Earnings Labs

Ionis Pharmaceuticals, Inc. (IONS)

Q3 2019 Earnings Call· Wed, Nov 6, 2019

$71.53

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Transcript

Operator

Operator

Good morning and welcome to Ionis Pharmaceuticals Third Quarter 2019 Financial Results Conference Call. As a reminder, this call is being recorded. At this time, I would like to turn the call over to Wade Walke, Vice President, Investor Relations, to lead off the call. Please begin.

Wade Walke

Management

Thanks John. Before we begin, I encourage everyone to go to the Investor section of Ionis website to find the press release and related financial tables, including a reconciliation of the GAAP to non-GAAP financial measures that we will discuss today. We believe non-GAAP financial results better represent the economics of our business and how we manage our business. We have also posted slides on our website that accompany our discussion today. With me on today’s call are Stan Crow, our Chairman of the Board and Chief Executive Officer; Beth Hougen, Chief Financial Officer; and Brett Monia, Chief Operating Officer. I like to draw your attention to Slide 3, which contains our forward-looking language statement. We'll be making forward-looking statements, which are based on our current expectations and beliefs. These statements are subject to certain risks and uncertainties to our actual results may differ materially. I encourage you to consult the risk factors discussed in our SEC filings for additional details. And with that, I'll turn the call over to Stan.

Stan Crow

Management

Thanks, Wade, and good morning, everyone. Thank you for joining us. Our commitment to innovation has led to the increase in value of our commercial medicines, our pipeline and technology, which today is reflected in our robust financial performance. Because of our strong performance in the first nine months of this year, we are significantly increasing our 2019 guide to – of significant improvement. We’re on track to deliver approximately $1 billion in revenue, more than $375 million in operating income, and more than $300 million in net income. This means that we expect to deliver our fourth year of operating income, our third year of net income. We’re achieving these strong results while continuing to invest as aggressively as justified across every element of our business. We’re achieving success and making progress broadly throughout the business and we’re extremely pleased with SPINRAZA’s continued blockbuster performance. SPINRAZA is the worldwide foundation of care for the treatment of all SMA patients of all ages supported by growing body of data, continuing to show [they have getting] getting stronger the longer they are treated with the product. We’re already seeing positive momentum at AKCEA as Damien assumed his leadership role. Damien is adding key new member to the AKCEA leadership team, with skills necessary to help the organization reach its commercial and development goals. The first of several additions to the senior management team is Kyle Jenne, who was recently promoted to Chief Commercial Officer after leading the AKCEA’s U.S. commercial organization TEGSEDI and WAYLIVRA. Importantly, we’re beginning to see momentum build at TEGSEDI and WAYLIVRA. AKCEA is expanding the market opportunity for TEGSEDI across the world. With approval in Brazil, TEGSEDI is now the first RNA-targeted therapy approved with a treatment of patients with TTR polyneuropathy in Latin America. Given the…

Beth Hougen

Management

Thank you, Stan. Our strong financial results continued in the third quarter. In the first nine months of this year, we delivered operating income of $217 million and net income of $189 million both on a non-GAAP basis. We also achieved substantial operating income and net income on a GAAP basis. These strong results were driven by nearly $630 million in revenue, a more than 50% increase compared to last year. Growth in both commercial revenues, including SPINRAZA’s continued blockbuster performance and R&D revenues as our partnered programs advance, contributed to the substantial increase. In the third quarter, we maintained our strong balance sheet with $2.2 billion of cash, and we expect our cash balance to increase when we receive payments from Pfizer and Bayer this quarter. SPINRAZA generated over $1.5 billion in worldwide net sales through the end of the third quarter, an increase of nearly 25% compared to last year. Reflecting SPINRAZA’s joint performance, our royalty revenue of $212 million increased by more than 25%, compared to last year. The total number of patients on SPINRAZA treatment increased by approximately 11% from last quarter to more than 9,300 patients worldwide. New patient starts in both the U.S. and around the world contributed to this growth. In the U.S., adult patients were a significant driver of growth in the third quarter increasing by 8% over last quarter and as the largest SMA patient segment, we and Biogen believe that adult SMA patients represent a continued opportunity for growth. Now approved in over 50 countries and with reimbursement in place in 40 countries, the number of patients on SPINRAZA outside the U.S. increased by approximately 18%, compared to last quarter. Strong performance in established markets such as the EU and Japan, plus rapid up take in key markets in Latin…

