Earnings Labs

BioMarin Pharmaceutical Inc. (BMRN)

Q4 2014 Earnings Call· Thu, Feb 26, 2015

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Transcript

Operator

Operator

Good afternoon, ladies and gentlemen, and welcome to the BioMarin Pharmaceutical Inc. conference call to discuss Fourth Quarter and Full Year 2014 financial results. [Operator Instructions] As a reminder, this conference call is being recorded. I would now like to introduce your host for today's conference, Traci McCarty, Director of Investor Relations for BioMarin. Please go ahead, Traci.

Traci McCarty

Analyst

Thank you, operator. Here today from BioMarin's management team are JJ Bienaimé, Chief Executive Officer; Dan Spiegelman, Chief Financial Officer; Hank Fuchs, Chief Medical Officer; Jeff Ajer, Chief Commercial; and Robert Baffi, Executive Vice President of Technical Operations. To remind you, this non-confidential presentation contains forward-looking statements about the business prospects of BioMarin Pharmaceutical, including expectations regarding BioMarin's financial performance, commercial products and potential future products in different areas of therapeutic research and development. Results may differ materially, depending on the progress of BioMarin's product program, actions of regulatory authorities, availability of capital, future actions in the pharmaceutical market and developments by competitors, and those factors detailed in BioMarin's filings with the Securities and Exchange Commission such as 10-Q, 10-K and 8-K reports. Now I'd like to turn the call over to BioMarin CEO, JJ Bienaimé. JJ Bienaimé: Thank you, Traci. Good afternoon, and thank you for joining us on today's call. So in the 2014 BioMarin delivered $751 million in total revenues which represents 37% total revenue growth year-over-year, driven in part by the exceptionally successful launch of our newest commercial product, VIMIZIM for the treatment of MPS IVA or Morquio A Syndrome. In addition we advanced all of our clinical development programs and as a result of our acquisition of Prosensa we added multiple new potential products to our portfolio for the treatment of patients with Duchenne Muscular Dystrophy. So 2014 was by far our most productive year-to-date and we begin 2015 while positioned to achieving new set of significant regulatory clinical and commercial milestones. Hank will discuss our full slate of regulatory rejecters for 2015 but I want to highlight our later stage product Drisapersen for the treatment of 13% of the Duchenne Muscular Dystrophy patient population or about 10,000 patients. Drisapersen is currently under rolling submission…

Dan Spiegelman

Analyst

Thanks, J.J. Earlier today we issued our press release summarizing our financial results for the fourth quarter and the full year 2014 and I refer you to that release for full details. Today I will discuss the results of the quarter and full year, provide guidance for 2015, and also provide some thoughts on a longer term vision of our next move into operating profitability and accelerating revenue growth. I'm pleased to say that financial results for 2014 meet or exceeded our financial goals for the year. In Q4 we saw solid revenue growth in all of our major products, as a result total BioMarin revenue in Q4 increased 57% year-over-year to $230.9 million. In the fourth quarter VIMIZIM delivered $36.9 million and Kuvan grew 27% year-over-year to $57.4 million. Naglazyme revenue increased 29% year-over-year to $88.5 million in quarterly revenue driven in part by large orders placed by governmental agencies in Latin America. As a result of each product in the portfolio turning in above expectations Q4 sales, total 2014 BioMarin revenues increased to $751 million, growing 37% compared to 2013, and exceeding the high end of previously provided guidance range by over $40 million. With Q4 and full year revenues exceeding plan and total operating expenses coming in line with our expense guidance, we reported a full year non-GAAP net loss of $25.9 million compared to our most recent target for the year at $50 million to $65 million loss. We also reported a $134 million GAAP net loss for the year. It's worth noting that our near breakeven operating result for 2014 is a key reason why cash balances at the end of the year 2014 being essentially unchanged at $1 billion in cash balances at the end of Q4 2013. I would now like to turn…

Jeff Ajer

Analyst

Thanks, Dan. We are extremely pleased with the execution of the VIMIZIM commercial launch in 2014, and the resulting sales of $77.3 million since approval in the US last February, and then the EU last April. Sales were recorded in 19 countries at the end of the fourth quarter and VIMIZIM commercialization continues to proceed at the high end of our expectations. A substantial portion of clinical trial and EAP patients had successfully been converted to commercial product, physician and patient acceptance of the only therapy to treat Morquio A has been strong and we expect this fact to be an important driver of success going forward. Finally, we continue to identify additional Morquio A patients effectively expanding the available market. Looking forward to 2015 we expect further progress as the global commercialization of VIMIZIM proceeds. Specifically we expect to further build out established markets and continue opening new markets to VIMIZIM each quarter. We are confident in our ability to maintain VIMIZIM’s current price quarter in both new and existing markets, and as important we are to conclude negotiating final price in market such as France, Germany and Italy. New registrations and the conclusion of price and reimbursement processes in certain countries will allow us to make further progress converting clinical trial patients to commercial. In short, the commercial opportunity for VIMIZIM this year is high and we expect continued success in year two of the global launch of VIMIZIM. Now turning to our base commercial products; starting with Naglazyme, continued sustainable growth in patient numbers and significant orders from Brazil drove the 23% increase in sales year-over-year to $334.4 million in 2014. The unpredictability of ordering patterns in this region is expected to result in lumpiness in 2015, a dynamic that has existed since Naglazyme was launched nine…

