Matt Gline
Analyst · Leerink Partners. Your line is now open
Thank you, Abby. Good morning, everybody, and thank you for joining our fiscal year March 31 call. I'm going to start just briefly on Slide 4 with a run for what we're going to talk about and then we'll go through the presentation. So we'll talk a little bit today about where we are in the year. It's been an exciting fiscal year for us already even though we're only a couple of months in as well as what our plans are for the balance. We're going to give some updates to Immunovant who also filed their earnings yesterday and who aren't doing a conference call. We'll review the brepocitinib data in noninfectious uveitis that we generated during the quarter. We'll talk a little bit about the ongoing VTAMA launch and actually we'll spend a minute or two on renegotiation of some of VTAMA's fixed obligations and debt that will take a significant amount of burn out of the cost of that program. We'll spend some time on some upcoming catalysts and on a financial update and then we'll go to Q&A. Thank you, everybody. So I'll start on Slide 5 and just to say, 2024 was always planned to be a year of expansion and growth as you're planning for the future from us and that includes some updates that we'll talk about today and exciting updates coming through the balance of this fiscal year out of Immunovant where we have a bunch of important clinical data coming, that we're going to continue to advance the rest of our pipeline including for example the data we generated already in brepocitinib as well as data coming later this year in sarcoidosis and others. We continue to make progress at Dermavant with VTAMA's sNDA now in for atopic dermatitis with a PDUFA date at the end of this year and we've continued plans to grow in psoriasis where we're already on the market. And then we're very active in our late stage business development activities and are looking forward to continuing to provide updates there including the program that we've been licensed that haven't yet tried which we'll talk more about later this year. And finally, one thing that we intend to do this year that I think we've made major progress on is to communicate about is to finalize and communicate about our plans to return some capital to shareholders. And as you'll know, within the last couple of months, we announced a buyback program of up to $1.5 billion and repurchased stock from Sumitomo what we think was an attractive price. So on Slide 6, before we get into the specific programs, I'll just say I am incredibly excited about the pipeline that we have today and the way that it is shaping up. Obviously, if VTAMA's launch atopic dermatitis will be an important event for us. The anti-FcRn franchise at Immunovant, I have never felt better about that franchise than I do right now. The clinical data that we continue to generate including the data that we're going to share in grades later this year underscores what we have. As does the uniqueness of our data relative to what we've seen in the competitive landscape in recent days, weeks and months. We just feel like we're in a really, really strong position there. And on top of that, we've had, and I'll talk more about this in a minute, a very important Type B meeting with FDA that sets forth the clinical development plan for IMVT-1402 that really establishes it as our lead program at Immunovant, then we've got brepocitinib, our dual inhibitor TYK2 and JAK1, which now has pretty obviously best ever demonstrated data, at least in a Phase 2 study in noninfectious uveitis. An ongoing pivotal program in dermatomyositis, just a really great set of data on which to build an exciting franchise in orphan autoimmune. And then we have some other readouts coming, including namilumab and sarcoidosis later this year and some data and expect in our future plans in this undisclosed program that I mentioned. So I'm going to go first into updates on Immunovant on Slide 8. So there's a lot of progress in the Immunovant portfolio and Immunovant put out the earnings release yesterday with some of that highlighted. I just want to hit what I think are really the key highlights here on Slide 8. First of all and perhaps most exciting to me. We have held a successful Type B meeting with FDA on 1402, which really covered a lot of the important topics around future development of 1402 in the clinic. And with that, we feel fully on track to initiate four to five potentially registrational programs for that antibody over this fiscal year. With that behind us, we're now comfortable saying 1402 is really our lead program at Immunovant. It is, we think, a potentially best-in-class anti-FcRn antibody, a target that we think is going to matter to a ton of patients and where we think we can deliver a lot of value. Batoclimab development efforts are being optimized to a point to inform 1402 development plan, so to serve as better and more robust Phase 2 studies in many cases to inform what we can do with pivotal program with 1402. But notably, because the way those studies are designed, we retain full optionality for registration with batoclimab if the data is supportive. And then finally I think an underappreciated fact about 1402 is that relatively recently, we've been issued a patent that gives us composition of matter, method of use and method of manufacturing IP out to June of 2043 and that's notably before any use of patent term extension. So designating that our lead program, we have a really long time here with a very exciting antibody with a lot of really promising clinical development underway in a target that is obviously going to matter broadly in immunology. So overall, updates that I think are important and positive in establishing what Immunovant looks like over the coming months and years. There are some program specific updates in Immunovant laid out on Slide 9. One is perhaps most importantly from my perspective, we're now announcing that we're planning