Earnings Labs

Cytosorbents Corporation (CTSO)

Q1 2015 Earnings Call· Mon, May 11, 2015

$0.62

+1.12%

Key Takeaways · AI generated
AI summary not yet generated for this transcript. Generation in progress for older transcripts; check back soon, or browse the full transcript below.

Same-Day

-3.23%

1 Week

-12.24%

1 Month

-9.99%

vs S&P

-10.47%

Transcript

Operator

Operator

Please standby. Good day, everyone. And welcome to the CytoSorbents’ First Quarter 2015 Financial Results Conference Call. [Operator Instructions] Today’s call is being recorded. And at this time, I’d like to turn the conference over to our moderator, Lee Roth. Please go ahead.

Lee Roth

Analyst

Thanks very much, Mickey, and good afternoon, everyone. And welcome to CytoSorbents' first quarter 2015 operating and financial results conference call. Joining me today from the company are Dr. Phillip Chan, Chief Executive Officer and President; Vincent Capponi, Chief Operating Officer; Kathleen Bloch, Chief Financial Officer; Dr. Christian Steiner, VP of Sales and Marketing from Germany; and Chris Cramer, VP of Business Development. Before I turn the call over to Dr. Chan, I would like to remind listeners that during the call management's prepared remarks may contain forward-looking statements, which are subject to risks and uncertainties and that management may also make additional forward-looking statements in response to your questions today. Therefore, the company claims protection under Safe Harbor for forward-looking statements that is contained in the Private Securities Litigation Reform Act of 1995. Our actual results may differ from the results discussed today and therefore, we refer you to a more detailed discussion of these risks and uncertainties in the company's filing with the U.S. Securities and Exchange Commission. Any projections as to future performance represented by management, including estimates, sorry, include estimates as of today, May 11, 2015, and we assume no obligation to update these projections in the future as market conditions may change. During today's call, we will have an overview presentation covering the financial and operational highlights for the first quarter by Dr. Chan and Ms. Bloch. Following that presentation, we will open the line to your questions during the live Q&A session with the rest of the management team. At this time, it’s now my pleasure to turn the call over to Dr. Phillip Chan. Dr. Chan, go ahead, please.

Dr. Phillip Chan

Analyst

Thank you very much, Lee, and thank you everyone for joining the call today. It's a pleasure to be here and welcome. For today’s call for the benefit of new shareholders and perspective investors, I will first start with the brief introduction of our company, then Kathy will go over financial results for the quarter and then we will discuss the factors that we believe will drive our growth in 2015. Then we will open up to a live Q&A period. An official transcript of today’s call will be available in the next few days on our website at www.cytosorbents.com. Cytosorbents is an emerging leader in critical care immunotherapy. We are leading the prevention or treatment of life-threatening inflammation in the ICU using CytoSorb blood purification. What we are targeting is a $20 billion opportunity in critical care. Every year millions of people are admitted to the intensive care unit in hospitals around the world for deadly inflammation -- inflammatory condition such sepsis, severe lung injury, burn injury, trauma, pancreatitis, influenza, complications of surgery, particularly cardiac surgery and many others. And in these conditions massive inflammation is often driven by a cytokine storm that cause cell death and organ failure, and nearly half of all deaths in the ICU are due to organ failure with no effective therapies, because of the lack of effective therapies approximately one out of every three patient dies and the cost can be staggering. The lack of active therapy leads to patients lingering days to weeks at a time at a cost of $2,000 to $3,000 a day on average in the intensive care unit and it's not surprising that we spend nearly 1% of our gross invested product or $80 billion to $90 billion on critical care medicines every year here in United States.…

