Joseph Belanoff
Analyst · Greg Fraser with Truist
Thank you, Charlie. Our Cushing's syndrome business is built on a solid foundation, a life-saving medication promoted by a commercial team that puts the interest of patients first. Leading endocrinologists increasingly believe that there are considerably more patients with Cushing's syndrome that was once assumed. Korlym is an excellent achievement for patients with Cushing syndrome and there are many eligible patients who have yet to receive it. We are making substantial investments to improve the screening and treatment of these patients, most notably our recently initiated CATALYST study and are extremely optimistic about the growth potential of our Cushing's syndrome business. In the first quarter, we saw an increase in the number of patients receiving Korlym and in a number of physicians prescribing the medication. We are raising our 2023 revenue guidance range to $435 million to $455 million. We are also very encouraged by the progress of our clinical development programs. Since inception, our research and development efforts have built on the hypothesis that cortisol modulation can be a powerful therapeutic mechanism in many serious disorders. Our proprietary compounds modulate cortisol's effects binding to the glucocorticoid receptor or GR. The receptor which is activated when cortisol levels are high. They do not bind to the progesterone receptor and so don't cause some of Korlym's our approved products in the serious off-target effects. Interestingly, while our compounds modulate cortisol activity without modulating progesterones activity, they are not identical. Some cross the blood-brain barrier, others do not. Some perform best in models of solid tumors, others are more [indiscernible] disease. Some appear to be tissue specific, others have more global effects. These diverse qualities allow us to study a wide variety of disorders. Currently, we are conducting programs with 3 of our proprietary selective cortisol modulators, relacorilant, dazucorilant and miricorilant in ovarian, adrenal and prostate cancer, ALS, NASH and, of course, Cushing syndrome. We have additional compounds in clinical and preclinical development. In the next 12 months, we expect data from our GRACE, Gradient and NASH Phase Ib studies, submission of the NDA for relacorilant in Cushing's syndrome, completion of enrollment of our catalyst, ROSELLA and DAZALS studies and initiation of a Phase IIb trial of miricorilant in patients with NASH. This is a very exciting time for Corcept. We are evaluating relacorilant in the treatment of hypercortisolism in 2 Phase III trials: GRACE and GRADIENT. Relacorilant is a selective cortisol modulator. Like Korlym, it achieves its effect by competing with cortisol at the glucocorticoid receptor. Unlike Korlym, it does not bind to the progesterone receptor, PR for short and so does not cause PR-related side effects, including termination of pregnancy, endometrial thickening and vaginal bleeding. By a different mechanism, relacorilant also does not cause hypokalemia, low potassium, a serious side effect experienced by 44% of patients in Korlym's pivotal trial. Korlym induced hypokalemia is a leading cause of discontinuation. Relacorilant's Phase II efficacy and safety data were compelling. Patients experienced meaningful improvements in hypertension and glucose control as well as in a variety of other signs and symptoms of Cushing's syndrome. There were no relacorilant-induced instances of endometrial thickening or vaginal bleeding and no drug-induced hypokalemia. The trial results were published in Frontiers and endocrinology in July 2021. We are pleased to share that we have identified all the patients necessary to complete our GRACE trial. We plan to complete enrollment in the coming weeks. GRACE will serve as the basis for our NDA submission in Cushing's syndrome which we plan to submit in the first half of 2024. Our second Phase III trial in hypercortisolism gradient is studying relacorilant effects in patients whose Cushing's syndrome is caused by an adrenal adenoma or adrenal hyperplasia. Patients with this etiology of Cushing's syndrome often experience a less rapid decline but their health outcomes are poor, including a higher risk of death. While we do not expect our NDA in Cushing's syndrome to depend on data from GRADIENT, we do expect that its findings will improve the care of these patients. We are also excited that our recently initiated CATALYST study is now enrolling patients. CATALYST is a 1,000-patient Phase IV trial examining the prevalence of hypercortisolism in patients with difficult to control type 2 diabetes. Patients diagnosed with hypercortisolism may enter a randomized, double-blind, placebo-controlled study of Korlym. Many independent studies conducted over the last 15 years have found that the prevalence of hypercortisolism in patients with type 2 diabetes is substantially higher than in the general population. The most prominent diabetologists in the United States helped us design and are participating in CATALYSTS which will be the largest study of its kind. Data from CATALYST will enable physicians to better identify and care for these patients. We expect to complete enrollment by the end of this year. Our oncology program is testing 3 anticancer mechanisms, first postulated by investor gates [ph] at the University of Chicago and later confirmed by other prominent researchers. One mechanism is increasing apoptosis, the program cell death that chemotherapy is meant to induce in solid tumors. Cortisol works against the beneficial effect of chemotherapy by suppressing apoptosis. And our successful controlled Phase II trial in women with platinum-resistant ovarian cancer, the addition of our selective cortisol modulator, relacorilant, enhance the effect of chemotherapy, likely by blunting cortisol's anti-apoptotic effect. Relacorilant provided meaningful benefit to many of the women in our study. While these women's disease have progressed on 2 or more previous lines of treatment, including previous taxanes, relacorn appear to resensitize the disease to chemotherapy's beneficial effects in some women. Those who received relacorilant intermittently the day before the day of and the day after they received nab-paclitaxel, exhibited a statistically significant improvement in progression-free survival and duration of response compared to the group who received nab-paclitaxel monotherapy. We went in the intermittent relacorilant group also live longer than those in the comparator arm with a p-value that approached statistical significance. 