Matt Gline
Analyst · SVB Securities. Your line is now open
Thank you, Jeff, and thank you, everybody, for joining this morning. It's been a really impactful quarter for us and I'm excited to share some updates both from the quarter and more recent. Some of these updates we already shared last week as a consequence of the financing that we did, and some of them are new. And as I said, I look forward to sharing everything. So we're going to cover a few topics. Notably, I'm going to start with a discussion on the launch of VTAMA and then we'll go through some clinical updates and some other updates around the business as well as the financial update at the end. So I'm going to start on Slide 6 with just a -- an update on the VTAMA launch. And really a reminder, we are really, really pleased with how this launch is going. So you can see the script data here, including for the quarter itself as well as for the more recent periods, And we continue to see great growth in scripts and we're very pleased with it. We'll talk a little bit more about the revenue, but also excited to announce that we did $5 million in net product revenue for the quarter ending September 30, which is a 12% net yield, which given that all occurred prior to the signing of our PBM contract, again sort of a testament to the quality of our script to the number of docs who are willing to go through the prior authorization process. So on Slide 7, one of the most important updates here is we have our first major PBM/payer contract signed. We indicated that would be coming before the end of the year, and we're very pleased that it was effective as of October 1. We haven't said which payer win, but most importantly, it gives us exactly the kind of coverage and access that we wanted, requiring only an automatic look back for steroid on the patient's chart. Or if the physician prefers an e-attestation of prior steroid use, which is a really easy bar to clear. So this is better than what we had initially hoped for in terms of the quality of coverage. And it ensures because close to 90% of psoriasis patients use a topical steroid as first-line therapy. This gives us really access to all of the patients that we are focused on. And notably, as we said, we're still focused on becoming the mainstay of therapy and ultimately supplanting steroids, which means, of course, the simplicity of access here is straightforward. And as a reminder as cons -- in this contract and our sort of copay card, any covered claim that the pharmacy should have a $0 copay for the patient and so they should create a really positive experience for the patients covered here as well. So on Slide 8, I'll also just remind everybody, we're obviously pleased with how the launch is going in absolute terms. We also -- we're pleased with how this looks relative to other psoriasis launches that we've observed. We became the number one most branded topical eight weeks into our launch, and we've comfortably stayed there since and we continue to keep pace with the launch of OPZELURA, which is notable because OPZELURA is atopic dermatitis and has about 4x as many scripts to draw from. We're now meaningfully over 50,000 prescriptions written, and we're over 6,000 by 6,400 unique prescribers since launch, so broad prescriber base and volumes that we're really happy with at this stage. I want to talk a little bit on Slide 9 about the P&L. So we're still not giving explicit long-term gross to net guidance, but we've said since our Investor Day that we are confident we're going to get to a commercially attractive P&L. And I think you can see in some of the metrics on Slide 9, sort of why we had that confidence even before we knew what the sort of PBM contract look like. We had $5 million in net product revenue, which for this stage in the launch we feel really good about and a 12% net yield, again, this is a clear demonstration of prescriber enthusiasm for the drug, given the sort of work required before that PBM contract to get medical exceptions during formulary review. So we're very pleased with these metrics and again, we expect to give steady state gross to net guidance after we've signed some additional PBM and payer contracts. But we expect to see this GTN yield improving from here as we execute on more of these contracts. We'll provide those updates as they come. On Slide 10, I think is just an important point to hit. We're really pleased with how the launch has gone and certainly the sort of weekly script numbers. But I want to point out; we are really just getting started here. There are over 90,000 topical prescriptions in psoriasis alone, the vast majority of which are topical steroids. And there are over 320,000 topical prescriptions in atopic dermatitis, which will be a market accessible to us after we get our data and approval there. And our data is coming in the first half of next year. And so no matter how well things are going at this stage, this is a huge market to draw from. As we work to replace steroids as the topical steroids is the mainstay of care for these diseases. And notably, to get to a blockbuster product, we need like 5% to 10% share here, so really modest relative to the quality of the product. So we've talked a little bit about sort of how the launch goes from here. And the one thing I'll say is, we have a lot of useful tools and levers to continue to drive adoption. And we're excited now that payer coverage is coming online to continue to build the script volume and to grow into what we believe should be an important multi-blockbuster product opportunities. So, excited to continue to share updates as we progress. As important at this stage is the quantitative metrics, if you look on Slide 11, we've gotten just tremendous high-quality feedback from early prescribers. We held on our Investor Day in September, a panel of KOLs, which I recommend listening to, if you haven't. And we got I think great to representative indications from prescribers on that panel, including great feedback on onset of action. We're seeing docs saying that their patients are telling them they're