Kathleen Bloch

Analyst

Well, thank you, Phil, and good afternoon, everyone. For today's call I will be providing an update regarding CytoSorbents’ first quarter 2015 financial results, including product sales, as well as an update around our working capital and cash runway. Turning to our financial results, the first quarter of 2015 product sales were approximately $704,000, which is a 24% increase over first quarter 2014 product sales of approximately $569,000. One factor negatively influencing first quarter product sales was the drop in the euro relative to the dollar. In the first quarter of 2015, the value of the euro averaged $1.13 as compared to the first quarter of 2014, when the euro value averaged $1.38. And this decrease in the value of the euro effectively reduced our first quarter 2015 sales by approximately $112,000 or 16% of total product sales. Grant income was insignificant for the first quarter of 2015 at approximately $19,000 as we are winding down several major grants. And then finally, we want to note that we were able to achieve growth product profit margin of approximately 59% in the first quarter of 2015 as compared to 61% for the first quarter of 2014, this despite the drop in the euro. Next, we’ll turn to our chart of products sales by quarter, which shows the decrease in sales in Q4 2014 and then again in Q1 2015. And this decrease in Q1 2015 sales is really attributable to three factors. The first is the decline in the value of the euro which I’ve just discussed. The second is the fact that there are no initial orders from new distributors in the first quarter of 2015, which is simply a matter of the timing of bringing new distributors on board. And third, it’s the impact of the restructuring and rebuilding…

Dr. Phillip Chan

Analyst

Thanks very much Kathy. Right now, I'd like to just cover our catalyst for growth. And as we’ve talked about in the past, one of the major catalysts is our core focus on CytoSorb sales. These are six of the most -- these are six of the very important factors that will hopefully lead to our success in the marketplace. One is that we are working with major key opinion leaders worldwide. We've been fortunate to have the sponsorship and leadership for many key opinion leaders not just in our direct territories of Germany, Austria and Switzerland, but also in many countries around the world that are supporting the use of CytoSorb. Now, this is very important because we look to not only sell to the key opinion leader, which is typically the Head of the Department but also to get junior and senior physicians who are in the department to use the therapy. So this could have dramatic impacts on our growth rate going forward. So if you just take the first and the second picture here, if you just take the first six doctors sitting in the front row here and if they use, CytoSorb every week on one patient, just each of them used it on one patient for every week, that would result in revenue -- a revenue opportunity for this ICU alone of approximately $1 million to $1.5 million. Now, when you coupled that with the fact that there are many ICUs in the hospital, not just a medical ICU but a surgical ICU, a cardiac ICU, a trauma ICU and others, the revenue opportunity here becomes very significant. Now to us, $1.5 million sounds like a lot of money, but when you think about what the operating budgets are for these hospitals, they are…

Lee Roth

Analyst

Operator, we are ready to pull for questions.

Operator

Operator

Yes. Thank you. [Operator Instructions] And we will take our first question today from Andrew D'Silva with Merriman Capital. Please go ahead.

Andrew D'Silva

Analyst

Good afternoon, guys. Thanks for taking my call. Just a couple quick questions for you, I guess, in your prepared remarks you said something about an initial order with one year strategic partners. Could you elaborate on which partner that was, was it Fresenius or another one? And then, when do you expect their sales teams to actually start pounding the table in France and distributing the product within their network?

Dr. Phillip Chan

Analyst

Yes. So the initial order was actually by our cardiac surgery partner in France that was to support the initial market evaluation. It was not a big order but it was certainly a good start and we were looking for more sales from this partner in the future. I think in terms of expectation -- setting expectation for sales, this is viewed as a in both the case of cardiac surgery, as well as Fresenius starting in Q3, there may be some upsides to that timing but that would be our expectation.

Andrew D'Silva

Analyst

And that our order that you mentioned, is that going to be a Q2 event or is that -- was that in Q1?

Dr. Phillip Chan

Analyst

That is a Q2 event.

Andrew D'Silva

Analyst

Okay. And then moving over to your FDA approval process, do you have any sense this time assuming you get to the REFRESH process? Is this going to be a PMA or 510(k) approval or anything else in between there?

