Earnings Labs

Rigel Pharmaceuticals, Inc. (RIGL)

Q1 2020 Earnings Call· Wed, May 6, 2020

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Transcript

Operator

Operator

Greetings and welcome to Rigel Pharmaceuticals Financial Conference Call for the First Quarter 2020. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. [Operator Instructions] As a reminder, this conference is being recorded. It is now my pleasure to introduce our first speaker, Dolly Vance, who is Rigel's Executive Vice President, Corporate Affairs and General Counsel. Thank you, Ms. Vance, you may begin.

Dolly Vance

Analyst

Welcome to our financial results and business update conference call. The financial press release for the first quarter was issued a short while ago and can be viewed along with the accompanying slides for this presentation in the News & Events section of our Investor Relations page on our website, www.rigel.com. As a reminder, during today's call, we may make forward-looking statements regarding our financial outlook and our plans and timings for regulatory and product development. These statements are subject to risks and uncertainties that may cause actual results to differ from those forecasted. A description of these risks can be found in our annual report on Form 10-Q for the year ended December 31, 2019 and subsequent filings with the SEC, including our Q1 quarterly report on Form 10-Q. Any forward-looking statements are made only as of today's date, and we undertake no obligation to update these forward-looking statements to reflect subsequent events or circumstances. At this time, I would like to turn the call over to our CEO, Raul Rodriguez.

Raul Rodriguez

Analyst

Thank you, Dolly, and thank you for joining us on our first quarter 2020 financial and business update call. Also joining me on the call is Tarek Sallam, our Vice President of Marketing; our Chief Medical Officer, Wolfgang Dummer; and Dean Schorno, our CFO. I'd like to begin on Slide 5. First, I'd like to say that during these extraordinary time, the entire team at Rigel hopes you and your families remain safe and healthy. Importantly, we would like to thank all of the healthcare workers for their selfless efforts, which are absolutely vital. From a company perspective, our primary goal this time is to ensure the safety and health of our employees and patients. Rigel is taking actions across all of our business areas in order to continue executing on our strategy amid this challenging times. We are monitoring the impact this will have on our business going forward and we'll continue to adapt to the environment and provide updates as necessary. Now on to Slide 6. Rigel has four key value drivers, growing TAVALISSE in the US ITT market, capturing value in the global ITP markets via collaborations, breeding and capitalizing on warm autoimmune hemolytic anemia opportunity and expanding our pipeline of programs. Q1 of 2020 was certainly not what we imagined it would be to say the least. Nonetheless, we adapted to our environment, transitioned to virtual platforms and made important progress. In the recent quarter, we continue to grow sales on a year over year basis, reporting a 57% increase compared to the first quarter of 2019. We are very pleased with this given everything that is going on externally. This is a testament to the high quality commercial organization we have in place, as well as the highly differentiated and effective product we provide. In…

Tarek Sallam

Analyst

Thank you, Raul. Our current commercial efforts are centered around our first marketed product TAVLESSE, which as you see on Slide 9, is a kinase inhibitor indicated for the treatment of thrombocytopenia in adult patients with chronic ITP, who have had an insufficient response to a previous treatment. Let's move to Slide 10. I'd like to further elaborate on our first quarter performance that Raul highlighted earlier. We generated net product sales of $12.7 million, which was an increase of 57%. Compared to $8.1 million in the first quarter of last year. There were 1,398 bottles shipped to patients and clinics during the quarter, which excludes any change in bottles remaining in distribution channels which Dean will review in his update. This was encouraging, given the typical headwinds pharmaceutical companies face in the first quarter, particularly for oral specialty products, which are created by insurance reauthorizations, patient starting new plans and Medicare resets. What was, of course, atypical for the quarter was the rapid outbreak of COVID-19. Leading up to the month of March, we were excited to get out in front of our customers with our recent clinical data in second line patients, which I'll discuss in a few minutes, and deliver on our strategic priorities for the year, despite these typical first quarter headwinds. But then, as we all know, the current pandemic quickly change the dynamic of how we all work and interact with one another. However, we did see an uptick in March that has persisted through April, driven by a combination of both refills and new patient starts. Additionally, our persistency rate remained in the 54% range for the quarter, all of these important indicators of future growth. All said, we are pleased with the progress and foundation we have in place. While we certainly…

