Keith Kendall
Analyst · BMO Capital Markets. Your line is open
Thank you, Bennett and thank you to 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 fourth quarter of 2021 and through early March. As always, Ernie and I will be joined by additional members of the Aquestive leadership team during the Q&A session afterward. We remain as a company keenly focused on the two most important value drivers for Aquestive, Libervant and AQST-109. We continue to engage with the FDA regarding the ongoing review of the NDA for Libervant. Related to our epinephrine program, we recently reported positive top line data from Part 1 of the EPIPHAST crossover study for AQST-109 and the commencement of Part 2 of that study. In late February, we received clearance from the FDA for the U.S. IND for AQST-109. Additionally, our core business outperformed our expectations in 2021. As you saw in our release last night, and as Ernie will discuss more fully in a few minutes, our full year 2021 revenue came in above the updated guidance provided in November and our non-GAAP adjusted EBITDA loss came in better than expected. Let’s start with Libervant. On December 20, 2021, we received notification from the FDA that it would not be ready to act by the PDUFA date of December 23 for the company’s NDA for Libervant diazepam Buccal Film. The agency was unable to provide an estimate of the timing of an expected action. We were surprised by the FDA’s unexpected notice that they were unable to provide a decision by the PDUFA date. The agency’s review division had finished its review and indicated that no additional information was necessary from the company. We had previously completed the pre-notice requirements such as labeling negotiations, additional information requests and post-marketing adverse drug experience reporting, or PADE audit. Since that notice in December, we have interacted with the agency, who in their most recent correspondence in February stated the following two points. And I quote the agency is continuing to consider whether the orphan drug exclusivity identified for another diazepam product affects the approvability of your application. Additionally, they went on to say again, “we are continuing to consider the information and arguments submitted by and on behalf of Aquestive. At this time, we cannot provide a specific update regarding timelines or an anticipated action date.” The company continues to believe that Libervant is an approvable product for safety and efficacy as evidenced by the completion of the pre-notice requirements I discussed a minute ago. With respect to the FDA granting market access, given the orphan drug exclusivity issue, we continue to believe we have made a compelling case that Libervant represents a clinically superior product to their previous rectal and nasal products, based on Libervant providing a major contribution to patient care as outlined in the agency’s guidelines. Libervant, if granted market access, has the potential to transform the lives of refractory epilepsy patients seeking a non-invasive and innovative product for the management of seizure clusters. This patient population remains underserved with more patients over the last 12 months across all age groups continuing to utilize the diazepam rectal gel product versus the diazepam nasal products despite good payer coverage. The vast majority of potential patients are still not accessing either of these difficult to interact with alternatives, providing a preferred method of delivery, an oral product that can be used where it’s needed, when it’s needed and in a preferred form is a potential highly differentiated treatment option for this patient population. Obviously, we believe Libervant utilizing our PharmFilm technology provides a preferred oral product that will be a meaningful improvement in treatment options available for these patients. Aquestive continues to prepare to launch this important product for epilepsy patients if granted market access by the FDA. Let’s move on to epinephrine. Our next key value driver and priority is advancing our epinephrine product candidate for severe allergic reactions, including anaphylaxis, AQST-109. Aquestive is advancing the clinical development of AQST-109, the first and only orally delivered epinephrine product candidate to demonstrate results comparable to auto-injectors such as EpiPen and Auvi-Q that are the current standard of care for the emergency treatment of severe allergic reactions. As we had committed on our last call, we announced in late February that the FDA has provided clearance for Aquestive’s IND, allowing clinical development in the United States. This is a necessary step to eventually moving the project toward an NDA filing expected in late ‘23 or early ‘24. As a reminder, the agency previously confirmed the 505(b)(2) regulatory approval path as appropriate for AQST-109. Additionally, we announced in late February positive top line results from Part 1 of our EPIPHAST study, evaluating AQST-109. The product candidate continues to show rapid absorption and conversion of the prodrug to epinephrine in subjects achieving a median time to maximum concentration or Tmax of 13.5 minutes. We are obviously pleased with these results and have already begun Part 2 of the study and expect to report top line data before the end of the second quarter. We are excited that we have again shown pharmacokinetic results that demonstrate delivery of epinephrine with the absorption and conversion speed necessary for our rescue product at this time. With the significant part of this patient population not having this medicine where they need it, when they need it for a variety of reasons, including needle phobia, convenience, delayed or incorrect administration, AQST-109 represents a meaningful improvement in this group of patients and caregivers lives. We are looking forward to the continued development of AQST-109 and as we have indicated previously, we expect to move forward with the manufacture of registration batches and to commence pivotal trials in the U.S. under the IND before the end of 2022. Finally, our core business. Our core business continued to contribute new opportunities as well as cash in 2021. Our Suboxone business remains resilient and continues to contribute at a higher level than expected. SYMPAZAN continued to perform and has now grown 12 straight quarters since its approval and launch. These will all contribute revenue and cash in 2022 and beyond. And as we just announced, we have signed a new licensing agreement with a China-based pharmaceutical company, Haisco, for the development, manufacture and commercialization of EXSERVAN in China. The deal contributes $7 million of upfront cash, manufacturing revenue with Aquestive as the sole supplier to Haisco and double-digit royalties once the product is launched in China. In conclusion, as we progress through the first quarter of 2022, we are focused on advancing our proprietary products. We remain in close contact with the FDA regarding the application for Libervant. The FDA is continuing to evaluate the impact of orphan drug exclusivity on our NDA. We believe that Libervant is an approvable product for safety and efficacy as evidenced by the completion of pre-notice requirements that I discussed earlier. We are prepared to launch immediately if granted U.S. market access. AQST has advanced into Part 2 of the EPIPHAST study after we reported positive results from Part 1 last month. Concurrently, the FDA has provided clearance for the IND and we are on track to commence pivotal trials later this year. And finally, again, our ongoing business continues to perform well and we look forward to delivering the strong results outlined in our release, which Ernie will discuss shortly.