Hank Fuchs

Analyst

Thank you, Jeff. Our development and regulatory teams are working tirelessly to integrate Prosensa employees and clinical assets into the BioMarin organization. The commitment that our new colleagues have demonstrated preparing the last module of the NDA for submission even in a few weeks of its original timeline and at the highest quality has exceeded my expectations. We've been very encouraged by our recent interactions with the Food & Drug Administration, and believe that there is an opportunity for near term approval of Drisapersen for the treatment of Duchenne Muscular Dystrophy. We believe Drisapersen is potentially an effective treatment for boys with DMD because the totality of data suggests that Drisapersen has a very clinically meaningful effect on these patients as measured by the primary end point six minute walk test. Drisapersen has the largest set of clinical data of products and development and we believe we'll be the first to be submitted for approval and potentially the first to market in the United States and in Europe. We have data from three placebo controlled trials and two long term open label trials. Over 300 patients have been treated with Drisapersen with less than 1% discontinuation rates in the randomized phase of the studies, and less than 3% discontinuation if you look at all the extensions. Drisapersen is the only Duchenne Muscular Dystrophy product in development that has been granted breakthrough therapy designation and fast track designations with the Food & Drug Administration. Most importantly there is an urgent need for an approved therapy to treat boys with Duchenne Muscular Dystrophy. As we have stated previously, we believe the clinical results of the Phase III study can be understood in context, especially considering the efficacy data from prior trials. We believe we can demonstrate that while the complete data set…

Operator

Operator

[Operator Instructions] Our first question comes from the line of Joseph Schwartz from Leerink Partners. Your question please.

Joseph Schwartz

Analyst

Great, thanks so much and congrats on a great quarter. I was curious, you said that you're encouraged by your interactions with the FDA, if you could characterize that a little bit more for us, what kind of things have they requested that you complete throughout the review here now that you've been in charge of that process. And also are you - how are you doing on the redosing of patients that were previously getting Drisapersen in the extension studies?

Hank Fuchs

Analyst

Yes, very good interaction with the Food & Drug Administration, at this stage what the conversations are typically about the format of the submission and the content of the submission, and we're pleased that essentially no new content has been requested and what's been asked for is simply information presented in a way that will facilitate review by the various different review divisions. So this is barely normal for this stage of the process. As far as bringing Drisapersen back into the clinic for patients who have previously received Drisapersen, we have so called extension studies ongoing internationally, and we plan to continue to increase the number of patients who can be - who stated drug administration can be resumed and that's an additional priority of the company to be working on concurrently. We've got a lot of resources here at BioMarin to add to the BioMarin Netherland team and we're selling those groups together in such a way that we can meet these various different needs in a timely fashion.

Joseph Schwartz

Analyst

Okay, great, sounds promising. And could I just ask one on an early program BMN 250, how are you thinking about end points in that disease and I know you have a natural history ongoing, when can we expect data out of that phase study?

Hank Fuchs

Analyst

The first study for BMN 250 is going to really focus on dose escalation, safety, tolerability, method of administration, immunoglycans measured in the cerebrospinal fluid, and exploratory evaluations of some of the clinical outcomes observed in Sanfilippo syndrome. As to when first data readouts will be available, I think it's really too early to know when data will become available from the natural history study or the treatment study, we're really just getting underway at this point.

Joseph Schwartz

Analyst

Okay, I'll stay tuned, thanks.

Operator

Operator

Thank you. Our next question comes from the line of Cory Kasimov from JP Morgan. Your question please.

Cory Kasimov

Analyst

Good afternoon guys, thanks for taking the questions, two of them for you. First of all big picture question, now that you guys have replenished your balance sheet with the recent capital raise, I'm curious how much of an appetite you may have for additional DD and the heels of the Prosensa acquisition? JJ Bienaimé: When we announced the Prosensa deal we also had to preannounce that we would like to replenish our cash balances and we did with the financing in January. But that doesn't mean that we are very hungry for any potential acquisition at this time. As I stated previously we are approached on a regular basis by other earlier stage Biotech companies that are developing drugs in the open space since we are a prominent player in the field. So when we are approached we always evaluate the assets and if we find the right assets at the right price we might continue on the business development front. But I think now our focus is on early stage buy [ph].

