Kevin Hrusovsky
Analyst · Canaccord Genuity. Your line is open
Thank you very much, Mike. On slide three, you see the agenda. I'm going to talk about our accelerated growth opportunity and also what I consider to be some of the transformation around utilizing our Simoa franchise to enable therapeutic drugs. Mike will then do some financial results summaries. And I'll then close the meeting with an update to the objectives that I updated after our last earnings call, so that you could see some of the advances that we're working toward between now and year-end. So to start, we showed this slide last time, blood-based biomarkers are fast becoming a gold standard for traditional Abeta PET imaging. And you may have been reading that ever since the FDA approved Biogen's drug they basically have become a buzzword. The biomarker has become a buzzword as a way to help evidence efficacy and also evidence, in some cases, safety. So I'd like to start off on slide five by showcasing the fact that we received at a record pace, a breakthrough device designation from the FDA for our pTau-181, blood-based assay, which will be utilized primarily with other modes of diagnostics, including imaging to help triage patients is the intent for this application that we've been given the breakthrough designation, which gives us a priority with the FDA. There also was some really important publications, namely in the Lancet, the Simoa diagnostic accuracy data were published. Also pTau-217, which is a next-generation of phosphorylated tau that we're also working on, Lilly showcase that they used it in Trailblazer 2, and they have also been given accelerated pathway for their drug. And they actually showed that it correlates pTau-217, both with the images -- the PET images as well as clinical benefit, which is a pretty significant advance. On the financial results, on a non-GAAP basis, we grew at nearly 50%. And year-to-date, we've been growing actually a little greater than 60% on a non-GAAP basis. Basically, the difference between GAAP and non-GAAP is removing all of the onetime items from GAAP to give us the non-GAAP. And in 2021, our utilization of consumables has actually been increasing fairly We been running at least the 60% level, which is significantly beyond our expectations going into the year. And we do have $411 million of cash balance at the end of Q3. Our value creation chain reaction has really been kicked off by utilizing biomarkers and trials and then getting them validated particularly for Alzheimer trials. And then the utility being an opportunity for us to transition over into diagnostics where there's a need for scalable blood-based testing of Alzheimer's to be able to really, at a full scale level, be able to move patients into the drug and then monitor for drug performance. And this is an area of opportunity. We also, interestingly, we're able to get very good progress on our EUAs in the COVID landscape. And that's how we really get to know the FDA pretty well by being able to get an asymptomatic reading on COVID saliva test for the Delta variant for antigen. This is a pretty significant breakthrough. And there's also been a couple of major webinars that further reference especially the University of Emory showcasing how they deploy four of our HD-Xs and measured over 120,000 saliva points for COVID. So this is the kind of advance that we are continuing to try to pursue. When you look at our financials on slide six, you can see that we had the 46% growth, very good movement on the non-GAAP basis. And what's also really impressive is the product growth, both instruments and consumables in Q3. Consumables, particularly almost 100% growth. And lab services, which we had projected would be down this year compared to at least last year, we had very significant onetime events of COVID. We knew for the full year, we would probably be about the same level of lab services as 2020. But on a two-year CAGR from '19 to '21, we are continuing to progress at an 18% level. So we are still seeing nice growth. And overall, I would say the RADx and the Abbott licenses, both from last year and then this year, having RADx, those being removed from our GAAP performance to create non-GAAP allows you to see the real growth of 46% in Q3. On a margin basis, on slide six, you can see that our Q3 delivered almost 55% gross margin, up from 51.5% last year. On a year-to-date, same type of performance. Interestingly, consumables is actually over 100% growth and instruments is over 70% growth. And the lab services is basically flat with last year for the first three quarters of the year. But on a CAGR basis, it's up 24%, the two-year CAGR from '19 to '21. And then once again, you can see that our gross margins for the three quarters have gone from 48.4%, up to 56%. When you look at the demographics on slide eight, you'll see that geography, we continue to be very strong in North America, but also evolving very nicely in Europe and Asia. Primarily, we see a lot of our position increasing in pharma CROs, but we continue to get a lot of publication pull-through through our academics. You can see we've had very strong growth in academics so far in the last 12 months as well. And then in neurology, you can see we were up over 100% in the last 12 months. And that is really the area that we're honed in on. And you can also see in consumables over the last 12 months, we're up nearly 100%, accelerated down slightly over that 12-month period, primarily due to the onetime