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Arcturus Therapeutics Holdings Inc. (ARCT)

Q2 2014 Earnings Call· Mon, Aug 11, 2014

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Transcript

Operator

Operator

Good day, ladies and gentlemen and welcome to the Alcobra Second Quarter 2014 Business Update. At this time, all participants are in a listen-only mode. Later we will conduct a question-and-answer session and instructions will fill follow at that time. (Operator Instructions) As a reminder, this conference call is being recorded. I’d now like to turn the conference over to Mr. Michael Wood of LifeSci Advisors. Sir, you may begin.

Michael Wood

Management

Good morning and thank you. Before the market opened this morning, Alcobra announced financial results for the second quarter ended June 30, 2014. If you've not yet received this news release or if you would like to be added to the company's distribution list, please call LifeSci Advisors in New York at 646-597-6979 and speak with Veronica Molina. Before we begin, let me remind you that this conference call will contain forward-looking statements within the meaning of the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995 and other federal securities laws. Because such statements deal with future events and are based on Alcobra’s current expectations, they are subject to various risks and uncertainties. Actual results, performance or achievements of Alcobra could differ materially from those described and/or implied by the statements on this conference call. For example, forward-looking statements include statements that Alcobra is expecting to receive multiple data readouts, timing of receipt of such data readouts, statements that imply Alcobra or receive favorable results in clinical trials of MDX, and timing of completion of clinical trials and receipt of results and reporting thereof. Statements regarding the design, timing of initiation of dosing and successful completion of enrollments in the company’s clinical trials if such trials are commenced at all, statements regarding the sufficiency of the company’s financial resources to be at certain milestones and whether such milestones may be achieved at all and the potential size of the MDX market. In addition, historical results or conclusions from scientific research do not guarantee that future results would not suggest different conclusions or that historical results referred to on this call could be interpreted differently in light of additional research or otherwise. The forward-looking statements contained or implied in this call are subject to other risks and uncertainties, including those described under the headline Risk Factors in Alcobra Ltd.’s annual report on Form 20-F for the fiscal year ended December 31, 2013, filed with the Securities Exchange Commission and in subsequent filings with the SEC. Except as otherwise required by law, Alcobra disclaims any intention or obligation to update or revise any forward-looking statements, which speak only as of the date of this call, whether as a result of new information, future events or circumstances or otherwise. Hosting today's call from Alcobra's senior management are Dr. Yaron Daniely, President and Chief Executive Officer, Dr. Tomer Berkovitz, Chief Financial Officer and Dr. Jonathan Rubin, Chief Medical Officer. It is now my pleasure to turn the call over to Yaron. Please go ahead.

Yaron Daniely

Management

Thanks Michael, and to those of you joining us today, thank you for participating. This is a very exciting time for Alcobra and its shareholders as we expect to have major clinical readouts in multiple placebo controlled studies before the end of this year. Following my corporate overview, I'll turn it over to Tomer for a review of the Q2 financials and then hand over the call to Jonathan to walk you through exciting new neuroimaging data, we've recently generated, but let me start with an update on our Phase III study of adult ADHD. In mid July, we announced the completion of enrollment in our Phase III clinical trial of MDX in adult ADHD patients. We're extremely pleased with our progress on this program as we completed enrollment of 300 patients in just four months. We congratulate our investigators for their rapid and meticulous job and thank all patients who participated in the trial. This Phase III study was a randomized placebo-controlled trial conducted at 18 sites in the U.S. and two in Israel. Patients who randomized to receive either MDX or placebo for six weeks, proceeded by a two weeks screening period and followed by a two-week safety follow-up period. The primary endpoint was the Conners' Adult ADHD Rating Scale or CARS. This the same endpoint we used in our successful 120 subject Phase 2b study and one of few FDA approved clinical endpoints in adult ADHD Phase III clinical trial. We've also predefined a key secondary analysis looking at the same primary endpoint in the predominantly inattentive or PI ADHD population subset. You may recall that our Phase 2b study show this subset responded very favorably to MDX with a high effect size and higher response rate than the combined type ADHD subset. In addition, the trial…