Dr. Phillip Chan

Analyst

So in our discussions with the FDA, the FDA has kept the order open to potential De Novo 510(k) application or a PMA application. There are potential advantages to both, the De Novo 510(k) path would potentially be for a biomarker reduction application, specifically, a reduction in free hemoglobin. And that could potentially be a very small trial, very fast trial and something that would be relatively low cost. The PMA trial would be focused more on clinical outcomes, such as the prevention of acute kidney injury or the reduction in ventilator days. And that would be a larger trial but currently we're waiting for the completion of the REFRESH feasibility study where we are collecting a lot of biomarker data, as well as clinical outcomes data and basically are waiting for our discussion with the FDA, following the completion of that trial in order to determine which path we are going to take.

Andrew D'Silva

Analyst

Is there a substantial cost difference between the two regulatory pathways?

Dr. Phillip Chan

Analyst

Yes. The De Novo 510(k) path would be much less expensive and the order of millions of dollars less expensive.

Andrew D'Silva

Analyst

Okay. Last question for you. As far as you know revenues that you're generating now and in the first quarter. Could you maybe give us a sense of where they're coming from, are they repeat orders from hospitals and ICU that you had to establish relationships with in Germany and so forth or is it the more related to new distributors and strategic partners filling up their funnel, little bit of context. Obviously all revenue isn’t created equal?

Dr. Phillip Chan

Analyst

Sure. Yeah. So the vast majority of our orders are reorders from existing customers or distributors. It is where we have been seeing a lot of traction. And I think that has been a very positive thing. Interestingly, however, we are seeing a lot of new orders as well. One of our strategies going to marketplace is really focusing on the largest hospitals, largest university and public hospitals and gaining key opinion leader support from them. But the consequence of doing that is that there's been a lot of excitement, lot of chatter, a lot of discussions with colleagues around the country. And in Germany, there are 2100 acute care hospitals on. There are 400 with more than 400 beds in the hospital. So we’ve been targeting really the top 400. But where we’re seeing a lot of interest is from small hospitals also sharing about the technology and ensuring about the successes from the larger hospitals and them being very receptive to starting their CytoSorb treatment experience with us. So I would say that you need both reorders as well as new orders in order to build the market. And I think that we have a very nice balance currently.

Andrew D'Silva

Analyst

Okay. Got it. Thanks for taking my questions…

Dr. Phillip Chan

Analyst

Thanks. Thanks a lot, Andy.

Andrew D'Silva

Analyst

And I [indiscernible]

Dr. Phillip Chan

Analyst

Appreciate it.

Operator

Operator

And we’re going to a question from R.K. with HC Wainwright. Please go ahead.

R.K.

Analyst

Good evening, Phil. Good evening, Kathy.

Dr. Phillip Chan

Analyst

Hi RK.

R.K.

Analyst

Looking at the revenues and COGs, just to start up from the top. I know we can blame the exchange rate for a while but if we do not consider the exchange rate, the Euro exchange rate. How did you do sequentially compare to the fourth quarter ‘14 because I don’t remember the clean number for the fourth quarter ‘14, just for that reason, I’m asking that question. And the second part of that question is it’s nice to see that you are putting in all your efforts to get the sales force get back to the number that increase a little bit. How along would that behave and then, not considering the euro exchange issue when would we start seeing that number and certainly up again?

Dr. Phillip Chan

Analyst

Kathie, would you like to take me to the first part of that question?

Kathleen Bloch

Analyst

Yeah. Sure, Phil. Hi, R.K. So the real number for the Q1 sales is the $704,000 that we reported and as we stated, the impact of the reduction, the decline in the euro was about $112,000. So, I’d say the comparable number to be working with that quarter is about $816,000. And also I want to just comment a little bit on what you can expect going forward. So another decline -- the euro has sort of stabilized, so we are happy to see that. But surely another decline in the euro would have a further negative impact on our sales. But in fact, this impact is somewhat mitigated by a fact that almost one-half of our sales are in U.S. dollars. So, a say, 10% drop in the euro would have approximately a 5% decline in product sales. And then just the other side of the coin because we are funding our German subsidiary, it's not at breakeven, right. So we are still funding it. The decreases in the euro also to some extent reduced the expenses associated with that operation that are being funded in U.S. dollars. I hope I answered your question.

