Brett Haumann
Analyst · Leerink Partners
Thanks, Rick. Turning to Slide 4. I'll start with our JAK inhibitor program. Our goal is to develop a highly differentiated treatment option for inflammatory bowel diseases, including ulcerative colitis. Our lead molecule, 1473, is designed to remain localized and only act within the gut wall thereby maximizing local anti-inflammatory efficacy and minimizing the systemic exposure that would otherwise lead to immunosuppression. As reported in August, we achieved a wide set of objectives in the first cohort of our Phase 1b study, a number of which are particularly meaningful given the study's treatment period of only four weeks. In the Phase 1b study, we've sought to evaluate PK properties, target engagement, biological activity and tolerability in patients? Results from the first cohort at 80 milligrams were highly encouraging. Firstly, we were able to confirm that patients with active disease had the same very low concentrations of drug in the blood that we've previously seen with healthy volunteers, despite these patients having an inflamed and disrupted gut wall. This was an extremely important finding, confirming that patients with active disease did not have high levels of drug in the blood. Second, we saw clear evidence of biological activity, not only in terms of reduced inflammatory biomarkers, but also in terms of clinical responses, such as reduced rectal bleeding, evidence of evidence of mucosal healing and evidence of clinical response using total Mayo and partial Mayo scores. We were particularly pleased to see evidence of clinical improvements in this four week study. These findings provide a wealth of information they confirm 1473 is having an affect on inflamed tissue and behaving in patients as designed. And these data provide a strong foundation for proceeding to design a large multidose induction and maintenance study while we complete the two additional cohorts of the Phase 1b study. These two additional cohorts have been run in parallel with doses intended to bookend the 80-milligram dose, with 20 milligrams at the low end and 270 milligrams at the high end. Recall that in our Phase 1 study in healthy volunteers, we dosed 1473 as high as 1,000 milligrams as a single dose and up to 300 milligrams once daily in the multiple dose study and saw no evidence of immunosuppression. In the completion of the Phase 1b study, we're building confidence around what doses to take into the induction and maintenance study. We expect data from the low-and high-dose cohorts in the first half of 2018, but we're not waiting on this data to mobilize our planning for the next study, which we plan to initiate in 2018. Our intent for the next study is to conduct an eight week induction phase followed by a maintenance phase, evaluating several doses for both efficacy and safety. Moving on to 9855 on Slide 5, nOH is a disorder of the autonomic nervous system characterized by the inability to regulate blood pressure when moving from a lying to a sitting or standing position. It's an often condition affecting fewer than 200,000 patients in the U.S. and includes patient with multiple system atrophy, Parkinson's disease and pure autonomic failure. The condition is very debilitating and often confines patients to their beds, severely impacting mobility and quality of life. As we've outlined on Slide 6, the current approved treatment for nOH are droxidopa and midodrine, both of which are exogenous analogs of norepinephrine. They essentially saturate the nerve endings in the autonomic nervous system with exogenous norepinephrine in order to increase blood pressure and reduce symptoms. That approach can, for a short period of time, maintain blood pressure while patients are active during the day. But the benefit is short-lived, requiring dosing three times a day. And in addition, patients cannot take these therapies after about 3:00 PM, as doing so may cause their blood pressure to be too high when they go to bed at night, a phenomenon called supine hypertension that increases the risk of cardiovascular side effects. Lastly, the effect does not appear to be durable. For example, droxidopa has not been shown in clinical studies to provide statistically significant improvements in key symptoms beyond one week. In contrast, 9855's mechanism as a dual norepinephrine and serotonin reuptake inhibitor is unique in this indication, and we believe it could lead to significant benefits to patients over existing therapy. As shown on Slide 7, the mechanism for 9855 uses the natural endogenous norepinephrine already present in patient's autonomic nervous system in order to modulate blood pressure. Rather than saturating the body with extra norepinephrine, it prevents the breakdown of what the body naturally produces, in turn, allowing the body's normal natural norepinephrine to remain in the nerve junction for longer and potentially show a durable response. This is a much more physiological approach, one that we think is better suited to the treatment of nOH patients. While we're highly encouraged by virtue of 9855's mechanism of action alone, our confidence for 9855 in nOH is also rooted in its distinction versus other compounds. First, 9855 has a particular advantage in PK properties, a half-life of approximately 30 hours and a T max of around seven hours, allow for once daily dosing and a stable and consistent profile at steady state, without peak-related side effects or trough-related dips. Turning to Slide 8, our Phase 2a study of 9855 in nOH is ongoing. After seeing encouraging responses in the majority of patients involved in the single ascending dose portion of the study, we moved into an open-label extension study to assess the durability of the effect in treating nOH patients. We expect to complete the study in the first half of 2018 and intend to seek an expedited development pathway for this debilitating orphan condition. Turning now to Slide 9, I'll briefly mention next steps with velusetrag, a highly selective 5-HT4 agonist in development for gastroparesis. In early August, we announced results from the Phase 2b study showing a durable efficacy and safety profile for the lowest dose tested. The Phase 2b study provided us with some key new learnings on the effect of different doses on the symptoms of gastroparesis. Higher doses may actually lead to a more rapid gastric emptying and in doing so, produce side effects in lower parts of the intestine. These side effects could counteract any symptom improvements associated with reduced gastric distension and fullness. With these results in hand now, we are preparing for multiple regulatory discussions in the U.S. and Europe to discuss the validation of our patient reported outcome tool and to inform a potential registration strategy for velusetrag. Now I’ll move on to Slide 10 and revefenacin, our once-daily nebulized LAMA. Having reported positive data form the 12-month safety study in July, we're now focused on finalizing the NDA filing. We believe that the therapeutic and commercial opportunity for revefenacin is meaningful. As of today, there are no approved nebulized LAMAs, despite a significant number of COPD patients needing or preferring nebulized therapy for the treatment of their disease. Having achieved positive efficacy and tolerability data in our Phase 3 program, we and our partner, Mylan, believe that revefenacin is well-positioned to address this important patient need. To complement our Phase 3 registrational program, we're conducting a Phase 3b study in approximately 220 COPD patients with low peak inspiratory flow rates. This study is not required for filing but rather is being conducted to better understand the needs of these patients and to support commercialization of revefenacin if approved. We believe that this patient group may particularly benefit from the use of nebulized therapy because they're not able to inhale with enough force to benefit fully from handheld inhalers. We expect to complete the PIFR study in the first quarter of 2018. We remain on schedule to submit the NDA in the fourth quarter of 2017, and our team has been working diligently with Mylan towards launch readiness. We are pleased with our partnership's continued progress and that we're close to potentially delivering the first once-daily nebulized bronchodilator to the COPD patient community. I'll now pass the call over to Renee to provide a financial update.