Brett Monia

Management

Thanks, Beth. Today, we have three medicines on the market of pipeline of over 40 medicines advancing through development and many more progressing through research towards clinical trials. SPINRAZA is the global foundation of care for the treatment of SMA patients of all ages in all SMA types. And Biogen continues to report new, even longer-term data demonstrating improved patient performance with prolonged SPINRAZA treatment. A new data from nurture study of pre-symptomatic infants now on treatment for approximately 45 months, we continue to see kids developing like their normal healthy counterparts. Remember, without SPINRAZA these babies would have rapidly [indiscernible] with their disease. And patients with later on SMA in the shine study, some of whom began the study as kids and have now reached adulthood, continues to show stabilization nor improvement in measures of their disease. Today, some patients treated with SPINRAZA in the shine study have gained the ability to walk on [indiscernible]. Biogen is also preparing to explore the potential of achieving even greater benefit with a higher dose of SPINRAZA with over 9,000 patients on SPINRAZA today including some patients who have been on treatment for nearly 6 years. SPINRAZA is well established safety profile is supportive of expanded dosing. Biogen's Phase 2/3 devote study which we expect to begin soon will evaluate the safety and potential to achieve increased efficacy with a higher dose with SPINRAZA with fewer loading doses in SMA patients of all ages, including the adults. Additionally, we and Biogen are developing a follow-on medicine for the treatment of SMA focused on less frequent dosing, which could enter development next year. Ionis HTTRx, also known as RG6042 is progressing in a comprehensive Phase 3 program in patients with Huntington's disease. Roche recently announced expanded enrolment in the Phase 3 generation HD1…

Stan Crow

Management

Thanks, Brett. We build Ionis on a foundation of our efficient technology and today the value of our technology is reflected in our financial strength and it's a product directly of our business model. Our financial strength then gives us the flexibility to maximize the value of each of our medicines and our technology. Our partners are recognizing the value of our technology as demonstrated by the substantial economics of our recent transactions. Our business strategy is succeeding, and today, we are sustainably profitable, and Ionis is delivering more value to patients and shareholders every day. Importantly, we’re delivering value while investing in the future potential of our business, including advancing our pipeline of over 40 medicines, growing our pipeline of wholly-owned medicines, advancing our technology in an ever faster pace, and potentially delivering commercially attractive aerosol and oral medicines, and enabling new routes of administration, while advancing new medicines for broad new therapeutic areas. On December 13, we plan to host a webcast to discuss many of the recent advances in our technology. This will be a deep dive in the exciting science that we’re working on right now and we believe positions the technology to be ever more powerful in the years to come. I look forward to the opportunity to discuss our work with you in this form and just as an aside, this is for real techno geeks, it's probably not for the faint of heart, but we hope you’ll join us anyway. So, watch for more information about the webcast, which will be announced very shortly. The business successes and financial strength we built give us confidence that we will continue to deliver value to our patients and shareholders today and in the years to come. And with that, I'll turn the call over for Q&A. Sean, if you can set us up for Q&A please.

Operator

Operator

We will now begin the question-and-answer session. [Operator Instructions] Our first question today will come from Chad Messer with Needham & Company. Please go ahead.

Chad Messer

Analyst

Great. thanks for taking my question and congrats on the very strong financial results. I believe these – share buybacks are really good sort of indicator of how you're feeling about the business.

Stan Crow

Management

Hi, Chad. Appreciate it.

Chad Messer

Analyst

Just wondering if you could share your thoughts about some recent comments from Pfizer about since the tafamidis launch, I believe they said they identified over 4,000 patients with TTR cardiomyopathy, especially given that you guys are about to start a trial in that indication?

Stan Crow

Management

Well, I think they know this disease and the space extremely well, and we believe that there is a sizable market opportunity there and we’re very confident that the LICA form of TEGSEDI is going to deliver a great performance for us like the other LICA performances of other medicines have done.

