Keith Kendall
Analyst · BMO Capital Markets. Your line is open
Thank you, Stephanie and thank you everyone on the call for joining us this morning. In our remarks today Ernie and I will be discussing recent developments in our business during the first quarter of 2021 and through April. As always, Ernie and I will be joined by additional members of the quest of leadership team during the Q&A session afterward. Through this period we were able to execute on our key priorities and delivered a number of key milestones that we'll talk about this morning. First and foremost, we continue to focus on building our CNS franchise. Our team is focused on preparing resubmission of our new drug application for Libervant. After receiving guidance from the FDA on its expectations for information and supporting analysis relating to the pharmacokinetic modeling and simulations included in our prior submission to the agency in December 2020 we're completing the necessary analysis the existing clinical data in response to the FDA's feedback. We're developing Libervant as an alternative to more invasive, inconvenient and difficult to administer device driven products, including a rectal gel for patients with refractory epilepsy. As a result of these issues, a large portion of the patient population does not receive adequate treatment or forgoes treatment altogether. We continue to believe that Libervant if approved by the FDA for and for U.S. market access will enable a larger share of these patients to receive more appropriate treatment by providing consistent therapeutic dosing and a non invasive and innovative treatment form. As we previously communicated, we resubmitted to the FDA a revised weight based dosing regimen alone with modeling and simulations data in December 2020 to address the issues raised by the agency in the CRL we received in September of 2020. The FDA confirm that the issues identified in the CRL may be addressed by utilizing modeling and simulations based upon the information provided in our FDA meeting package submitted in October. In response to our December submission the FDA provided written feedback in February that clarified the agency's expectations relating to the information to be presented in the population PK model, and the safety data that should be included in the NDA resubmission. Based on the FDA feedback, we continue to believe that no further clinical studies will be necessary for the resubmission of the NDA for Libervant. We are on track to complete these analyses and resubmit the NDA as committed by the end of the second quarter of 2021. Once we submitted, we anticipate a six month review process. We continue to expect to produce the PDUFA action date in 2021. There have been no indications to date from the FDA relating to approval for market access, however, and we do not expect to receive any FDA guidance regarding market access prior to the PDFUA action date. Regarding FDA approval of U.S. market access, we believe that we have provided a strong set of facts supporting a decision by the FDA of clinical superiority, prior approved drugs for this indication based upon the finding that Libervant represents a major contribution to patient care. Once we've resubmitted the NDA for Libervant, we will re engage with the FDA and update our prior communications to demonstrate our position that Libervant lis an orally delivered product meets one or more of the following criteria to be considered a major contribution to patient care, convenience of treatment location, duration of treatment, patient comfort, reduced treatment burden, advances in ease and comfort of drug administration and longer periods between doses. Subject to FDA approval, we're committed to launching Libervant as soon as possible after that approval. Our next key priority is our epinephrine program. At our EBITDA event in March of this year, our team and two nationally recognized KOLs provided an overview of anaphylaxis, discuss the hurdles that accompany the needle based delivery standards of care and outline the significant market opportunity that exists for a highly differentiated formulation utilizing our PharmFilm sublingual formulation. Our R&D team provided an extensive review of our two epinephrine project candidates, clinical results, and development strategy for the program. As you may recall, our first generation candidate AQST-108 was granted Fast Track designation last year and was approved to use the 505(b)(2) regulatory pathway by the FDA, potentially making the clinical development trajectory faster and cheaper. Moreover, the FDA acknowledged that our sublingual film formulation of epinephrine satisfies an unmet need in the patient population relating to those patients resistant to taking intramuscular or subcutaneous injections. As such, our candidates have the potential to be the first orally administered epinephrine based rescue medications for this patient population. We anticipate that any product candidate that we bring forward for this indication would be eligible for fast track designation. At the March R&D event, our team reviewed the clinical data from the two completed phase one PK studies for AQST-108 composed of the pro drug Dipivefrin. The data from the two phase 1 PK Studies demonstrate that AQST-108 can consistently deliver epinephrine sublingually, and all subjects had measurable plasma concentrations of epinephrine. Top line data for AQST-108 provides further evidence that we have developed a unique technological solution that can deliver epinephrine sublingually. We have five multiple patent applications to protect these findings and we're excited by the possibilities this new platform presents to Aquestive. The first in human PK case study for our second generation candidate AQST-109 commence just a few weeks ago after the trial dossier received clearance from Health Canada. We are on track to complete part one of this study in the second half of 2021 and anticipate scheduling a meeting with the FDA shortly thereafter to discuss a path forward to the regulatory approval for AQST-108 and AQST-109. Finally, our first proprietary commercial product, SYMPAZAN continues to meet key performance metrics. Throughout the first quarter of 2021 SYMPAZAN continued to perform and grow despite COVID-19 related restrictions on face to face interactions with healthcare providers. It is worth noting that while total prescriptions nationally were down 8% in the first quarter of this year, SYMPAZAN scripts shipped to pharmacies grew nearly 13% quarter-over-quarter, and 40% year-over-year. Our continued growth in prescriptions and net revenue demonstrates our ongoing ability to continue to connect with the prescribers even virtually and grow this product. SYMPAZAN saw continued growth in the prescriber base with over 30% penetration into the company's focused group of prescribers with approximately 80% of those prescribers writing multiple scripts. We believe our position with prescribers in the epilepsy field and payers continues to pave the way for a successful launch of Libervant if approved, given their familiarity with our PharmFilm technology and the major contribution to patient care that our products provide to epilepsy patients. In conclusion, as we progress through the spring, we're focused on advancing our proprietary products. Our team is continuing to perform the additional analyses outlined by the FDA and actively drafting our NDA resubmission for Libervant, we expect to resubmit at the end of the second quarter of 2021 and subject to FDA approval for U.S. market access, we are committed to launch Libervant as soon as possible after approval. We commence the first in human phase 1 PK study for a Aquestive-109 in April 2021. This pro drug candidate has demonstrated very compelling data for rapidly converting into systemic epinephrine in animal models. We look forward to completing the part one of this study later in the year. Thereafter, we're planning for an FDA meeting in the second half of 2021 to discuss a path forward for AQST-108 and AQST-109. And as demonstrated by our first quarter figures we continue to efficiently grow SYMPAZAN shipments and revenue as well as expanding strategic relationships across the epilepsy market in preparation of a potential Libervant launch. We look forward to continuing to update all of you as we advance these initiatives throughout 2021. With that I'd like to turn the floor over to Ernie who provides specifics around financial performance and outlook. Ernie?