to disclose detailed results from batoclimab study in Graves' disease. This fall, together with an overview of our upcoming development plan. As you know, we've seen some of that data and are excited about it, but have declined to share detail thus far due to competitive reasons and we expect to be ready to share that data this fall and we think it will set up for a lot of clarity on what we believe Graves' can be. Top line data for bato in MG is expected this fiscal year. And notably, Immunovant is expecting also to begin registrational development in MG with 1402 in the same timeframe. So again we retain full registrational flexibility with bato. We think MG is an important enough indication and 1402 is an important enough program that it deserves to be developed in MG. Immunovant has decided to extend the run time effectively of the CIDP study in bato by about two quarters prior to unblinding the period 1 data. This really is to optimize the potentially pivotal plans for 1402 in CIDP. And that is to treat the sort of period 1 more as a robust Phase 2 for 1402 and to get as much information as we can about dose response. That's in particular informed by trying to make sure that we continue to enroll the most severe patients into that study and really understand the profile of that patient population. And finally, we are on track to produce the potential registrational data in TED in the first half of next year, and that will be a first-in-class opportunity and another indication where we think it's relatively clear that deeper IgG suppression will produce better efficacy. That point I want to underscore again on Slide 10. This is not a new slide, but I think it's a really important framing point to keep in mind as we generate data to come this year. And that is -- it has been very consistently shown across different anti-FcRn antibodies across different indications that deeper IgG suppression matters. It's been true at a patient level in MG, but across our competitor programs at argenx and J&J. It's been true to a significant degree in our own thyroid eye disease data. We stated and we'll show better this fall that it is true with the data that we have generated in Graves' disease. It's been true in the data that UCB has generated in ITP and it's been true that patients with greater IgG reduction have correlated with greater auto antibody reduction and greater clinical response in J&J's RA data. So we say over and over again that we think 1402 is a best-in-class drug. But I want to remind everybody, the data we are generating this year, in particular, in MG this fiscal year, is among the very important possible proof points to demonstrate that deeper IgG suppression, could yield meaningfully better clinical efficacy. And we think there's a lot of supportive evidence to suggest that data set matters. And then the last point I want to underscore on Slide 11 as we get sort of closer to the fall is we're excited about Graves' disease. It's an indication, obviously, that requires a little bit more imagination than MG because there is not yet any approved product. But that is also other than sort of any thyroid's drugs. But that's also the opportunity for us is that it's real white space where we can deliver a significant clinical benefit to patients with high unmet need. What we've said so far is that results from the initial cohort of patients in that ongoing 24-week trial meaningfully exceeded our target response rates and that we saw numerically higher responses, both for dose tapering and discontinuation in patients at 680 as compared with patients with 340 further supporting our more is better hypothesis. And so and also that we continue to demonstrate best-in-class IgG reduction with a mean of 81% meaningfully greater than what we saw at the 340 milligram dose. And as good or better as anything we've seen from, frankly, any competitor inside or outside of our class. And then finally, as I said, we expect to produce detailed data along with the development plans this fall to underscore where we are in Graves' to give people a picture for what that's going to look like in the future as an important indication for the program. So I'm sure there will be questions on Immunovant we'll come back to. Now I'm going to move to other elements in the pipeline now. I'm going to take a few minutes to recapitulate or go over some of the data that the Priovant team presented on our call earlier this spring on brepocitinib in noninfectious uveitis because it's an opportunity we think is really exciting. It's a larger market than we think most people appreciate. And frankly, we're really proud of the data that we've generated to-date. So uveitis is not a widely discussed indication, obviously, in our industry. There's not a lot of approved therapies. It is, however, the fourth leading cause of blindness among the working age population it's a significant severe disease with difficult morbidities. There are and this is an updated claims analysis that we've continued to define about 40,000 patients both with non- anterior NIU on biologics, which includes adalimumab, which is the only approved therapy as well as a number of off-label therapies. And we continue to see rapid growth in those scripts. So we're excited about the already existing biologics population. That's against a backdrop that we'll talk about in a second, that those therapies do not work particularly well. And so far, what we've seen in Phase 2, our data looks meaningfully better. And notably, there are no competitors currently in Phase 3 in uveitis with only a limited number of competitors in Phase 2. So we think at any kind of orphan price point with our kind of differentiated data this is a multibillion-dollar peak sales potential opportunity even in a post biologic refractory population with additional opportunities in a broader non-anterior population. This is on Slide 14. I think interestingly, we feel like NIU is a little bit where something