Wolfgang Dummer

Analyst

Thank you, Tarek. Good afternoon, everybody. I will begin on Slide 14. As you know, Fostamatinib is currently in an ongoing phase three pivotal trial in warm autoimmune hemolytic anemia. Here's an update on our progress, and how we are adapting in this current environment. Currently, we have 41 patients randomized into the study, which is nearly half of our target enrollment number. We had very good recruiting momentum until early March when the COVID-19 pandemic spread widely, and clinical trials sites begin to temporarily postpone screening. While this is effectively delaying enrollment for now, I'd like to emphasize the importance of the established operational foundation of our trials. We have over 80 trial sites in 22 countries that remain active. Hence, as soon as the COVID-19 situation normalizes, we should regain momentum rather quickly and efficiently. And since some countries are likely to normalize quicker than others, we can restart enrollment on a country-by-country basis, which will provide a competitive enrollment advantage. During the quarter, we also had productive conversations with the FDA about the program. As a reminder, the trial is placebo controlled with a one to one randomization to Fostamatinib placebo. Originally, the sample size was claimed to be 80 patients. We have increased the trial size slightly to 90 patients, which adds incremental powering to the study, and could help mitigate any potential missing data caused by COVID-19. We're still working with the FDA on finalizing the most appropriate usability measure. Since there is no drug approved to AIHA and we have the only AIHA trial in a pivotal phase three, we are setting the standards and work with the FDA to establishing this durability criterion. Turning to Slide 15. Like others in the industry, Rigel has been forced to rapidly adapt our phase three clinical…

Dean Schorno

Analyst

Thank you, Wolfgang. I'm on Slide 20. For the first quarter of 2020, we shipped 1,393 bottles to our specialty distributors. We shipped 1,398 bottles to patients and clinics which is comparable to the fourth quarter, where we shipped 1,422 bottles to patients and clinics. As in the prior year, we did see typical first quarter reimbursement issues, such as the resetting of co-pays and the Medicare donut hole. Incrementally, we did start to see the effects of COVID-19 in the latter part of the quarter. Also during the quarter and for the first time, we saw a five bottle reduction in bottles that remained in our distribution channels, resulting in a total of 591 bottles at the end of the quarter. We reported net product sales from TAVALISSE of $12.7 million, a 57% increase compared to the first quarter of 2019. Our net product sales from TAVALISSE were recorded net of estimated discounts, chargebacks, rebates, returns, copay assistance and other allowances of $2.7 million, a gross to net adjustment which is approximately 17.5% of gross product sales. We currently expect our gross to net adjustment to remain in the 18% to 19% range throughout 2020. In the first quarter, we did see a sequential reduction in net product sales, resulting primarily from the changes in the bottles remaining in our distribution channels and to a lesser extent to the impact of COVID-19 in the latter part of the quarter. Specifically in the fourth quarter of 2019, we saw a 96 bottle increase in bottles remaining in our distribution channels, compared to a five bottle reduction in the first quarter of 2020. The effect of this change in bottles remaining in our distribution channels was approximately $1 million when comparing the change in the fourth quarter of 2019 to the…

Raul Rodriguez

Analyst

Thank you, Dean. As you can see that the COVID-19 pandemic has had an impact to varying degrees on all areas of the business but what we are trying to achieve has not changed. There will be unavoidable impacts on our business in the short term, but fundamentally, we remain on track. This is driven by the resilience and focus of our employees and their commitment to our patients. We will continue to grow TAVALISSE in the U.S. ITP market using virtual engagements to communicate across all the vehicles we use. We are excited about the use of TAVALISSE in earlier lines of therapy and the data that we have to support this position. Similarly, we look forward to European patients that suffer from ITP also having access to tablets and will support our excellent partner Grifols in their efforts. We will work to complete the enrollment of our AIHA Phase 3 study. The patient needs in warm autoimmune hemolytic anemia is no less real, no less pressing or no less important today than it was earlier this year. We will give them a much-needed treatment option. We will explore how TAVALISSE could potentially provide patients with COVID-19 related pneumonia a much needed new therapy. We will continue to advance our RIP-1 [ph] and IRAK1 programs and put in place a partnership for one or both of these important assets. We will work harder, smarter and more thoughtfully to accomplish what we set out to do. With that, I'd like to open the call up to your questions.

