Brian Lian
Analyst · SunTrust Robinson Humphrey. Please go ahead
Thanks Mike. During the third quarter, we made multiple announcements highlighting data from our development programs, which we believe serve as an important reminder of the breadth and depth of the value drivers in our pipeline. I'll summarize the highlights now. In September, we were pleased to announce positive topline results from a 12-week Phase II study of VK2809, our novel thyroid receptor beta agonist. As a reminder, VK2809 is an orally available agonists of the thyroid hormone receptor that possesses selectivity for liver tissue, as well as the beta receptor subtype, suggesting promising therapeutic potential in a range of lipid disorders, including non-alcoholic steatohepatitis or NASH. Our Phase II trial was a randomized, double-blind, placebo controlled parallel group study designed to evaluate the efficacy, safety, and tolerability of VK2809 in patients with non-alcoholic fatty liver disease and elevated LDL-cholesterol. Patients were randomized to receive 10 milligram oral doses of VK2809 every other day or 10 milligrams of VK2809 everyday or placebo for 12 weeks. The trial's primary endpoint evaluated the effect of VK2809 on LDL-cholesterol after 12 weeks compared to placebo. The secondary endpoint, which for many was the endpoint of greatest interest assess the change in liver fat by MRI proton density fat fraction after 12 weeks. Other endpoints assess changes in atherogenic lipid, safety and tolerability. We were pleased to report in September that the study successfully achieved its primary and secondary endpoint. With respect to the trials primary endpoint, the results demonstrated that patients receiving VK2809 experienced statistically significant reductions in LDL-C compared with the placebo-treated patient. In addition, VK2809-treated patients experienced statistically significant improvements in other lipids, including the atherogenic proteins, apolipoprotein B and lipoprotein A. While we are happy to achieve our primary endpoint, results for our secondary endpoint are potentially even more important for the future development path for VK2809. As we reported in September, topline results demonstrated that patients receiving VK2809 experienced unprecedented reductions in liver fat content compared with other oral agents. Specifically patients receiving VK2809 dosed at 10 milligrams every other day for 12 weeks experienced a median relative reduction in liver fat content of approximately 57% from baseline as assessed by MRI-PDFF. Patients receiving VK2809 doses of 10 milligrams daily experienced the median relative liver fat reduction of approximately 60% from baseline. By comparison, patients receiving placebo experienced a median relative reduction in liver fat content of approximately 9%. The magnitude of these effects, particularly at these low doses is very encouraging. To our knowledge, this magnitude of liver fat reduction is unprecedented among oral agents and development for NASH today, so no head-to-head studies had been conducted. We believe these results at these relatively modest doses support our view that VK2809 unique liver targeting features provide differentiated benefit on this important measure of efficacy for NASH. Trial also included the responder analysis, which was intended to assess whether the observed reduction in liver fat may predict broader clinical benefit. Patients were characterized as responders if they experienced a greater than or equal to 30% relative reduction in liver fat content. This threshold is of interest as multiple studies have demonstrated that one liver fat is reduced by 30% percent or more, a corresponding increase in the odds have improved overall histology is also observed. Our responder analysis of our data revealed encouraging results, among patients treated with VK2809 dosed at 10 milligrams every other day, approximately 77%, demonstrated at least a 30% reduction in liver fat content. Among patients treated with VK2809 dose of 10 milligrams per day, approximately 91% demonstrated at least a 30% reduction in liver fat. We also performed an additional responder analysis looking for patients whose liver fat was reduced by half or 50% over the course of study. We coined the term super responder to define this population and found the exercise intriguing because a 50% relative reduction is substantially larger than the 30% at which histology has been shown to improve. In this analysis, approximately 67% or two-thirds of all patients who received VK2809 in this study experienced at 50% or greater reduction in liver fat. This outcome is compelling as we believe it confirms not only the depth, but also the breadth of the signal observed in this study. Starting to safety, VK2809 was shown to be safe and well tolerated in this study. No serious adverse events were reported among patients receiving VK2809 or placebo. The overall numbers of adverse events were relatively evenly distributed across treatment arms. So numerically, there were slightly more observed among patients randomized to placebo. Finally, VK2809 was shown to be extremely well tolerated in this study. We're encouraged by the safety and tolerability profile, display it thus far, particularly in light of the potent pharmacodynamic effects demonstrated in the efficacy measures. Overall, we believe these results point to a best-in-class therapeutic profile for VK2809. Following our receipt of the results, we submitted a late-breaker abstract for presentation at the Liver meeting, which is the Annual Meeting of the American Association for the Study of Liver Diseases. In October, we are notified of abstracts acceptance and we're happy to say that our presentation will be part of the Late-Breaking Oral Abstract Session I, which will take place on Monday, November 12 in San Francisco. In addition, we were informed that our abstract has been nominated for inclusion in the best of AASLD, which serves to highlight contributions of particular important at each annual meeting. Given these results, we're in the process of preparing for next clinical steps with VK2809, which we anticipate will involve a study in patients with biopsy-confirmed NASH. The design of that study is a topic of intense focus at the company and we are working diligently with our advisors on the best path forward. At this point, we plan to file an IND and initiate the next clinical study in 2019. As we proceed with the planning and implementation of next steps for VK2809 in NASH, we had also been evaluating our efforts in the area of glycogen storage disease. As a reminder, as we've discussed in prior updates, VK2809 has demonstrated impressive efficacy in vivo models of GSD Ia. In this work, VK2809 produce substantial reductions in liver fat content as well as improvements in inflammation and on