Sabrina Martucci Johnson
Management
Thank you for that question, and that opportunity to highlight that. So let's start with the current standard of care today. So the current standard of care has curates in the mid-30s to the mid-60s. So that's all your FDA approved products for bacterial vaginosis, and that includes oral as well as vaginosis. The challenge with bacterial vaginosis treatments is that many of the treatments on the market require administration every several days, which is often challenging, both in terms of compliance and then outcomes. So on top of the curates, you have the challenges and just how those many of those products are administered. And so, but however, they tend to rely upon two of the same antibiotics predominantly metronidazole or clindamycin. So in the case of BV1, we are using 2% clindamycin. It's a dosage form. And a antibiotic that has been previously studied in bacterial vaginosis, has a cure rate in that range that I talked about. The challenge, and physicians typically and patients prefer a vaginal administration in this indication because of the types of symptoms she's experiencing, there's benefits to delivering something vaginally, given also that it's a highly recurrent condition. So you want to avoid as much as possible recurrent administration of oral antibiotics. The challenge with vaginal administration is frankly just keeping the product where it needs to be. So products tend to leak out that vaginally, and that is likely what has negatively impacted the cure rates of antibiotics like clindamycin, that really are time cord, they need to be present, you need to have the resident to fight the infection. So the innovation in DARE-BV1 is that drug delivery platform, it's the hydro gel thermosetting hydro gel formulation, it's quite viscous and bio adhesive and thermo settings, it becomes more so once it's heated to her body temperature, and that one and done delivery. So it's just one administration of the product. So she only has to do it once. In terms of nominate turn to the cure rate in the trial design. So the nice thing about bacterial vaginosis, in terms of clinical studies is that pretty much we've across time, essentially, as products have been developed in bacterial vaginosis, they're looking at some permutation, where they looking at two or three or four. But it's always been kind of the same sort of clinical signs and symptoms that distinguish the condition and become part of the cure, calculation. And in the recent years, the FDA actually in 2019, finalize their guidance. So typically, you're looking and now you're specifically looking at whether there's resolution in a very distinctive vaginal odor that is present, a very distinctive vaginal discharge that is present with bacterial vaginosis, and then you're looking for a reduction, a specific percent reduction down to below 20% in a type of cell called cells that are associated with this sort of inflammatory sort of response. So that that is how you determine cure. And like I said that that same array of symptoms and sometimes pH is looked at as well has been looked at kind of across time of the products that have been approved for bacterial vaginosis. So with our program, given that the range right now of the approved treatments is mid-30s to mid-60s, most of them with few exceptions or multiple dose administration's there are one time vaginal and one time oral but most of the products are multiple dose administration's. Frankly, a cure rate in that high end of that range is great because this is a onetime administration. It's a very clean formulation. It's aesthetically because of how bio-adhesive it is, there are some features and benefits that are attractive to a potential user. And this is all data by the way, there were also, encaptured in the Phase 3 is around that acceptability and her perception of the product. The investigator initiated pilot study using that same criteria, but it is 7 to 14. I'm going to talk about the time points in a second, show that 86% cure rate, and it maintained in that 80 range, even today, 21 to 30. And so, we'd love to see curate in that range. But your question of like, what do we need, we don't need that range, we'd love to see it, you know, anything that shows an improvement over the standard today of the mid-30s to mid-60s. And given that this is a onetime vaginal clear gel formulation is definitely very attractive. In terms of the trial design and what you should expect. So we announced in the queue that there were a total of just over 300 patients that we ended up enrolling in the study, a little bit higher than we expected. And so one thing I'll say is that, you're hearing a lot about COVID and impact of COVID on studies. We did not see any impact on enrollment in this study. And in fact, we ended up over our enrollment target because of how fast enrollment was going and you know what we need to do to support that. And so we ended up a little higher than what we had expected, which is fine. It's two to one, ask it to placebo. The primary endpoint is that test of cure assessment that I talked about, that vaginal odor, discharge and clue cells returning to non BV state at day 21, to 30. So I'll also highlight that of our clinical programs, this was a, if you're going to pick two clinical programs to run during COVID, I would say BV1. And our HRT1 programs, at least out of our portfolio were the obvious choices for us. They're both 30 day studies. So they're fairly quick for the patient, in terms of duration of commitment. And they allowed us frankly, to get a lot of really valuable information that we are now using as we're planning for Sildenafil Cream and Ovaprene studies which are which are longer, which are longer than a month. So in terms of what you should expect, when we when we announced top line, it's really around that primary endpoint, which is test of cure in the active arm versus placebo. And we're looking for statistical separation between the two.