Christopher Anzalone
Analyst · Ted Tenthoff from Piper Jaffray. Your line is open
Thanks, Vince. Good afternoon, everyone, and thank you for joining us today.We made substantial progress during the quarter toward our short term and longer term goals. In particular, we took some very important regulatory and clinical steps that I will discuss in a moment.We now have a good mix of early, mid and later stage programs, both wholly-owned and partnered, and soon we will add candidates targeting cell types outside of the liver. This will be a big step for Arrowhead and more broadly for the entire RNAi field.In addition, we have multiple years of cash on our balance sheet and potentially access to more non-dilutive capital through milestone payments from our two external partnerships. Taken together, we have three critical components of success for a company like ours.One, a platform on which to build a variety of important new medicines; two, a pipeline of potential medicines spanning early discovery to later stage clinical trials; and three, the capital to fund development in further innovation; the fourth critical component is effective and a rapid execution.I believe we have clearly demonstrated this over the past few years and during the last quarter. Our overriding focus is on bringing important new medicines to patients who need them. And if we're able to do that, we will continue to build long-term value.Before I give a review of some of the highlights of the quarter, I want to make a couple of announcements. First, I am proud to announce a previously undisclosed program for which we expect to file a CTA at the end of this year, and begin first-in-human studies shortly thereafter.We have never discussed this program publicly. The target is HSD17B13, and potential indications we could address are alcohol related and non-alcohol related liver disease. The candidate is called ARO-HSD, and it is currently in IND-enabling GLP-toxicology studies.HSD17B13, a hydroxysteroid dehydrogenase involved in the metabolism of hormones, fatty acids and bile acids. In humans, it is extensively expressed in hepatocytes. Human genetic studies indicate the loss-of-function mutations in HSD17B13 are protective against development of both alcohol related and non-alcohol related liver disease, with approximately 30% to 50% risk reduction compared to non-carriers.Carriers of this variant show lower transaminase levels, both ALT and AST compared to non carriers. This protective effect has inspired therapeutic interest in the treatment of liver disease. We are excited about the program and I expect that not only will we have the first RNAi candidate against this target in the clinic, but I expect we'll be the first to bring any candidate using any modality into the clinic against this target. We have a large and exciting pipeline, and it is now larger and more exciting.Second, Arrowhead will hold an Analyst Day in New York on October 18 to give a more in-depth review of some of our programs, including the new ARO-HSD program. We have come so far, so fast. So I think it will also be helpful for us to take a step back and give investors a more long-term view of where we see the company over the coming years. We plan on having presentations from folks at Arrowhead as well as some external experts, in addition to panel discussions and interactive question-and-answer sessions.The event will be open to analysts and institutional investors by invitation, and there will also be a live webcast. We're planning to engage an event with various presentation formats. So we hope many of you can join us in person or by webcast. Additional details will be available on our website as we approach the event.Let's now turn to our pre-clinical programs. I want to give a brief update on the timing of ARO-HIF2 and ARO-ENaC, the first to TRiM enabled candidates targeting tissues outside the liver.As I mentioned, being able to effectively target tissues outside the liver is a big step forward for us, broadly opens up a vast set of diseases that may not be addressable with small molecule and/or antibody drugs and makes them accessible to Arrowhead. This can drive a significant value for us, and more importantly, give us the opportunity to provide hope for many patients without adequate options.We have believed all along that for RNAi to reach its true potential as a paradigm shifting new modality medicine and must be able to address diseases outside of the hepatocytes. Because of this belief, we have spent the last several years improving our technology and finding solutions to the many technical challenges that exist beyond hepatocytes delivery. We think we are there. This gives us a distinctive strategic and technical advantage over other RNAi companies.ARO-HIF2 has been developed as a promising new drug candidate for the treatment of the clear cell form of renal cell carcinoma or ccRCC. ARO-HIF2 is designed to inhibit the production of HIF2 alpha, which has been linked to tumor progression and metastasis in ccRCC.We believe it is an attractive target for intervention because the overwhelming majority of ccRCC tumors are thought to express a mutant form of the Von Hippel-Landau protein that is unable to degrade HIF-2 alpha, leading to its accumulation during tumor hypoxia and promoting tumor growth. We are still on schedule to file a CTA for HIF2, for ARO-HIF2 this year.Similar to ARO-HSD, we are currently conducting IND-enabling GLP-toxicology studies. The anticipated completion of these studies should support a CTA filing by the end of the year.Our second extra-hepatic program to leverage the TRiM platform is ARO-ENaC. ARO-ENaC is an inhaled RNAi therapeutic candidate designed to reduce production of the epithelial sodium channel alpha subunit or alpha ENaC in the airways of the lungs.In cystic fibrosis patients, increased ENaC activity contributes to airway dehydration and reduced