Tom Wessel
Analyst · ROTH Capital Partners. Your line is open
Thanks, Christoph. 2016 is a year of significant clinical activity for the Flex R&D team since we achieved our key goals in 2015. We have demonstrated statistically significant efficacy results in individuals with nocturnal leg cramps which exceeded our own internal expectations and we have identified our lead drug candidate, a single molecule chemically synthesized potent TRPA1, V1 ion channel activator. These achievements have positioned us to initiate three human efficacy studies in NLC, MS, and ALS this year with single agent molecules. In early February we announced that our prototype extract formulation beverage demonstrated statistically significant efficacy results across multiple endpoints in treating subjects with nocturnal leg cramps that we believe are clinically meaningful and compare well to the efficacy of Quinine. These results were presented at a late breaking abstract at the recent American Academy of Neurology Meeting as one of only 14 selected abstracts in a data bliss presentation. As a young company we are thrilled to have been chosen for two consecutive years now for podium presentations at this most important neurology conference. My presentation of these NLC results at AAN two weeks ago was met with much interest among practicing neurologists. Neurologists recognized the lack of therapeutic options for cramps to spasms and spasticity associated with many neurological diseases. The choices available to treat these common symptoms are imperfect. Anticonvulsant medications and other drugs have significant side effects and here in the United States Quinine is no longer available. In our randomized control blinded crossover study, we included healthy subject, 50 to 77 years of age who experienced nocturnal leg cramps at least four nights I believe, 50 subjects completed this study and we observed statistically significant effect on several important endpoints, cramp frequency, cramp-free days, physician-rated global the compression of change, CGI of change, difficulty in staying asleep is a sub question on the insomnia severity index and a VAS pain intensity over the last three days of each treatment period. The end results exceeded our expectations. Additionally, the formulation appear to be safe and well tolerated and no serious adverse events were reported. The positive effects were seen across a broad range of enrolled subjects. In addition, as commonly seen in CNS drugs, the subset of patients showed pronounced responses, 12% of patients had a 75% or greater reduction in cramp frequency done in the placebo group. And physicians accessed 40% of patients to be much or very much approved on active compared to 24% on placebo. These are just some of the ways of looking at clinical responses in this observation. We believe the benefits to subjects were clinically meaningful. The magnitude of effect in this study on reduction muscle cramps is similar to published Class 1 level Quinine efficacy study. As you know, Quinine was removed from the U.S. market more than 20 years ago. However it is still widely used in Europe and elsewhere. In the UK where Quinine is still prescribed, 4.5 million prescriptions were written in 2013, the population is fifth of the size of the United States. No other treatment besides Quinine has been shown to be effective for nocturnal leg cramp in randomized blinded control clinical studies and to our knowledge there are no other pharmaceutical agents in clinical development for nocturnal leg cramps. We estimate that nocturnal leg cramp effect four million Americans over the age of 65 and they suffer nightly. There is no FDA approved therapy in the United States to treat this condition. The lack of any approved medication for NLC in the United States represents a significant unmet medical need. Before going into the upcoming studies, I would like to remind you that after conducting a decomposition analysis of the extract formulation for the most potent TRPA1 and V1 agonists, we utilized our electrically-induced cramp model in normal, healthy volunteers to study various chemically synthesized TRPA1 and V1 agonists. We discovered that two separate synthesized single agents demonstrated enhanced efficacy by significantly reducing cramp intensity. These two individual TRP channel activators were superior not only compared to vehicle but also statistically significantly more effective than our original proprietary extract formulation. On this basis, we selected single agent FLX-787 to take forward as our lead drug candidate for our IND and to start clinical development outside of the United States. FLX-788 is another viable drug candidate. Now with positive results in nocturnal leg cramps we are able to accelerate product development of the single agent to treat NLC. As we previously announced, we expect to initiate another NLC study with our lead TRP activator later this year, with results expected in the first half of next year. Our current plan for the study is as a randomized control blinded crossover design and slightly larger than the NLC study concluded earlier this year which had 50 evaluable subjects. Since we have made substantial progress in our formulation work, the study article in this study will likely be formulated as an orally disintegrating tablet or ODT anticipating the eventual commercial formulation. As part of our NLC development program, we are also concurrently conducting smaller studies exploring alternative study designs, delivery mechanisms, dosage amounts, and/or product formulation. We believe these studies will help inform the planned clinical studies conducted under IND in the future, as we expect to start early next year in the United States. The study design of the MS and ALS studies outside the United States utilizing 787 will be similar to the recent NLC study design, randomized controlled blinded crossover studies. These studies are expected to initiate in the coming weeks and months. Thus, we will have several data readouts over the next year fall. In addition to our nocturnal leg cramp results, independent researchers at Penn State University recently presented results in athletes adding to the body of evidence that Chemical Neuro Stimulation via A1 and V1 TRP ion channels effectively decreases neuronal hyper-excitability, thereby preventing cramping. At the Experimental Biology Conference in April, Dr. Larry Kenney, a renowned researcher in the field of Exercise Physiology at PSU presented data from the own model of volitional muscle cramping in athletes. This is a positional non-electrical cramp paradigm closer to what athletes would experience in the real world. These experiments nicely complement our induced results and demonstrated a specifically significant benefit for our proprietary consumer formulation in reducing muscle cramps in athletes as compared to vehicle control. This effect was measured by surface EMG and showed a reduction in the intensity duration profile of the induced muscle cramp. Additionally subject ratings of muscle soreness resulting from cramps were also statistically significantly lower compared to vehicle control. As Dr. Kenney noted, these results are unique and that we have the only consumer product that has demonstrated efficacy in mitigating muscle cramp in a rigorous double-blinded scientific study. In summary, Flex is expeditiously advancing the clinical development in nocturnal leg cramps and the statistically significant human efficacy data generated in our first NLC study hold great promise as a new treatment for the millions of individuals in the United States who currently have no space on effective therapeutic options. These recent results certainly encourage us to look beyond exercise associated cramps and nocturnal leg cramps to spasms and spasticity in MS and other neurological diseases because we believe they are common underlying neurobiological mechanisms at place. With our ongoing and future clinical development programs, we expect to find the impact in this novel therapeutic approach to control neuronal hyper-excitability and prevent muscle cramps and spasms in different clinical setting. I will now hand the call to Marina to discuss the progress of our consumer efforts.