Cory Kasimov

Analyst

Okay. And then second question is how do you think about the potential evolution of the Batten’s market opportunity, obviously it's a small prevalent population but if BMN 190 is successful in keeping these patients alive, is this the type of market that can build upon itself? JJ Bienaimé: Yes, I mean I think when we - in January we talked about the earlier results of the ongoing trial, we communicated that the disease first of all we believe is under diagnosed and that's based on some studies in the UK whereby we come to do a survey to - for early detection of Batten Disease and finding some patients that Batten Disease and were under diagnosed and then the other reason why would be the prevalence could be more important than the current - if product DPT1 [ph] gets approved and if it's a significant impact on slowing down the evolution of the disease it could potentially increase the life expectancy of the patients and increase the prevalence.

Cory Kasimov

Analyst

Alright, thanks J.J.

Operator

Operator

Thank you. Our next question comes from the line of Philip Nadeau from Cowen. Your question please.

Philip Nadeau

Analyst

Yes, thanks for taking my questions. First a follow-up on Battens Disease for you Hank, the data that you presented in January was very impressive but I'm curious what you think the FDA and physicians will find to be meaningful improvement on the Hamburg/Cornell scale, is it one point difference versus historical control sufficient, do you have to show stabilization? What's your sense of work would be considered meaningful?

Hanks Fuchs

Analyst

Well it's a little early to talk about how a health authority anywhere in the world is going to determine what they think to be a clinically meaningfully important improvement. I think what impressed us the most was essentially disease progression was halted, I mean another way of looking at that is there is a 100% stoppage of the progress of the disease. We were impressed by that, I think the investigators were impressed by that and that's what led them to want to open the study up for the treatment of pre-symptomatic effective siblings which of course has led us to disclose the data. But we're going to talking about these data with health authorities and certainly the observed magnitude of treatment benefit will be in a part of the topic of discussion and we look forward to giving you an update once we've had those meetings.

Philip Nadeau

Analyst

Great. And then my second question is on BMN 111, you again committed to give us the dose, the data from first three cohorts at the end of Q2. Where are you in enrolling the studies, have you moved in three cohorts to fourth or fifth cohort?

Hanks Fuchs

Analyst

No, we've completed enrollment of the third dose level and we're gathering data from those patients.

Philip Nadeau

Analyst

And have you - I guess formally decided not to go to afford those cohort or is that decision yet to be made?

Hanks Fuchs

Analyst

We're going to - we have not formally decided on the beginning of the enrollment of our fourth cohort and I'd say stay tuned for a data update in the second quarter for a more substantial progress report.

Philip Nadeau

Analyst

Great, thanks for taking my questions.

Operator

Operator

Thank you. Our next question comes from the line of Heng Weng [ph] from Bank of America-Merrill Lynch. Your question please.

Unidentified Analyst

Analyst

Good afternoon guys and thank you for taking my questions as well. First of all, I noticed that the timeline for finishing the NDA for Drisapersen is slightly pushed from March to April. I suspect it's just formatting, any additional requests from FDA that caused the delay? And then secondly also on the VIMIZIM guidance here, can you provide a little bit color on what is excluded in that guidance, what additional territory launch are you expecting in 2015? And then just lastly on BMN 111, I think you guys talked about potentially expecting maybe 80% to even 100% increase in growth here, should we hold that for any update expect to release in late second quarter. Thank you.

Hanks Fuchs

Analyst

I'll start and then I will probably come back to answer 111 question with Jeff as a sandwich in the middle. So the NDA timeline you pointed out was March and as of this call is down April, it's really driven by - it's a complicated dataset, and we want to make sure that the information that is presented is presented as clear way as possible and that information that's made available for viewers is presented in a way that enables them to do their job in the most efficient way possible and we had a similar experience at the tail end of the VIMIZIM submission where we decided to take just a little longer to facilitating more fact style review. I think what we learned out at the VIMIZIM application process is that a little bit of extra investment to facilitate review goes a long way towards showing an effective review process and effective decision making. JJ Bienaimé: And I may add so from perspective that we've been in control of the database for less than six weeks.

Hanks Fuchs

Analyst

Jeff, if you want to take the second part of that question and come back to me?