clearing as early as a couple of weeks into therapy. Docs understanding that this is really potentially a first-line monotherapy topical treatment that cleans up the sort of use of steroids and the use of multiple steroids. And it's a real significant paradigm shift in how psoriasis patients can be managed. We've had great feedback on the feel of the cream itself and certainly have not heard any meaningful reports of tolerability issues that affect prescriber behavior. And yet just a huge amount of tremendous support for VTAMA from prescribers, a really fantastic fab base to build from. I want to highlight on Slide 12, an update that is relevant for our upcoming atopic dermatitis data, as well as just a good reminder on sort of the quality of the safety profile for VTAMA. We reported earlier last week, the results of our pediatric maximal use study in atopic dermatitis. And notably this included subjects, pediatric patients with a body surface area of atopic dermatitis up to 90% with a mean body surface area of 43%. So if you just picture what that literally means on a person, that's a remarkable body surface area to be treated with VTAMA. So we were using quite a lot of VTAMA on these patients and we saw a really favorable safety profile with a very low incidence of adverse events, no SAEs, a PK profile consistent with what we saw in the adult psoriasis population and really minimal to no systemic exposure even under these sort of maximal use conditions. So we feel really good about the quality of this data and what it's going to mean for safety and tolerability. And I'll note that it has a real commercial benefit as well, because it gives us something that is differentiated, which is a single dose form. So in peds [ph], in adult patients in psoriasis and atopic dermatitis, there's only one script for anyone to remember, it's a single dose of the product, a single sort of 1% spinner off the cream VTAMA, whereas some of our competitor products have multiple doses depending on whether you're in psoriasis, whether you're in AD, whether you have a pediatric patient or not. And so, really pleased with that simplicity and is a direct function of the safety profile of the compounds. So very pleased with that data and think it'll be a useful fact as we get towards the AD data. And then as a final reminder on VTAMA on Slide 13, that AD data is coming. Our Phase 3 program enrollment is on track. We expect data in the first half of next year. There's a ton of patients in investigator enthusiasm for the study, and that's built obviously including on the safety data that I just described, but also on the very strong Phase 2b data that that we've already sort of made public as well as the positive outcome from our Japanese partners atopic dermatitis study, which they reported over the summers. So overall, again, incredibly pleased with the quality of launching in -- for VTAMA looking forward to continue to provide those updates and looking forward to the improvement in GTN and other things that will come from PBM contract, as well as from other contracts that we'll be looking to do here. So in offset on VTAMA, although I'm sure we'll come back to it in the Q&A. So I want to turn now and talk about a couple of other clinical updates in the rest of our pipelines. So Slide 15, again, you can see a review of our late-stage pipeline with a number of really important therapies, many of them in inflammation and immunology, but also in some other areas as well. A truly broad late-stage pipeline with some opportunities that we won't talk about as much today like Brepocitinib, where we've talked a fair amount in the past about that upcoming data set in SLE and in dermatomyositis as well as Batoclimab and others. So as of right now on Slide 16, we have seven ongoing major studies including at least four of them pivotal and we expect three more to initiate in the near future as well. So we'll be up sort of 10 pivotal total enabling studies which is a great breadth of R&D from our perspective across the portfolio. I want to spend a few minutes, and this was an update during the September 30 quarter reminding everybody about an important development at Immunovant in our anti-FcRn franchise starting on Slide 17. We announced is that we've got a new next-generation anti-FcRn antibody to compliment batoclimab there IMVT-1402, which was developed in-house, and which we've shown in animal studies, delivers what we think should be deep potentially best-in-class IgG lowering, similar to what we get from our first antibody batoclimab. Notably, however also and we'll talk more about this in the data, minimal impact in albumin and LDL. So we think this could be the only anti-FcRn antibody to have both minimal or no impact in albumin and LDL, as well as that deep potentially best-in-class IgG and all of that in a simple subcu administration that is also differentiated versus our competitors. And one of the great things, and we'll hit this again at the end of this section about anti-FcRn antibodies is that IgG lowering has been a really great biomarker across a range of indications. And so we feel like we have a real potential for accelerated development here, where we can use proprietary data from our own studies and well known biology as well as data from industry-wide trials in anti-FcRn antibodies to design our own pivotal programs. And so we think immediately after getting our first in-human data from IMVT-1402, which will come in the middle of next year, we'll be able to go sort of on an accelerated path straight into pivotal studies thereafter, which is something that's unique to the class and sets us up to be really right in the pack with all of our competitors with a best-in-class drug. So you can see the data as a reminder on Slide 18. And I love this data because it shows so clearly. We get the same IgG suppression as batoclimab. We've got here the sort of supersaturated 50 mg dose, and you can see right on top of each other in terms of the level of IgG suppression, which is important because we think it's necessary to be able to get to that