Dr. Phillip Chan

Analyst

Yeah. So, I think Q4, we did about $171,000 in product sales and adjusting for the steep drop in the euro at the beginning of Q1 of this year, that number on a comparable basis would've been approximately $816,000. So it's roughly comparable. I would call it flat. But clearly, our goal is to be working on all three cylinders of revenue generation where currently direct sales is a major part. So again, the two other engines of growth are distributor sales as well as potential partner sales as well. So in terms of your second question about the sales force, our goal is to have the team rebuild by the end of Q2. Because of the labor laws in Germany, there's typically a waiting period before they can actually start. But the two that we have already signed with, will start at the beginning of Q3 and the other two may, depending on their ability to get out of their current employment situations would potentially, that timing would be more variable. But I think while we continue to rebuild the sales force, we are not stopping with the effort on distributor sales as well as partner sales and those will continue and we expect that as we mentioned, Q3 is a good conservative timing for the initial Fresenius. The initial launch of the product by Fresenius could be sooner but we are saying Q3 is what we are targeting and then the cardiac surgery company also, as they go through this market evaluation, we expect that to pick up in the remainder of Q2 and hopefully be in a position of a larger partnership in Q3.

R.K.

Analyst

Just as a follow-up to those questions, we also saw that the COGS decline was also a factor of euro. So is that also going to be mitigated -- not actually, do manufacturing the products here and selling there, actually that’s not an issue or you have it wrong?

Dr. Phillip Chan

Analyst

Well, I think of the calculation of gross margins, you're looking at a sale in Europe that is converted into dollar, initially in euros is converted into dollars and then in the United States, the COGS are really dealt around dollars. And so any drop in the ASPs because of the conversion of the euro into dollar will result in a decrease in our gross margins. That being said, our COGS, we actually have a path to continue to drop our cost of goods sold that will culminate ultimately with the expansion of our manufacturing facility and hopefully the economies of scale that we will gain by the larger facility that we’re planning. But that being said, we are not sitting still in terms of our gross margins. We continue to believe that we can drive our gross margins higher as we gain economies of scale and drive the cost of goods sold, and also -- and hopefully that will be helped by stabilization of the euro, if not rebound in the euro.

R.K.

Analyst

Okay. Again another question on these German accounts. Are the German accounts normally renegotiated every year or do you have German accounts which run over multiple years? The reason I am asking the question is, because if you don’t have the personnel in place for the direct sales, would that hinder in getting any negotiations or contracts that you planned over the next three to six months, then they are still building the sales force site?

Dr. Phillip Chan

Analyst

Yes. So our sales are not based on contracts. So in other parts of the world like Middle East, they do work on tenders where they -- or even Turkey for example, they work on large orders, large tender orders are then filled over time. In Germany, it is still a very much quarter-to-quarter sale, direct sale and so there are no long-term contracts in Germany yet. But as we used more, as we start being used as a standard-of-care for different therapeutic indications, the potential for contracts exist, but currently right now it’s a quarter-to-quarter sale basis, direct sale basis.

R.K.

Analyst

Okay. A couple more questions. The French cardiac surgery partner, have they started evaluation period? Or because it’s a six month evaluation period and I am not clear from your comments whether it has started or they are not started, I do certainly heard that you’re expecting revenues from Q3.

Dr. Phillip Chan

Analyst

Yes. So they are just about to start and maybe let me turn this over to Chris and maybe to talk about sort of the activities that have led up to the state, because we certainly have not been standing still with this partnership. I think both sides have been pretty motivated to get this off the ground. But as with all things, there is a process involved. And Chris, maybe if you could comment?

Chris Cramer

Analyst

Sure. Thanks, Phil. Hi, RK. So for the cardiac partnership, you can think of this as really two phases to the market evaluation. One is procedural and administrative, and then the second is clinical usage. So the majority of the heavy lifting takes place during the first phase. This is where you’re getting everything setup. It includes matters such as registration, getting setup in the partners purchasing system, trainings and other activities, and typically it takes longer than the clinical evaluation. So I am pleased to say that we are finished with this first phase, really the setup phase. And when Phil talks about the ordering from the partners, so they have ordered, they received the product and we are very close to starting the actual clinical usage. And that part will begin with identifying patients to receive CytoSorb therapy. So once underway the goal would then be to treats 10 to 12 patients and we believe this can be accomplished over the next two to three months. And so ultimately, this evaluation will give us the information needed to potentially expand to additional sites within France and to possibly negotiate a larger partnership with this partner. So that’s where we currently stand. Hopefully that answered your question.