Jeff Ajar

Analyst

Sure, this is Jeff, I will answer the question about VIMIZIM guidance. So previously we have set expectations and we're presently doing business in 50 markets with Naglazyme and it's our intention to get to all of those 50 markets with VIMIZIM but it's going to take certain years or little bit more to do that. Earlier today we disclosed that through the end of Q4 we successfully gotten into 19 markets, that includes many but not all of the top major global markets. So in that set of 19 markets there is what we think plenty of growth potential for getting new patients and continuing to convert clinical trial patients onto commercial VIMIZIM therapy. Combined with that we've got roughly 31 markets to go to get into and we guided that - it's our expectation that we'll be announcing successfully gotten into additional new markets each quarter of this year. So all of those new markets are essentially virgin territory for naïve to treatment patients and conversion of clinical trial patients where they exist. So if you add those two together in very short terms, we’d say building out our penetration in existing markets of 19 plus new penetration into new markets and penetrating naïve patient pools.

Hanks Fuchs

Analyst

And as to your last question, we have not set a target of efficacy to make it go or no go decisions for CMP 111 in achondroplasia, we have described the quantitative difference between growth velocity of achondroplastic children and normal children, and we have described quantitatively what would be required to catch up in achondroplasia patient to a normal child in growth if therapy is delayed in its administration in the prevalent population. The establishment of the target of efficacy for decision making purposes is many facet, it includes consideration of growth velocity, safety, proportionality, potentially other efficacy signals and we have not established what our go criteria are because of the complexity of those interacting dynamics, nor have we evaluated the third cohort of data because as you know the study is ongoing. So I'd say stay tuned again for a readout in the second quarter on the comprehensive dataset and more information at that time.

Unidentified Analyst

Analyst

Thanks for the color.

Operator

Operator

Thank you. Our next question comes from the line of Yaron Werber from Citi. Your question please.

Unidentified Analyst

Analyst

Hi, this is Kumar [ph] for Yaron, thank you for taking my question. So far drisapersen, what do you think would be the focus of the ad com panel and also given that drisapersen has breakthrough designation, is it possible for it to be approved earlier than the end of the year timeline?

Hanks Fuchs

Analyst

Thank you for the question on focus of attention on the Advisory Committee, I'm expecting that this will be a question throughout the course of the year and I think the answer to that is relatively general during the course of the year. Advisory Committee’s focus on general considerations of safety, efficacy, data quality, data integrity, interpretability of the data etcetera; we don't have any more specific information today about what the more specific focus will be as time goes by. Having not submitted the application we don't know what review designation - sorry, having not completed the submission of the NDA we don't know what review designation we'll receive and we don't know therefore what PDUFA action date we'll receive. It is possible that as you know that action can be taken prior to PDFUA date but it is way too early to talk about, even what the PDUFA date is.

Unidentified Analyst

Analyst

Okay, great. Thank you.

Operator

Operator

Thank you. Our next question comes from the line of Terence Flint [ph] from Goldman Sachs. Your question please.

Unidentified Analyst

Analyst

Hi, this is Camren for Terence [ph], taking her questions, I had a couple on drisapersen. First of all if it's not approved, do you think you can still achieve profitability of the current portfolio of approved products? And then second, if you are approved, do you think there is a possibility that you would have the indication restricted only to ambulatory patients, and if so, can you quantify what percent of the eligible 10,000 patients that would represent. Thanks.

Hanks Fuchs

Analyst

Well the second question is to the labelling, it's clearly premature to discuss what the labelling ramifications and negotiation might be, I would say that in case of for example, Aldurazyme, where we had an issue, as J.J. mentioned in his prepared remarks about the primary end point of the clinical trial, or as we experienced with Naglazyme where there were imbalances and randomization; in either case did that result in confinement of the label to a specific patient population. I think it's sort of a general principal in the orphan disease space that labelling tends to be relatively broader than simply the pivotal trial that's been conducted. So although it's - although there is some background that's worth having about labelling in the orphan space, sorry again, just to remind that we're early in the process here and can't really comment on expectations for product labelling at this stage. JJ Bienaimé: And to collaborate on what Hanks said, you would think labelling - we are going to - we are looking into implementing some studies, additional studies to document the potential benefits of drisapersen on non-ambulatory patients and on upward limb mobility for instance which is very dramatically impacted by the disease. I mean in other practical simple way the answer to your question is that there will be patients assuming drisapersen is approved and treated, there will be patients on drisapersen for years that eventually might become non-ambulatory and imagine the difficulty after these patients saw you in a wheelchair say sorry now you cannot get the drug anymore.

Dan Spiegelman

Analyst

And this is Dan, with respect to profitability I mean, our focus right now is on getting drisapersen approve early in one of the territories and growing VIMIZIM revenues, you postulated what happens if drisapersen doesn't get early approval, we would still be working towards profitability but the pace and the timeline will be a function of what additional work if any were doing for drisapersen, so the exact details of that would come if we get there which we're not planning to.