Chad Messer

Analyst

Alright, great. And then, as you know, very excited about the concept of an oral antisense and I’m sure we’ll, you know, be hearing a lot more about that in the future, but any thoughts on what makes sense to move first either new indications that, you know, might not have been as amenable to, you know, using a subcu injection or, you know, basically newer forms of existing sort of tried-and-true drugs that you have?

Stan Crow

Management

You will be hearing a lot more about it and you’ll first hear it, as Brett describes it on December 13, at our upcoming technology webcast. And the answer to your question is, I'd say all of the above.

Chad Messer

Analyst

Alright, kind of what I was expecting. Looking forward to that webcast and congrats again.

Stan Crow

Management

Okay, thanks so much Chad.

Operator

Operator

Our next question will come from Jim Birchenough with Wells Fargo. Please go ahead.

Jim Birchenough

Analyst

Yes, hi, guys. Let me add my congratulations and great to see the share buyback and the confidence underlying that. So, a couple of questions, I guess, number one, just thinking about the financial side of things, could you maybe give us some sense of how we should think about the outlook both in terms of revenues and earnings? Do we expect revenues to be a little lumpy given the contribution of R&D revenues and then to smooth out over time and just want to make sure we’re still guiding or expecting a sustainable profitability? And then, I’ve got a follow-up.

Stan Crow

Management

Well, yes, we now are reporting our first year of operating income and our third year of net income. And we’re very confident and optimistic that next year will be another successful year financially and across the business. We are really excited about the things that are going on in the company and AKCEA and look forward to another better year next year.

Jim Birchenough

Analyst

And then just in terms of capital allocation, I think, one of the things you've highlighted historically or maybe even more recently is just investment in technologies that could maintain your leadership in the genetic medicine space. And so, could you maybe talk to your efforts to go beyond antisense or extend your dominance in this area of medicine? And how you're allocating capital to that?

Stanley Crooke

Analyst

Yes. We are excited about that, Jim, and it is progressing, and it is progressing on two or three broad fronts. Number one, is any access to anything that might enhance the performance of the technology we've invented today. Number two, is to expand our use of genomic information to an even greater extent than what we're doing today. And then number three, we're looking for the next antisense technology. Yes, and if you think about those three components of the investment strategy, you would expect investments in the first couple of components long before the third, because enabling technologies like antisense don't come along every day. So, I do expect that you'll begin to see some investments in those areas in the coming months based on the progress that we've made so far.

Jim Birchenough

Analyst

And then maybe just final question. I know there's not much you can say on partner programs, beyond what partners have said and what you said in your prepared remarks, but maybe for your wholly-owned pipeline, what are the key products that you're most excited about? Maybe a question for Brett, and maybe speak to the visibility will get on those wholly-owned products over the next year or so?

Stanley Crooke

Analyst

Brett?

Brett Monia

Management

Yes. Sure, Jim, The – thanks for the question. Our wholly-owned pipeline is growing rapidly across all therapeutic areas, or many therapeutic areas. I suppose the answer depends on how advanced the program is, plus, coupled with how potential – what the potential is for the – for that medicine to have a big impact to be a transformative medicine on the market. I'd have to highlight a couple of three growth hormone receptor for acromegaly is a very exciting program that is in Phase 2 and it's due to readout next year and potentially move on to Phase 3. So, that could be a wholly-owned program that's in patients with acromegaly in Phase 3 next year. Our TMPRSS6 program is very exciting. It's a program that has the potential to treat multiple disease populations, including beta thalassemia intermedia, alpha thalassemias, as well as myelodysplastic syndromes, MDS. So, lots of opportunity for that drug. It's performed very well in Phase 1, and is in Phase 2, and it's moving very rapidly. And then our neuro pipeline, it’s also worth commenting on Alexander's disease, prion disease, Lafora disease are all moving forward very nicely. And obviously, we have validated nerve degenerative diseases with our platform. So, that has a very high potential upside on that. And then the last thing I would say is, watch out for our lung platform or run a pulmonary disease pipeline. As I mentioned in the webcast, our ENaC program is in Phase I, is showing great promise and more to come behind that.

