Terry Matkovits
Analyst · BTIG. Please proceed with your question
Thanks, Jerry. And good afternoon everyone. As Jerry mentioned, we recently received official minutes from a very productive meeting with the FDA held in April. We believe that the written feedback reflects the clinical benefit the agency sees in developing a safe, targeted, orally administered form of amphotericin B for the treatment of patients with life-threatening IFIs. FDA also expressed its desire to continue to work collaboratively with us to advance development of MAT2203, while also acknowledging the impressive novelty of our LNC platform technology and its unique pharmacokinetic profile for the delivery of amphotericin B without the toxicity associated with IV administration. Importantly, the FDA provided us with the valuable guidance for pursuing MAT2203 registration in a broader IFI indication. The agency was encouraged by the impressive results from our EnACT Phase 2 trial in cryptococcal meningitis, which demonstrated that our LNC platform was able to deliver amphotericin B in a safe, well-tolerated oral form across the blood-brain barrier with unprecedented survival outcome for oral antifungal therapy. During our meeting, FDA advised us that a larger Phase 3 trial focused solely on cryptococcal meningitis would be challenging to establish the pharmacodynamic bridge necessary to support a pharmacodynamic bridge necessary to support a streamlined 505(b)(2) approval pathway in broader IFI indications since MAT2203 would be administered as combination treatment with flucytosine or fluconazole. While surprising, following robust discussion with FDA, we now believe that the revised Phase 3 aspergillus IFI study design, assessing the efficacy and safety of MAT2203 as early step down monotherapy in a comparative non-inferiority Phase 3 trial in aspergillus should establish the desired pharmacodynamic bridge to unlock the 505(b)(2) pathway to indications for the treatment of other invasive fungal infections. We expect this strategy to result in the broadest possible label for MAT2203, utilizing the most efficient clinical development pathway. Now let’s take a look at our Phase 3 strategy. We are designing this trial to include a comparative study targeting a single IFI, the deadly fungal infection aspergillosis and will include both first- and second-line treatment indications. The main aspergillosis cohort in this new trial design will include a non-inferiority comparison with standard of care IV azole or IV amphotericin B with a step down to oral azole or oral MAT2203 as monotherapy treatment beginning as early as two days after treatment with IV amphotericin B. The proposed trial will also include an additional cohort in a non-randomized experimental arm of patients with a broad range of probable or proven IFIs who are not able to step down to oral azole therapy. The IFIs in this cohort will likely include invasive mucormycosis and other rare mold infections, invasive candidiasis, candida cystitis and endemic mycoses, including coccidioidomycoses, histoplasmosis and blastomycosis. Our strategy of including a cohort with a broader group of IFIs will benefit from leveraging the pharmacodynamic bridge we expect to establish in the comparative aspergillosis portion of the Phase 3 trial. We plan to capitalize upon this bridge to justify label expansion to IFIs under the 505(b)(2) pathway and to continue to qualify for QIDP incentives under the FDA priority review and Fast Track designation, as well as orphan drug exclusivities that could allow for 12 years of exclusivity protection in the U.S. and possibly 10 years in the EU. We are in the process of finalizing this revised Phase 3 protocol for submission to FDA later this month, and FDA has agreed to review the protocol and provide comments on an off-cycle basis. This benefits us from a timing perspective and is another example of the FDA working collaboratively with us. We also expect this collaborative spirit to impact agreement on the acceptable non-inferiority margin for the main aspergillus cohort in this trial, which will directly impact the size of this cohort and the overall timing for study completion. During our meeting, FDA also recognized the clinically meaningful outcomes from compassionate use patients receiving MAT2203 as part of our expanded access program. While the case numbers are limited, the data demonstrates the ability of MAT2203 to safely target and effectively eradicate several invasive fungal infections even in the most clinically challenging cases. Since beginning this program in August of last year we have received inbound requests from physicians at the National Institutes of Health, University of Michigan, Nationwide Children’s Hospital and Johns Hopkins among others on behalf of patients who have experienced significant renal toxicity while receiving IV amphotericin B and/or have not responded to or are unable to tolerate azole or other classes of antifungal. To date, seven patients with various life-threatening fungal diseases including: candida, aspergillosis, mucormycosis, coccidioidomycosis, fusarium, rhodotorula and protothecal infections have been treated with MAT2203 as part of our program. These infections have presented across various tissues in the body, including bone, skin, lung, sinus, bladder and the brain or central nervous system. Treatment courses with MAT2203 administered as monotherapy have ranged from two weeks to six months or longer with no evidence of any renal toxicity. Off the seven patients five have successfully completed treatment with resolution of the infection with one patient, discontinuing treatment for reasons unrelated to MAT2203. Renal function for the patients return to normal after switching to MAT2203 with no further need for any electrolytes supplementation. Additionally, all were discharged from the hospital soon after switching to MAT2203 and received treatment on an outpatient basis. Of note, the pace of inbound request for our expanded access program has increased following a highly impactful case study presented at ECCMID last month as Jerry mentioned. We will continue to identify and support requests for access where the compassionate use of MAT2203 makes sense for the patient and presents opportunities to generate additional meaningful clinical data outside of the clinical trial setting. I’d now like to turn the call over to Dr. Terry Ferguson to discuss our nucleic acid programs. Terry?