like HS or even TED was a few years ago, where there's an understanding of the population. But again, as I said earlier, this is -- the imagination is required and so people don't fully see the farce for the treatment. But if you look at the overall prevalence of the disease, the prevalence in our relevant subpopulation. If you think about whether this is a sort of TNF approved market and you think about the level of morbidity of the disease and the size of the competitive opportunity or the number of competitors against us. This is an indication that ought to get the same level of attention as other severe diseases, including something like HS, but also including something like TED where the need is high or it's another ocular disease. And as a reminder, docs just have no tolerance for things like ocular inflammation and patients really want good treatment options. So the study that we completed that we've now put out on Slide 15, was a Phase 2 randomized double mass dose-ranging study, that studied both 15 milligrams and 45 milligrams. And the endpoint is a thing called treatment failure rate, which is what it sounds like. It's patients who have effectively a worsening or non-improvement of disease while on therapy. One background point of note on Slide 16 that we talked about on our prior call. The way these studies all work because there is so little tolerance for ocular inflammation, if these patients show up with disease and are put on a high dose burst of prednisone, which has then tapered quickly. And we used a quite aggressive steroid taper. Meaningfully more aggressive than the HUMIRA studies in order to give our drug the hardest test in Phase 2 so that we would understand what we had and the goal here is to be able to preserve or improve benefit even after the steroid taper, which is sort of the name of the game here and the basis on which HUMIRA was effectively approved. So on Slide 17, you can see the data. I know we've put this out before, but it's a slide that I really enjoy looking at. This is a really, really good data by our own measure on the left side here, which includes treatment discontinuations on the treatment failure calculation. HUMIRA had about a 62% treatment failure rate. At our high dose, we had a 29% treatment failure rate. So effectively twice as low and a really exciting result. On the right hand side, you can see the data as HUMIRA presents it in their label. There they excluded treatment discontinuation rates and treatment failures. So they had about a 50% treatment failure rate. There we had a sub 20% treatment failure rate and a nice dose response both on this and on the other sort of subcomponent endpoints that gives us some confidence that this data should be translatable to a placebo-controlled study. One last point on the data on Slide 18. I think that there's a question like how to think about this. Maybe put another way, in HUMIRA, after about six months, half of HUMIRA page, which after about 11 months, half of HUMIRA patients have developed macular edema. And after about six months, half of placebo patients that develop macular edema. And these are among patients who didn't have a macular edema at baseline. We had 10 such patients in our 45 milligram arm and none of them had macular edema by week 24. And then of patients who came in with macular edema, three of those patients had resolution of the macular edema by week 24, whereas in HUMIRA, it was about 22% and resolution. So again, just another way of thinking about this data that in our opinion underscores the uniqueness of our data set and the opportunity we have. Yes. I think on Slide 19, just to reiterate, this is a large commercial opportunity. This supports a differentiated product profile with a real early treatment option. The physicians look to intervene aggressively to prevent blindness. And if you call these docs, I think, the thing you'll find over and over again is the tolerance for inflammation of the eye is basically zero. And in our opinion, there's really no agents, certainly no nonsteroidal agent. That has shown an ability to reduce or mitigate ocular inflammation as well as brepocitinib has so far. So we are incredibly excited about this opportunity. We'll continue to talk about it, and we're paring for a pivotal program to begin later this year, and we'll share more about that sign and timeline as it comes together. So now I'm going to transition to VTAMA. On Slide 21, which kept the results for the fiscal year to about $75 million in net product revenue, a gross net yield of about 24% for the quarter. We expect those numbers to continue to improve and grow over time. We'll talk more about that guidance as time goes on. And we're sort of expecting steady progress in psoriasis. Most notably, as we get closer to the end of this year, we feel like we have a strong foundation for a quite rapid launch in atopic dermatitis. First of all, we have a proven ability on slide 22 to drive switches from standard-of-care just based on the existing VTAMA patterns in psoriasis and 75% of the early adopter health care providers in AD, the ones who writes novel mechanisms early have already been engaged with in our psoriasis launch. So we know these docs. And this is against the backdrop on the right-hand side, of a topical market in AD that is frankly growing a lot faster than the topical market in psoriasis with many more scripts to begin with. So we think the AD market dynamics are meaningfully different than the psoriasis market dynamics. And we think our data set, which we've talked about before, we won't spend a lot of time on today as well as the sort of commercial infrastructure that we've built set us up for an exciting possible launch in atopic dermatitis. Again, as a reminder, our PDUFA date is in the fourth quarter of this year. And then one important update that I suspect is not high on people's minds is Dermavant had some debt and royalty obligations that came from the early