Stanley Crooke

Analyst

And Jim, I would add TTR-LRx is our number one asset that's wholly-owned. It's going to be commercialized through AKCEA. We're really excited about the potential of the lack of form of tech savvy to deliver incredible value. And if you look at the economics of the large medicines that we have, APO(a), APOCIII, ANGPTL3, of the Parkinson's and Alzheimer's medicines and Factor XI, I think people tend to have forgotten how extraordinary the data with Factor XI were in that 300 patients of knee replacement study. I think it's, to some extent, a mistake to focus solely on our wholly-owned pipeline because of the dollars that will come from those large products that are licensed under the economic terms we have, are going to matter a great deal. And it's – and again, it's manifestation of the business model work. So, I fully subscribed to what Brett said, but I would add the comments that I made, obviously since I just did it.

Jim Birchenough

Analyst

Correct. Well, thanks for taking the questions.

Stanley Crooke

Analyst

Okay, thanks.

Operator

Operator

Our next question will come from Tyler Van Buren with Piper Jaffray. Please go ahead.

Tyler Van Buren

Analyst

Hi, guys, congrats on the results. I know in the press release under key upcoming events, you didn't give a timeline, of course. But I just want to get your updated thoughts on timing of Huntington's data, of course. And then once we get the data with the open label, what would you expect these patients to show on the composite endpoint and what would be a successful outcome with the active therapy?

Stanley Crooke

Analyst

It sounds like a question that Brett should answer and I should avoid.

Brett Monia

Management

Thanks, Stan, and thanks, Tyler. Well, I mean, the data that we're all focused on, of course, is the randomized Phase 3 study, which stood, as Roche said, filing 2022 range, or if not sooner, and that's what we're laser focused on is that randomized pivotal study. Regarding the open label data, Roche has said that they will share the results of that study next year, which will include open label data from both the Phase 2 study that we conducted as well as the Phase 3 study – the initial start of the Phase 3 study, which evolved about 100 patients, which then the dosing regimen was changed versus a lot of data there plus the natural history data. As far as what to look for, obviously, in the randomized study, you're looking for a significant improvement in clinical endpoints compared to the placebo group. That's obvious in the rating scale for Huntington's as well documented and has been published on. Sort of the open label data, it's going to be looking for strong trends, I would say. It's a small, relatively small sample size relative to the Phase 3 randomized study. And it's going to be compared to natural history data, but it's – they are going be looking for, I assume, Roche is going to be looking for many of the same benefits in clinical endpoints that are going to be part of the Phase 2 – that are part of the Phase 3 study, maybe just some subcomponents to that, such as cognition or motor function or those sorts of things. But they're going to be looking for strong trends and clinical endpoints that differentiate from the ongoing natural history work that they're doing.

Stanley Crooke

Analyst

Just to add a comment or two. We remain based on what we're observing, encouraged, as does Roche about the ongoing open label study. And I think we were very pleased that Roche made the decision to focus on the every four-month dosing. We've always felt that that was the best dose schedule for this medicine. And so, all-in-all, we like the decisions that Roche just made and we're encouraged by the performance that we're seeing in the open label study.

Tyler Van Buren

Analyst

Okay, thanks for that. And then on TEGSEDI, we're seeing a slower trajectory in the launch relative to Onpattro. So just broadly, could you maybe help us understand what’s going on other than obviously, you guys launched a quarter later is – are you guys maybe in different territories and receiving different uptake in different territories? For example, in Europe, should Portugal come online soon and then also in the U.S. I noticed the slide actually did not list U.S. as a territory. So, maybe you guys are seeing slower uptick in U.S., which is a larger percentage of Onpattro sales?

