Roger A. Jeffs
Analyst · Canaccord
Yes, certainly, Martine. So maybe I'll just back up and speak to sort of the strength of the package and the sort of the anchoring position for the NDA. So, as we've said previously, it's an oral treprostinil is an alternate dosage form of treprostinil for which there is a myriad of safety experience in thousands of patients, both from the subcu, IV and inhaled routes. So there's a lot of comfort, if you will, by the agency with this molecular entity. Our FREEDOM-M trial, which was in naive patients, showed a highly significant improvement in 6-minute walk distance, which was the primary endpoint, with a 23-meter improvement in the p-value of .0125. So that's, in fact, the best efficacy result we've had with any dosage form of treprostinil and something we're quite proud of. A couple of other things with regard to the safety. We now have patients, and it's almost 400 patients in long-term open-label extension, with the longest duration of exposure of about 5.6 years, and there are many, many patients over 4 years of exposure, which I think is self-evident in speaking to the clinical utility of this agent, because if it didn't work and it wasn't durable, then patients would not remain on the therapy in this open-label extension trial. I think the other thing that we've done recently that gives us great enthusiasm and confidence for the potential of the molecule in the market is, under very strict and tight control by a few investigators, we have begun transitioning patients who are on Remodulin to oral treprostinil. We've done 4 such transitions at this point. These patients have been on Remodulin for anywhere from 2 to upwards of 8 years. They're on subcu forms. They were having some site pain and they were at doses ranging anywhere from 25 nanograms per kilogram per minute to 75 nanograms per kilogram per minute and we've been able to transition these patients off of parenteral therapy to twice daily oral therapy in the course of 2 to 3 days. The patients have been on this trial 1 to 3 months. They seem to be doing well. They are delighted that they don't have the rigors of parenteral therapy to manage. They are now swimming, hiking and increasing their activities and their quality of life seems to be vastly improved. So that's an anecdote, if you will, but I think it shows that this agent is treprostinil. It can work analogously to the other approved forms of treprostinil, such as Remodulin. And we remain quite confident in the data package that we've submitted. So that's a little bit of a primer on where we are. We won't comment on the dialogue we've had with the FDA about the package for oral treprostinil at this time and we'll wait till the decision date and the conclusion of those discussions before we go public.