Simon Pimstone
Analyst · Stifel. Your line is open
Thank you, Jodi, and good afternoon, everyone. 2018 was a pivotal year for Xenon as we build out our neurology pipeline and advanced multiple product candidates using a variety of development strategies including a precision medicine approach to address rare pediatric disorders. This foundational work has resulted in four distinct therapeutic candidates XEN496; XEN1101; XEN901; and XEN007. These are expected to be in Phase 2 or later stage development this year, as well as the potential for additional development candidates which we’re very excited about and which we expect to report on in the second half of this year. On our call today I’ll provide an update in all of Xenon's clinical stage products before turning things over to Ian, who will then provide a financial and milestone overview. Let me start with XEN496, a Kv7 potassium channel modulator with the active ingredient ezogabine. We’re developing XEN496 as a treatment for KCNQ2 epileptic encephalopathy or KCNQ2 epilepsy which is a rare severe neuro-developmental pediatric disorder with a significant seizure burden and profound developmental impairment. Ezogabine was previously approved by the FDA as an antiepileptic drug or AED as an adjunctive treatment for adults with focal seizures with or without secondary generalization. In fact, ezogabine is the only AED previously approved by the FDA with a mechanism of action that potentiates Kv7 mediated potassium current. GlaxoSmithKline marketed ezogabine in various jurisdictions as Potiga in the U.S. and as Trobalt in Europe but withdrew the drug from the market worldwide in June 2017 citing commercial reasons. In the landscape of other approved AEDs in the adult population, ezogabine never gained a large market share due to a number of liabilities including pigmentation risk, especially the initial concerns about potential visual toxicity related to retinal pigmentation which to-date have not been proven. As well as issues around the three times a day dosing regimen and Cmax related CNS adverse effects, as well as urinary retention observed in approximately 1% of patients. While ezogabine was approved for adult focal epilepsy, published case series reported on the successful use of ezogabine in children with KCNQ2 epilepsy suggesting that XEN496 could be efficacious in this orphan hard to treat pediatric patient population with good reported tolerability. While non-controls these clinical series reported improvements in seizure burden, as well as in development and behavior. We received Orphan Drug Designation or ODD from the FDA for XEN496 as a treatment of KCNQ2 epilepsy. Importantly, we obtained a regulatory right of reference from GSK authorizing the FDA to reference GSK's nonclinical and clinical data when considering our regulatory submissions. This is especially valuable considering that ezogabine has been used by thousands of patients. We established a steering committee made up of key opinion leaders in pediatric, epilepsy fields to help guide the clinical development of XEN496. In response to our pre-IND briefing package submitted in 2018, the FDA indicated that it was acceptable to study XEN496 in infants and children up to four years old and that a single pivotal trial in approximately 20 patients may be considered adequate provided we show evidence of a clinically meaningful effect. Recognizing that ezogabine was initially developed as a hard-coated tablet that is unsuitable for use in children, we are finalizing a pediatric-specific formulation and we expect to complete preclinical formulation testing with a final drug product in the second quarter of 2019. We are on track to file an investigational new drug or IND application in the third quarter of 2019 and based on this regulatory feedback, we anticipate initiating a Phase 3 clinical trial thereafter. This timeline is based on our assumption that the testing of our new XEN496 pediatric formulation in healthy adult volunteers will not be a regulatory requirement prior to initiating a Phase 3 clinical trial. We're excited that XEN496 provides us with the opportunity to move rapidly into late stage development and to apply precision medicine approach to treating KCNQ2 epilepsy. We look forward to providing additional details regarding the clinical development of XEN496 including the final anticipated trial design and endpoints. Next in our development pipeline is XEN1101 a differentiated next generation Kv7 potassium channel modulator being developed for the treatment of focal adult epilepsy and potentially other neurological disorders. We announced final data from the XEN1101 Phase 1 clinical trial including the transcranial magnetic stimulation or TMS studies at the American Epilepsy Society Annual Meeting this past December. Just to briefly review, the objectives of XEN1101 Phase 1 clinical trial were to evaluate the safety, tolerability and PK of both single ascending doses, and multiple ascending doses using a powder and capsule formulation of XEN1101 in healthy subjects The XEN1101 Phase 1 clinical trial also included a pharmacodynamic read-out from TMS studies that were designed to assess XEN1101 ability and potency to modulate cortical excitability thereby demonstrating activity in the target CNS tissue. To summarize the results presented at AES, the Phase 1 1101 data include a PK profile that supports once a day dosing and exhibited an AE profile consistent with antiepileptic drugs of this class. The majority of AEs