Operator

Operator

Thank you. We will now be conducting the question and answer session. [Operator Instructions] Our first question comes from the line of Yigal Nochomovitz with Citigroup. Please proceed with your question.

Yigal Nochomovitz

Analyst

Great, thank you for taking the question. First question is related to the prescribing patterns for TAVALISSE in light of COVID. I understand you've shifted to telehealth primarily. But what happens for new patients? Is it possible for a hematologist to prescribe TAVALISSE to a new patient just via telehealth, or do they actually need to see the patient?

Tarek Sallam

Analyst

Sure. Thanks for the question you got and absolutely an appropriate one, given these unique times. When I was referring to the telehealth capabilities that we're seeing out there with our providers and our subsequent than ability to interact with them virtually, in fact, a lot of our activities that have taken place in March as well is continuing to April, as I had articulated, are supporting new prescribers. Not only are we ensuring ongoing support of existing prescribers but to answer your question simply, yes, we've absolutely been able to support new hematologist, new chemo clinics with virtual in services, onboarding even so far as sending via snail mail materials or even digitally so that their nurses and their staff are able to educate patients, whether they're educating patients in see to, live in person in the clinic or they themselves are doing it through telehealth mediums. I'll be honest, I've been very impressed by both our internal team as well as our external customers' ability to adapt to meet the needs of new patient identification. Hopefully, that answers your question.

Yigal Nochomovitz

Analyst

That's very helpful. Thanks. I just wanted to make sure I understood Dean's comments a little better with respect to the sequential decline for 1Q 2020 versus Q4 2019 which I understand was driven by COVID in the latter part of the quarter, as well as the typical headwinds. With respect to 2Q 2020, to the extent that you can comment, are you saying, are you preparing the market to expect another sequential decline given the COVID headwinds or is that reading into it too much?

Dean Schorno

Analyst

A couple of things you got there. The description of the reduction, the sequential from Q4 to Q2, we had 96 bottle increase in inventory in Q4, a five bottle decrease in Q1. So 101 bottles at a bit more than $9,000 per bottle on an average net sales price across our business. That's almost $1 million. As you look at the graphics that we showed that showed the reduction in Q1 of 2020 that was our purpose there. With respect to our view going forward, what we've said at this point is just kind of reiterate what Tarek said. Is that our view is that we haven't given guidance to date. We did see a sequential or we saw an uptick in our business in March that persisted into April but we just don't know the full effect and the access that will become available to us and we just haven't provided more information beyond those comments. Let me pause there and ask Tarek or Raul to add any incremental color.

Tarek Sallam

Analyst

Thanks, Dean. This is Tarek. The other thing too, just to reinforce is as Dean articulated, while we're not providing guidance and certainly like many organizations COVID-19 is adding an unknown variable. I spoke a little bit about the opportunity as well and so well, as an organization -- as a commercial organization, we would have loved to have had our fields face to face in front of our customers talking about the second line data, particularly as we had launched it towards the mid to late February timeframe. That still represents opportunity for us and so using the vehicles that we have in place, we are consistently delivering that message whether to new prescribers or existing prescribers as they're thinking about the appropriate patients for TAVALISSE. So just consider that as part of the balance of really how we're actually executing out there and delivering messages. Clearly, we can't wait to get in front of them in person when things abate, but we are certainly delivering those messages virtually right now.

Yigal Nochomovitz

Analyst

Okay, great. That's helpful. This one might be best suited for Wolfgang. With respect to the new initiatives you've announced regarding COVID-19 trials and the sixth pathway, I just want to get a sense was this something that originated internally within your-- among your scientists or were you approached by academic groups that saw the potential for this drug to potentially treat COVID-19 patients? Just trying to get a sense as to how it originated and the extent of the investments that you would make in this sort of program?