Operator

Operator

Thank you. Our next question comes from the line of Mark Schumbum [ph] from Evercore ISI. Your question please.

Unidentified Analyst

Analyst

Hi guys, this is Shawn filling in for Mark. I just had a couple of questions. So the first on drisapersen, given that ex-US is the majority of the market have you guys begun to identify the DMD patients worldwide and would you wait for a global regulatory fillings after you see something happen in the US or EU or that's something you can do in parallel? And then on VIMIZIM, so you've been following Naglazyme patients for ten years now, and have you quantified how earlier treatment would increase patient weight through adolescence compared to natural history? And then I guess lastly, should we expect the trial for VIMIZIM ’07 trial under phase to read out this year and then would you apply for label revision if the data look good? Thanks. JJ Bienaimé: Lots of questions.

Unidentified Analyst

Analyst

Sorry. JJ Bienaimé: The right person is Jeff, you want to answer that question on patient identification?

Jeff Ajer

Analyst

Yes, so let's start Shawn with your question, ex-US patient identification; we think we know a little bit about DMD based on epidemiology and the specific incident of exon 51 mutations and we've guided that we think that's about 10,000 patients. We also think that - so we think that the epidemiology is pretty well characterized, we also think that boys with Duchenne Muscular Dystrophy don't experience the same kind of diagnostic delays that we've seen for example with MPA VIA, IA, and IVA; so that gives us a degree of confidence that these patients are being diagnosed. Perhaps not always genetic mutation analysis which will be important, one of the hallmarks of BioMarin success has been our ability to go beyond epidemiology and to actually locate the positions that diagnose and treat these patients and then get a read on how many and where these patients are. So I would guide that we intend to go out and actively begin that work this year including in international markets, and I would also guide that, that is not the trivial effort, so that will take some time and effort. Maybe I'll turn it back over to Hank on…

Hanks Fuchs

Analyst

Our process [ph] show that the plan is to file with the Europeans Medicine Agency shortly after the US submission of the new drug application. As far as rest of the world, certain countries do take their action on the basis of having submitted in the US, for having submitted in the European Union or based on action taken in either of those territories. We have - beyond the US and the EMEA, we have a complicated math of when the file and sequential roll out, the key really starts with US and EMEA submission which will be processed nearly contemporaneously. JJ Bienaimé: Another question on the…

Hanks Fuchs

Analyst

Yes, presently I don't believe the label is restricted to patients who are under five, and mostly the information about patients under five spreads by academic presentations and scientific meetings, I don't believe that we've committed to specific timetable for presenting the data but just as soon as it's sufficiently mature to be discussed in public I think that will begin the communication process, we don't see that as being something that's gated by a health authority action. And in fact in the real world it's pretty widely accepted that the earlier you start therapy for inborn errors that better the long term clinical outcome. So I think VIMIZIM is probably the - there is the least negative pressure overall in this therapeutic indication because of the history of all that's been established in enzyme replacement therapy, really good. JJ Bienaimé: So I think there was another question on the early treatment leading to patients in their weight increase, Jeff you have some…

Jeff Ajer

Analyst

Yes, just following on the logic that Hanks set up, earlier events leads to better outcomes in different ways, healthier patients are frequently larger or gain weight even without getting taller, just by virtually being healthier. I don't think that we've fully characterized that in a scientific sense but qualitatively that would be our experience in the conclusion from Naglazyme certainly.

Operator

Operator

Thank you. Our next question comes from the line of Andrew Peters from UBS. Your question please.

Andrew Peters

Analyst

Great, congrats on the progress and thanks for taking my question. I had one really kind of more bigger picture question on the market opportunities, DMD, I just wanted to understand now that the Prosensa acquisition has closed, how is outreach to the community been going and what sort of plans do you have to kind of increase the profile relative to sort [ph] little bit whose been a little bit more active, at least in the US on that front. And then touching on an earlier question on 111, I just wanted to get an update on any goals for pediatric study and moving it to younger patients. Thanks. JJ Bienaimé: I'll give a start, I think we have initiated on that first to outreach - community outreach, patient’s organizations specifically, KOP leaders [ph]. As you pointed out, there is definitely a big difference between US and Europe where US threat to have the bigger presence in Europe, not very well recognized as compared to Prosensa but we are trying to reach out in different parts of the world in this respect. I mean, Jeff you want to add some color to that or Hanks, I mean Hanks on the KOL and Jeff on the patients organizations?