mucociliary transport. ENaC inhibitors have been tried previously in cystic fibrosis, but have not been able to get enough reduction in the lung while sparing the kidney. ENaC inhibition in the kidney can lead to high levels of potassium in the blood called hyperkalemia , that can be dangerous and potentially life threatening.Consistent with other targets in our pipeline, this is another case where RNAi using our TRiM platform may have a distinct mechanistic advantage over prior small molecule approaches and thus ENaC is an attractive target for us. We have demonstrated it in multiple pre-clinical studies that we can selectively silence pulmonary ENaC expression with no effect on renal expression or serum potassium levels.In addition, RNAi appears to have a much longer duration of effect, which has been a limiting factor for inhaled small molecule inhibitors. Needless to say, we are very excited about the program. We previously presented data at the 2018 North American Cystic Fibrosis Conference, among others. We anticipate additional data presentations at future conferences.Because of the specialized nature of inhalation studies, there are a small number of high quality facilities capable of doing activity in toxicology work for ARO-ENaC. This has affected our ability to get studies scheduled and has slowed the program a bit. We expect to begin IND-enabling GLP-toxicology studies for ARO-ENaC next quarter, but they will not be done in time to file a CTA before the end of the year. So we are adjusting guidance on our CTA filing to the first half of 2020.Keep in mind that this is our first inhaled RNAi therapeutic candidate and the first to target the lung. So while we are disappointed that the program has delayed by about a quarter, it is a small price to pay to ensure that we go into the clinic with a substantial amount of pre-clinical data and that the animal studies are done well.Further, the new ARO-HSD CTA filing by the - further up - sorry, with the new ARO-HSD CTA filing by the end of this year, we continue to build our clinical pipeline at a speed that meets or exceeds our own aggressive expectations.As we get clinical experience and validation with this first lung targeted program, we anticipate that new programs will follow more quickly and we will be able to achieve the same high level of speed that everybody has come to expect from Arrowhead.Moving on, I want to review some important progress in our clinical stage programs. I will start with ARO-AAT, our later stage RNAi therapeutic candidate being developed to treat a rare genetic liver disease associated with alpha-1 antitrypsin deficiency.We achieved two important regulatory milestones during the quarter. First, we announced that following the filing of an IND, we received FDA clearance to begin the SEQUOIA Phase 2/3 trial with the potential to serve as a pivotal registrational study. Importantly, this is the first potentially pivotal study for a compound using Arrowhead's TRiM platform.We also secured Fast Track Designation for ARO-AAT from the U.S. FDA. Fast Track is designed to facilitate the development and expedite the review of drugs to treat serious conditions that fill an unmet medical need. The purpose is to get important new drugs to the patients earlier.We intend to utilize a number of the important advantages the Fast Track provides. You may also recall that we previously announced that ARO-AAT received orphan designation in both the EU and the U.S.In addition to these key regulatory achievements, we have also pushed forward with the clinical studies. We have multiple sites that are operational with patients already enrolled. We expect those to begin this week. The 2002 open-label study is also moving along well, where we continue to open sites. We expect enrollment to begin shortly. Bruce will talk about the status of these studies in a moment.I want to mention a few things about the ARO-HBV program being developed in collaboration with Janssen, and now called JNJ-3989. The clinical development program has continued to advance. In April, we announced that the ARO-HPV 1001 study was expanded to include a new triple combination cohort, cohort 12 in 12 patients with chronic hepatitis B infection. All 12 patients have been enrolled and have received all planned doses of JNJ-3989.This cohort includes JNJ-3989, JNJ-6379, Janssen's investigational orally administered capsid assembly modulator of the class that forms normal capsid structures, and, a NUC, in connection with the start of dosing of cohort 12, Arrowhead earned a $25 million milestone payment.In addition to the AROHBV1001 study, Janssen is currently initiating a Phase 2b study called Reef one of different combination regimens, including JNJ-3989 and/or JNJ-6379 /or a NUC for the treatment of chronic hepatitis B virus infection. The study will include up to 450 patients who will be randomized to receive up to 48 weeks of treatment. Arrowhead is eligible to receive an additional $25 million milestone payment from Janssen upon the dosing of the fifth patient in Reef one. The study is on ClinicalTrials.gov if you want additional information.Part of our October 2018 agreement with Janssen included a research collaboration, an option agreement to potentially collaborate for up to three additional RNAi therapeutics against new targets to be selected by Janssen.We are actively working on the first candidate now referred to as ARO-JNJ1 against an undisclosed, never expressed target. These potential new candidates leverage Arrowhead's proprietary TRiM platform and do not include targets in our current pipeline.Arrowhead is responsible to perform discovery optimization and pre-clinical development entirely funded by Janssen, sufficient to allow the filing of the U.S. IND or equivalent, at which time Jansen will have the option to take an exclusive license.If the option is exercised, Janssen will be wholly responsible