Tomer Berkovitz

Management

Thank you, Yaron and thank you to our shareholders for joining us. Today we'll be comparing second quarter 2014 to first quarter 2014 results unless otherwise stated. Total operating expenses for the first quarter of 2014 were $7.8 million similar to the previous quarter, netting out non-cash charges for stock-based compensation of $0.9 million this quarter and $1.3 million in the previous quarter, result in net operating expense of $6.9 million this quarter, compared to $6.5 million in the previous quarter. Research and development expenses were $5.9 million for the second quarter of 2014 compared to $5.5 million in the previous quarter. This increase was driven by the progress in our Phase III adult ADHD clinical trial. Pre-commercialization expenses were $0.6 million this quarter, compared to $0.5 million in the previous quarter and G&A expenses declined to $1.3 million this quarter from $1.8 million in the previous quarter. Finally our liquidity position as of June 30 was $38.9 million, which includes $6.9 million in cash and cash equivalents as well as $32 million in short-term deposit. This is compared to total liquidity of $44.4 million as of the end of the first quarter. So net cash used this quarter was $5.5 million compared to $5.7 million in the previous quarter. The company's solid financial position allows us to move forward with the plan filed in adult and pediatric ADHD and in Fragile X both this year and in 2015. I’ll now turn over the call back to Yaron.

Yaron Daniely

Management

Thank you, Tomer. I am now excited to share with you new data we have recently generated with shed additional light on the mechanism of action and neurological activity of MDX. The data will be presented by Dr. Jonathan Rubin our Chief Medical Officer. Jonathan, the floor is yours.

Jonathan Rubin

Management

Thank you, Yaron and good morning, everyone. I am delighted to be here today to share with you exciting new information on the neurological activity of MDX and its potential to address cognitive impairment. We've been interested in learning more about the brain activity associated with MDX administration. Although we have a robust set of clinical data we recently decided to launch a pharmacological MRI study in rats to evaluate the regions of the brain that are modulated by MDX. I invite you to review the slides on the webcast as I walk through these data. Pharmacological MRI is a widely used imaging technique to investigate alternations in brain function following treatment with pharmaceutical in comparison to brain function following treatment with placebo-control. Pharmacological MRI data in animals and humans has been reported with many CNS active compounds including most approved ADHD pharmacotherapy. We have recently completed a study with the objective of evaluating brain response to a single administration of Metadoxine in awake rats. The study was conducted by a CRO as a center for translation neuroimaging and North Eastern University in Boston. 36 adult male rats were trained on imaging device for five days before the test day in order to reduce the stress induced response during the actual imaging capture. The experiment included three treatment arms; a placebo group, a low dose group corresponding approximately to the 700 mg MDX dose in humans and a high dose group, corresponding approximately to the 1400 mg MDX dose in humans. Technical details regarding the imaging protocol and data analysis can be found in various publications on the conduct of pharmacological MRI studies references for which are available on the slide. Blood oxygen level dependent or BOL MRI imaging is a measure of brain oxygen levels that is related to…

Yaron Daniely

Management

Thank you, Jonathan. In conclusion, I want to thank all of you for participating in today’s call. Alcobra and it's shareholders are on the verge of exiting times as we continue to generate data establishing MDX as a novel and effective compound, showing rapid cognitive effects together with favorable tolerability. We expect to provide multiple meaningful data readouts in the coming month; first with our Phase III adult ADHD study later in this quarter followed by our Phase IIb pediatric ADHD study and our Phase IIb study in adolescents and adults with Fragile X syndrome. I will now turn the call back to the operator for the Q&A session.

Operator

Operator

Thank you. [Operator instructions] Our first question is from Annabel Samimy with Stifel. Your line is open. Annabel Samimy – Stifel Nicolaus: Hi. Good morning. Thanks for taking my questions. I actually had a question for Dr. Rubin. I am not professing to be a neuroscientist or anything, but can you just help us understand, my understanding is that the prefrontal cortex was involved in a lot of executive function activities and the amygdala is more like an emotional response. Can you just help us understand why increasing or decreasing stimulus in these areas should help?