Jeff Ajer

Analyst

Well, Prosensa has a great relationship with global KOLs now in Netherlands, and couldn’t possibly more pleased by the mutual respect and support that's out there for the efforts and from my exposure in terms of patient advocacy relationships, I wanted to say we are blessed to work in a world where there is such strong patient advocacy at the level of research development communication, the scientific process, the regulatory process, those are pretty high level of comprehension of the process and how to interpret scientific in clinical trial data and so that process had begun before we were on the scene and continues. I recently went to a very large patient organization meeting and was just overwhelmed by how committed the advocacy organizations worldwide are to advancing the cause of Duchenne Muscular Dystrophy, how committed they are to collaboration as a way of being collaboration with each other, collaboration scientists and medical doctors, collaboration, advocates and industry; it really is a great area to work in and I can see why there is an enormously high level of mutual commitment and trust that exists between patient advocacy organizations and the people around them.

Hanks Fuchs

Analyst

Absolutely nothing further to add. JJ Bienaimé: And there was a question on BMN 111, sorry, what was the question?

Jeff Ajer

Analyst

So BMN 111 pediatric plans - the pediatric plans and study in young children?

Hanks Fuchs

Analyst

So the other criteria for the present study goes down to age five, we do plan to initiate studies in patients that are under age five with a more severe forms of the disease. In our time, just to remind people, with Aldurazyme we didn't begin studies in younger patients until post marketing commitment and in the case of VIMIZIM the pediatric studies patients under five were studied as part of the approval plan and we're starting even earlier studying patients who are under five; in achondroplasia, although we haven't committed a specific timeline for starting those studies. Thank you Jeff, for assist on the question.

Operator

Operator

Thank you. [Operator Instructions] Our next question comes from the line of Ian Somaiya. Your question please and you're from Nomura Securities.

Unidentified Analyst

Analyst

Hi, thank you very much, it's Matthew on for Ian, two following manuals if I may. First I want to ask on one of the earlier stage pipeline products, BMN 270 for hemophilia, I know the phase I/II study is expected to begin in the second half of - in the first quarter, later this quarter, I just was wondering if you could give us some color on sort of the larger clinical goals for the program or really said in other way, how should we be thinking about what will be considered a good data coming out of that? And then on VIMIZIM, I know you're not providing any update any more on the size of the registry of the number of identified patients so what I was hoping as you might be able to give some color around maybe the geographic distribution of patients that are currently on drug, I mean how that maybe compares to sort of what you've previously described as overall distribution of mercurial patients. Thank you. JJ Bienaimé: I can start with the later one which is the distribution, as we've said we think ultimately and 1,650 plus patients that we've identified will be roughly 15% in the United States, 45% in Europe and so on. At the moment since the United States launched first, the United States is disproportionate in our current VIMIZIM patient profile though we expect it to normalize over the next couple of years.

Hanks Fuchs

Analyst

On the hemophilia program, so filing the clinical trials application or help authority permission for initiation of clinical trials this quarter and we expect that actual administration of study medication to begin in the following quarter. The goal of the first study is dose response safety and activity of the gene therapy and producing circulating factor VIII levels. We think a good target to aim for is a steady state factor VIII level of about 5% or more, the higher you get the more impact you have on patients presumably in terms of reducing the need for prepelactic factor therapy, the need - the reduction of breakthrough bleeding and so on. So that's how we're thinking about the initial part of the program and then ultimately sort of success criteria. Again, because we have even gotten a clinic it is little early to talk about what would be a win but that gives you a little bit of a sense of how clinicians think about management of hemophilia with factor replacement therapy.

Operator

Operator

Thank you. Our next question comes from the line of Salveen Richter from SunTrust. Your question please.

Salveen Richter

Analyst

Thanks for taking my questions. Just firstly, now that you've integrated Prosensa and given the FDA interaction how does it impact clinical development for the three exon skipping programs that are in phase II?

Hanks Fuchs

Analyst

Hi, Salveen. We're on track with what has been underway, we're continuing the other exons as had been previously implemented. I think that we're at a stage of gathering safety pharmacodynamics activity and in some cases PK data, and we're coming to a point where we'll have accumulated an update that make decisions on what the next steps are. We're working on the NDA for drugs producing around the clock, we're setting up a dedicated team to work on, we have set up a dedicated team to work on the initiation of the extension studies to resume studying drugs on person/patients who have previously received drug as a person. As J.J. mentioned, we're working on defining and implementing ancillary studies or supporter studies for various person and in addition, we're working on implementing studies, further studies for the other exons including exon etcetera. So there is quite a lot of activity, no significant changes of any kind as far as the program at this stage.

Operator

Operator

Thank you. Our next question comes from the line of Christopher Raymond from Robert W. Baird. Your question please.

