Brian Lian
Analyst · Raymond James
Thanks, Greg. The third quarter of 2022 was a productive time at Viking, as we continued to advance each of our clinical programs. Based on the progress made through the first three quarters of the year, we expect to report data from each of these programs over the next several quarters. I'll begin with an update on our lead compound VK2809 for NASH and fibrosis. VK2809 is an orally available small molecule agonist of the thyroid hormone receptor that is selective for liver tissue as well as the beta isoform of the receptor. To date this program has generated exceptional data. And despite the number of programs that remain in development for NASH, we believe VK2809 is a highly competitive best-in-class program for the treatment of patients with this disease. Our prior 12-week Phase 2a trial of VK2809 in patients with hypercholesterolemia and non-alcoholic fatty liver disease successfully achieved both its primary and secondary endpoints and demonstrated significant reductions in liver fat and plasma lipids. Most notably, the trial demonstrated that cohorts treated with VK2809 experienced up to 60% mean relative reductions in liver fat content and that 88% of patients receiving VK2809 experienced at least a 30% reduction in liver fat content. This outcome was consistent even among patients receiving five milligrams per day the lowest dose evaluated in the study. The reductions in liver fat were also durable with the majority of patients remaining responders four weeks after completion of dosing. This study also demonstrated the promising safety and tolerability profile of VK2809. No serious adverse events were reported and the rate of GI disturbances such as nausea and diarrhea was lower among VK2809-treated patients when compared to patients treated with placebo. Further enhancing VK2809's competitive position is the compound's effect on plasma lipids. Patients in the 12-week Phase 2a study experienced robust reductions in plasma lipids including LDL cholesterol, triglycerides and atherogenic proteins all of which have been correlated with cardiovascular risk. This is notable as multiple studies evaluating other drugs and mechanisms for the treatment of NASH have demonstrated an increase in these lipids following treatment. We believe VK2809's broad lipid lowering properties combined with its safety significant liver fat reduction and oral route of administration distinguish it from other drugs in development for the treatment of NASH. Following the encouraging Phase 2a results, Viking initiated the VOYAGE study, which is a Phase 2b trial designed to evaluate VK2809 in patients with biopsy-confirmed NASH and fibrosis. VOYAGE is a randomized double-blind placebo-controlled multicenter trial designed to assess the efficacy, safety and tolerability of VK2809 in patients with biopsy-confirmed NASH and fibrosis. The target population includes patients with at least 8% liver fat content as measured by magnetic resonance imaging proton density fat fraction as well as F2 and F3 fibrosis. Up to 25% of patients may have F1 fibrosis provided that they also possess at least one additional risk factor. The primary endpoint of the VOYAGE study will evaluate the change in liver fat content from baseline to Week 12 in patients treated with VK2809, as compared to patients receiving placebo. Secondary objectives include the evaluation of histologic changes assessed by hepatic biopsy after 52 weeks of treatment. During the third quarter, enrollment in VOYAGE continued and we remain on track to complete enrollment by year end. Moving to our second metabolic disease program. Earlier this year, we announced the initiation of a Phase I trial of our newest clinical stage compound VK2735. VK2735 is a dual agonist of the glucagon-like peptide 1 or GLP-1 receptor, and the glucose-dependent insulinotropic polypeptide or GIP receptor. This compound was developed internally at Viking, and based on the data to-date we are excited about its potential for the treatment of various metabolic disorders such as obesity, NASH and certain rare diseases. Initial data from our dual agonist program were presented last November in two posters at the Annual Meeting of the Obesity Society. The data demonstrated that GIP receptor activity improved upon the metabolic effects achieved through activation of the GLP-1 receptor alone. For example, these posters highlighted significant improvements observed in weight loss glucose control and insulin sensitivity among diet-induced obese mice, following treatment with our compounds as compared to a GLP-1 mono-agonist when administered at the same dose for the same period of time. In addition, the observed reductions in liver fat content were generally larger among animals treated with our compounds relative to the liver fat reductions observed among animals treated with the GLP-1 mono-agonist. Based on these promising preclinical data earlier this year we announced the initiation of a Phase I clinical trial of VK2735. This trial is a randomized double-blind placebo-controlled single ascending and multiple ascending dose study. The single ascending dose portion of the study is designed to enroll healthy adults, while the multiple ascending dose portion of the study is designed to enroll healthy adults with a minimum body mass index of 30 