in humans. As a reminder, batoclimab gets to 80%-plus suppression of IgG, which is more than some of our competitors are able to achieve, and which we think will be relevant across disease populations and across patient populations within a disease. And then you can see on Slide 19, as a reminder again, that we're sort of right on top of placebo at therapeutic doses as far as albumin and LDL impact are concerned. And so we get kind of everything we need here in terms of in these monkey studies, minimal impact or no impact on albumin and LDL and the level of IgG suppression that we think will continue to keep us differentiate as best-in-class. So again, as a reminder data coming in humans in the sort of the middle of next year. I get fairly often the question of sort of how did we achieve this? And so, on Slide 20, just as a reminder, we've put this slide up before you can see the crystal structures, batoclimab as with many of the full length antibodies FcRn binds to FcRn and the configuration that's very good for suppressing IgG, but also you can see sort of interferes with a steric hindrance of albumin binding on the FcRn as well. And so that sort of causes an impact on albumin. IMVT-1402 on the right-hand side, similarly, high quality binding from an IgG suppression perspective but does not sort of interfere with albumin binding. And so it doesn't affect the albumin level in there for LDL. As a reminder and this is another question that we've got a little bit on Slide 21, we wanted to summarize all of this in one place. Across all of the known anti-FcRn programs generally including batoclimab, our own program as well as many of the other antibodies that are sort of probably have published data. The translation from monkey data to clinical data has been very strong on albumins. So the impact on albumin observed in NHP has generally been translatable to humans. And so I wanted just to summarize this data in one place so that people had a good reference for it. And we've got all the publications at the bottom there that demonstrated over and over again that monkeys are a good predictor of human data for impact on albumin and therefore we think impact on LDL. And again, we'll get the data from IMVT-1402 on this in mid-2023. So last thing, I'll say on our anti-FcRn franchise before moving on to other updates, on Slide 22, just as a reminder, this is very broad disease biology. There are many different diseases ranging from sort of ultra-rare diseases to more common diseases. And we have a pretty unique ability because we have both batoclimab and IMVT-1402 in our pipeline to tailor the development strategy for each drug, two different disease populations, and to be able to sort of compete in ways that I think our individual competitors will struggle, are sort of differentially in let's say rare disease settings versus in more common settings where we can take the profile of our drug and we can take the commercial strategy around each of these different compounds and optimize the choice of compound and the development strategy and the commercial strategy to the selection of indication. So looking forward to providing more updates on our development strategy for both IMVT-1402 and batoclimab in the quarters to come. You should expect continuous updates on those as we get programs up and running, and as we sort of learn from our own data and from industry-wide data and think it's going to be an incredibly exciting opportunity. We are truly and I view the best in class anti-FcRn franchise at this moment with the sort of 1402 being a sort of clear best-in-class potential antibody. And with both 1402 and batoclimab in our portfolio allowing us to do some really interesting and differentiated things. Good. So I'm not going to cover many of the other sort of clinical updates at this point. We continue to make progress in a number of other programs including brepocitinib, which is marching toward its SLE data, as well as namilumab and sarcoidosis and so on. But I wanted to stay focused today on some of the key new things. So I'm going to give just a couple of additional updates on other parts of the business now including on Slide 24, some data that we have not presented before. So we've not spent a lot of time talking about our discovery organization or a greater discovery efforts, those continue to chug along, and we're doing some interesting things there. It remains a small fraction of our overall burn and obviously a lesser focus. But given some of the high quality data that we've seen recently in ER Degraders, just wanted to highlight that we have an ER Degrader program and this is some new data about that program demonstrating either equal or better tumor volume reduction compared to the most Advanced Degrader known in ER and you can see on the left-hand side, you can see the in vitro data on degradation. And on the right-hand side, you can see that, that, that our compound has either equal or better tumor reduction mouse models. So exciting opportunity. It's early days there. We'll provide more updates on that program when we have them. But just want to highlight that we continue to believe we're going to be able using our unique combination of platforms to develop some interesting best-in-class degraders. And this is not a bet on the next couple of years. This is a bet on the future beyond, but excited what we're going to be able to do with our pipeline as these programs mature. The other update I'll give briefly, because we get questions about it often on Slide 25, is an update on Genevant's IP litigation. So this is a relatively recent development that some of you may have seen, which is on November 2, the Federal District Court in Delaware denied Moderna's partial motion to dismiss, which as we've talked about before they had filed on the basis of this U.S. contractor defense 1498, which was an attempt by Moderna to shift liability for its alleged infringement, or at least a portion of it to U.S. government taxpayers. And we were pleased to see that the court deny that motion. And most importantly for the case, that