Unidentified Analyst

Analyst

This is Alison Bramston [ph] for Chris Raymond, thanks for taking the question. So first, could you provide any color on compliance rates, are you seem to - coming off therapy and could you give a sense maybe how many and reasons? And second back on to BMN 250, would the competitor out there can give us starting on Sanfilippo, be a trial. How should we be thinking about patient recruitment, wont it be challenging to sign out patients from the study with two players actively pursuing patients?

Jeff Ajer

Analyst

Okay, this is Jeff, I'll take the first part of the question Alison. In terms of VIMIZIM compliance rate, great question, I can't give you a quantitative answer but I'll give you a qualitative answer and that is we lost remarkably few patients that has started VIMIZIM all the way back to the clinical trials including the EAP program in the United States, and now with a year of commercial experience under our belt. So we have previously guided for Naglazyme that's a key success factor in maintaining and building that business as a high rated compliance and persistence with the therapy over the time. We're anticipating that there will be different issues that emerge for Morquio A patients related to MPA VI, but so far the experience has been very positive and qualitatively would say compliance and persistence very high. I'll turn over it Hank.

Hanks Fuchs

Analyst

So on BMN 250 the initial natural history and safety studies are reasonably small and there are certainly and sadly inadequate number of patients in the world available for clinical trials, it reminds me of the early days of the development of VIMIZIM when there was - we were launching a natural history study and somebody else was launching a natural history study and the question came up is it really possible for two to coexist and of course, here we are five years later having enrolled over 300 patients in that initial study several hundred patients had randomized in controlled clinical trials and launching VIMIZIM only five years later. And I kind of feel like BMN 250 is in a similar place, we have a lot of experience with intracellular ventricular delivery, direct delivery to the affected organ, we have a lot of experience measuring retro glycans [ph] in biological fluids using a proprietary technology that's really available specifically to BioMarin because we developed it. So we think there are lot of reasons to participate in BioMarin clinical trials, we feel like we have a really good relationship with academic clinicians and most importantly there is a huge demand for new therapies for MPS IIIB, Sanfilippo Syndrome, and that we want to work hard to assess whether BMN 250 is that product that can help patients. JJ Bienaimé: And based on our experience with TPP1 in inter cerebrovascular attritions [ph] might be in some respect a better role of administration than IV in terms of no to various huge infusion associated with reactions.

Operator

Operator

Thank you. Our next question comes from the line of Robyn Karnauskas from Deutsche Bank.

Robyn Karnauskas

Analyst

Hi guys, thanks for having in. On just a big picture question, you have a lot of specifically this is within the prepared remarks, and you're talking about earning positivity in 2017, do you probably understand what are the key moving parts for you that would just step forward or backward from an earnings perspective? And then on the hemophilia program, where are you out with manufacturing as far as critical with the FDA and review for that product? Thanks.

Hanks Fuchs

Analyst

On the earnings front, the driver is new revenues and continued growth of our existing products and that's why we've said that on early approval with drisapersen either the US or Europe would be the basis on which we believe we could be profitable in 2017 and I commented that potential for additional revenues from PEG PAL and 190 would be accelerators to that going forward. JJ Bienaimé: The top line growth from existing products comes to the only approval of drisapersen and potential launch of PEG PAL and/or TPP1.

Robert Baffi

Analyst

And this is Robert Baffi, relative to your question about our gene therapy manufacturing, we are in the final stages of compiling the regulatory documentation that would support introduction into clinical trials. We're literally in the last stages of that, so we have had not had direct feedback yet from regulatory agencies who expect that very soon and we're very confident with the package and the dataset that we will be providing.

Operator

Operator

Thank you. Our next question comes from the line of Shin Keng [ph] from Wells Fargo. Your question please.

Unidentified Analyst

Analyst

Hi guys, this is Shin sitting in for Brian, thanks for taking my question. A couple of questions on BMN 111, I was wondering what are some key secondary measures you guys are looking for in the upcoming data that might collaborate 111’s positive effect on bone growth and clinical meaningful growth [ph]. And on the safety side, if you do see cardiovascular signal, how should we think about the risk benefit assuming that you do see a clinically meaningfully efficacy?

