Doug Ingram
Analyst · Baird
Thank you, Mary. Good afternoon, everyone. And thank you for joining Sarepta Therapeutics third quarter 2020 investor conference call. Tonight, I’m very proud to share with you the progress we have made this quarter, including our performance and serving the Duchenne community with EXONDYS 51 and VYONDYS 53, our progress with respect to our RNA platform and the strides we’ve made in building out our enduring gene therapy engine. But, I’m going to take things a bit out of order this evening. I’m going to commence to this call by discussing an important milestone for Sarepta and for the Duchenne patient community. As you will have read in our press release today, having worked with the FDA, we now anticipate dosing a trial with commercial process material this year. Let me provide some background and context. As you will know, SRP-9001 is our gene therapy, and the goal is to treat Duchenne muscular dystrophy by safely delivering the skeletal, diaphragm and cardiac muscle, a gene that robustly codes for a truncated functional form of the structural protein dystrophin that we call micro-dystrophin. Children with DMD make essentially no dystrophin, which results in rapid degeneration and inevitable death, and the goal is to arrest this degeneration by giving them back a properly localized, functional form of that structural protein. After many years of design and preclinical testing by doctors, Jerry Mendell and Louise Rodino-Klapac, we commenced and completed a small four-patient proof-of-concept study, Study 101, that was positive and very encouraging. The therapy was well-tolerated; the gene was indeed robustly delivered to the target muscles, about 3.3 genome copies per nucleus. The expression of the protein approached nearly normal levels, and on all functional measures the children continued to improve in ways that cannot be explained by natural history. Based on this proof-of-concept study, we commenced a randomized blinded placebo-controlled trial, we recall that as Study 102. Study 102 is intended to show a well-controlled trial of SRP-9001 is safe and effective in children with DMD. The last one year visit will occur in December, and we plan to release results from Study 102 in the first quarter of 2021. Now, the material for Study 101 and 102 was manufactured by our partner, Nationwide Children’s Hospital, pursuant to a process that will not scale for large commercial purposes. Over the last two years or so, we have developed a commercial process, and we’ve built significant manufacturing capacity. Assuming SRP-9001 proves effective, these efforts are expected to provide us capability to produce and launch a commercial product to fully serve the community. By early 2020, we completed our process development and analytical development, and we commenced our GMP runs for SRP-9001 commercial process material to use in future clinical studies. In the summer of this year with GMP material in hands to conduct additional studies, we requested a meeting with OTAT. OTAT is the division of the FDA responsible for cell and gene therapy. And we did that to obtain their blessings to commence a commercial material validation study. We originally contemplated a larger 70-patient blinded placebo-controlled trial called Study 301. However, in light of the likelihood of a second wave of COVID-19, which now may be coming to fruition, and the risks it poses to clinical trial participation and execution, in anticipation of our September Type C meeting, we proposed a leaner, open-label commercial material validation study, Study 103 in the same patient population, as Study 102, our ongoing with placebo-controlled trial. The goal of Study 103 is to gain insight and validate the performance of our commercial process material on both micro-dystrophin expression and safety in up to 10 patients with the primary analysis or part one of the study conducted at 12 weeks, post infusion, in all treated patients. Our Type C meeting with the division which was conducted entirely in writing, occurred in September of this year. In its written response, the division raised concerns with the potency release assay approach that we had proposed. As I stated, at the time, if it’s occurred, if we were to follow a formal process to resolve our issues with the division, it would have taken a minimum of a matter of months and could have extended into next year. However, I am pleased to report that the division was willing to work with us expeditiously and informally, to discuss the issues to provide guidance to us, and to provide us with a pathway to commence our commercial validation study this year. Indeed, the division moved quickly to meet with us in late September. And we’ve spent the time since then gathering the data necessary for our updated potency assay approach for Study 103 and finalizing the meeting minutes. Based on those discussions, the status and the next steps of our program are these: First, after discussion and obtaining division guidance, we proposed and the division accepted a potency assay approach for Study 103. We have already completed the work and generated the data for the new potency assay approach for Study 103. Second, the division will permit us to commence Study 103 which we intend to do before the end of this year. And third, to remind you, Study 102 will have the last 12-month visits in December of this year, and we will report the results of Study 102 in the first quarter of 2021. Depending on the external environment and the pandemic, we anticipate speaking with the division and starting our largest Study 301 in 2021, after we have data available from Study 103. We also intend to design and propose to the division for their review and input, additional studies including importantly, in older and non-ambulant patients. I would like to thank OTAT for their responsiveness and their willingness to informally and rapidly meet with us on this extremely important program, even in the midst of a pandemic that has placed additional burden on an already overworked group of professionals at the FDA, so that we may embark on Study 103. Now, staying with the build of our gene therapy engine, over the course of this quarter, we’ve had a number of very-positive updates. As you will recall, back in June, the one-year results for Study 101 were published in JAMA Neurology, reporting robust expression, good tolerability and safety, and functional improvements across all measures in the cohort of Duchenne boys in that study. At the World Muscle Society Conference in the third quarter, we provided an update on Study 101, reporting not only continued safety and tolerability, but also durability of effect, with all boys continuing to show functional benefits of the gene therapy at two years. At World Muscle as well, we also provided updates on our three-patient cohorts for SRP-9001 for the treatment of limb-girdle muscular dystrophy type 2E, or LGMD2E. Cohort 1 was dosed at 5 e to the 13th and Cohort 2 was dosed at 2 e to the 14th, same dose used in our studies for SRP-9001. As you will recall, both cohorts were generally well-tolerated with a significant dose dependent increase in expression in Cohort 2. At World Muscle, we reported the 18-month results for Cohort 1, showing not merely stabilization, but a substantial