acquisition of the program actually represented a relatively meaningful portion of our burn on Dermavant during this prelaunch and sort of early launch period. We have successfully renegotiated those obligations with the counterparties that includes NovaQuest and a number of other lenders. And this renegotiation has reduced our potential payments by about $300 million, of which about $225 million, we expect to realize over the next three fiscal years saw a pretty meaningful reduction in the expected burn at Dermavant that overall gets to one of the theme that I'll hit in a minute, which is that we are focused on maximizing the longevity of our capital and our ability to deploy it either on buying our own stock or on investing in valuable programs to the maximum extent possible. And so we're really focused on in this period where we are cash rich being as dogmatically efficient around capital as we possibly can be and this renegotiation is certainly a part of that commitment. So we have some pretty important catalysts coming on Slide 25. And we're through at this point, the exciting data from brepocitinib. We're through the sNDA filing for VTAMA. We have the upcoming Graves' data batoclimab and an overview of our 1402 development plans this fall. We have top line data from our Phase 2 trial in sarcoidosis and namilumab in the fourth quarter. And then by the end of this fiscal year, we have upcoming top line data from Myasthenia gravis as well as potentially that data from period 1 of the Phase 2b study in CIDP and Immunovant expects to initiate four to five potentially registrational studies for 1402 on the back of the recent positive FDA interactions. We also, this quarter on 26, as a reminder, announced this $1.5 billion share repurchase program, including our repurchase of the entire Sumitomo stake at a price of $9.10 a share. We continue to be excited about that commitment and we have that program outstanding. We will use it to buy back stock at attractive prices. I expect we'll use it in the coming months to be thoughtful around continuing to take advantage of that opportunity, and it's a way that we expect to be efficient with our capital. And frankly, we think our shares are, I'll just say, attractively priced at the moment. On Slide 27, not expecting to spend a lot of time on this, I have not spent a lot of time on it historically, but we continue to have some really exciting work ongoing in early-stage drug discovery. In this case at VantAI where we have a set of tools for probably the best out there capability for modeling and predicting protein-protein interactions. We really do think we may be the best in the world of this thing. And notably, I think this is clear to the most. We have mostly been funding our discovery efforts through external partnership and external investment, and that continues to be true at VantAI, where we've recently entered into partnerships with Bristol-Myers Squibb and Blueprint that are both important for developing our capabilities and are providing a significant portion of the capital required to continue to progress VantAI. Finally, two other business updates on Page 28. One is something that we give our questions about over time, which is our patent ligation with Moderna. In April of this year, as many of you know, the court agreed with our proposed constructions for most of the distributed terms against Moderna in our Markman ruling, which sets us up with a clear set of favorable boundaries in the playing field as we get through the rest of the free trial disputes through the rest of the year, and we are in the midst of fact and expert discovery. We're expecting a filing of summary judgment motions late this year and a trial date less than a year from now. So looking forward to that. And then finally Kinevant has fully enrolled at this point that we've announced publicly our Phase 2 potentially registrational study for Immunovant and sarcoidosis. We're expecting that to read out in the fourth quarter, that is a high SKU opportunity that I think most people have not paid a lot of attention to historically. We'll talk more about it as it gets a little closer and especially as we generate that data. But needless to say, if that is successful, it would be a potentially first novel therapy for pulmonary sarcoidosis, which is another one of these large untapped orphan disease markets. So finally, I'll wrap up here with a financial update. I won't go through all of the numbers on Slide 30. I'll point out a couple of things here. One is that our net cash utilization for the quarter was $108 million, which is a function of a number of things, including streamlined burn and the fact that we generate meaningful interest on our cash balance. So we're excited about that. And it's, again, a part of our significant commitment here to being efficient with our capital as we focus on deploying on the most valuable opportunities. We ended the quarter again, this was prior to the Sumitomo repurchase with $6.6 billion in cash and I'll point out that the carrying value of our debt in this 10-K does not yet reflect the renegotiation with Dermavant. So you will see that renegotiation reflected on our 10-Q for the 6/30 financials. So with that I'll leave off on Slide 32 and just say in addition to everything we've talked about for catalyst perspective, there's just a bunch of interesting data and a bunch of opportunities coming. And all this is in addition to pipeline growth for our pipeline that we are excited to talk about on an ongoing basis and in some cases, as soon as it happens. So stay tuned. We're really excited about what we see in that opportunity set. And I've never felt better about that either in terms of the space of opportunities that we may be able to access. With that I will wrap up the prepared remarks portion of this call, and I will hand it back over to the operator for Q&A. Thank you, everybody, for joining this morning, and I look forward to your questions.