavanserin in this patient population, and to inform us on potential design enhancements for future studies in this program. We're planning to use the MPI scale, the nursing home version, in our ADP study. We're very excited by the opportunity to pursue the ADP indication and we look forward to sharing more information on the design of the -019 Study when it is initiated. I'll now turn the call back over to Uli.