improvement in function above baseline and above natural history. We also reported the early 6-month data for Cohort 2, where the children are already showing not near stabilization of function, but improvement in function, again, against both baseline and against natural history. We are particularly pleased with these LGMD2E results, and in particular, the safety, expression, biomarker and functional results of Cohort 2. And so that’s potential read through to our remaining LGMD portfolio and supportive confirmatory read through to our SRP-9001 program in DMD as the program shares the same vector, the same promoter, the same design approach, and then in case of Cohort 2, the same dose as well. With respect to LGMD2E, we are completing manufacturing material for our next trial, and we’ll engage with the agency on the design for what we hope will be the pivotal study. We will provide an update on both of these matters, and our perspective on the development and regulatory pathway and timing for our entire LGMD portfolio in 2021. We continue to build our gene therapy platform and gather technologies to improve and enhance gene therapy. Over the course of 2020, we have completed some 22 gene therapy-related transactions, 20 of which were completed since this pandemic sent us all to a largely work-from-home environment. We also have what is likely the largest pipeline of high-potential gene therapy candidates in biopharma today. We are considering an R&D Day in 2021, at which we can update on our entire pipeline of gene therapy and RNA, and we will provide more details on this early next year. Moving on now to our RNA platform. Let me now discuss our commercial performance in the quarter. As you will recall, in light of the dynamic and unpredictable nature of the COVID-19 pandemic, we withdrew our guidance for 2020. Nevertheless, due to the collaborative work of our multidisciplinary team, I am pleased to once again report that we’ve been able to serve the Duchenne community with our approved therapies with only modest impact from the current pandemic. For our PMO franchise, currently EXONDYS and VYONDYS, our net product revenue for the quarter is $121.4 million, and that represents a nearly 23% increase over the same quarter last year. As we have never taken a price increase on our therapies, our performance relates directly to our ability to serve the patient community. We continue to monitor performance closely as we are indeed in uncertain times. It is important to our patient community that they have an uninterrupted supply of therapy. While challenging, we have been able to largely ensure that this is the case, in part due to great execution from the team and also due in part to the fact that the vast majority of our patients receive in-home infusions rather than having to go into a clinic or hospital, and also due to the fact that thus far, the majority of payers have responded positively in this pandemic and have shown flexibility in authorizations and re-authorizations for this vulnerable DMD patient community. Now, moving to our PMO pipeline. The FDA has accepted our filing for our third Duchenne therapy, casimersen, a PMO therapy intended to treat those 8% of Duchenne patients, who are amenable to skipping exon 45. The brand name for casimersen will be AMONDYS 45. Our PDUFA date is February 25, 2021, and the review is going well. If we obtain approval for casimersen, we will have three approved therapies, capable together of treating nearly 30% of the DMD community. And as we have mentioned before, our RNA technology has the potential to bring therapies to as many as about 85% of patients living with DMD. So, we do have much left to do. As you will know, we are also making progress on our next generation of the PMO, which if successfully, may profoundly improve the efficacy and convenience of our RNA technology. We are in our multi-ascending dose study, called the MOMENTUM study for our peptide-conjugated PMO or PPMO, and that’s candidate SRP-5051. To remind you, we are using a proprietary positively charged peptide to increase penetration. In animal models, we have shown that if we can safely achieve appropriate dose levels, the PPMO greatly increases tissue exposure, in turn, greatly increasing exon skipping and thus dystrophin production. Before the end of this year, we will provide an update on the safety -- systemic exposure in exon skipping for our PPMO SRP-5051 candidate at 20 mgs per kg. And for us the most important measure of all of these, and I’ve said this many times in the past, will be safety. Consider the following. Our PMOs are safe and they’re precise. Their ultimate limitation, however, is that they are also mutually charged. They penetrate muscle cells passively, and they clear the body in about four hours. This will limit the amount of therapy that can get to the right place. And simply increasing the dose will not reverse this limitation. Our PPMO technology, on the other hand, potentially addresses this limitation in a dose dependent way. Indeed, our preclinical models have consistently shown that if one can safely dose the PPMOs to a sufficiently high level, we should hit a point where we get a significant increase in cell exposure and a great increase in exon skipping and dystrophin production. And that should translate into a great increase in benefit to patients living with Duchenne muscular dystrophy. Our most significant question in the MOMENTUM study has always been safety upon repeat dosing and maximum dose. We will present the 20 mg per kg results this year. So, we have already moved to 30 mgs per kg, and intend, if safety signals will permit, to continue to dose even up to 40 mgs per kg early next year, and ultimately potentially even higher than that, if we are able to do so. While we can make some educated guesses from animal models, until we observe it in human clinical trials, we can’t know with any certainty, precisely where the inflection point on exposure and dystrophin will occur in patients, purely based on animal studies. But, what we are confident about is the PPMO’s mechanism of action, which means we are very confident that if we can safely achieve high enough doses, we should see a very-substantial increase in dystrophin production. So, not to belabor this point, but it is all about safety, safety signals and maximum tolerated dose, at this point. In conclusion, notwithstanding the unusual external environment, the team continues to execute with an unrelenting purpose. And the third quarter of 2020 perfectly exemplified our culture of performance. Consistent with our message -- our mission, apologies, we kept the patient front and center in everything we did, which gives me focused on the science, we continued to execute with a sense of urgency that our mission requires, and when faced with inevitable obstacles and roadblocks, we did not simply accept them or regressed to the mean, but we moved with rapidity and creativity to address them to remove them and to keep progressing towards our ultimate goal of intervening and saving the lives of as many children living with and dying from Duchenne, limb-girdle muscular dystrophy, and other rare diseases as science will make possible. And with that, let me turn the call to Ian Estepan, who will update on the financials.