Jonathan Rubin

Management

Yes. So you’re correct actually in both regards. The prefrontal cortex has many activities including regulating attention also regulating emotion. Amygdala is a site for regulating emotion, fear as well as anxiety and regulation of the prefrontal cortex could help to reduce the hyperarousal or hyperactive state and that also can be associated with improvement of function in amygdala as well. Annabel Samimy – Stifel Nicolaus: Okay, nice say. All right, I guess maybe this next question is for Yaron, if I am understanding correctly, I guess the timing of enrolment of both the pediatric and the Fragile X studies, it looks like its -- we're not going to be seeing data now until 2015.

Yaron Daniely

Management

I wouldn’t say that. I would be careful. We certainly expect to fully enroll these studies, both these studies by the end of this year and at this time, we’re still anticipating to be able to report topline data. Of course when we have yet to randomize our first patient, we’re expecting both these studies to be randomized in patients this month and depending on the rate of recruitment, we’ll be at a better position, maybe a month or two from now to say whether we’re going to be reporting data by the end of this year or maybe shortly after the new year. Given the rapid recruitment that we’ve seen in our previous ADHD trial and given the lack of significant competition in Fragile X studies with these top U.S. sites we may be seeing rapid recruitment that would allow us to both complete and report the data by the end of the year. So I would say that at this point our plans have not changed to enroll and report data and we will provide core guidance and update as these trials continue to randomize. Annabel Samimy – Stifel Nicolaus: Okay. And then one more on the Phase III, I am glad to hear that you’ve got 39% of permanently inattentive patients in your trial. How does that change the time from the base that you expect or that you designed the study for?

Yaron Daniely

Management

So if you run the numbers with a 116 predominantly inattentive ADHD patients, if you keep the effect size at the conservative 0.6 level, it's now powered to over 90%. Of course if you -- you can, I guess reduce the power meaning go down let's say to 85% and at that, level you could actually have a lower effect size like a 0.5 effect size. So power and effect size of course are related. But if you stick with the -- within the hypothesis that this trial will show at least a 0.6 effect compared to the 0.9, which was shown in the recent -- in the Phase IIb study, the 0.6 effect size given 116 patients is now powered at 90% instead of 85%, which was powered before. Annabel Samimy – Stifel Nicolaus: Okay. Great. All right, thank you very much.

Yaron Daniely

Management

Sure.

Operator

Operator

Thank you and our next question is from Charles Duncan with Piper Jaffray. Your line is open.

Charles Duncan - Piper Jaffray

Analyst

Good morning guys and thanks for taking my question and congrats on the progress in the quarter with the enrolment. Yaron, quick question regarding that Phase III and I too appreciate the color on the enrolled patient population. I guess I am wondering if you mentioned the prespecified statistical analysis; will those results be available at the time that you readout the study and at the PR or will only be that kind of topline intent to treat population?

Yaron Daniely

Management

Thanks Charles. Yes, we expect the results at the very least on the primary endpoint and the key secondary endpoint, which are both the CARS evaluation at week six for the overall ADHD population and the predominantly inattentive ADHD population to be available at the same time by the end of this quarter. So both of these would be available at the same time. There may be additional readouts as well.

Charles Duncan - Piper Jaffray

Analyst

Okay. That’s helpful and then if I were just being a paranoid sell-side analyst, assume that the trial only read out in predominantly independent and not the combined type, would that impact the design of the Phase III that you’re planning on doing -- comparing to Strattera and have you discussed this scenario with the FDA?

