Anne-Marie Duliege
Analyst · Kyung Yang of Jefferies. Your line is open
Thank you, Raul. As always, I want to thank my colleagues for their ongoing hard-work and dedication in support of our NDA submission for the ITP indication. We continue to work closely with the agency and remain hopeful that we will be able to bring this investigational product as a new drug to a patient population with unmet medical need. In addition, we continue to accumulate data in patients with autoimmune hemolytic anemia. Finally, we're on track for the results of the IgA Nephropathy study in Q2 2018. Rigel focused on chronic ITP at its first indication for fostamatinib, because there is a significant unmet medical need in this orphan disease. ITP is a rare autoimmune condition with approximately 65,000 adult patients with chronic ITP in the U.S. ITP arises from various disease mechanisms of platelet destruction and in some cases insufficient platelet production. This disease is characterized by an increased risk of bleeding, often with minor forms of bleeding such as bruising [in particular] [ph]. In addition, patients may also have considerable fatigue and a reduction in the quality of life. Bleeding episodes such as GI or brain hemorrhage can be more severe and potentially lethal. The physiopathology of ITP is complex and many factors have contributed to the disease may differ from patient to patient, making this a clinically heterogeneous disease. Treatment options exist, but they are limited, often associated with side effects and the response can wane over time. There is no treatment that specifically prevents platelet destruction. SYK kinase is a key player in the immune system's destruction of platelets in ITP, fostamatinib is a SYK inhibitor with a first-in-class unique mechanism of actions. As a clinical summary of fostamatinib in ITP, the combined Phase 3 studies with fostamatinib demonstrate consistent clinical benefit in treating patients with ITP with a stable response of approximately 18% and a post-hoc overall or clinically relevant platelet response rate of 43%. Patients with platelet increase had a rapid, robust and enduring response. The safety profile in the studies was consistent with a substantial prior experience in the rheumatoid arthritis population. Adverse events were generally mild or moderate, with diarrhea, hypertension, liver toxicity being the most frequent one. Hence, if approved by the FDA, fostamatinib may be an important new treatment option for patients with chronic ITP. Slide 14 gives us a quick overview of the U.S. regulatory interactions to date. We submitted the NDA in April 2017, which was accepted for review. We have had positive interactions with the FDA at both the mid-cycle and the late-cycle review meetings. Regular collaborative discussions are ongoing with the FDA, but we will not comment further on the details of these discussions at this time. We can confirm that we're on track for PDUFA date of April 2017. Regarding the European regulatory path, we've received positive feedback from the MHRA last December with no objection to the filing. Based on this, and the fact that we know the data so well, we have decided to submit an MAA ourselves by the end of 2018. We went with this decision rather than identifying a partner who would then submit dossier in 2019. As we could gain approximately a year in timing, and this could strongly benefit patients in Europe. We're still actively looking at partnership for the product in Europe. On Slide 16, focusing on our fundamental target fostamatinib we now look at our next indication in the Phase 2 study with this product. Autoimmune hemolytic anemia is a condition associated with increased destruction of red blood cells, in the presence of anti-red blood cells antibodies. There are approximately 40,000 cases of autoimmune hemolytic anemia in the U.S. Symptoms can include fatigue, shortness of breath and reduction of activity in quality of life, all of which can be severe at times. Currently, other than steroids, there are no approved products in the treatment of warm autoimmune hemolytic anemia and no standard therapeutic approach to its treatment has been developed. The relative rarity as well as the heterogeneity of this disease has make it difficult to conduct randomized clinical trial. Thus, the treatment approach to warm autoimmune hemolytic anemia is largely based on the preferences of the treating physicians. Hence, autoimmune hemolytic anemia represents an attractive opportunity for the potential extension of fostamatinib usage, with unique mechanism of action potentially addressing the underlying cause of this autoimmune disease. Slide 17, this Phase 2 study is a Stage 2 study. Patients enrolled are treated with fostamatinib for 12 