were milds or moderates results spontaneously and were consistent with antiepileptic drugs of this class. Sedation including somnolence, and drowsiness and dizziness including lightheadedness and presyncope were the most common AEs, while mild cognitive effects including memory and speech impairment and blurred vision were also observed in a dose dependent manner. There were no serious AEs, no deaths and no clinically significant ECG or laboratory findings and no urine refindings and no pigmentation was observed. Thus these Phase 1 data suggest that XEN1101 is generally safe and well-tolerated in the doses examined including single doses of up to 30 milligrams and multiple doses of up to 25 milligrams once daily. In the Phase 1b TMS study, XEN1101 reduced corticospinal excitability as demonstrated by a concentration-dependent elevation in resting motor threshold the key TMS EMG measure. In addition, XEN1101 modulated TMS evoked EEG potentials otherwise known as TEPs in a patent consistent with reductions in cortical excitability. Overall the Phase 1b TMS study provide evidence of the CNS effects of a single 20 milligram dose of XENE1101 as indicated by suppression of cortical and corticospinal excitability and helped us with dose selection for our XEN1101 Phase 2b clinical trial with this 20 milligram dose was set as the mid-dose of three active dose groups. We have recently initiated our Phase 2b clinical trial in adult patients with focal epilepsy. The Phase 2b clinical trial is designed as a randomized double-blind placebo-controlled multicenter study to evaluate the clinical efficacy, safety and tolerability of XEN1101 administered as adjunctive treatment in adult patients with focal epilepsy. Approximately 300 patients who we randomized in a blinded manner to one of three active treatment groups or placebo in a 2:1:1:1:2 fashion using doses of XEN1101 of 25 milligrams 20 milligrams and 10 milligrams plus placebo arm. The primary endpoint in this trial is the median percent change in monthly focal seizure frequency from baseline compared to treatment period of active versus placebo. An IND application for XEN1101 has been accepted by numerous regulatory authorities including the FDA and site selection and patient enrollment are now underway for the trial in the United States, Canada and Europe. Depending upon the rates of enrollments which we will have a better idea of around mid-year topline results from XEN1101 Phase 2b are anticipated in the second half of 2020. Turning to the third product in our development pipeline XEN901 a potent, highly selective Nav1.6 sodium channel inhibitor being developed for the treatment of epilepsy. There is strong human genetic validation supporting the rational for treating epilepsy by blocking the Nav1.6 sodium channel. Nav1.6 is a highly expressed sodium channel in a excitatory pathways in the CNS. When mutation is in the SCN8A gene which encodes the Nav1.6 sodium channel result in a gain of function in the Nav1.6 sodium channel, children can present with a very severe form of epileptic encephalopathy in infants known as SCN8A epilepsy or EIEE13. Also at the December AES meeting, we disclosed interim results from a randomized double-blind placebo-controlled Phase 1 clinical trial to evaluate XEN901 safety, tolerability and PK in both single and multiple ascending dose cohorts of healthy adult subjects and included a pilot TMS arm as well. The XEN901 Phase 1 clinical trial is now complete. To summarize the results presented at AES briefly, XEN901 PK data demonstrated dose proportionality with a predicted half-life of 8 to 11 hours which suggests that XEN901 could be compatible with the ones or twice daily dosing regimen. The majority of AEs in the Phase 1 trial were deemed unrelated to XEN901 were mild or moderate transient and resolved spontaneously. All AEs considered possibly related to XEN901 were mild, only muscle twitching, nausea and dizziness were reported in more than one subject. The safety results suggest XEN901 is overall generally safe and well-tolerated in the doses examined. The pilot TMS study for XEN901 was previously presented during AES but to summarize XEN901 showed increases in resting motor threshold and active motor thresholds of approximately 2%, decreases in amplitude of TMS evoked potential at a 180 milliseconds or the P180 and an increase in delta power and the resting state EEG. To observe changes in TMS EMG and TMS EEG parameters suggest activity of XEN901 in the target CNS tissue. Given the PK and safety profile in Phase 1 and the fact that we are reaching exposure in humans where we demonstrated efficacy in preclinical models. We are now planning for Phase 2 development either to evaluate XEN901 as a treatment for adult focal seizures or for rare pediatric forms of epilepsy including SCN8A epilepsy patients depending on feedback from planned discussions with regulatory agencies. We expect to receive regulatory feedback on advancing XEN901 directly into pediatric SCN8A epilepsy patients in the second quarter of 2019 and pediatric formulation development and juvenile toxicology studies are underway to support pediatric dosing. Also wish to update you today on fourth development stage product, XEN007 a CNS-acting calcium channel modulator which contains the active ingredient flunarizine. Flunarizine is available in certain countries outside of the United States and has been approved for the prevention of chronic migraine and for vertigo. Given its activity on enhancing cerebral