effect in the previous year. Instruments, greater than 50%, which is a very strong indicator for future consumable pull-through growth. On slide nine, you can see that the publications, which is the way we validate third-party validation of our technology and that continues to accelerate, and we're nearly 1,500 third-party peer-reviewed publications now, and we have over 650 instruments now installed around the world. And you can see in the accelerator even though we do know our growth this year is not going to be like to the last 12 months due to COVID, we still have up to 160 Phase I/II/III trials that have been run in our laboratory. On slide 10, I'd just like to showcase that we started out and researched. We really started this company in research in Neuro, and then we've moved very productively into antigen serology for COVID and research. And then we've utilized the technologies that we've got COVID in creating the diagnostics, and that's how we got the two EUAs, one for serology, one for antigen. We're now taking those advances that we showcased at Emory, working with the NIH, gave us $20 million to scale up given our capabilities that we're now moving that down into Alzheimer's, and that's where we got the breakthrough designation for phosphorylated taus. And as I think you'll see in the updated objectives, we also plan and we updated these objectives at the end of Q2. But we said at that time, we would also submit by year-end, the MS Nf-L for breakthrough designation. So that's another key advance for us in our overall objectives for the second half. You can also see on slide 13 that we continue to have really strong growth catalysts in our research business. And this breakthrough designation for 181 is causing many customers who want to utilize our technology for their drug trials, given our access and our direction moving into the clinic. And this has also further represented the drug trials being revitalized using biomarkers given the success finally of ADUHELM being approved by the FDA is the fact that the accelerated growth path for Lilly's So we're pretty excited that the whole industry is now revitalized on Alzheimer's trials, and that puts a lot of pressure on us scaling our company and also making sure the HD-X is ready for clinical use expanding our accelerator, and we think Alzheimer's even earlier before cognitive impairment is benefited by the 100 times. And so you're going to see that we would -- are planning to accelerate a lot of our investments to really bring these four items into a very sharp focus of opportunity in '22 and '23. So you'll see us making additional OpEx investments particularly around these four items in fourth quarter in 2022. Also on the right-hand side, you can see that this is the diagnostic where we do believe the TAM is about 10 times the size of the research TAM. And we see mounting evidence of these plasma phosphorylated tau biomarkers for Alzheimer's creating a significant opportunity on the diagnostic side, it's a much focus. We see a lot more value and potential maybe with greater risk. But if we can get an Alzheimer plasma test into the market via the breakthrough designation, it represents a way to triage, screen and diagnostically improve the scaling and even monitoring of patients with Alzheimer's with our biomarkers. For that reason, we're accelerating our LDT footprint in our accelerator and believe that we will be able to run LDT, and you'll see later slide in 2020 at the latest. Payer leapfrog for health screens, we also think is a big gold catalyst longer term for our diagnostics business opportunity. Slide 11, we've shown over the years that basically shows that by increasing the sensitivity, it's a significant opportunity to take the IVD proteins today that are measured by There's about 200 of them. Collecting about $25 billion, almost all of that being and a large proportion of it being after patients have symptoms by being able to move earlier before symptoms and to even create multiplex for greater disease specificity, we think we can move the number of IVD proteins over the next 20 years from 200 proteins to as many as 1,000, significantly ramping up the opportunity for diagnostics of protein measurement. And to do that noninvasively symptoms, which we think creates a chance to revolutionize healthcare. And we think that the fueling of that will come via the research products, where today, there's 1,300 proteins that are being analyzed. But we think with a lot of new entrants into the industry, going to be a chance to significantly ramp up the number of proteins that are tested from a research standpoint. Slide 16 and 17 basically show you that the sensitivity is what really is enabling in the area of neuro and cancer, the ability to see the disease before symptoms present and to do it noninvasively in blood, saliva and urine. And our goal would be to truly get utility from this technology in a diagnostic setting with this noninvasive, sometimes home care sampling for testing it is very much noninvasive for -- even if there's infectious disease that might plague society, if you can get home care testing and/or at least sampling and then disease before symptoms, it has a profound effect on the overall opportunity. In slide 19, we are simply showing that traditionally, the diagnostic industry is $30 billion in revenue roughly. And the pharma industry is more like $300 billion, 10 times the size. And you can see that many of the pharma and diagnostics, there's