Wolfgang Dummer

Analyst

The answer to your question is both. We have been approached by renowned institutions who are interested in using this drug. At the same time, of course, internally and based on the data that I have shown you we have thought there might be there for this compound and so this came at the right time. How much money would be spent? Raul, do you want to take that?

Raul Rodriguez

Analyst

I do. A couple of comments. We were interested in acute lung injury, ARDS prior to the COVID pandemic in the experiments that Wolfgang showed on Slide 18, that's published. Something we've been very interested in exploring ourselves because ARDS is a substantial opportunity corollary to many other diseases, not just COVID-19. So when this came about, we knew that this was a good opportunity for us to consider. What we did is didn't have any discussions about it and we were subsequently approached, as Wolfgang said, by institutions that are already working in this area, doing trials, testing molecules. This is an opportunity for us to explore the use of our product in this important new area and obviously, we'll take advantage of it as fast as we can to put it into human testing. How much money it will take? I think I can't say just yet because we don't have that done yet. Right now we're exploring this investigator sponsored trial just because they are the fastest way to begin testing the molecule in this setting.

Yigal Nochomovitz

Analyst

Okay, got it. Thanks for all that's very helpful.

Operator

Operator

Thank you. Our next question comes from Chris Raymond with Piper Sandler. Please proceed with your question.

Ally Bratzel

Analyst · Piper Sandler. Please proceed with your question.

Hi, this is Ally Bratzel for Chris, this afternoon. Thanks for taking the question. I think first just on the FDA interactions regarding the AIHA trial, could you clarify what the driver was there for increasing the sample size to 90 patients? Was that purely in response to potential COVID-19 interruptions or was that upsizing always a possibility as part of a pre-planned interaction with FDA?

Wolfgang Dummer

Analyst · Piper Sandler. Please proceed with your question.

Sure. There was some overlap. We wanted to meet with the FDA and we arranged for a date and at the same time, COVID-19 began. Our original driver was to increase the sample size slightly because it gives us a little bit more incremental power. Actually, to be specific, 90 would allow for one additional placebo responder to get a response and with that 25% delta still is statistically significant. There was a precaution and since enrollment went well, we thought, this is a very good idea. Now in the times of COVID-19, it does also mitigate against the potential risks to the handful of patients or not getting enough data to be fully evaluated. Right now that situation looks pretty good. We are looking very carefully into the amount of missing data and how patients come to the site and get their blood draws and it looks actually pretty good. The sites are doing a very good job, but this is-- the increase of sample size to 90 is a little bit of an added risk mitigation against that.

Raul Rodriguez

Analyst · Piper Sandler. Please proceed with your question.

So the answer is both, Ally. I think we were prior to this COVID thing enrolling eight to nine patients a month in a pretty good clip and we're seeing good trajectory. I think we'll get back to that once the sites begin screening patients again. It's worth that extra little by the securities for both reasons.

Ally Bratzel

Analyst · Piper Sandler. Please proceed with your question.

Okay, next time. And then maybe shifting to ICP. A question about four months [indiscernible] that's going really nicely since they can queue for you first started describing that at around 45% and now it's up in the mid-50s. I think what we saw quote-unquote at around 54%. Could you just talk about the drivers that are impacting that? Were there Q1 seasonality impacts that maybe what allowed that to be flat in Q4 and Q1? And then maybe talk about how we should think about that we probably growing or maybe beyond the mid-50s or staying steady in the mid-50s throughout 2020.

Tarek Sallam

Analyst · Piper Sandler. Please proceed with your question.