for clinical development and commercialization. This is an important opportunity to create novel medicines by leveraging Arrowhead's speed and expertise in RNAi drug discovery and Janssen's clinical development and commercial capabilities. We have made a rapid progress on this program and we look forward to working with Janssen further on ARO-JNJ 1 and potentially two other programs.Let's now move to our Amgen partnership. Amgen continue to make progress on AMG-890, formerly called ARO-LPA. The targets lipoprotein(a) also known as LP(a). AMG-890 is being investigated as a potential treatment for cardiovascular disease.Amgen has been enrolling patients with elevated LP(a) in a Phase 1 study and expects to share the initial data late this year or early next year. Amgen also anticipates launching the next phase of a development of AMG-890 in the first half of 2020, which would trigger development milestone payments.We share Amgen's excitement in this program and believe that AMG-890 could one day be an important new treatment for cardiovascular disease. On the terms of our September 2016 agreement, Amgen also received an option to a worldwide exclusive license for an RNAi therapy against an undisclosed cardiovascular target, which we subsequently called ARO-AMG1.In August 2018, Arrowhead delivered to Amgen a candidate that met or exceeded the activity and safety requirements stipulated in the collaboration agreement. The option period expires on August 7, 2019, and Amgen has advised us that they do not intend to exercise the option. Consequently, we'll be removing ARO-AMG1 from our development pipeline.Let's now move to our two wholly-owned cardiometabolic candidates ARO-APOC3 and ARO-ANG3. These targets both provide some optionality with respect to which patient populations and indications we will pursue. For each target, there may be opportunities to treat well-defined orphan diseases such as familial chylomicronemia syndrome and homozygous familial hypercholesterolemia, as well as higher prevalence diseases.In addition, the Phase 1 study for both candidates are designed to provide a readout on safety and tolerability, as well as a robust look at the pharmacologic activity and duration of effect in both healthy volunteers and various patient populations, further enhancing our optionality at quite an early stage.To that end, we secured orphan drug designation from the FDA for ARO-APOC3 for the treatment of familial chylomicronemia syndrome or FCS and for ARO-ANG3 for the treatment of homozygous familial hypercholesterolemia or HoFH. Our intention is to pursue these orphan indications immediately and potentially initiate pivotal studies for both ARO-APOC3 and ANG3 next year.Beyond these rare disease populations, we also plan to pursue a staged clinical development and go-to-market approach where we study larger indications in parallel involving larger studies that will take longer to mature. We like this model. It allows us - allows for the possibility of getting to market quickly while also enabling growth into other markets.From a chemical entity standpoint, of course APOC3 and ANG3 candidates are just one drug each. From any economic end market standpoint, however, these single drugs could behave like multiple drugs. As we do multiple studies to support treatment for marketing two different indications we expect to substantially increase our total addressable markets.Importantly, the addition of each new indication area benefits the others because they will all contribute to a single safety database for each candidate. So there is clear leverage here. So what are some of these larger market opportunities? For ARO-APOC3, it could simply be patients with elevated triglycerides with some history of pancreatitis. For ARO-ANG3, there are many possibilities.For instance, we could look to treat heterozygous FH patients or those who are not meeting their LDL cholesterol goal while on statins. Because we expect ARO-ANG3 may decrease liver fat and help with insulin resistance, among other things, we could also look to treat patients with NASH, NAFLD, and those with metabolic syndrome.We believe we have a substantial opportunity to help a large number of diverse patients, and that ANGPTL3, is a uniquely powerful target. As a reminder, we're developing the first and, I believe, only clinical RNAi candidates against both APOC3 and ANGPTL3. These two programs are essentially on the same schedule and at the same stage currently.We completed dosing in the single ascending dose portions of both studies and are now enrolling in a multiple dose portions in various patient populations. We are still on schedule for potential data readouts starting this year and likely continuing into next year. Specifically, Bruce will be a keynote speaker at the Global Summit On Cardiology & Heart Disease taking place in Dubai on September 16 and 17. He will be talking about our ANG3 and APOC3 programs and will include some top line clinical data we have generated.Later this month, we will submit a late breaker abstract for the American Heart Association conference in November. If accepted, we expect to present a fuller data set from the ANG3 and APOC3 clinical programs. These are data rich studies, so we believe we will have additional readouts through the November AHA conference. We will then therefore expect to submit abstracts to present more data at the EASL International Liver Conference and/or the American College of Cardiology meeting in April.At our R&D day last year, we mentioned a breakthrough in targeting skeletal muscle cells. We have continued down this path and are getting closer to designating our first target in entering the clinic. We are not prepared to discuss data today, but we see the potential to enter the clinic with our first muscle targeted candidate next year.With that overview, I now like to turn the call over to Dr. Bruce Given, Bruce?