blood flow and reducing cortical spreading depression flunarizine has been used in many indications and has been reported to have clinical benefits in treating multiple neurological disorders including hemiplegic migraine or HM alternating hemiplegia of childhood or AHC pediatric cyclical or periodic migraine and as an adjunctive treatment in certain epilepsies. You may recall that we previously received orphan drug designation from the FDA for XEN007 for the treatment of both AHC and HM. The FDA has recently granted Xenon a rare pediatric disease designation for the treatment of AHC with XEN007. Receipt of this RPD designation from the FDA is an important milestone for our XEN007 program and it underscores the need to find treatments for AHC a rare severe and debilitating neurological movement disorder that presents within the first 18 months of life and causes lifetime mobility and increased mortality. Importantly, the RPD designation allows recipient companies upon approval of the subject indication to be eligible for priority review voucher which may be used to obtain what is referred to as a priority review for future submission of a new drug application or NDA. Despite literature reports of efficacy with flunarizine in over 300 cases of AHC. There are no FDA approved drugs for AHC and we have the support of key physicians and patient efficacy groups to pursue the development of XEN007 as a treatment of AHC. We will continue to obtain and evaluate regulatory feedback an anticipate supporting at least one Phase 2 or later stage clinical trial in an orphan neurological indication this year. Given the wide spread use of flunarizine in parallel with our regulatory interactions with the FDA we are also considering other development strategies for XEN007. As we continue to explore our interest in pediatric epilepsy disorders we have had a number of discussions with physicians who have expressed interest in supporting investigated sponsored studies and we're making very good progress working with an investigator on a specific protocol in order to initiate a physician sponsored clinical trial. To further enable advance clinical development of XEN007 across the variety of development pathways that I've outlined. We have entered into key exclusive licensing agreements in order to access regulatory files and drug product manufacturing. Also wanted to flag for an important industry collaboration that was announced just last week. We, along with Invitae and other corporate partners are sponsoring behind the seizure a unique collaboration that aims to provide faster genetic testing for infants and young children with epilepsy. Previously available to 2 to 4-year-old children behind the seizure program has now expanded eligibility to make no cost genetic testing available for healthcare providers to order testing for infants and children who had an unprovoked seizure from birth up to age 5. The aim is to encourage the rapid identification of the genetic causes of seizures in infants and children including those with KCNQ2 and SCN8A epileptic encephalopathies. By offering this no cost genetic testing for very young patients it is hope that earlier diagnoses would lead to improved treatment outcomes through the introduction of personalized precision medicine approaches. Behind the seizures epilepsy panel comprehensively surveys more than 180 epilepsy genes including KCNQ2 and SCN8A and to-date hundreds of institutions in the United States have participated in the program. As a collaborating company we received data reports containing all identified gene mutations and other variance and the physicians contact that ordered the test. In addition to the behind the seizures program data we’ll have access to retrospective mutation data for selected genes going back to 2017. This physician and genetic based information assists with identifying those physicians who have patients for example with ultra orphan KCNQ2 and SCN8A epileptic encephalopathy. This data helps to build the registry of high priority physicians for the potential commercialization of our precision medicines and for selecting specific clinical sites and cases for clinical trials of XEN496 and XEN901. Before turning this over Ian who will summarize our 2018 financial results and provide some concluding remarks I want to reiterate how proud I am of the immense amount of progress Xenon team has made over this past year. I believe that Xenon currently is one of the most innovative and exciting CNS pipelines and developments in the biotech industry with numerous important catalysts over the next 12 months. We intend to pursue a variety of development strategies such as those focused on using a precision medicine approach to address rare pediatric disorders with a genetic basis such as KCNQ2 or SCN8A epilepsies or alternating hemiplegia of childhood as well as those targeting broader patient populations including with 1101 adult patients with focal epilepsy or children with more common forms of childhood epilepsy. With the support of a healthy balance sheet, we have four very promising drug candidates all poised to be in Phase 2 or later stage development over the next six to 12 months. We are also working on numerous potentially new development candidates and we expect to have updates in this regard in the next six months as well. With this positive backdrop we intend to enthusiastically advance our drug development programs and I look forward to keeping you up-to-date on our progress. Now over to Ian.