Raul, feel free to layer on. Great question in regards to our persistency rate. As I share it, we're seeing approximately a persistency rate at four months for the quarter at 54% and as you articulated some good progress since launch. Actually significant progress since launch. I think as we think about to your question about what are the drivers, what are behaviors and how do we potentially perceive that looking forward? Well, certainly we don't have a crystal ball. I think what we've articulated in the past is that as clinicians and their staff become more familiar with the product, understand about how to manage the disease with this specific product, understand how to educate their patients about AEs and onboarding of it. As well as frankly, we talk about the specific patient type that they're using it in. We believe that all of these factors are going to impact and then correspondingly improve the persistency rate. One of the key drivers we think to the persistency rate and its potential growth in the future is really the line of therapy because obviously, later line patients have poor prognosis and potentially cycle on and off therapies more frequently. We believe, particularly that the second line data and as we move TAVALISSE into regular usage in the second and third line setting, that that is going to also correspondingly impact the persistency rate. Hopefully, that answers your question.

Raul Rodriguez

Analyst · Piper Sandler. Please proceed with your question.

Ally, we've just started this in terms of moving into earlier lines of therapy with this new data from the meeting, as Tarek pointed on in this presentation. Really our presence in that segment, those earlier segments is really very small and that provides tremendous opportunity to grow. The opportunity would benefit itself in more patients, but also more patients staying on drugs longer, higher persistency. It's not just month four, but really across the entire crew that we expect to increase. Whereas we get into those earlier lines of patients who have a better response to products generally and are specifically with 78%. I think that's pretty exciting. You should expect to see that continue to increase. You're right we were 45, now it's 54 and it should continue to move upward.

Ally Bratzel

Analyst · Piper Sandler. Please proceed with your question.

Okay, got it. Thanks so much, guys.

Operator

Operator

Thank you. Our next question comes from Do Kim with BMO Capital Markets. Please proceed with your question.

Do Kim

Analyst · BMO Capital Markets. Please proceed with your question.

Hi, good afternoon. Thanks for taking my questions. I was hoping if you could talk more specifically about the dynamics of how COVID impacted TAVALISSE sales in the first quarter. Other biopharma companies have been reporting that oral therapies have been seeing early refills and increase in 90-day scripts, causing a temporary pull forward in sales. Is that something you also saw or is it just difficulty in getting new patients and some slippage in existing patients?

Raul Rodriguez

Analyst · BMO Capital Markets. Please proceed with your question.

Let me take a first stab at that and Tarek I'll ask you to comment as well. Thank you, Do. I hope you're doing well. So really Q1 is typically a challenging quarter. Remember last year, we had a quarter that was about flat. This quarter, we were thinking it was going to be about flat and then in March we usually see an uptick. We saw an uptick. It was not as pronounced as maybe we were expecting it to see and that's what causes moderation of growth there. We came in largely flat maybe slightly below where we were last quarter. Really, it had impact in many ways. Doctors and patients not seeing their doctor on a regular basis. Some of that is insurance reset. Some of that is want to go see a doctor and under COVID conditions, it's hard to separate the two out frankly and say it was due to this and that other than in Q1 you see the impact of both those effects, insurance resets as well as the COVID keeping patients from moving forward. We saw that and that's what depressed our growth. As you saw in March, we did see an uptick. It was not as pronounced and that continued into April. Tarek, any other observations?

Tarek Sallam

Analyst · BMO Capital Markets. Please proceed with your question.

No. It's a great question, though. I think to Raul's point, it's hard to pinpoint the specificity in terms of acceleration due to long-range like 90-day refills and things like that. We haven't necessarily seen that level of granularity impacting our business. Ultimately, with the headwinds we've seen from a reimbursement and insurance perspective, as Raul articulated, we really have seen momentum built in March and April. Obviously, the timing of this and our inability to be face to face with our customers is an area that we would have rather obviously been up been out there in person. To articulate whether it's A or B is a little difficult for us but needless to say, we're really encouraged by just the level engagement. I can tell you just based on sheer interest alone, physicians are amenable to meeting with our both commercial and medical field forces, they are excited to hear about the new data. So, just using that as a little bit of a litmus test to indicate that there's a willingness and a need for this information, I will say I'm actually pretty encouraged by that.

Do Kim

Analyst · BMO Capital Markets. Please proceed with your question.

Okay, great. That's very helpful

Raul Rodriguez

Analyst · BMO Capital Markets. Please proceed with your question.