Stanley Crooke

Analyst

Yes. So, the – we certainly are happy – we're certainly considered the U.S. very important market. And if it's not on the slide, it was an oversight sorry. What we're looking at right now is not so much what happened last quarter, but what's happening in the coming quarters. And we are optimistic with the new leadership at AKCEA, we're seeing very significant shifts in momentum. I do think that we will see growth accelerate a bit in the U.S., obviously Brazil is a really important opportunity for us. We are very pleased with what’s happened in Sweden, the UK and Austria. So, these new markets are important and of course Portugal is an important opportunity for us too. So, TEGSEDI is a little behind of what we hoped, but based on the new team and the progress that we are seeing out of them, I think we are optimistic that next year we will see an even better performance, and hopefully in this next quarter we will see an improvement.

Tyler Van Buren

Analyst

Okay. Thank you so much.

Operator

Operator

Our next question will come from David Lebowitz with Morgan Stanley. Please go ahead.

David Lebowitz

Analyst

Thank you very much for taking my question. Would you be able to give us a run through of the recent HPV data and I guess talk about the reason that the non-LICA form of the drug is being pushed forward as opposed to LICA form?

Stan Crow

Management

Yes. We don't have a full answer to that question. What we do believe is that HPV infection has an effect on the asialoglycoprotein receptors. So, we didn't see the level of increased potency that we expected, but we saw also great performance out of the parent. And so, we agree with the decision that PSK has made, and we’re excited about what we’re seeing with the drug. It is also a little further along. So, overall, I think the performance of the parent was very exciting, haven’t seen those kinds of viral reductions in quite a while. And it looks like [the drug].

David Lebowitz

Analyst

Thanks for taking my question.

Stan Crow

Management

Brett, do you want to add anything to that?

Brett Monia

Management

No, I don't. Stan, I think you got it. You covered it nicely.

Operator

Operator

Our next question will come from Vincent Chen with Bernstein. Please go ahead.

Vincent Chen

Analyst

Congratulations on the progress. Speaking about the less frequently dosed SMA drug that you alluded to and how that might work. I have a bit of a geeky question about this one. Broadly, what's your approach to this? You probably won’t say, what technology is, but is it more a matter of increasing the half-life of the active fraction of drug? Is it increasing dose, is it increasing our drug to enter the cell or that escapes the endosome? Is that increasing potency or something else to the extent to provide some color, and could you readily apply this to other programs in the portfolio such as the Huntington's program and what implications you might just have for the therapeutic windows in these drugs?

Stan Crow

Management

These are really solid questions and we will get into more detail on December 13, and I think you will enjoy what we can tell you then much more than what I'm going to tell you now. We continue to invest obviously in all of those areas, of medicinal chemistry and remember that neurological program is relatively newer compared to other programs. And so, you were still exploring novel medicinal chemistry approaches that we think can add some value there. We know that these drugs distribute very broadly in the central nervous system. And we understand the fact there is that define how long they last. So, it’s just taking all of the knowledge that we have, plus all that we’ve learned over 30 years and applying it. We will be talking about endosomal release. That gets very technical and complex and I don't think I want to get into it, try to explain it on this call, but that’s another area of very, very active progress for us, and approving delivery within the cell, as this as well as improving delivery to the cell or focal points for the – of what we're doing in core antisense reserve. Did that help you? I hope.

Vincent Chen

Analyst

Yes. Thank you very much. I look forward to the third.

Stan Crow

Management

Yes. We will be talking at some length about all that.

Operator

Operator

Our next question will come Ritu Baral with Cowen. Please go ahead.

Ritu Baral

Analyst

Hi guys, thanks for taking the question and thanks for sequencing my questions perfectly. I did want to follow-up Stan on the new CNS programs that you mentioned. I believe you mentioned that there were two new programs with Biogen and then one wholly-owned, can you elaborate a little more of where they some of the ones that Bret mentioned, the prion disease etcetera? Would love to know what’s in the pipeline and what sort of timelines we could be seeing for four clinical data from – of the additional CNS programs?

Stan Crow

Management

So, we will take that. But before we get into that, I wanted to remind people of how exciting 12% is. And we are based on all of the observations with that medicine. We and Biogen are really excited about that drug. And that is, you know, is an importantly relatively near-term opportunity. And so, with that addition, I will turn the question over to Brett.