29% of the patients who took intermittent relacorilant were live 2 years after their study start versus only 14% who took nab-paclitaxel alone. Perhaps even more important, the women who received relacorilant plus nab-paclitaxel experienced no additional side effect burden compared to those who received nab-paclitaxel alone. The results from this study have been submitted for peer review publication and were featured in podium presentations at the 2021 and 2022 European Society for Medical Oncology, ESMO meetings and the 2022 American Society of Clinical Oncology, ASCO Annual Meeting. ROSELLA, our pivotal Phase III trial in recurrent platinum-resistant ovarian cancer is enrolling patients. ROSELLAs design closely tracks our Phase II study. Planned enrollment is 360 women randomized 1:1 to receive either elacorilant plus nab-paclitaxel or nab-paclitaxel alone. The primary endpoint is progression-free survival with overall survival, a key secondary endpoint. We are conducting this study in collaboration with leading clinicians from the Gynecological Oncology Group in the United States and the European Network of Gynecological Oncology Trials Group in Europe. We are on track to complete enrollment in ROSELLA by the end of this year. Our goal in Phase IIi is simply to replicate our positive Phase II results. Leading gynecological oncologists have told us that, in their view, elacorilant potential benefit, improved progression-free and overall survival without increased side effect burden would constitute an important medical advance in the relacorilant plus nab-paclitaxel has the potential to become a new standard of care in women with platinum-resistant ovarian cancer. A second mechanism by which cortisol modulation may prove useful is by blocking an important tumor growth pathway. Cortisol stimulation is a major reason why patients with prostate cancer treated with the widely prescribed androgen receptor antagonist enzalutamide, eventually experience resurgent disease. Deprived of androgen stimulation, their tumor switched to cortisol activity to stimulate growth. Our hypothesis is that adding a cortisol modulator to androgen deprivation therapy will close this tumor escape route. By midyear, our collaborators at the University of Chicago plan to begin a randomized placebo-controlled Phase II trial of relacorilant plus enzalutamide in patients with prostate cancer before these patients have had an initial prostatectomy. A third therapeutic mechanism seeks to treat tumors by enhancing the body's immune response. Cortisol suppresses the immune system which made lunky [ph] effectiveness of cancer therapies intended to stimulate the immune system. Our hypothesis is that adding a cortisol modulator to immunotherapies such as checkpoint inhibitors, may enhance the effectiveness of those therapies. We are conducting a Phase Ib trial of relacorilant, plus the PD-1 checkpoint inhibitor, teplizumab in patients with advanced adrenal cancer whose tumors produce excess cortisol. Pembrolizumab is rarely effective as monotherapy in treating this form of adrenal cancer. ALS, commonly known as Lou Gehrig's disease is a devastating illness with an urgent need for better treatment. DAZALS, our 198-patient randomized double-blind placebo-controlled Phase II trial dazucorilant in patients with ALS is briskly enrolling patients. Dazecorilant is a selective cortisol modulator that has shown great promise in animal models of ALS, improving motor performance and reducing neuroinflammation and muscular atrophy. We are conducting this important study in collaboration with TRICALS, the leading ALS academic consortium in Europe. We are on track to complete enrollment in DAZALS by early next year. Finally, I'll turn to our program in NASH, a serious liver disorder that affects millions of patients in the United States. Miricorilant an oral medication continues to demonstrate great promises of treatment for NASH. In our prior NASH study, patients who receive miricorilant exhibited large rapid reductions in liver fat but also substantial albeit transient, elevations in the liver enzymes ALT and AST. The improvement in liver fat in these patients was greater and occurred much more rapidly than we had expected and is rarely seen over any period of treatment. Our Phase Ib dose-finding study which has completed enrollment, has identified a range of doses, all substantially lower than our originally tested doses that appear to cause large reductions in liver fat without causing excessive liver irritation. We expect to share results from the study by midyear and plan to start a Phase II trial in the fourth quarter of this year. In conclusion, we are extremely optimistic about the growth potential of our Cushing's syndrome business which continues to generate substantial profits even as our development programs advance. We have raised our revenue expectations for this year and expect growth for years to come. Our newest study, CATALYST, represents a significant investment to improve the screening and treatment of patients whose difficult to control diabetes is caused by hypercortisolism, a population who's Cushing's syndrome to frequently goes undiagnosed. Our development programs are generating increasing evidence that validates our long-held belief that cortisol modulation has the potential to treat a wide range of diseases. Reducing cortisol activity is a straightforward and effective way to treat Cushing's syndrome and can offer substantial benefits to patients with other serious disorders. Ovarian cancer, ALS and NASH are current examples but there will be others. In addition to relacorilant dazucorilant and miricorilant, we have many other proprietary selective cortisol modulators in our portfolio with potentially very different clinical attributes. In the next 12 months, we will see data from our development programs in Cushing's syndrome and liver disease will submit relacorilant's NDA in Cushing's syndrome and will complete enrollment in large controlled studies of recurrent platinum-resistant ovarian cancer, ALS and diabetes caused by hypercortisolism. We will also begin a Phase IIb trial in patients with NASH. As I said, it is an exciting time for Corcept. I thank our dedicated creative employees and loyal investors for making that possible. I'll stop here for questions.