R.K.

Analyst

Yes. Thanks. So after the evaluation period, you don’t expect a long-term formalizing this relationship, you expect these things to be done quickly, is that…

Dr. Phillip Chan

Analyst

I’m hoping that’s the case. We’re assuming that the evaluation goes well and that we can quickly move to formalize something like that.

R.K.

Analyst

Got you. Fantastic. Thank you, folks. Thank you for taking all the questions.

Dr. Phillip Chan

Analyst

Sure, R.K. Thank you very much.

Operator

Operator

[Operator Instructions] And we’ll now go to Thomas Yip with MLV & Company. Please go ahead.

Thomas Yip

Analyst

Hey, guys. Thank you for taking my questions. Rob sends his regard.

Dr. Phillip Chan

Analyst

Hi, Thomas.

Thomas Yip

Analyst

Hey everybody. So just a couple of quick ones. I guess, we’ll go back to your European sales force ramp up and reorganization. What do you see to be the near-term impact of that on the topline for rest of this year in those areas?

Dr. Phillip Chan

Analyst

It’s hard to quantitate the impact of the sales force. I think, certainly in the first half of the year, particularly in Q1, without having the sales people on the ground, we saw a decrease in direct sales because we just did not have people in the territories, knocking on doors and driving those sales. I think it's really important to note that when it comes to selling. It is not just about getting the key opinion leader or the Head of the Department or your champion to say yes and agree to buy the product. It is really a process of getting everybody on board, the five or six stakeholders in the hospital, the household administrator, the person who handles reimbursement, the formulary person, et cetera, who are really involved in that decision-making process. So, we see actually a tremendous amount of interest and demand from the end-user physician. But sometimes it requires a lot of effort on the part of our salespeople to push through these orders through the hospital administration. So, we expect that to really -- our sales force will be back to full force in the second half of this year. The majority of the sales force will be up and running in early Q3. The people that we've signed for the Northeast and Northwest territories in Germany that will start in early Q3 are well known to our folks in Germany. And we believe that they will be able to start up very quickly. They are ICU salespeople. They have their established network of ICU doctors that overlaps in a good part with our current ICU network plus adding additional contacts, which I think is great. And so I think that they can actually begin to generate revenue relatively quickly. Now, that being said just to set expectations, when someone starts, it does take time, right. You are learning the ropes. You are getting trained. There's a lot of start-up type activities. So, we expect them to be in full force in Q4. In Q3, we certainly expect them to contribute and take up where some of the other salespeople have left off. And then in Q2 again, what we said previously is that the growth will be driven predominantly by distributors and partners. The direct sales force, we expect will continue to be flat but the growth will be driven by the other drivers of our revenue. Does that helps?

Thomas Yip

Analyst

Sure. To me, it sounds like 2015 will be important time to set up for the sales force, get all the people on the ground for a more meaningful 2016 I think. So, I guess we can move on to the EAP Expedited Access Pathway in the U.S. that you talked about earlier.

Dr. Phillip Chan

Analyst

Sure. Maybe before we go there, just a couple other things to note. I mean, in Germany, we’re looking creatively about how do we address two markets in Germany in our direct sales territories. One is clearly the ICU. The other is in cardiac surgery. Those are two different kinds of -- two different kinds of markets. Today we’ve been effective in terms of being able to detail both of those. But there are ways to potentially leverage our current sales force and do so rapidly and that represents a potential upside in the near term, if we are successful in our efforts to do that. And we’ll -- I know that's a little bit vague, but we will most likely detail that in the future when things progress. So sorry, and so you got a question about EAP.