Brett Monia

Management

Sure. Thanks. Thanks, Ritu. So, we’re continuing and we will continue to add new exciting programs to the neuro pipeline with Biogen. The two recent programs that were entered into our development pipeline, our targets that are undisclosed at this point [indiscernible] but the wholly- owned program is our Lafora drug, and we’ve talked about Lafora disease before which is a glycogen storage disease of the CNS. So, we're very excited about that program. The prion drug you mentioned before is not a Biogen drug, it is a wholly- owned program by – from Ionis, and we are expecting that to reach development shortly. And that really has a, you know a rather, that’s not an ultra-rare disease. That’s a disease with very significant populations to be treated. So, more and more drugs are coming. We don’t disclose them with Biogen right up front, but our wholly-owned pipeline for neuro continues to expand as well.

Stan Crow

Management

And it is a little early Ritu to just give you, even a general sense of when there is going to be clinical data. I think we will hold off on that until next year when it will become much clear.

Ritu Baral

Analyst

Got it. And then pulmonary programs that you are going to talk a little bit more about on December 13, are those programs based on I guess, new formulations like encapsulation or something involving enhancement agents like your oral program or these sort of pure, is it a pure potency play for delivery?

Stan Crow

Management

It’s a pure potency play. You will recall that we showed quite a many years ago, that these agents are really very nice to delivery by aerosol. We took the IL-4 drug into clinical trials and we demonstrated broad distribution, a meaningful pharmacology. We didn’t feel it was in the end quite good enough to continue developing for asthma and that given all the other medicines are available, but that blazed the trial, and so these are formulated very simply just in sailing and they could be administered then by any of the devices that you – that you know about and so the key chain is increase in potency and we are seeing really remarkably exciting performance now in the lung. And, you know like every organ that we work on, before we really move drugs forward, we invest in understanding the organ and how these drugs distribute not just to the organ but in the various cells of the organ and so we know all that. And Brett will share some of that with you at the December 13 call.

Ritu Baral

Analyst

Great. Thanks for taking the questions. Congratulations on that oral poster at DIA. Everybody was at that poster, to the exclusion of the open bar.

Stan Crow

Management

We are excited. Do you remember, we will remind you on the 13 that we already showed it was feasible with KYNAMRO. What we needed was just a big step up in potency and we think we go it. And you will be hearing a lot more about that in the coming months, not just from us.

Ritu Baral

Analyst

Thanks.

Stan Crow

Management

Okay. Next question.

Operator

Operator

Our next question will come from Jessica Fye with J.P. Morgan. Please go ahead.

Daniel Wolle

Analyst

Hi. This is Daniel for Jessica Fye. Thanks for taking our questions. In light of the platelet decline observed with the HBV LICA product, can you make the case for widening the product expect issue versus a reason to worry about the other LICA products as well?

Stan Crow

Management

No, I won’t do that. I will tell you it is not an issue at all. There is a lot of confusion about that. What actually happened was very minor declines in platelets that are not even, not remotely clinically significant and it was just the way the data represented. There really is no significant platelet issue, even at doses of 418 mg a month with the LICA drugs. That’s what those data actually show. Brett, do you want to add anything to that?

Brett Monia

Management

Just to add to that those were as you said Stan, those were at very high doses and the drops in platelets were not clinically meaningful in anyway. So, really it has no bearing at all on our LICA platform. And again, the confidence has been demonstrated by the licensing of drugs like Factor XI LRx and ANGPTL#-LRx and Lp(a)-LRx (sic) [APO(a)-LRx] by Novartis and Bayer and Pfizer just illustrates the confidence in our LICA platform from not just on efficacy, but also safety and tolerability.

Stan Crow

Management

Even at 480 mg a month we did not have a single patient who have gotten below normal level if I recall correctly in that study.

Brett Monia

Management

That’s correct, Stan.

Stan Crow

Management

It was simply the way that it was presented that caused a confusion. We regret that, but those are the facts.

Daniel Wolle

Analyst

Thank you.

Operator

Operator

Our next question will come from Mani Foroohar with SVB Leerink. Please go ahead.

Mani Foroohar

Analyst

Hi, thanks for taking my question and congratulations on the results. First of all, on behalf of your investors thank you for returning capital to shareholders rather than the reverse, which seems to be the normal in my coverage.