Yaron Daniely

Management

Yes, so I’ll be careful about it because we don’t normally disclose details of our discussions with regulatory agencies. We have discussed the Phase IIb finding of the differential effect on predominantly inattentive ADHD. This was the study that was not powered to show these differences, but the market effect on the predominantly inattentive ADHD was certainly not ignored by the agency. We believe that a hit or a success on the secondary endpoint for predominantly inattentive ADHD patients in the current Phase III study is likely to drive a statistical significance of the overall study as well. Having said that, if the entire clinical benefit and the favorable response is emanating from the predominantly inattentive population, there is a route with the agency to develop the remaining clinical development program for that subtype as well. It would not change the design of the study necessarily, the primary endpoint, the number of patients etcetera, but it could affect the inclusion-exclusion criteria for example, focusing on that subject. That remains to be seen.

Charles Duncan - Piper Jaffray

Analyst

Okay. That makes sense. And then final question regarding and I know this is jumping way ahead, but if that scenario arose, would you -- would that impact the label that you would seek and i.e. would you seek a class label or would you seek one that is targeted at a certain patient population and could that actually be a positive or would it in some way give you some competitive advantage in the market?

Yaron Daniely

Management

Well, the best person to answer that is not on the call today. It’s Mr. David Baker, our Chief Commercial Officer, but David once told me that if there was a way to bake in our value proposition into the label that would be a marketer’s dream come true and I believe if this drug was uniquely identified as a highly beneficial predominantly inattentive drug and it clearly would be on the label, that would actually be a marketing advantage and not a disadvantage. I’ll remind you that with the adult market becoming the predominant market over the next few years in a multibillion dollar market and the predominantly inattentive population being about half of that market having a kind of first line well positioned drug that addresses that population could be a significant benefit.

Charles Duncan - Piper Jaffray

Analyst

Okay. Thanks for the added color.

Operator

Operator

Thank you. Our next question is from John Newman with Canaccord. Your line is open. John Newman – Canaccord Genuity: Hi guys. Thanks for taking the question. So the question for Yaron and I guess it’s a follow-up to Charles question that is if for whatever reason the data readout that we see here in the coming weeks shows a strong effect in primary inattentive, but did not hit on the overall endpoint, would you still feel comfortable I guess moving forward specifically in primary inattentive and foregoing the larger opportunity and have you discussed this kind of idea with the agency or has it sort of been broader discussions at this point? Thanks.

Yaron Daniely

Management

Thanks John. No this discussion took place with the agency. This is how the design and the powering of the study was assembled so that it is large enough to not only look at effect sizes and powering assumptions for the overall population, but also look specifically at the drivers of that effect size on the two ADHD subtypes. And again despite the fact that you heard me say that numerous times that I believe that a statistically significant effect on the PI ADHD population should and will drive a statistical significant effect on the overall population simply by statistics and the numbering perspective. We do have in place the pathway to decide on focusing on the predominantly inattentive population in the consequent second Phase III study. John Newman – Canaccord Genuity: Okay. And when you report topline data, can you give us a sense as to what you might talk about in terms of the safety profile?

Yaron Daniely

Management

I think that whatever information in broad range including discontinuation, significant adverse events and most common adverse events, we could discuss -- we have that information now in a broad way for the blinded study and we’re able to some safety cut, again particularly for the most abundant and any serious adverse events if there are any in this study. John Newman – Canaccord Genuity: And assuming that the data readout positively, do you think that could accelerate the enrolment in your pediatric study?

Yaron Daniely

Management

So we don’t anticipate any slowness in the pediatric study. Our expectation is that given the opportunity to enroll in a study with a nonscheduled novel agent, parents of adolescent subjects with ADHD are very keen on enrolling in the study. So I guess you can accelerate an already accelerated recruitment, but I don’t think that would necessarily affect or it would need to affect the pace of recruitment in that study. John Newman – Canaccord Genuity: Okay, great. Thank you.

Yaron Daniely

Management

Sure.

Operator

Operator

Thank you and our next question is from Jason Butler with JMP Securities. Your line is open.

Unidentified Analyst

Analyst

Hi this is [Caroline] (ph) in for Jason. So the pharmacological MRI was conducted in rats. How predictive do you believe MDX activity in rats is for humans and then also if you could elaborate on the predictive value of these kinds of data for other drugs in ADHD and other diseases as well? Thanks.