lot of research on antibodies and proteins that lead to this incredible two markets for Life Sciences. And inside of this, we're showing the brain in all the different biomarkers that we now can see in blood, some of them were actually multiplexing and advancing the field for both diagnostic and pharmaceuticals. And we think there's a whole new category, neurodiagnostic therapies. It's really about getting the therapy into the patient before symptoms. We think that the earlier you can get these diagnostics to teach you when a patient has the pathology and you can then deploy the drug, you can do it safer and with greater efficacy is a lot of what we're seeing drug companies now attempting to achieve with our technologies. And so on slide 20, you can see that the TAM over on the left-hand side, when it's simply a research biomarker for Alzheimer's is really only like $0.5 billion for the drug trials, and we do have the probability, we think, of significantly increasing the probability of a drug getting approved by using these biomarkers for earlier phase disease. In the center, you can see one of the game-changing publications that came out, where it showed that you could actually create correlations by measuring in blood, our biomarkers with what you used to see in a spinal tap sample result as well as a PET image or an MRI. And that breakthrough of that correlation, we think, has allowed a much less invasive high-throughput approach to move into utility and diagnostics, which we think the TAM to be as much as $11 billion versus the original $0.5 billion. And that's a lot of what we're focused on is trying to capture 10% of those TAMs someday. On slide 21, Lilly has gotten the accelerated pathway for their drug and they are utilizing our technologies as they've stated in their press releases. So we're really excited to see if we can continue to evolve it. slide 22 just shows that the area under the curve for our phosphorylated pTau-181, where we got the breakthrough designation, third-party peer view pubs show that the area under the curve is 80% roughly, if it's before cognitive impairment, but it's as high as 90% after you start to see cognitive impairment. And so that's why we want to continue to advance our sensitivity. Because on slide 23, you can see there's different biomarkers that can measure pathology -- disease pathology sometimes as early as 10 to 15 years before starts. And the earlier you can see this pathology, the better chance drugs have been approved using these biomarkers as well as longer-term moving patients into these drugs utilizing these same biomarkers. And so on slide 24, we just want to show that today, there's 55 million people that have Alzheimer's with dementia and it's projected by 2050 to be $152 million, three times the level. And if you just assume that 10% of the world has access to diagnostics and that those that get -- that actually get diagnosed with Alzheimer's would utilize our technology four times a year to make sure that the biomarkers are progressing, it would suggest that a TAM could be as large as 7.5 billion today, and someday, as large as $22.5 billion with the emergence of greater levels of age and population around the world and the greater population of Alzheimer's. So on slide 25, we just show that our overall approach is to start out with an LDT, which is conservatively, we feel like by the end of 2023, there's an opportunity to be in an LDT for Alzheimer using pTau-181 and/or even beyond that in a multiplex for even greater specificity. We think there's an investment of $10 million to $15 million to achieve that. And then to get a single-site IVD or a laboratory IVD, which has FDA approval that gives you the dual source of reimbursement of Medicare with the actual regulatory approval, we think it's more like $40 million to $60 million, and we feel our 2024, this is achievable if we can continue advancing the way we are. And then ultimately, we do think distributed IVD would be beneficial for the Alzheimer landscape. And their new platform would be required, and we have relationships, as you know, already with Abbott, and we also have an NFL relationship with Siemens, maybe this is done via partner, but there's probably as much as $100 million required to achieve those TAMs that you see on the right-hand side. So up above the title, we basically say partnering this could further derisk and accelerate our ability to get into the diagnostic landscape. Initially, it's triage, but ultimately has a screen. So we're pretty excited that we are making these advances, and we would like to increase our investment, given that the certainty has been improved. And what we don't know right now is from a clinical perspective, we'll rule out the way in which many neurologists want to use the test, which would need to maximize sensitivity or would rule in saying that for sure, this patient has Alzheimer's which would require maximum specificity. We think that both of these are achievable with different cutoffs with our technology, and that's a lot of what we're trying to deploy right now. And finally, I would say that we did say that we would plan sometime, as I said in the update of the second quarter objectives, we would plan sometime in 2022, to file for MS, the breakthrough designation. So that remains our goal for the second half and to make sure that, that's done completely in the second half. And so with that, Mike, I'll turn it back over to you for some financial review.