Hanks Fuchs

Analyst

Hi, this is - just to introduce myself, this is Hank, and I'd be happy to take that question. As regards to the secondary outcome measures, I think one of the most interesting and important ones is proportionality. Here comes [ph] what's important and they say scathe the slate which is characterized by disproportionate growth of bones. So in addition to increasing total stature of an outcome variable which is sort of main efficacy variable, that's - a related question is are you restoring proportionality, and we showed some slides at Analyst Day comparing the ratio, the upper body, the lower body but you could also think about measuring probably the upper arms, and the lower arm, or the upper leg to the lower leg, etcetera. And we think that will be important information to help us understand the extent to which we'll reverse saying the fundamental underlying defect in achondroplasia which is aberrant signaling under the control of constitutively after FGFR3 [ph]. So turning to the second part of your question, if it turns out that there is a safety signal that is occurring at the same dose that there is an efficacy signal and there isn’t a dose below that which causes an efficacy without a safety signal then we can think about ways to mitigate that safety signal which might include for example, dosing patients when they are recumbent, dosing patients at night, splitting the dose. But I think that it's important to recognize that patients with achondroplasia are - and their families are highly motivated to have medical therapy for achondroplasia. As we talked about at Analyst Day, the currently available therapy is surgical remediation of disproportionality and its complications, those surgeries are difficult, complicated and an available medical alternative would be greatly wanted. And so I think that we have a lot of options in the queue of how to maximize the therapeutic benefits and minimize the potential side-effects.

Operator

Operator

Thank you. Our next question comes from the line of Tim Lugo from William Blair. Your question please.

Unidentified Analyst

Analyst

Hey guys, this is Raj [ph] for Tim, thanks for taking my question. Just a quick one again on BMN 111, regarding the study design, are you seeing the majority of patients the completed cohorts to-date that are enrolling openly to proportion and regarding that 18 month timeframe, just given the growth hormones that is in short stature, that is out for a little longer by 24 to 36 months, do you think there is a potential for the open label to be extended if you want to use it for regulatory filings? Thanks.

Hanks Fuchs

Analyst

Yes, as we retain or drive a person [ph] and it's true for VIMIZIM and all the products before it, we do extension studies for it in the severe chronic diseases, obviously with achondroplasia, the consideration really is that administration of the experimental agent would be appropriate up till the time the growth plate grows as to numbers of patients disposition of numbers of patients in ongoing studies, we won’t comment on that but we do plan extension studies and I think there is second part to your question. Well, the growth hormone I think is on some level irrelevant compared to growth velocity as primary outcome variable, some considerations of sustained improvements in growth velocity. I do think that these extension studies will play an important role in supporting the interpretation of the data, both in terms of phase II data but also in terms of supporting registration. It's a little bit I'm going to talk about at this stage what's going to - what the primary end point of the registration directed trials is going to be, what the design is going to be, and what length of follow-up is going to be required just for registration because we haven't really test the proof-of-concept point just yet, so I would say stay tuned.

Operator

Operator

Thank you. Our next question comes from the line of Michael Yee from RBC Capital Markets. Your question please.

Unidentified Analyst

Analyst

Hi, thanks. This is John on behalf of Mike Yee. I'm sorry if this is addressed early as I got disconnected in middle. In the beginning you mentioned that the FDA interaction is regarding drisapersen, it has been very encouraging and that you expect potentially early approval. Yet on an earlier question you sort of characterized a content of the discussion as with normal steps without stage. So can you just provide more color on your reason for encouragement, perhaps that's been a change in tone. And is there related exploitation to still run to confirmatory post-marketing studies? Thank you.

Hanks Fuchs

Analyst

Yes, this is Hank and I'm from BioMarin. I think it’s one thing to read about corresponding to another to actually engage in it directly. So I think the extent to which we are pleased with the progress that's been made with the Food & Drug Administration comes from just being involved in it directly ourselves. And there is clearly collaborate tone, I've said before that the FDA, in other settings that they are really excellent outstanding reviewers of an application, I think we're all benefited by the fairness, the comprehensiveness, and the insight that their review has generated. And then that specifically leads to a comment about confirmatory studies themselves, there has been some preliminary signaling about what might be required. We continue to believe that we will be able to fulfill any potential requirements for post-marketing registration, post-marketing commitments for confirmatory studies, but as we are just about to enter the review process it would be premature to speculate any further on what the specific content of review is. The really important principle is that post-marketing requirements must match issues raised during the reviews, so stay tuned, be patient with us and allow the time for the review to occur, and as we do that we believe that the outcome of that review will be better for everybody, patients especially.

Operator

Operator

Thank you. This does conclude the question-and-answer session of today's program. I'd like to hand the program back to management for any further remarks. JJ Bienaimé: Thank you, operator. So in summary BioMarin continues to meet or exceed its financial, commercial, clinical and regulatory roles. The strong foundation that we've put in place in 2014 including the acquisition of Prosensa and the DMD franchise with the potential near term opportunity for approval of drisapersen, continued progress of our robust development pipeline, the strongest new product launch today at BioMarin of VIMIZIM worldwide, continued growth of our legacy products including Naglazyme and Kuvan, and we're selling our cash reserves to enable our path to profitability; all these factors position BioMarin for a very busy and fruitful 2015. So we thank you for your continued support and joining us on today's call. Bye.