Thomas Yip

Analyst

No, it’s okay. Yes. So regarding EAP, it sounds like there are a pretty large number of both regulatory and financial incentives for the EAP. So when do you expect to file that application and when do you expect to get a response from the FDA?

Dr. Phillip Chan

Analyst

So working backwards, contractually just like the 510(k) process and other processes, it’s a 30-day turnaround from when you submit the application to when you expect to hear back from them. And so our goal is to submit a very well thought out and a very detailed application. The application is not a simple one. It involves not only a determination on why you meet the criteria of being a medical device that addresses a major unmet medical need. But you also have to propose a preliminary data designation plan where you are proposing what you plan to do to get early market approval and then what you plan to do in the post market period. Now once you get EAP designation, then you’re really going to hike your with the FDA and then are really negotiating these points in detail. But that being said, we are aggressively pursuing this and hope to have something to submit in the near future

Thomas Yip

Analyst

Sure. That's understood. So I am [indiscernible] application. So you need to prepare it as fast as possible. So I guess we can move on to a little bit to cytokine release syndrome indication that you mentioned earlier that CytoSorb could potentially expand into. You also mentioned some initiatives regarding this CRS indication. Can you expand a little bit more on what these initiatives are?

Dr. Phillip Chan

Analyst

Well, currently we can’t discuss that right now, but I think that when we make progress in those areas, I think that will be talking to shareholders about that. So I think some of the things that we are working on are very exciting and I think will provide us with the necessary background information to be able to go and demonstrate the potential of our therapy in this space. But again the cytokine release syndrome is -- the cytokine release syndrome is a kin to cytokine storm. And so it is just yet another cause of cytokine storm, that's right in line with things like sepsis and burn injury, trauma, pancreatitis, lung injury and other things. We are not -- don't necessarily have to be connected to clinical studies to be used as a rescue therapy for this or any other complication of cancer immunotherapy, whether or not it would be CAR T-cell therapy or other therapy. I think that's very important. So I think the way that we are thinking about this right now is that there are certainly potential opportunities in the CAR T-cell arena and activated T-cell arena with companies and alliances and that kind of thing and strategic partnerships. But if nothing else, we are firmly embedded in this space already. And we could be used today in fact if these were happening in Europe and they had a complication of CAR T-cell therapy, we could be used on those patients today. So very exciting area for us, and it is very much right up our family so to speak.

Thomas Yip

Analyst

Sure. Understood that. Thanks for the clarification. One last question regarding REFRESH, do I -- just want to clarify that and start enrolling in the next couple of months to mid 2015. And can you remind us what some of the future catalysts are?

Dr. Phillip Chan

Analyst

What was that last part, Thomas?

Thomas Yip

Analyst

For the REFRESH study, can you please remind us some of the expected data readout date though or enrollment target date etc cetera?

Dr. Phillip Chan

Analyst

Sure. Yeah. Well, we are on target to begin the trial midyear. And so -- sometime around summer time and again, we’re looking this is -- should be hopefully relatively short trial based of what my comments were before. In terms of the ability to roll patients very rapidly and really the minimal work that needs to be done, in terms of the intervention because it just happens during surgery. And then the follow-up period is more of a -- is a more way blood draw and clinical evaluation kind of thing. So we expect that the enrollment to occur very rapidly. And we are working with number of major centers in the country well known to our clinical enrollment team. And hopefully we'll have that study done before the end of the year with the goal of meeting with the FDA and look in to file an IDE for a pivotal study hopefully thereafter, once our -- the clinical development plan had -- the clinical development path has been clearly defined.

Thomas Yip

Analyst

Okay. Sounds good. Thank you again for taking my question.

Dr. Phillip Chan

Analyst

Okay, sure. Thanks so much.

Operator

Operator

And we’ll now go to the Jan Wald with Benchmark Company. Please go ahead.

Jan Wald

Analyst

Good afternoon. And thanks for taking my questions.

Dr. Phillip Chan

Analyst

Hi.

Jan Wald

Analyst

Hi. I guess, a couple of more clarifications than anything else. I just want to make sure when you were talking about the sales people and bringing them up to let’s called a full productivity. You said it has been taken by the quarter to do that, is that right?