Stan Crow

Management

By the way we are not normal.

Mani Foroohar

Analyst

I have a couple of quick questions. First, regarding the ENaC opportunity, how do you guys think about the role of that in cystic fibrosis patients, given the number of failure effective oral therapies, would that be developed as an add-on, would that be developed in failures an and then I have one more question after.

Stan Crow

Management

One of the most interesting things about that is this directly at the cause of the disease. It’s not a modulator, it is not a modifier, it improves the performance of that sodium channel and in fact it reduces. And so at least based on animal data and early returns from the clinic, I think we have a significant winner there not just for cystic fibrosis, but other lung disorders. And what I like about it is it is a primary mechanistic approach to managing the disease that is accessible to antisense and really very difficult to do with other technologies because of their lack of specificity. Brett do you want to add anything?

Brett Monia

Management

Yes. Just add this, Mani, the ENaC should do all of what you said. It should be useful for patients that progress on small-molecule CFTR inhibitors or activators. It should be effective for – as add-on therapy and as well as those that have mutations that are not treatable. So, the 10%, 15% of patients that are not treatable with the combo small molecules for CFTR are going to be treatable with ENaC because of its mechanism of action. And as Stan mentioned, cystic fibrosis is we think is just one indication we think that this drug has the potential to treat a much broader population as well on patients with different types of pulmonary diseases.

Stan Crow

Management

Yes. I would add one more comment. We, as a general rule, want to lead, as we have, we have spent [indiscernible] Factor Xi and so on. So, for us to pursue an opportunity in cystic fibrosis, we really had to be very convinced that we had something that could do something that is very substantial these patients can use and we believe that. And we believe that the mechanism can provide benefit in a number of other important pulmonary diseases and so this is for us a much more important investment than simply cystic fibrosis, which is important, but it is a broader investment.

Mani Foroohar

Analyst

Okay. And for my follow-up, when I look at the TTR-LRX study, correct me if I am wrong, but it sounds like you guys are allowing essentially unlimited tafamidis use in both arms? Tafamidis obviously is an active drug in cardiomyopathy with an overall survival benefit. How do you think about maintaining balance, drop ins so presumably you will have efficacy in the placebo patients who will do worse? So, you may have more tafamidis drop-in in the placebo arm, how do you expect to maintain balance and think about the impact on powering assumptions for the scale of the study as a whole?

Stan Crow

Management

Brett?

Brett Monia

Management

Yes, sure. Mani. As you are referring to the cardiomyopathy study obviously and we are allowing patients to have standard of care in the control group or on top of TTR LICA. And we'll stratify appropriately so that we’re not imbalanced for patients on tafamidis, patients on any other forms of standard of care that they wish to take. So, we can control for that and overpowering assumptions are about based on the wealth of data that’s out there from Pfizer tafamidis phase 3 study, as well as our own study with TEGSEDI in same – in similar patient population. The other thing I wanted to, maybe I could just add to that Mani is, just to drive your attention, remind you that we have an investigator study, Phase 2 study in progress in which we are looking at TEGSEDI in patients with cardiomyopathy both wild-type and hereditary. That's with Dr. Merrill Benson in Indiana University, and we just -- he just presented an update on patients that have been treated would take three years or longer with TEGSEDI and which he has shown strong evidence for patient benefit on all kinds of clinical endpoints compared to natural history. So, we also have that data to fall back on as a natural history and the performance of TEGSEDI in patients with cardiomyopathy. So, we feel very confident in the powering assumptions of our phase 3 cardiomyopathy study and we are confident that we will be well balanced in our treatment arm versus our control group.

Stan Crow

Management

And things are getting ready to get underway in a big way here, so we will be, you should be hearing about from us about all of that in the very near future.

Mani Foroohar

Analyst

Great. Thanks for taking my questions guys.

Operator

Operator

Our next question will come from Paul Matteis with Stifel. Please, go ahead.