kilograms per meter squared. The primary objectives of the study include an evaluation of the safety and tolerability of single and multiple doses of VK2735 delivered subcutaneously, as well as the identification of doses suitable for further clinical development. The trial will also evaluate the pharmacokinetics of VK2735, following single and multiple doses. Exploratory pharmacodynamic assessments include evaluations of changes in body weight and liver fat content after four weeks of once weekly administration. During the third quarter, enrollment in this study continued and we expect to report the initial results from the study early next year. I'll now provide an update on VK0214, Viking's second orally available small molecule thyroid receptor beta agonist in clinical development. This program is currently being evaluated in a Phase Ib clinical trial in patients with X-linked adrenoleukodystrophy or X-ALD. X-ALD is a rare and often fatal metabolic disorder caused by genetic mutations that impact the function of a peroxisomal transporter of very long chain fatty acids. As a result of the mutations, transporter function is impaired and patients are unable to efficiently metabolize very long chain fatty acids. The resulting accumulation of these compounds is believed to contribute to the onset and progression of clinical signs and symptoms in patients with X-ALD. Early data from preclinical studies have demonstrated that VK0214 has the ability to stimulate the expression of a compensatory transporter of very long chain fatty acids. Preclinical studies have shown that treatment with VK0214 can reduce the levels of very long chain fatty acids in plasma and tissue. These data provide the support for our decision to advance VK0214 into clinical development, and we believe this compound has the potential to be a first-in-class treatment for X-ALD. In 2021, Viking announced the results from the initial clinical evaluation of VK0214 which was a randomized double-blind placebo-controlled single ascending and multiple ascending dose Phase I study in healthy volunteers. In this study VK0214 demonstrated dose-dependent exposures, no evidence of accumulation and a half-life consistent with anticipated once-daily dosing. After 14 days of treatment subjects who received VK0214 experienced reductions in LDL cholesterol, triglycerides, apolipoprotein B, and lipoprotein A. Many of these lipid reductions achieved statistical significance though the study was not powered to demonstrate statistical significance on lipid assessments. Importantly, in this study VK0214 demonstrated encouraging safety and tolerability. Among the more than 100 subjects enrolled no serious adverse events were reported and no treatment or dose-related signals were observed for vital signs or cardiovascular measures. Based on these findings, we initiated the Phase Ib study of VK0214 in patients with the adrenomyeloneuropathy or AMN form of X-ALD. AMN is the most common form of X-ALD affecting approximately 50% of those with the disease. The Phase Ib trial is a randomized double-blind placebo-controlled multicenter study in adult male patients with AMN. The primary objectives of the study are to evaluate the safety and tolerability of VK0214 administered orally once daily for 28 days. The study also includes an evaluation of the pharmacokinetics of VK0214 in AMN patients as well as an exploratory assessment of changes in plasma levels of very long chain fatty acids. Pending a blinded review of preliminary data additional dosing cohorts may be pursued. During the third quarter, we continued to make progress with this study and we expect to report the initial results in the first half of 2023. While each of our clinical programs is advancing, it's important to note that we have maintained a strong balance sheet and continue to carefully manage our financial resources. To this end, we completed the third quarter with approximately $155 million in cash, which we believe provides the runway to advance each of our clinical programs into later-stage development. In conclusion, the first three quarters of 2022 have been highly productive and as a result, we expect to announce data from each of our ongoing clinical programs within the next nine months. With respect to our lead compound VK2809 for the treatment of NASH and fibrosis, we expect to complete enrollment in our Phase IIb VOYAGE trial by the end of the year and report initial data in the first half of 2023. In addition, the Phase I study evaluating our dual agonist compound VK2735 continue to enroll and we expect to report the initial data from this study early next year. And finally, our Phase Ib trial evaluating VK0214 in X-ALD patients is continuing and as with VK2809 and VK2735, we expect to report data from this trial in the first half of 2023. The anticipated data announcements from these three clinical programs serve to highlight the fact that over the past several quarters Viking has transformed from a company with a single clinical program to a diversified biopharmaceutical company with a pipeline of programs across multiple therapeutic areas. We look forward to reporting the data from each of these programs in the upcoming quarters. This concludes our prepared comments for today. Thanks again for joining us and we'll now open the call for questions. Operator?