autophagy, which are characteristics that support the compounds potential benefit in both GSD Ia and NASH. However, given the efficacy signal that was observed in our recent Phase II study, we have decided to focus our efforts more closely on the development of VK2809 for NASH. As a result, we plan to defer additional clinical work in GSD Ia. I want to emphasize this does not imply any lack of enthusiasm for VK2809 potential benefit in this important setting. It merely reflects our belief that the focus required to successfully execute a program in NASH will not allow us at this time to dedicate the attention required to effectively manage a clinical program in GSP Ia. I'd now like to turn to Viking’s other orphan disease program, which is evaluating our small molecule thyroid receptor agonists VK0214, as a potential treatment for X-linked adrenoleukodystrophy or X-ALD. X-ALD is a devastating disease caused by a defect in peroxisomal transporter called ABCD-1. These patients are often characterized by the accumulation of very long chain fatty acids in plasma and tissue. Sustained elevations in very long chain fatty acids are believed to contribute to the severe cerebral and motor neuron toxicities commonly observed in the disease. Activation of the thyroid beta receptor is believed to stimulate the metabolism in very long chain fatty acids, providing a potential therapeutic benefit. VK0214 is an orally available small molecule thyroid receptor agonist that possesses selectivity for the beta receptor subtype and may therefore represent a potential pharmacologic approach to the disease. Last year, we and our collaborators at the Kennedy Krieger Institute completed a 25-week study evaluating VK0214 in an animal model of X-ALD. The result of this study showed promising effects on markers of disease, notably an improvement in very long chain fatty acid levels in both plasma and tissue. We're currently conducting IND enabling work for this program and plan to file an IND to conduct a proof of concept study in 2019. I’ll now provide an update on VK5211 our novel selective androgen receptor modulator for musculoskeletal disorders. As a reminder, VK5211 is designed to selectively stimulate muscle and bone formation with reduced activity in peripheral tissues such as skin and prostate. Following surgery to repair hip fracture, many patients experience a loss of bone and muscle at accelerated rates placing them at increased risk of further morbidity, refracture and prolonged disability. For these reasons, hip fracture is a serious medical condition and as our population continues to age we believe the incidence of hip and other fracture injuries will continue to increase. It is our belief that VK5211 may represent an important treatment option for these patients by stimulating the formation of muscle and bone thereby improving musculoskeletal health and facilitating recovery from the injury. Topline data from our Phase II study in-patients recovering from hip fracture were announced in November of last year. The results showed the trial successfully achieved its primary endpoint demonstrating statistically significant dose-dependent increases in lean body mass, less head, following treatment with VK5211 as compared to placebo. The study also achieved important secondary endpoints demonstrating statistically significant increases in appendicular lean mass, as well as total lean body mass for all doses of VK5211 compared with placebo. In addition, though not powered for significance, endpoints assessing physical functions also showed numerical trends favoring treatment arms. Importantly VK5211 also demonstrated encouraging safety and tolerability in this study with no drug-related serious adverse events reported. During the third quarter Viking was notified that the results from our Phase II study were selected for presentation as part of the oral plenary session at the annual meeting of the American Society for bone and mineral research. In addition, we were informed that our abstract had been awarded the Most Outstanding Clinical Abstract Award by the ASBMR Conference organizers. The study results were presented on September 30 and we were honored to have received such a prominent position at this important meeting. We believe that this recognition speaks about the quality of the data generated as well as the potential for VK5211 to offer a much needed treatment option in this setting. During the second quarter, we submitted request to the FDA for Type C meeting to discuss the potential regulatory path forward for VK5211 in hip fracture. Later in the third quarter we received written answers to the questions posed in our Type C meeting briefing package. These comments provide useful input for further development of VK5211 hip fracture. As we've indicated on prior calls, in our view, any subsequent studies of VK5211 in orthopedic indication would be best executed by partner, particularly one with an existing bone or musculoskeletal franchise. We continue to explore partnering opportunities that will allow us to optimize the value of VK5211 and move the program forward in the most efficient manner possible. We will provide updates on these activities as warranted. I'll now wrap up with some comments on a recent corporate activity. During the third quarter following the announcement of positive Phase II data for VK2809, we completed a successful offering of common stock which resulted in gross proceeds of approximately $176 million. This financing provides us with the funds needed to aggressively advance our pipeline programs and provides a financial runway that we expect will it extend beyond 2020. We are grateful to the investors who participated in this offering and we wish to thank all of our investors for their continued support as we move forward. In conclusion, during the third quarter, we announced Phase II data indicating that VK2809 holds tremendous promise as a potential therapeutic for fatty liver diseases such as NASH. We look forward to presenting these results in just a few days. Also during the quarter, we’re honored to have the Phase II data from our VK5211 program presented at the ASBMR Annual Meeting and recognized as the most outstanding clinical abstract by the conference organizers. We continue to explore partnering opportunities for VK5211. And finally, we are continuing to build our clinical pipeline by advancing our VK0214 program for X-ALD. We currently planned to file an IND and initiate a proof-of-concept trial for this program in 2019. These assets combined with our exceptional team and the support from our investors have positioned Viking for further success in the clinic and with potential partners. This concludes our prepared statements for today. Thanks again for joining us. And I'd now like to open the call for questions. Operator?