means that we'll now move to this pretrial discovery phase where we'll be able to learn more about the state of play and we should be able to provide more updates on that as that phase progresses. So look to round out the overall discussion on the sort of heart of the business here on Slide 26. I'll just say, I could not be more excited for 2023. It's an incredibly impactful year for us. First of all, it'll be our first full-year of VTAMA on the market, and we look forward to continued prescription and meaningful revenue growth as well as sort of watching early PBM and payer wins really translate into sort of approaching a steady state GTN and a commercially attractive P&L that we've signaled over and over again at this point. We are confident we're going to obtain. So looking forward to be able to provide more guidance there. Looking forward to watching that mature and really think we're going to do some impressive things there. On top of that, we'll continue to build on the VTAMA sort of franchise, if you will, with Phase 3 data in AD coming in the first half, which opens up an even larger market for VTAMA that we're excited to get into. And we think the high quality of our safety data, the simplicity of our dosing, all going to be important in continuing to sort of grow into that market. Then as I mentioned just a moment ago we're going to get human data in IMVT-1402, which is expected to be in the clinic starting in the first quarter with the initial Phase 1 data expected mid-year that'll come together with in the second half of next year, initial Phase 2 data in Graves' disease with the ability to take 1402 straight to pivotals thereafter and that Graves' data is in batoclimab but will inform development strategy for 1402 which is a great example of sort of how we think we can move fast with 1402. And then, finally, not a focus for today's call, but as a reminder the sort of pivotal readout from our global Phase 2b study now fully enrolled in SLE should be one of our two registrational studies if that data's successful in the second half of next year. And reasons that we believe we have a possibility of being some of the best SLE data the world has ever seen, so really looking forward to that data as well. I'm going to round out today's call with the financial update. I'll use Slide 28 as a partial guidance here. Some of these updates, including some of the updates I've already given on this call, we gave beginning of last week because as I'm sure many of you saw, we did a $150 million follow-on offering with some great institutional investors that we were really excited about. It was catalyzed by our reverse inquiry that that we were excited to take advantage of especially in this market. Even before that offering, we had taken some important steps in our business to make sure that we could give that we'd extended our runway -- that we could give extended runway guidance. So our runway is now comfortably extended into the second half of calendar year 2025. And I will talk in a moment about what we've sort of achieved there, what that extended runway buys us in terms of additional catalysts, there are many, including some really important datasets. We achieved that in a variety of ways. We achieved it with some cross reduction and efficiencies. You may have seen an article over the weekend about an impactful, relatively modest round of layoffs that we've done, that we don't think are going to have any meaningful business impact in terms of slowing us down or changing catalyst. But together, with other changes we made, the business will give us the ability to really sort of drive length of runway, which we think is important given where the market is and given how choppy things have continued to be. Overall for the quarter adjusted R&D expense of $123 million, adjusted G&A of $102 million and notably, the majority of that G&A expense relates to Dermavant and the commercial launch of VTAMA at this point. So we think that's sort of an important position to be in. And then, ended the quarter with $1.6 billion of cash or $1.9 billion in effect after our follow-on offering, Immunovant follow-on offering and anticipate proceeds from the sale of minority to Sumitomo Pharma. So a really strong financial position, continue to be pleased with our ability to generate cash from a variety of sources to fund the business many of which non-dilutive. And looking forward to taking advantage of this position in a number of ways, including frankly with some attractive in licensing opportunities that we see that could bring new programs into our portfolio. So stay tuned for updates on that as well. So I'll finish my prepared marks on Slide 29, with just a reminder, I said 2024 -- 2023 is a really impactful year from a catalyst perspective. As we sort of thought about extending runway and making sure that we sort of catalyze well into 2025, there's really a tremendous amount now within that window. Not only the data from exterior atopic dermatitis data, the brepocitinib data and so on, but additional important data from batoclimab and multiple indications including CIDP, including MG, including thyroid eye disease, the brepocitinib data in dermatomyositis in addition to the brepocitinib data and SLEs coming next year, as well as continued data from RVT-2001 our program in low-risk in transfusion-dependent anemia in low risk Myelodysplastic syndromes and a number of other important catalysts. As well as what will then be multiple years of sales in VTAMA and sort of a clear demonstration of what we think we'll be doing at that point, which is through adding towards blockbuster territory on that product. So really, really excited for next year. Really, really excited for what our current capital runway allows us to achieve in a choppy market and looking forward to continue to provide updates at each quarter and more frequently as they present. So I'm going to wrap up my comments there and I want to thank everyone again for joining, and I'm going to hand it back over to the operator to open line for Q&A. So thank you, everybody.