Joe, if I could just add one quick comment there. You know, what's interesting, maybe a little surprising to me, is that in the quarter, Q1, we saw a decline in inventories that are at our distribution channel or in the distribution channel. Usually, we see about a decrease as Dean said, in Q4, we saw almost 100 bottle increase in inventories. And this quarter, Q1, we saw a five bottle decrease, no increase in inventory which created that unfavorable comparison. Actually, that was a surprise to me, I would have expected some increase in inventory just because of all that's happening, that didn't occur in Q1.

Do Kim

Analyst · BMO Capital Markets. Please proceed with your question.

Right, right. No, that makes sense. And for Grifols launch in Europe, in your communications with them, has there been any discussions in a potential delay in that considering how hard Europe has been hit by the pandemic?

Raul Rodriguez

Analyst · BMO Capital Markets. Please proceed with your question.

Well, what they've told us, actually, they put out in their press release last week, is that the product will be available to patients in Europe this month -- this quarter. And so that's good. Doctors can actually write the script and have it filled. The -- in terms of their active promotion of the launch, it's just very difficult to execute on that right now. No doubt they'll delay some of that activity. But the product will be available this quarter, which is good to see. And when things clear up a bit, they'll move forward. Interesting, different countries in Europe are suffering from this pandemic very differently. Italy and Spain, maybe one extreme, but it seems that some other countries, Germany is frankly handling it quite well, as well as we expected, not a lot of disruption. The Scandinavian countries, Norway, for example, are doing well. And so it's highly varied in Europe. It's not -- maybe not too dissimilar to the US in terms of different regions, but in some places, I expect them to move forward more quickly than in other places.

Do Kim

Analyst · BMO Capital Markets. Please proceed with your question.

Okay. And last question, for Wolfgang, in the clinical studies for TAVALISSE to treat COVID, pneumonia and ARDS, are you thinking about a particular severity of the disease where TAVALISSE will be most effective? And as you have all these other therapies, anti-virals working for the more moderate patients, will -- would you think that TAVALISSE would be effective in the more severe patients?

Wolfgang Dummer

Analyst · BMO Capital Markets. Please proceed with your question.

Yes, so as you said yourself, TAVALISSE is not an antiviral, it's an immune modulator, right. So, I see the greatest opportunity certainly, in particular, initially in the cases that have advanced to pneumonia, and they could start as early as just verified pneumonia, but no invasive ventilation required. But I could also see potential in the patients who are already on a ventilator. And as you know, they have like very high mortality rates. Given what I have shown you, and how sick inhibition might work, I think that definitely, that will be the place to start. Once you get to a point where you have establish safety and efficacy at that stage, you could, move yourself forward and say, well, shall we use this as soon as you have any type of respiratory symptoms? But there will be probably the second step.

Do Kim

Analyst · BMO Capital Markets. Please proceed with your question.

Got it. I hope everyone stays safe there too. Thanks for taking my questions.

Raul Rodriguez

Analyst · BMO Capital Markets. Please proceed with your question.

Thank you, Joe.

Operator

Operator

Thank you. Our next question comes from the line of Tessa Romero with JP Morgan, please proceed with your question.

Tessa Romero

Analyst · JP Morgan, please proceed with your question.

Hi, guys. Hope you're all doing well. Thanks for taking the question. First one for me, on [indiscernible]. if I could. So you have widespread sites geographically, which I think could be favorable in rebuilding momentum when the COVID pandemic normalizes. Sort of what are the key push pull levers to consider on the enrollment side and potentially still meeting the prior mid-2021 data timing? I think you have a 24-week or a six-month primary endpoint for this study? And then I have a follow up.

Raul Rodriguez

Analyst · JP Morgan, please proceed with your question.

Sure. I'll ask Wolfgang to add, but I will just preface it by saying, we think that this is a very attractive opportunity, and the product will be very important product for patients suffering from warm autoimmune hemolytic anemia. So our view of the opportunity really hasn't changed at all. And the reason we believe so strongly in this is that we opened up baby centers across the world in order to execute on this trial as fast as we can. And that does give us a lot of geographic diversity that allays the impacts of COVID being very different in different European countries. And so it'll help us a good deal and I think we'll get back to enrolling patients at a clip of eight or nine patients a month once the sites are back focused on the. But that'll be different, and they'll come back at different speeds. And it's hard to predict right now what that speed differential might be, which is why it's harder for us to say this is when we think it'll be completed. Wolfgang, do you want to add any other thoughts on that?