Nate Tower

Analyst

Hi, guys. Thanks for taking the question. This is Nate on for Paul. Maybe just to put a finer point on the prior question about the ENaC, on the clinical studies, would you think you are enrolling all CS patients or would you narrow it down to patients who are aren’t currently eligible for CFTR modulator?

Stan Crow

Management

I don't think we want to get into details of the clinical development program beyond what Bret said. We think it’s an agent that can be used as a single agent and we think it can be used in combination and we believe that can be used in patients who have mutations that are unresponsive to current therapy. I think we will leave it there.

Nate Tower

Analyst

Got it. That makes sense. Could you just discuss the inhaled dosing route given the pulmonary mucus burden? I mean, I know it translates on it, but is that a crazy concern? Or is that something you guys have looked at so far?

Stan Crow

Management

No, it’s not a crazy concern at all. It’s something we looked at very carefully. We had the benefit of having clinical experience with IL-4 in meaningful asthmatic patients. And then we looked very, very carefully in animals and asked, does a significant mucus barrier affect distribution to the bronchioles and to the layer – the smaller airways. The answer was no. And based on the early returns in the clinic, we believe the humans are telling us now as well. So, absolutely something that we were concerned about, but we think we’ve resolved it and I think that Brett will be sharing some of that with you on December 13, is that right Brett?

Brett Monia

Management

Yes, that’s correct Stan.

Nate Tower

Analyst

Got you. And then maybe one more. On HPV, message understood loud and clear on the platelet declines, but can you help us understand why GSK was dosing at 120 mgs per week in the first place?

Stan Crow

Management

Yes, because that is the only time, you know we’ve gotten 13, 14 LICA, liver LICA drugs in development. That is the only example where we didn’t see the expected level of increase in potency. And we know it is tied in some fashion to the HPV infection, but beyond that still very much a research project throughout what happened. But that’s the reason, we just didn't get the level of potency that we have seen with the other 12 or 13 liver LICAs.

Nate Tower

Analyst

Got you. Interesting, thanks for the color.

Operator

Operator

Our next question will come from Eli Merle with Cantor Fitzgerald. Please go ahead.

Eli Merle

Analyst

HI, guys. Thanks so much for squeezing me in. Just in terms of the Factor B program, could you explain a little bit more of your scientific rational, I guess your decision to target Factor B versus D, and I guess, your perspective on the clinical advantage or key differences between the targets, and I guess given that your partner Roche has already studied programs looking at factor D and geographic atrophy with some what sort of mixed results, maybe you can comment on the thoughts on Factor B versus D specifically in geographic atrophy? Thanks.

Stan Crow

Management

Well, I will comment that we typically, when we were in one of these pathways like crowding factors and complement and so on, look at everything. It’s easy for us to do. And so, we look at all of the various factors and based on all the data we had, we believe that that will be – offers a significant advantage as both potentially and benefit and safety, compared to some of the other complement factors. So, it’s based on data. Brett, do you want anything to that?

Brett Monia

Management

Yes. Just a little bit, it’s certainly based on the data we’ve generated directly, looking at different complement factors in our annual models, but also, where Factor B lies in the alternative complement pathway it is – I don't want to get into the fine details, but it is a more relevant target to that pathway in Factor D. And of course, what is really interesting and important to remember is that Roche developed a Factor D antibody and they came to the conclusion that Factor B was a better target, which is why they partnered with us on this program for age-related macular degeneration. So, it's based on our data, as Stan said. It is based on what we would expect in the pathway. In the confident pathway, and we're not the only ones that believe in Factor B, Roche does too.

Stan Crow

Management

And the study is progressing well. So, we're going to have some answers here, it’s going to be awhile, but the study certainly is progressing. Wade, how many more questions? I think, we should probably bring this to a close.

Wade Walke

Management

That is the last one, Stan.

Stan Crow

Management

That’s great. Well thanks everyone. We appreciate your attention on this busy day. And we look forward to continuing to deliver great results this year and the rest of this year and next year. And look forward to sharing some of the nuts and bolts, the pixels behind the big picture with you on December 13 as we focus on the technology and the advances that we’re making.

Operator

Operator

The conference has now concluded. Thank you for attending today's presentation. And you may now disconnect.