weeks and can then participate in a long-term extension study. The study design and the definition of the primary endpoint were done in collaboration with key opinion leaders. The primary endpoint is the response rate during the 12-week study. The definition of the response is widely accepted as hemoglobin of greater than 10 gram per deciliter and at least 2 gram per deciliter increase from baseline. On the next slide, the patient - the next slide, the patient population is also characteristics of the general patient population with moderately severe to autoimmune hemolytic anemia, mostly middle aged women with anemia. The goal in Stage 1 of this Phase 2 study was the enrollment of 17 patients. During the study, two patients discontinued for reasons unrelated to safety or efficacy and were replaced. So we have 17 evaluable patients for efficacy and 19 patients for safety. On Slide 19, we review the Stage 1 results. Of the 17 patients evaluable for efficacy, 53% of these patients, 9 of 17, have now had a clinical response on fostamatinib. Six patients responded during the 12-week evaluation period, and an additional three patients started to increase their hemoglobin levels during the initial 12 weeks of the trial, and have now met the clinical response criteria in the extension study. And further comprehensive analysis of the Phase 2 data will continue. The figure on Slide 20 provides the hemoglobin response during the 12-week study by responder status. In green, you see six subjects who responded in the 12-week study at a rapid median hemoglobin increase to over 3 gram per deciliter in the first four weeks. Among the 11 initial non-responders, three patients met the criteria for response in the extension study. These late responders are noted on this graph in blue to show the increase in hemoglobin that happened in these individuals during the first initial 12 weeks, taking them into the extension study, where they achieved a clinical response. These results are meaningful, because they show that fostamatinib is associated with a hemoglobin response that is generally rapid and sustained in a disease with significant unmet need. There were no new adverse events in the program. Three patients with serious adverse events all assessed are non-treatment related by the investigators. In summary, on Slide 22, we have had 53% response rate in Stage 1 of this trial. This is a disease with significant unmet medical need. And study investigators, including our lead investigator, David Kuter, are very encouraged by these results, because of the clinically meaningful increase in hemoglobin. Remember, current treatment options include steroids or Rituxan, treatments that are not approved for this condition, and also splenectomy. Many patients initially respond to this treatment, but either failed to achieve a durable response or find the long-term side effect unacceptable. Hence, an investigational drug that targets the mechanism of disease is an attractive option that deserves further clinical testing. There were no new safety signals and the primary endpoint was achieved in the Stage 1 portion of the trial. Another exciting news is that we have been granted orphan drug designation for fostamatinib in autoimmune hemolytic anemia The next step is to enroll 20 additional patients onto Stage 2 of this study. We look forward to discussing these results with the FDA and the best regulatory strategy to move this product forward to a potential approval. Our third indication that is currently completing a Phase 2 clinical study with our fundamental target fostamatinib is IgA nephropathy. IgA nephropathy is a chronic autoimmune disease associated with inflammation in the kidneys that can diminish their ability to filter blood. There are an estimated 82,000 to 165,000 cases in the U.S. with a higher prevalence in Asia. Outside of angiotensin blockade, primarily for blood pressure control, there are no disease-targeted therapies for IgA nephropathy. Preclinical data show that fostamatinib may decrease SYK activation in the kidney, potentially resulting in the reversal of the inflammation in the glomeruli and improvement in kidney function. Slide 24 shows the study design for the IgA nephropathy Phase 2 study. Rigel announced results of the first cohort of the Phase 2 study, which used 100 milligram twice a day of fostamatinib in January of last year. The study showed no safety signals and a trend towards greater reduction in proteinuria over 20 weeks compared to placebo. Rigel expects results of the second cohort evaluating a higher dose of fostamatinib using 150 milligrams bid in Q2 of this year. That concludes our clinical review for this call. And now I would like to introduce Eldon to discuss our commercial readiness. Eldon?