Wolfgang Dummer

Analyst · JP Morgan, please proceed with your question.

Yes, you covered most of the answer for the question. I guess we have -- so basically, what we discussed is you need to be comfortable, and your patients’ needs to be comfortable to participate in the study and that means you want to come to your study visit so that they can draw your blood and all this type of things. And in the -- obviously in the height of the pandemic, their comfort level wasn't very high. I would say now that the things are more and more reopening and beginning to normalize, we can start thinking about this again. But again, it -- things change very quickly these days, but once we feel it is safe for the patients to come back to the site and participate in the study, then reopening of enrollment could be considered.

Tessa Romero

Analyst · JP Morgan, please proceed with your question.

Okay, that's helpful. That's helpful. And I may have missed it in some earlier comments, but just a quick one for me. What -- sort of in the height of the pandemic, what were you seeing on NRXs versus TRXs versus kind of what you're seeing sort of in late March? I think you said there was an uptick into April. I'm just kind of trying to get at, can you give any more kind of color on if it was new patients that were kind of declining or if it was some of your existing patients? Yes, any additional color you can provide on that point would be helpful. Thank you.

Raul Rodriguez

Analyst · JP Morgan, please proceed with your question.

Sure. I'll take a stab at doing that. And Tarek, if you could follow the -- we saw continuing activity in both the new patients and continuing patients. And pretty good reaction in terms of that we were very positive in the start of the year in terms of what we were expecting to see, especially given the early-line data that we had presented at the ASH meeting. And so we were seeing good, and as expected, performance in the business across new and established patients. And then surprising this COVID hit at the month where you see an uptick. We saw a bit of an uptick, but not as -- maybe as profound as you would have expected.

TarekSallam

Analyst · JP Morgan, please proceed with your question.

Yes, Raul. Tessa, to your question. I think that last point, Raul is probably the only point I would have just layered on is specifically is that, as you can imagine, Tessa these are chronic disease patients and for a lot of oral therapies like TAVALISSE, not just ourselves, they tend to kind of work their way through these reimbursement hurdles in the first couple of months and so with that dynamic that we've seen, we have seen a more robust uptick in the past to March. So I think that last point that Raul articulated is just kind of the key points…

Tessa Romero

Analyst · JP Morgan, please proceed with your question.

Okay, great. That's helpful. Thank you for taking my question.

Raul Rodriguez

Analyst · JP Morgan, please proceed with your question.

Thanks, Tessa.

Operator

Operator

Thank you. [Operator Instructions] Our next question comes from the line of Kristen Kluska with Cantor Fitzgerald. Please proceed with your question.

Kristen Kluska

Analyst · Cantor Fitzgerald. Please proceed with your question.

Hi, good afternoon and hope everyone on your team remains well. So my first question is, as it relates to the Warm AIHA trial, I noticed on clinicaltrials.gov that you made modifications and added new centers during April. Were these centers part of the plan or have you made any changes as it relates to a result of the pandemic? And also, are you looking to potentially explore any backup centers in specific geographies as you continue to monitor the situation? Thank you.

Raul Rodriguez

Analyst · Cantor Fitzgerald. Please proceed with your question.

Thanks, Kristen. I hope you're well as well. I'll ask Wolfgang to answer that.

Wolfgang Dummer

Analyst · Cantor Fitzgerald. Please proceed with your question.

Yes. No, so we opened sites according to our plan -- to our originally existing plan, there was no change. To your other point, I think with our 22 different countries, we are geographically pretty well prepared for a reopening, and as I said in my in my script, this could be a site by -- a country by country approach, right. So if you see that countries like Germany come back to normal a little bit quicker, we can certainly open enrollment, they are faster than in something very hard hit like Italy, for example. So I think we are extremely well prepared -- as prepared as we can be for the time of reopening and re-resume of randomization.