Yaron Daniely

Management

Thanks Carolina. Let me hand it over to Jonathan to comment on that question.

Jonathan Rubin

Management

So I would view this data as supportive of our mechanism and another piece in the puzzle that suggests that we could work for ADHD. So this shows that we -- our drug is active in areas that are associated with ADHD. There are profiles not mentioned previously, but our profile is to some extent consistent with other ADHD medications, what’s been observed in pharmacological MRI studies in rats. But we also have certain differences, which I did mention, notably the lack of effect on the mesolimbic system. So it suggests that we -- the commonality but important difference is put up as a distinct therapeutic option for ADHD. The bottom-line now is that this is supportive evidence and that we have to show clinical evidence in our Phase III study.

Unidentified Analyst

Analyst

Right, thanks.

Operator

Operator

Thank you. [Operator Instructions] And our next question is from Debjit Chattopadhyay with Roth Capital. Your line is open.

Debjit Chattopadhyay - Roth Capital

Analyst

.:

Yaron Daniely

Management

Okay, so two separate questions. The first question, this is a study in ages 13 to 18, so it's pediatric because it’s sub18, that’s how FDA views it but first in the adolescent population, historically studies in ADHD have been separately done for pediatric 6 to 12 and adolescent 13 to 18. So our first venture into sub18 or non-adult is in the adolescents. They also have relatively high rates of predominantly inattentive patients and this is how we decided to move forward into that pediatric investigation. In terms of the formulation challenges, I am not quite sure that I understand your question. The Metadoxine oral tablet is a bilayer tablet that has a layer of immediate relief and a layer of slow relief that are engineered to provide a birth effect that is then taken over by its slow release effect to last throughout the day. We can make those tablets as large as we need for the adult dosing and as small as we need for pediatric dosing. We've described before that we’re developing microcapsules and other formulations for even younger population such as young kids and we have done that and continue to work on that for both the younger ADHD population as well as the Fragile X population.

Debjit Chattopadhyay - Roth Capital

Analyst

Yes, that’s what I was trying to go at. The younger population given that it’s a fairly large pill size when you talk about the 1400 mg pill right, so given that younger kids normally do have swallowing issues, smaller tablet so I was just going towards that and I wasn’t sure the Phase II population, was whether it was 13 and higher, which kind of takes out that formulation challenge out of the question. Now going back to the Phase III study, the Phase IIb study in adults, the effect size of 0.4 that you mentioned in the combined subtype, could you remind us how tight the confidence intervals were in that subgroup of patients and how that could impact a 0.3 assumption in the Phase III study?

Yaron Daniely

Management

So just to -- I want to clarify one thing on your last question and one thing in your current question. On the last question, just so you are aware, the 1400 mg dose is an adult dose. The pediatric dose is reduced from that. So they’re not taking the adult dose even at that what quote unquote, “what you suggested a large tablet” that’s not the tablet size that will be used in the adolescent study. With regards to your question on the effect size in the Phase IIb, the effect size of 0.4 was not on the combined type, it was on the overall patient population. So it was an [all commerce] (ph) basically on the intent to treat analysis of 113 subjects out of 120. The effect size on the predominantly inattentive was 0.9 and the effect size on the combined type population was I think only about 0.2. I don’t have the data files in front of me but I am happy to go back and relate that. I am sure that it’s provided in one or both of our publications on this study in the Journal of Clinical Psychiatry and the Journal of Postgraduate Medicine.

Debjit Chattopadhyay - Roth Capital

Analyst

Thanks Yaron.

Yaron Daniely

Management

Sure.

Operator

Operator

Thank you. And I am not showing any more questions at this time, and I would now like to turn the conference back over to Yaron Daniely, CEO of Alcobra.

Yaron Daniely

Management

Thank you, operator. So thanks everyone for joining us this morning. We look forward to continue to communicate with you as we finalize our work in starting to report data later this quarter. Thank you.

Operator

Operator

Ladies and gentleman, thank you for participating in today's conference. This does conclude the program and you may all disconnect. Everyone have a great day.