Dr. Phillip Chan

Analyst

Yeah. I think, what I was saying is that, these are our sales people that are well known to our team. They have -- they are very experienced in the area of IC sales and but whenever you transfer over to a new product, it's getting up speed and making sure that, how to address the questions and how to pitch the product. And, so I think it's a bit of a learning curve, but again these are entities that are well known to the company which I think gives us a lot of confidence that we will be able to get up to speed very quickly. And we do expect them to contribute in Q3.

Jan Wald

Analyst

Okay. And on the Sepsis Trial, in case you don’t get the expedited review. Is the only flow back to the 28-day all-cause mortality endpoint or are there other ways to approach the FDA?

Dr. Phillip Chan

Analyst

So our original strategy for sepsis in United States is really to pursue a pivotal study that was not -- that where the outcome was not where you are not relying on the outcome for approval. And so that's one of the reasons why we went to a cardiac surgery trial in United States, because it was a much faster trial that the endpoints were not mortality, but they were more either biomarker reduction or a clinical outcomes. And if we do not qualify for the EAP pathway, we would fall back to the original strategy of getting CytoSorb approved initially in the United States for cardiac surgery. And then conducting a pivotal trial what I would say 28-day all-cause mortality endpoint trial in either Europe where we’re already approved or here in the United States, and then using that data to expand the label for CytoSorb here in the United States. So we want -- but if -- so that would be the case, if we did not achieve EAP designation. But -- so we'll see what will happen, but we do believe, based on the analysis of the FDA guidance that CytoSorb is a very good candidate for EAP designation.

Jan Wald

Analyst

I just was wondering what would happen if not expecting that would happen. And I guess, just my last question there is a lot of investigator trials that are going on. And I'm sure that part of your -- it's a great strategy but just a question, how many of them single centered, how many of them randomized? I guess, when I’m looking at is, what are you going to bring to the United States as part of the data package even you -- when you come to the United States your approval from the stuffs that going on in Europe?

Dr. Phillip Chan

Analyst

Yeah. So we -- the investigated initiated studies are a mix of different types of trial designs. Many of them are randomized controlled studies and some of them are retrospective studies using an active treatment arm against a retrospective control. For example, we have two cardiac surgery trials, one in University of Hamburg and one at Medical University of Vienna, that are actually randomized control trials and they are actually -- have actually completed enrollment. And so we’re hoping to see some data coming out of those studies in the future -- in the near future. And those will help support clinical usage, not only the support our discussions with the FDA, but also support clinical usage around the world. Now the FDA is the reason why we’re doing this feasibility study, this REFRESH feasibility study, is that they are looking specifically for safety data in the United States and hopefully, we'll get that done. And they've indicated that depending on the outcome of this study that they are very open to having a discussion about a potential pivotal study in the United States. So I think it is -- the U.S. regulatory path is not predicated on any kind of studies outside of the U.S. It is very self-contained study. But that being said, we will have hopefully safety data and cytokine and biomarker reduction data and other things that we can bring to the FDA and that would hopefully, help support our case. There is also been some recent guidance from the FDA where they are looking more favorably on ex-U.S. data, clinical data and I think, we’ll hopefully have that -- have a lot of different studies when we approach the FDA for different applications.

Jan Wald

Analyst

Okay. Thank you very much for taking the question.

Dr. Phillip Chan

Analyst

Sure. Absolutely. Thank you, Jan.

Operator

Operator

And at this time, I would like to turn it back to management for any additional or closing remarks.

Dr. Phillip Chan

Analyst

Great. Well, thank you everyone for taking the time today to get on this call. We certainly appreciate your participation. If you do have any other questions, please feel free to reach out to Amy Vogel at avogel@cytosorbents.com and we’ll try to get you answers to some of your questions as needed. In the meantime, we look forward to the next update on the next quarterly call. Thank you very much.

Operator

Operator

Thank you. And that does conclude our conference for today. I’d like to thank everyone for their participation and have a great day.