Raul Rodriguez

Analyst · Cantor Fitzgerald. Please proceed with your question.

Kristen, thank you. And if I could add on that. In April, clinicaltrials.gov had additional sites opening in April, that -- I don't think that's correct. I think it may have been just a delay in updating the site because I don't think we've added any sites in April. But one thing that's useful to think about is, as we went forward with this and had the sites opened, our thought was having a patient enroll and then not having to make it able to make any of their visits would have not been a useful advancing program; we really prefer to have the patients where we're confident that they'll be able to make their visits because otherwise they're not going to be useful patients to study and enroll.

Kristen Kluska

Analyst · Cantor Fitzgerald. Please proceed with your question.

Okay, thank you for that. So while the majority of centers are postponing enrollment, is there anything that your team or investigators can do during this time to try to find patients that could be eligible once things start to open up again?

Raul Rodriguez

Analyst · Cantor Fitzgerald. Please proceed with your question.

Well, you know, the patients are still there. And we know that the patients need a new product such as this, so that hasn't changed. Their willingness to come to a clinical trial site on a regular basis during stay at home orders is limited because of that. And also the -- some of the centers, especially centers that are part of major healthcare facilities in some of these cities are also reluctant to undertake additional obligations like monitoring patients and so forth when they are focused on other things; so for both of those reasons, it's quite understandable. But as the pandemic has nodded [ph] substantial impact in some countries, say Germany, for example; they'll have to be back to focusing and patients will be back to visit the clinic looking for potential therapies. And as part of that, we'll consider enrolling in our trial. But we're following that very carefully, all the centers are places where there are patients, we know they have patients that are potential patients for our clinical trial. Wolfgang, anything to -- anything further than that?

Wolfgang Dummer

Analyst · Cantor Fitzgerald. Please proceed with your question.

Yes, maybe just to add; it is such that all of these sites have an open eye on who might qualify for that study before they even screen the patient. Meaning, they have a list of names that they know they have AIHA, some of them might qualify now, some of them they observe for a while until the haemoglobin goes down. So that list of names exist for most of the sites, and once things normalize and we say, well let's continue enrolling; you can reach out through these patients, and then put them in real screening and see if they qualify for enrollment and randomization. So, there is activity ongoing.

Kristen Kluska

Analyst · Cantor Fitzgerald. Please proceed with your question.

Okay, thank you. And my last question here is, last quarter you listed some potential indications you might look at fostamatinib and beyond chronic ITP and Warm AIHA. Have your thoughts changed here at all or is the same potential list of indications what you're considering at this time? Thank you.

Raul Rodriguez

Analyst · Cantor Fitzgerald. Please proceed with your question.

I think it's a similar list with the addition of ARDS and COVID ARDS specifically or COVID pneumonia, more broadly. That obviously was not something that a quarter ago we were thinking about, and now it's risen quite quickly, as you have surmised, in terms of our level of interest and we're looking at that very carefully.

Kristen Kluska

Analyst · Cantor Fitzgerald. Please proceed with your question.

Okay, thank you.

Raul Rodriguez

Analyst · Cantor Fitzgerald. Please proceed with your question.

Great, Kristen. Thank you.

Operator

Operator

Thank you. There are no further questions at this time. I would like to turn the floor back over to Mr. Raul Rodriguez for any additional closing comments.

Raul Rodriguez

Analyst

Well, thank you for your interest. These are times that I think are extraordinary. Never have we gone through such a period of time, and -- but I have to say, I'm incredibly impressed and delighted to be part of an organization that worked so diligently to continue their work, whether it's at home, whether it's out in the field, and on virtual calls. It's been very impressive how quickly and thoughtfully our staff has made that transition. And I think a tribute to the dedication to the goals that we have to provide the product to our patients, to provide them additional product opportunities to treat their illnesses, AIHA, COVID ARDS. We will continue with that effort and make sure that we continue to make progress every single week whether it's in our living rooms, our bedrooms, our homes, or back in the office, I hope soon or in the labs. So, thank you for your support. And look forward to providing further updates. Take care.

Operator

Operator

This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation.