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spk16: Good day, and thank you for standing by. Welcome to the Nectar Therapeutics fourth quarter 2023 financial results conference call. At this time, all participants are in the listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Vivian Wu. Please go ahead.
spk22: Thank you, Crystal, and good afternoon, everyone. Thanks for joining us today. With us on the call are Howard Robin, our President and CEO, Dr. Jonathan Blaski, our Chief of Research and Development, Dr. Mary Tagliaferri, our Chief Medical Officer, Sandra Gardner, our Chief Financial Officer, and Jennifer Roddick, our Chief Business Officer. On today's call, we expect to make forward-looking statements regarding our business, including statements regarding the therapeutic potential of and future development plans for drug candidates and research programs, the timing of the initiation of clinical studies and the availability of clinical data for drug candidates, the timing and plans for future clinical data presentations, the formation, future development plans, or success of our collaboration agreements, The expectations following are corporate restructuring and reorganization, financial guidance, and certain other statements regarding the future of our business. Because forward-looking statements relate to the future, they're subject to uncertainties and risks that are difficult to predict, many of which are outside of our control. Our actual results may differ materially from these statements. Important risks and uncertainties are set forth in our Form 10-Q that was filed on November 8, 2023, which is available at sec.gov. We undertake no obligation to update any performance statements, whether as a result of new information, future developments, or otherwise. A webcast of this call will be available on the IR page of Nectar's website at nectar.com. With that said, I would like to hand the call over to our President and CEO, Howard, Robin. Howard?
spk33: Thank you, Vivian, and thank you for all joining us today. 2023 was a pivotal year for Nectar. We refocused the company's development pipeline on immunology and inflammation with our primary near-term goal to advance RESPEG to meaningful data catalysts in the first half of 2025. RESPEG is poised to be highly disruptive in the biologic treatment landscape for ectopic dermatitis by offering a novel agonistic mechanism. RESPEG is designed to both dampen the inflammatory response and simultaneously restore immune balance by directly expanding functional Treg cells and engaging multiple immunoregulatory pathways in patients with ectopic dermatitis and other autoimmune disorders. Through its unique mechanism, Respec also has the potential to provide patients with superior efficacy as well as more favorable in frequent dosing. There are over 30 million people in the U.S. alone battling this chronic skin condition, and it can greatly impact quality of life and mental health for these patients. We made significant advancements in 2023 with respect to our RESPEG program. Most notably, we regained the full rights to RESPEG from Eli Lilly and now own the program 100% with no encumbrances. We moved to quickly design a phase 2b study in ectopic dermatitis based on the promising results from the phase 1B placebo-controlled randomized study of ResBag, which showed an 83% drop in eczema skin scores after just 12 weeks of treatment. Our phase 2B global study in this indication was launched in October of 23, and enrollment is on track for data readout in the first half of 25. In late 2023, we also began work designing a Phase IIb study in alopecia areata, another area of high unmet need. The study is starting this month. There are approximately 7 million patients in the United States and 160 million people worldwide who have alopecia areata. JAK inhibitors are the primary treatment option for patients with alopecia but have a significant rebound effect with treatment cessation and several black box warnings. Based on the data we generated to date on RESPEG in the skin-related autoimmune condition of ectopic dermatitis, psoriasis, and in patients with cutaneous manifestations of lupus, we believe RESPEG has strong scientific rationale in the setting of alopecia and could have the potential to be a highly differentiated treatment option with a similar remittive effect for this unserved patient population. As I stated earlier, we look forward to the Phase 2b data for our ectopic dermatitis study and for our alopecia study in the first half of 2025. These will be highly meaningful data catalysts for NECR. In addition to RESPEC, we have another important immunology program that we're moving toward the clinic. This is a first-in-class differentiated mechanism in immunology, a TNFR2 agonist antibody, Nectar 165. TNFR2 has been shown to potentiate the suppressive effects and overall functional properties of Tregs, and the program is built on what we've learned through our deep experience with ResPeg and the Treg field and represents a promising mechanism for treatment of autoimmune disease, including multiple sclerosis and ulcerative colitis. We're currently conducting IND-enabling studies with the goal of targeting an IND submission in the first half of next year. In line with our objectives to advance our immunology pipeline, today we announced a $30 million financing that further bolsters Nectar's financial position as we head into transformative data catalysts. Importantly, we're pleased to bring on a new high-quality long-term investor, TCG Crossover, who clearly shares our belief in the potential of ResBank. At a price of $1.20 per share, the transaction represents a premium of over 80% to Nectar's 30-day VWAP. This puts us in a strong financial position and extends our cash runway from our previous guidance, which was the middle of 2026, to now well into the third quarter of 2026. And with that, I'll hand the call over to Jay Z for an R&D discussion. Jay Z?
spk06: Thank you, Howard. Let's begin today with RASPEG, which is the most advanced IL-2-based T-RAG mechanism in the field. Across the RESPEC studies that have been conducted to date, we have observed a consistent and highly predictable clinical pharmacology profile with respect to target engagement as well as the peak and duration of Treg mobilization. It has demonstrated a well-tolerated safety profile and clear clinical efficacy in atopic dermatitis and also psoriasis and in patients with cutaneous manifestations of lupus. Our deep experience with RESPEG to date across the totality of this clinical program gives us conviction in our ongoing Phase IIb studies in atopic dermatitis and alopecia areata. Specifically in atopic dermatitis, there are three important issues that patients with this disease continue to face. First, there is a need for great efficacy, specifically a deeper magnitude of response and rapid onset of treatment. Second, patients lack durable responses and therapy-free remission. Once current therapies are discontinued, patients rebound rapidly. And third, treatments with favorable safety profiles are lacking. This is especially important given the chronic nature of the disease and the need for continuous dosing. We believe there are major opportunities in this disease state that the differentiated profile of RASPEG could potentially address. Diving into our Phase 1b data in atopic dermatitis, through the 12-week induction period, RASPEG demonstrated dose-dependent efficacy across both physician-assessed and patient-reported efficacy measurements, reaching statistical significance across many of these measures. At the highest dose level, RESPEC demonstrated a very rapid onset of response, with over 40% of patients achieving EZ75 by week 3, after only two doses of RESPEC. This rapid onset of action rivals that of JAK inhibitors, which have outperformed topilumab at this parameter. At the end of the induction period of 12 weeks, we observed a profound magnitude of efficacy. an 83% reduction in percent change from baseline EASY score with the highest dose tested. This is the largest magnitude of change that we've seen for a biologic and outside of one JAK inhibitor. Importantly, we are encouraged by the extended durability seen for RESPEC. Long after the completion of the 12-week induction period, many patients maintain durable disease control for an additional 36 weeks after the end of doses. And this type of extended disease control after the end of dosing is not observed for dupilumab or for JAK inhibitors. Durability of the EZ75 response was observed with approximately 70% of EZ75 responders maintaining that response for 36 weeks after the end of the 12-week induction period. This is a very exciting result and suggests that REDPEG has the potential to be the first remitted therapy for atopic dermatitis. For both patient-reported outcomes and physician-assessed endpoints, we observed these same trends, rapid onset of effect, dose dependence, and long durability of control. Additionally, RESPEG was well-tolerated, and treatment with RESPEG did not induce anti-drug antibodies in patients, which has been reported with some examples of the IL-2 mutine class. These promising data have us and KOLs very enthusiastic about the potential for long-lasting responses and infrequent maintenance dosing with ResPag in the setting of atopic dermatitis. In October 2023, we initiated the phase 2B study of ResPag in biologic-naive atopic dermatitis patients, and enrollment is well underway. Our goal is to enroll roughly 400 patients with three different regimens of ResPag versus placebo, evaluated over a 16-week induction period. After the induction period, patients that meet a threshold to advance from induction to maintenance will be re-randomized into one of two maintenance regimens at different dosages at either once a month or once every three months dosing, and that schedule will continue for another 28 weeks. Our enrollment for this study is on track, and we expect data in the first half of 2025. Moving to alopecia areata, We believe respite has strong scientific rationale in this indication. Alopecia areata is also a disease of the skin where your immune system starts to attack the hair follicles, thereby weakening the ability of stem cells to grow hair. With prolonged immune attack, this eventually causes the hair follicle to release the hair altogether, leading to patchy hair loss, and as the disease progresses, to baldness. Biologically speaking, Red Bag, through its central pathway of Treg rescue, is uniquely poised to address the diversity of immunopathology, providing broad potential for targeting multiple dermal diseases, including alopecia. For example, in alopecia, there are almost no immune cells in normal hair follicles, meaning the hair follicle is an immune-privileged tissue. Tregs are very important in maintaining that immune privilege. and people with alopecia areata develop a breakdown of that immune privilege state. We think the Treg mechanism of ResPeg can restore immune privilege and could provide durable disease control, which we believe would be game-changing in this indication. JAK inhibitors are the only agents approved in alopecia, and they do not provide disease durability after a patient discontinues treatment. With JAK inhibitors, it can take a patient anywhere from 9 to 18 months to grow hair. And once a patient stops taking a JAK inhibitor, which may happen for a variety of reasons, including toxicity, their hair falls out again rapidly. There is a high unmet need in this patient population for tolerable treatment options that provide durable responses. And we believe that restoration of immune privilege is key to obtain durability. For these reasons, we believe there is an opportunity for RESPEG to become a novel biologic therapy in alopecia areata. We are initiating a Phase IIb study of RESPEG in alopecia this month. The Phase IIb study plans to recruit roughly 80 patients with severe to very severe alopecia who will be randomized to RESPEG or placebo. Patients will be treated for a period of 36 weeks and observed up to 60 weeks in total. Our primary endpoint for this study is mean percent improvement in SALT, or the severity of alopecia tool, at week 36, which is the validated outcome measure used for regulatory approval. We will also be looking at a number of other secondary endpoints, including proportion of patients who saw a reduction in SALT. Now turning to NECTAR-0165, our TNFR2 agonist antibody. TNFR2 is highly expressed on Tregs, myeloid suppressor cells, regulatory B cells, neuronal cells, and others, and TNFR2 agonism has been shown to potentiate the suppressive effect in overall functional properties of Tregs and these other suppressive cell populations. If TNFR2 is absent, it is associated with autoimmunity and other genetic conditions that resemble FOXP3 loss of function. In contrast, its presence has been associated with immunoregulatory function and protective effects for multiple cell populations and tissues in the body. This TNFR2 agonist program in our pipeline is built upon many years of Treg experience gained from ResMed. For example, we know that central Tregs, such as thymic Tregs, require a substantial JAK-STAT signal. that is physiologically provided by the IL-2 receptor pathway, and this is a central theme in the mechanism of action of RESPEC. In contrast, Tregs that leave the central compartment and infiltrate the distal organs and tissues, they are less dependent on the JAK-STAT pathway and instead shift their reliance onto NF-kappa-B pathway engagement for their maintenance of suppressive function. TNFR2 is the most abundant TNF superfamily member expressed on Tregs, and a key driver of NF-kappa-B signaling in those cells. And consequently, a bona fide TNFR2 agonist would be an incredibly exciting addition to our pipeline. Examples of indications that could be addressed by TNFR2 agonism include multiple sclerosis, mucosal immunology conditions such as ulcerative colitis of the GI or other oral mucosal diseases, and even dermal autoimmune diseases like vitiligo. We have identified several lead TNFR2 antibody programs from an artificial intelligence-based antibody discovering campaign with our partner, Biologic Design. The lead antibody is called Nectar 0165, and it has highly desirable properties, including exquisite TNFR2 selectivity, TNFR2 agonism in primary human cells, activity in multiple preclinical efficacy models, and a very well tolerated profile in early non-GLP toxicology studies. We have developed a manufacturing cell line for the lead and are conducting upstream and downstream process development with the aim to enter the clinic for this program in the first half of 2025. Later this year, we plan to present the first preclinical data for Nectar 0165 at an upcoming medical conference. As we move forward with our IND enabling studies, there is growing interest for a novel selective TNFR2 agonist like Nectar 0165, and thus we remain open to the opportunity of working with companies that have interest in these areas to strategize on the best path forward. Now let's switch gears to our IL-15-based oncology program, Nectar 255. Nectar 255's IL-15-based mechanism of action holds great promise as a combination agent with cell therapies and other mechanisms, such as checkpoint inhibitors, and we are exploring the best partnering paths for continued development for this drug candidate. Our NECTAR-sponsored trial, combining NECTAR-255 with the approved CD19 CAR-T, use Brianzi, and use CARTA, for treatment of patients with the large B-cell lymphoma, has enrolled 15 patients in the dose escalation portion of the study. The combination of Nectar 255 embryon is also being studied in the separate investigator-sponsored trial at Fred Hutch. We are targeting the potential submission of data from these studies at medical meetings in the second half of this year. A clinical trial in non-small cell lung cancer, sponsored and funded by AbleZeta, which evaluates the combination of AbleZeta's tumor-infiltrating lymphocyte cell therapy, plus Nectar 255 and checkpoint inhibitor is also ongoing and enrolled in patients. And with our partner, Merck PGA, we have also been evaluating Nectar 255 in combination with Bavencio versus single agent Bavencio in the phase two javelin bladder medley study. And that study is on track to potentially report interim PFS data later this year. And with that, I will turn the call over to Sandy for a review of our financial guidance. Sandy?
spk15: Thank you, Jay-Z, and good afternoon, everyone. We ended the year in a very strong financial position with $329.4 million in cash and investments and with no debt on our balance sheet. As Howard stated earlier, today's announcement of a $30 million financing further strengthens our cash position. Our revenue was $23.9 million for the fourth quarter of 2023, and $90.1 million for the full year of 2023. Our operating costs and expenses for the fourth quarter of 2023 were $57.4 million and $353.8 million for the full year 2023. Our non-operating expenses for the fourth quarter of 2023 were $8.6 million and $12.6 million for the full year 2023. Q4 2023 included a non-cash charge of $6.1 million or 3 cents per share for the reclassification of the foreign currency translation adjustment to income related to the wind down of our India legal entity. As a reminder, our India facility was sold in December 2022 for approximately $12 million with the wind down of the entity occurring in 2023. Our net loss for the fourth quarter of 2023 was $42.1 million, or 22 cents per share. For the full year of 2023, our net loss was $276.1 million, or $1.45 per share. Excluding $111.8 million in non-cash goodwill and other impairment charges, Net loss on a non-GAAP basis for the full year 2023 was $164.3 million, or 86 cents, basic and diluted loss per share. Looking forward to 2024 and beyond, our financial position remains strong, in part reflecting the cost savings initiatives we undertook last year. We plan to end 2024 with $200 to $225 million in cash and investments. In addition to the $30 million pipe we announced this morning, our 2024 cash guidance also includes $15 million resulting from an amendment executed today on a former 2020 agreement with certain entities of healthcare royalty. Our cash runway now extends well into the third quarter of 2026, which will take us through key value generating milestones, including phase two RESPEG data in atopic dermatitis and alopecia areata. Our revenue for the full year of 2024 is expected to be between 75 million and 85 million, which includes 55 to 65 million in non-cash royalties and $20 million to $25 million in product sales. We anticipate full-year R&D expense will range between $120 million and $130 million. This includes approximately $5 to $10 million of non-cash depreciation and stock-based compensation expense. The increase in R&D spend for 2024 over 2023 represents an increased investment in two RESPEG Phase IIb studies in atopic dermatitis and alopecia areata, as well as IND-enabling studies for our antibody program, NECTAR-0165. This increase is partially offset by decreased spending on NECTAR-255 clinical studies and cell therapy, which are completing in 2024. The remaining ongoing clinical studies for Nectar 255 are primarily funded by our external partners. We expect G&A expense for the full year of 2024 to be between $70 million and $75 million, which includes $5 to $10 million of non-cash depreciation and stock-based compensation expense. Our full-year non-cash interest expense is expected to be between $20 and $25 million. As I stated earlier, we expect to end this year with $200 to $225 million in cash and investments. And with that, we will now open the call for questions. Crystal?
spk16: Thank you. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. In the interest of time, we do ask that you please limit yourself to one question at this time. Please stand by while we compile the Q&A roster. And our first question will come from Jay Olson from OPCO. Your line is open.
spk04: Oh, hey, this is Cheung on the line for Jay. Thank you for taking the question and congrats on the progress. Maybe just on RASPAC-80 study, wondering if you can talk about the initial feedback from doctors and patients participating in the study, especially in the context that there are many other competing trials out there. Also, if you also could comment on the recruitment progress thus far versus your internal expectation, that would be great. And I have a quick follow-up question after that. Thank you.
spk34: Mary, you want to take that question?
spk21: Yeah, sure, Howard. Thank you. Hi, Joe. This is Mary . You know, when we look at the aggregate of data from site activation, screening activities, and enrollment, we are on track to have our top line induction data from the AD study in the first half of 2025. And in terms of the feedback, you know, we're really pleased with the type of screening we're seeing, and we believe this is driven by the data that was presented by Jonathan Silverberg at EADB 2023. The doctors really do see that, one, ResTech has a very rapid onset of action. Number two, the depth of response that we're seeing with the mean percent change and easy after only 12 weeks of treatment. When most studies look at an induction period of 16 weeks, the doctors have been very impressed with that. And then certainly for the benefit of their patients, they really love the durability that we saw when patients were off treatment for nine consecutive months, and they were able to maintain that very deep response and easy. This is all very, very attractive for recruiting patients to the study. So we're doing very well. I have heard that other studies are with enrollment, and we're not experiencing that.
spk04: Got it. Thank you. And just a quick follow-up. I'm just wondering to what extent you can leverage the clinical sites for the AD study for the upcoming alopecia areata initiation. So can you just use the same sites, or there's another layer of work you need to do?
spk21: Yes, so we are going to use 12 sites that are participating in the AD study, in our alopecia study, and those physicians are very excited to have an opportunity for a second skin disease to evaluate RESPEG in alopecia, and again, they're really eager to see a durability of response because, of course, when they treat their patients with JAK inhibitors and they grow JARBAC, immediately they start to lose their hair once they discontinue treatment with the JAK inhibitor. So the promise of an age of durability and restore immune privilege is definitely really encouraging and exciting to the students I've been speaking to.
spk03: Okay. Thank you so much.
spk16: Thank you. And our next question will come from Roger Song from Jefferies. Your line is open.
spk08: Hi, team. This is for Roger. Maybe just following up on the alopecia areata study, how many total clinical sites will you be enrolling? And what's kind of the geographic distribution of those sites? And then what are some key baseline characteristics for the patients in these studies? Will most of them be a JAK inhibitor or refractory? Any detail there would be appreciated.
spk21: Sure. Yeah. Yeah, thanks, Howard. We'll have slightly over 30 sites. We're going to be in Canada, in the United States and in Poland. You know, as you may imagine, when you're in Poland, they, you know, definitely have an access issue. And it's also takes a very long time for those patients to get in to see a dermatologist. So You know, it's actually a very favorable environment to enroll patients. These patients are going to be JAK inhibitor naive patients. And then our key, you know, inclusion criteria is the severe to very severe alopecia patients. So these patients all have to have a SALT greater than or equal to 50. And of course, this is the same patient population where baricitinib and Pfizer's JAK inhibitor have the same eligibility criteria for their pivotal trial.
spk31: Great, thank you.
spk16: Thank you. Our next question will come from Jessica Pfei from J.P. Morgan. Your line is open.
spk24: Hey, thanks for taking my question. For the Phase IIb atopic derm trial, What's the threshold patients need to meet to be considered a responder and be re-randomized at week 16? And then also curious, what's your latest thinking on whether the AD or the alopecia trial will read out first and why?
spk21: Yeah. Hi, Jessica. It's Mary. So to be re-randomized, the patient has to have easy 50 or above when they are re-randomized to the maintenance dose of once a month or once every three months. they will be on the same dose that they were randomized to in the induction period. And do you have a second question?
spk24: Just the timing of alopecia versus AD data?
spk21: Yeah.
spk24: Yeah.
spk19: So we expect the AD trial to read out first. Thank you.
spk20: Thank you.
spk16: Thank you. Our next question will come from Julian Harrison from BTIG. Your line is open.
spk09: Hi, congrats on the progress and thank you for taking my questions. I'm curious if you could remind us how you're thinking about efficacy beyond 12 weeks of dosing with Brezpeg and atopic derm. Do you expect a plateau at some point or do you expect response rates to maybe be progressive through 44 weeks of dosing? And then with regards to the Lilly litigation, sorry if I missed it, I'm wondering if you could comment on its current status and timing of next steps.
spk33: Mary, why don't you take the first part and I'll take the second part.
spk21: Yeah, you know, I definitely think that as we extend our induction period from 12 weeks to 16 weeks, we're going to see a greater number of patients experience a deeper response. So I very much look forward to, you know, seeing what the mean percent change is. As you know, our easy mean percent change from baseline to 12 weeks was 83%. And as such, that was greater than any of the biologic agents. If you look at Doopie or Audrey or Libri or Nemo or Roca, you know, we definitely saw the deepest response. But I do believe that we'll probably see more patients you know, who experience an ED75 and even an ED90 as we go out additional four weeks in the induction period.
spk33: With regard to Lily, you know, Lily, after we filed our complaint in federal court, Lily tried to convince the federal court judge to dismiss the case, as you know. And last week, the federal judge refused Lily's request. And the judge agreed to allow Nectar's claims, primary claims, to move forward. And we expect the judge to settle trial date in 2025. The court also ordered the parties to engage in mediation within the next three months to try to resolve the issue. And so we're very, very happy the case is moving forward. The judge did not dismiss the case. And we look forward to vindicating ourselves through the litigation process.
spk07: Excellent. Thanks very much.
spk16: Thank you. And as a reminder, to ask a question, please press star 11. And our next question will come from Andy Shea from William Blair. Your line is open.
spk10: Great. Thanks for taking our questions. Two quick ones for us. One is, can you talk about this ebb and flow dynamic associated with hair loss in alopecia, would enrolling kind of severe and really severe patients kind of mitigate that variability? And the second question has to do with the TNF receptor 165 program. We know that the receptor family is a trimer, so I guess to maximally agonize this receptor, you might have to have like a trimer design. I'm just curious if that's kind of a part of the design that goes into 165. And downstream from that, there's also kind of clustering. So is that also a part of the design of the molecule?
spk02: Thanks.
spk19: Mary, do you want to take the hair loss? Yeah.
spk21: So, hi, Andy. It's Mary. So, you're exactly right. Once patients go into the severe and the very severe, generally speaking, there is not a regrowth of the hair. And you're exactly right that that's why the eligibility criteria and even the threshold for approval by the FDA is this patient population. You know, patients do start out with experiencing just patchy hair loss, but as the disease progresses, certainly the hair loss becomes more extreme and, you know, even towards baldness. But once a patient loses their hair, it's very unusual for them to have regrowth of their hair without some sort of medical intervention. And then I'll pass over the second question to Jason.
spk06: Yeah, thanks, Mary, and thanks, Andy, for your question. So you're right. So TNF proteins are trimers. But as we've learned more and more about the biophysics of the receptors and the way the plat domains, right, which are the cysteine-rich domains that hold together the receptor subunits, they actually work to create dimers of receptors. And then a trimer comes along and clusters six receptors or three pairs of dimers. And then you can get additional clustering, and some of this ultrastructure has been published and some structural studies have been done. What we've come to understand, A, through learning about the cell biology of these receptors, the way these dimers need to multimarize, and the way the epitopes for binding to the receptors need to work, is that the epitope is actually fundamentally important. One of the things we discovered with Nectar 0165 is that it's an epitope that has its own unique properties, and it can signal in a completely cluster-independent fashion. For example, it doesn't need FC. It doesn't even need valency. That's one of the things that's really unique and highly differentiated about the antibodies that we've created. And keeping in mind all of these ultra-structural forms of the receptor, And then the different states that the receptor can occupy is obviously one of the key things that's important for developing a successful acne. Thanks for the question.
spk16: Thank you. And I am showing no further questions from the phone lines, and I'd like to turn the conference back over to Howard Robin for any closing remarks.
spk33: Well, thank you, everyone, for joining us today. As we stated on our call, we really remain focused on executing the development of RESPEG in our immunology-focused research programs. I'd like to thank all of our employees for their very hard work and thank all of our shareholders, new and existing, for their continued support. And we look forward to providing you with updates on our progress. So stay tuned. Thanks for joining us again.
spk16: Thank you. This concludes today's conference call. Thank you for your participation. You may now disconnect. Everyone, have a wonderful day. Thank you. Good day, and thank you for standing by. Welcome to the Nectar Therapeutics fourth quarter 2023 financial results conference call. At this time, all participants are in the listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 11 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Vivian Wu. Please go ahead.
spk22: Thank you, Crystal, and good afternoon, everyone. Thanks for joining us today. With us on the call are Howard Robin, our President and CEO, Dr. Jonathan Zlatsky, our Chief of Research and Development, Dr. Mary Tagliaferri, our Chief Medical Officer, Sandra Gardner, our Chief Financial Officer, and Jennifer Roddick, our Chief Business Officer. On today's call, we expect to make forward-looking statements regarding our business, including statements regarding the therapeutic potential of and future development plans for drug candidates and research programs, the timing of the initiation of clinical studies and the availability of clinical data for drug candidates, the timing and plans for future clinical data presentations, the formation, future development plans, or success of our collaboration agreements, The expectations following are corporate restructuring and reorganization, financial guidance, and certain other statements regarding the future of our business. Because forward-looking statements relate to the future, they're subject to uncertainties and risks that are difficult to predict, many of which are outside of our control. Our actual results may differ materially from these statements. Important risks and uncertainties are set forth in our Form 10-Q that was filed on November 8, 2023, which is available at sec.gov. We undertake no obligation to update any statements, whether as a result of new information, future developments, or otherwise. A webcast of this call will be available on the IR page of Nectar's website at Nectar.com. With that said, I would like to hand the call over to our President and CEO, Howard. Robin, Howard?
spk33: Thank you, Vivian, and thank you for all joining us today. 2023 was a pivotal year for Nectar. We refocused the company's development pipeline on immunology and inflammation with our primary near-term goal to advance RESPEG to meaningful data catalysts in the first half of 2025. RESPEG is poised to be highly disruptive in the biologic treatment landscape for ectopic dermatitis by offering a novel agonistic mechanism. RESPEG is designed to both dampen the inflammatory response and simultaneously restore immune balance by directly expanding functional Treg cells and engaging multiple immunoregulatory pathways in patients with ectopic dermatitis and other autoimmune disorders. Through its unique mechanism, Respec also has the potential to provide patients with superior efficacy as well as more favorable in frequent dosing. There are over 30 million people in the U.S. alone battling this chronic skin condition, and it can greatly impact quality of life and mental health for these patients. We made significant advancements in 2023 with respect to our RESPEG program. Most notably, we regained the full rights to RESPEG from Eli Lilly and now own the program 100% with no encumbrances. We moved to quickly design a phase 2b study in ectopic dermatitis based on the promising results from the phase 1B placebo-controlled randomized study of ResBag, which showed an 83% drop in eczema skin scores after just 12 weeks of treatment. Our phase 2B global study in this indication was launched in October of 23, and enrollment is on track for data readout in the first half of 25. In late 2023, we also began work designing a Phase IIb study in alopecia areata, another area of high unmet need. The study is starting this month. There are approximately 7 million patients in the United States and 160 million people worldwide who have alopecia areata. JAK inhibitors are the primary treatment option for patients with alopecia but have a significant rebound effect with treatment cessation and several black box warnings. Based on the data we've generated to date on RESPEG in the skin-related autoimmune condition of ectopic dermatitis, psoriasis, and in patients with cutaneous manifestations of lupus, we believe RESPEG has strong scientific rationale in the setting of alopecia and could have the potential to be a highly differentiated treatment option with a similar remittive effect for this unserved patient population. As I stated earlier, we look forward to the Phase 2B data for our ectopic dermatitis study and for our alopecia study in the first half of 2025. These will be highly meaningful data catalysts for NECR. In addition to RESPEC, we have another important immunology program that we're moving toward the clinic. This is a first-in-class differentiated mechanism in immunology, a TNFR2 agonist antibody that Nectar 165. TNFR2 has been shown to potentiate the suppressive effects and overall functional properties of Tregs, and the program is built on what we've learned through our deep experience with ResPeg and the Treg field and represents a promising mechanism for treatment of autoimmunities, including multiple sclerosis and ulcerative colitis. We're currently conducting IND-enabling studies with the goal of targeting an IND submission in the first half of next year. In line with our objectives to advance our immunology pipeline, today we announced a $30 million financing that further bolsters Nectar's financial position as we head into transformative data catalysts. Importantly, we're pleased to bring on a new high-quality long-term investor, TCG Crossover, who clearly shares our belief in the potential of ResBank. At a price of $1.20 per share, the transaction represents a premium of over 80%. to Nectar's 30-day VWAP. This puts us in a strong financial position and extends our cash runway from our previous guidance, which was the middle of 2026, to now well into the third quarter of 2026. And with that, I'll hand the call over to Jay-Z for an R&D discussion. Jay-Z?
spk06: Thank you, Howard. Let's begin today with RASPEG, which is the most advanced IL-2-based T-RAG mechanism in the field. Across the RESPEC studies that have been conducted to date, we have observed a consistent and highly predictable clinical pharmacology profile with respect to target engagement as well as the peak and duration of Treg mobilization. It has demonstrated a well-tolerated safety profile and clear clinical efficacy in atopic dermatitis and also psoriasis and in patients with cutaneous manifestations of lupus. Our deep experience with RESPEG to date across the totality of this clinical program gives us conviction in our ongoing Phase IIb studies in atopic dermatitis and alopecia areata. Specifically in atopic dermatitis, there are three important issues that patients with this disease continue to face. First, there is a need for great efficacy, specifically a deeper magnitude of response and rapid onset of treatment. Second, patients lack durable responses and therapy-free remission. Once current therapies are discontinued, patients rebound rapidly. And third, treatments with favorable safety profiles are lacking. This is especially important given the chronic nature of the disease and the need for continuous dosing. We believe there are major opportunities in this disease state that the differentiated profile of RASPEG could potentially address. Diving into our Phase 1b data in atopic dermatitis, through the 12-week induction period, RASPEG demonstrated dose-dependent efficacy across both physician-assessed and patient-reported efficacy measurements, reaching statistical significance across many of these measures. At the highest dose level, RASPEG demonstrated a very rapid onset of response, with over 40% of patients achieving EZ75 by week 3, after only two doses of RASPEG. This rapid onset of action rivals that of JAK inhibitors, which have outperformed Topilumab at this parameter. At the end of the induction period of 12 weeks, we observed a profound magnitude of efficacy. An 83% reduction in percent change from baseline EASY score with the highest dose tested. This is the largest magnitude of change that we've seen for a biologic and outside of one jackkniver. Importantly, we are encouraged by the extended durability seen for RESPEC. Long after the completion of the 12-week induction period, many patients maintain durable disease control for an additional 36 weeks after the end of dosing. And this type of extended disease control after the end of dosing is not observed for dupilumab or for JAK inhibitors. Durability of the EZ75 response was observed with approximately 70% of EZ75 responders maintaining that response for 36 weeks after the end of the 12-week induction period. This is a very exciting result and suggests that REDPEG has the potential to be the first remitted therapy for atopic dermatitis. For both patient-reported outcomes and physician-assessed endpoints, we observed these same trends, rapid onset of effect, dose dependence, and long durability of control. Additionally, RESPEG was well-tolerated, and treatment with RESPEG did not induce anti-drug antibodies in patients, which has been reported with some examples of the IL-2 mutine class. These promising data have us and KOLs very enthusiastic about the potential for long-lasting responses and infrequent maintenance dosing with ResPag in the setting of atopic dermatitis. In October 2023, we initiated the phase 2B study of ResPag in biologic-naive atopic dermatitis patients, and enrollment is well underway. Our goal is to enroll roughly 400 patients with three different regimens of ResPag versus placebo, evaluated over a 16-week induction period. After the induction period, patients that meet a threshold to advance from induction to maintenance will be re-randomized into one of two maintenance regimens at different dosages at either once a month or once every three months dosing, and that schedule will continue for another 28 weeks. Our enrollment for this study is on track, and we expect data in the first half of 2025. Moving to alopecia areata, We believe respite has strong scientific rationale in this indication. Alopecia areata is also a disease of the skin where your immune system starts to attack the hair follicles, thereby weakening the ability of stem cells to grow hair. With prolonged immune attack, this eventually causes the hair follicle to release the hair altogether, leading to patchy hair loss, and as the disease progresses, to baldness. Biologically speaking, RedBag, through its central pathway of Treg rescue, is uniquely poised to address the diversity of immunopathology, providing broad potential for targeting multiple dermal diseases, including alopecia. For example, in alopecia, there are almost no immune cells in normal hair follicles, meaning the hair follicle is an immune-privileged tissue. Tregs are very important in maintaining that immune privilege. and people with alopecia areata develop a breakdown of that immune privilege state. We think the Treg mechanism of ResPeg can restore immune privilege and could provide durable disease control, which we believe would be game-changing in this indication. JAK inhibitors are the only agents approved in alopecia, and they do not provide disease durability after a patient discontinues treatment. With JAK inhibitors, it can take a patient anywhere from 9 to 18 months to grow hair. And once a patient stops taking a JAK inhibitor, which may happen for a variety of reasons, including toxicity, their hair falls out again rapidly. There is a high unmet need in this patient population for tolerable treatment options that provide durable responses. And we believe that restoration of immune privilege is key to obtain durability. For these reasons, we believe there is an opportunity for RESPEG to become a novel biologic therapy in alopecia areata. We are initiating a Phase IIb study of RESPEG in alopecia this month. The Phase IIb study plans to recruit roughly 80 patients with severe to very severe alopecia who will be randomized to RESPEG or placebo. Patients will be treated for a period of 36 weeks and observed up to 60 weeks in total. Our primary endpoint for this study is mean percent improvement in SALT, or the severity of alopecia tool, at week 36, which is the validated outcome measure used for regulatory approval. We will also be looking at a number of other secondary endpoints, including proportion of patients who saw a reduction in SALT. Now turning to NECTAR-0165, our TNFR2 agonist antibody. TNFR2 is highly expressed on Tregs, myeloid suppressor cells, regulatory B cells, neuronal cells, and others, and TNFR2 agonism has been shown to potentiate the suppressive effect in overall functional properties of Tregs and these other suppressive cell populations. If TNFR2 is absent, it is associated with autoimmunity and other genetic conditions that resemble FOXP3 loss of function. In contrast, its presence has been associated with immunoregulatory function and protective effects for multiple cell populations and tissues in the body. This TNFR2 agonist program in our pipeline is built upon many years of Treg experience gained from ResMed. For example, we know that central Tregs, such as thymic Tregs, require a substantial JAK-STAT signal that is physiologically provided by the IL-2 receptor pathway, and this is a central theme in the mechanism of action of RESPEC. In contrast, Tregs that leave the central compartment and infiltrate the distal organs and tissues, they are less dependent on the JAK-STAT pathway and instead shift their reliance onto NF-kappa-B pathway engagement for their maintenance of suppressive function. TNFR2 is the most abundant TNF superfamily member expressed on Tregs, and the key driver of NF-kappa-B signaling in those cells. And consequently, a bona fide TNFR2 agonist would be an incredibly exciting addition to our pipeline. Examples of indications that could be addressed by TNFR2 agonism include multiple sclerosis, mucosal immunology conditions such as ulcerative colitis of the GI or other oral mucosal diseases, and even dermal autoimmune diseases like vitiligo. We have identified several lead TNFR2 antibody programs from an artificial intelligence-based antibody discovering campaign with our partner, Biologic Design. The lead antibody is called Nectar 0165, and it has highly desirable properties, including exquisite TNFR2 selectivity, TNFR2 agonism in primary human cells, activity in multiple preclinical efficacy models, and a very well-tolerated profile in early non-GLP toxicology studies. We have developed a manufacturing cell line for the lead and are conducting upstream and downstream process development with the aim to enter the clinic for this program in the first half of 2025. Later this year, we plan to present the first preclinical data for Nectar 0165 at an upcoming medical conference. As we move forward with our IND-enabling studies, there is growing interest for a novel selective TNFR2 agonist like Nectar 0165, and thus we remain open to the opportunity of working with companies that have interest in these areas to strategize on the best path forward. Now let's switch gears to our IL-15-based oncology program, Nectar 255. Nectar 255's IL-15-based mechanism of action holds great promise as a combination agent with cell therapies and other mechanisms, such as checkpoint inhibitors, and we are exploring the best partnering paths for continued development for this drug candidate. Our NECTAR-sponsored trial, combining NECTAR-255 with the approved CD19 CAR-T, use Brianzi, and use CARTA, for treatment of patients with the large B-cell lymphoma, has enrolled 15 patients in the dose escalation portion of the study. The combination of Nectar 255 embryos is also being studied in the separate investigator-sponsored trial at Fred Hutch. We are targeting the potential submission of data from these studies at medical meetings in the second half of this year. A clinical trial in non-small-cell lung cancer, sponsored and funded by AbleZeta, which evaluates the combination of AbleZeta's tumor-infiltrating lymphocyte cell therapy, plus Nectar 255 and checkpoint inhibitor is also ongoing and enrolled in patients. And with our partner, Merck PGA, we have also been evaluating Nectar 255 in combination with Bavencio versus single agent Bavencio in the phase two javelin bladder medley study. And that study is on track to potentially report interim PFS data later this year. And with that, I will turn the call over to Sandy for a review of our financial guidance. Sandy?
spk15: Thank you, Jay-Z, and good afternoon, everyone. We ended the year in a very strong financial position with $329.4 million in cash and investments and with no debt on our balance sheet. As Howard stated earlier, today's announcement of a $30 million financing further strengthens our cash position. Our revenue was $23.9 million for the fourth quarter of 2023, and $90.1 million for the full year of 2023. Our operating costs and expenses for the fourth quarter of 2023 were $57.4 million and $353.8 million for the full year 2023. Our non-operating expenses for the fourth quarter of 2023 were $8.6 million and $12.6 million for the full year 2023. Q4 2023 included a non-cash charge of $6.1 million or 3 cents per share for the reclassification of the foreign currency translation adjustment to income related to the wind down of our India legal entity. As a reminder, our India facility was sold in December 2022 for approximately $12 million with the wind down of the entity occurring in 2023. Our net loss for the fourth quarter of 2023 was $42.1 million, or 22 cents per share. For the full year of 2023, our net loss was $276.1 million, or $1.45 per share. Excluding $111.8 million in non-cash goodwill and other impairment charges, Net loss on a non-GAAP basis for the full year 2023 was $164.3 million, or 86 cents, basic and diluted loss per share. Looking forward to 2024 and beyond, our financial position remains strong, in part reflecting the cost savings initiatives we undertook last year. We plan to end 2024 with $200 to $225 million in cash and investments. In addition to the $30 million pipe we announced this morning, our 2024 cash guidance also includes $15 million resulting from an amendment executed today on a former 2020 agreement with certain entities of healthcare royalties. Our cash runway now extends well into the third quarter of 2026, which will take us through key value generating milestones, including phase two RESPEG data in atopic dermatitis and alopecia areata. Our revenue for the full year of 2024 is expected to be between 75 million and 85 million, which includes 55 to 65 million in non-cash royalties and $20 million to $25 million in product sales. We anticipate full-year R&D expense will range between $120 million and $130 million. This includes approximately $5 to $10 million of non-cash depreciation and stock-based compensation expense. The increase in R&D spend for 2024 over 2023 represents an increased investment in two RESPEG Phase IIb studies in atopic dermatitis and alopecia areata, as well as IND-enabling studies for our antibody program, NECTAR-0165. This increase is partially offset by decreased spending on NECTAR-255 clinical studies and cell therapy, which are completing in 2024. The remaining ongoing clinical studies for Nectar 255 are primarily funded by our external partners. We expect G&A expense for the full year of 2024 to be between $70 million and $75 million, which includes $5 to $10 million of non-cash depreciation and stock-based compensation expense. Our full-year non-cash interest expense is expected to be between $20 and $25 million. As I stated earlier, we expect to end this year with $200 to $225 million in cash and investments. And with that, we will now open the call for questions. Crystal?
spk16: Thank you. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 11 again. In the interest of time, we do ask that you please limit yourself to one question at this time. Please stand by while we compile the Q&A roster. And our first question will come from Jay Olson from OPCO. Your line is open.
spk04: Oh, hey, this is Cheung on the line for Jay. Thank you for taking the question and congrats on the progress. Maybe just on RASPAC-80 study, wondering if you can talk about the initial feedback from doctors and patients participating in the study, especially in the context that there are many other competing trials out there. Also, if you also could comment on the recruitment progress thus far versus your internal expectation, that would be great. And I have a quick follow-up question after that. Thank you.
spk34: Mary, you want to take that question?
spk21: Yeah, sure, Howard. Thank you. Hi, Joe. This is Mary . You know, when we look at the aggregate of our data from site activation, screening activities, and enrollment, we are on track to have our top line induction data from the AD study in the first half of 2025. And in terms of the feedback, you know, we're really pleased with the type of screening we're seeing, and we believe this is driven by the data that was presented by Jonathan Silverberg at EADB 2023. The doctors really do see that, one, ResTech has a very rapid onset of action. Number two, the depth of response that we're seeing with the mean percent change and easy after only 12 weeks of treatment. When most studies look at an induction period of 16 weeks, the doctors have been very impressed with that. And then certainly for the benefit of their patients, they really love the durability that we saw when patients were off treatment for nine consecutive months and they were able to maintain that very deep response and easy. This is all very, very attractive for recruiting patients to the study. So we're doing very well. I have heard that other studies are with enrollment, and we're not experiencing that.
spk04: Got it. Thank you. And just a quick follow-up. I'm just wondering to what extent you can leverage the clinical sites for the AD study for the upcoming alopecia areata initiation. So can you just use the same sites or there's another layer of working to do?
spk21: Yes, so we are going to use 12 sites that are participating in the AD study, in our alopecia study, and those physicians are very excited to have an opportunity for a second skin disease to evaluate RESPEG in alopecia, and again, they're really eager to see a durability of response because, of course, when they treat their patients with JAK inhibitors and they grow their back, immediately they start to lose their hair once they discontinue treatment with the JAK inhibitor. So the promise of an age of durability and restore immune privilege is definitely really encouraging and exciting to the students I've been speaking to. Okay.
spk03: Thank you so much.
spk16: Thank you. And our next question will come from Roger Song from Jefferies. Your line is open.
spk08: Hi, Payne. This is for Roger. Maybe just following up on the alopecia areata study, how many total clinical sites will you be enrolling? And what's kind of the geographic distribution of those sites? And then what are some key baseline characteristics for the patients in these studies? Will most of them be a JAK inhibitor or refractory? Any detail there would be appreciated.
spk21: Sure. Yeah. Yeah, thanks, Howard. We'll have slightly over 30 sites. We're going to be in Canada, in the United States, and in Poland. You know, as you may imagine, when you're in Poland, they, you know, definitely have an access issue, and it also takes a very long time for those patients to get in to see a dermatologist. So, You know, it's actually a very favorable environment to enroll patients. These patients are going to be JAK inhibitor naive patients. And then our key, you know, inclusion criteria is the severe to very severe alopecia patients. So these patients all have to have a SALT greater than or equal to 50. And of course, this is the same patient population where baracitinib and Pfizer's JAK inhibitor have the same eligibility criteria for their pivotal trial.
spk31: Great, thank you.
spk16: Thank you. Our next question will come from Jessica Pfei from J.P. Morgan. Your line is open.
spk24: Hey, thanks for taking my question. For the Phase IIb atopic derm trial, What's the threshold patients need to meet to be considered a responder and be re-randomized at week 16? And then also curious, what's your latest thinking on whether the AD or the alopecia trial will read out first and why?
spk21: Yeah. Hi, Jessica. It's Mary. So to be re-randomized, the patient has to have easy 50 or above when they are re-randomized to the maintenance dose of once a month or once every three months. they will be on the same dose that they were randomized to in the induction period. And did you have a second question?
spk24: Just the timing of alopecia versus AD data? Yeah, so we expect the AD trial to read out first.
spk19: Thank you.
spk20: Thank you.
spk16: Thank you. Our next question will come from Julian Harrison from BTIG. Your line is open.
spk09: Hi, congrats on the progress, and thank you for taking my questions. I'm curious if you could remind us how you're thinking about efficacy beyond 12 weeks of dosing with Breast PEG and atopic derm. Do you expect a plateau at some point, or do you expect response rates to maybe be progressive through 44 weeks of dosing? And then with regards to the Lilly litigation, sorry if I missed it, I'm wondering if you could comment on its current status and timing of next steps.
spk33: Mary, why don't you take the first part and I'll take the second part.
spk21: Yeah, you know, I definitely think that as we extend our induction period from 12 weeks to 16 weeks, we're going to see a greater number of patients experience a deeper response. So I very much look forward to, you know, seeing what the mean percent change is. As you know, our easy mean percent change from baseline to 12 weeks was 83%. And as such, that was greater than any of the biologic agents. If you look at Dupuy or Audrey or Libri or Nemo or Rocha, you know, we definitely saw the deepest response. But I do believe that we'll probably see more patients you know, who experience an ED75 and even an ED90 as we go out additional four weeks in the induction period.
spk33: With regard to Lily, you know, Lily, after we filed our complaint in federal court, Lily tried to convince the federal court judge to dismiss the case, as you know. And last week, the federal judge refused Lily's request. And the judge agreed to allow Nectar's claims, primary claims, to move forward. And we expect the judge to settle trial date in 2025. The court also ordered the parties to engage in mediation within the next three months to try to resolve the issue. And so we're very, very happy the case is moving forward. The judge did not dismiss the case. And we look forward to vindicating ourselves through the litigation process.
spk07: Excellent. Thanks very much.
spk16: Thank you. And as a reminder, to ask a question, please press star 11. And our next question will come from Andy Shea from William Blair. Your line is open.
spk10: Great. Thanks for taking our questions. Two quick ones for us. One is, can you talk about this ebb and flow dynamic associated with hair loss in alopecia, would enrolling kind of severe and really severe patients kind of mitigate that variability? And the second question has to do with the TNF receptor 165 program. We know that the receptor family is a trimer, so I guess to maximally agonizes receptor, you might have to have like a trimer design. I'm just curious if that's kind of a part of the design that goes into 165. And downstream from that, there's also kind of clustering. So is that also a part of the design of the molecule?
spk02: Thanks.
spk19: Mary, do you want to take the hair loss? Yeah. And then JV can take the penis, won't you? Yeah.
spk21: So, hi, Andy. It's Mary. So, you're exactly right. Once patients go into the severe and the very severe, generally speaking, there is not a regrowth of the hair. And you're exactly right that that's why the eligibility criteria and even the threshold for approval by the FDA is this patient population. You know, patients do start out with experiencing just patchy hair loss, but as the disease progresses, certainly the hair loss becomes more extreme and, you know, even towards baldness. But once a patient loses their hair, it's very unusual for them to have regrowth of their hair without some sort of medical intervention. And then I'll pass over the second question to Jason.
spk06: Yeah, thanks, Mary. Thanks, Andy, for your question. So you're right. So TNF proteins are trimers. But as we've learned more and more about the biophysics of the receptors and the way the plat domains, right, which are the cysteine-rich domains that hold together the receptor subunits, they actually work to create dimers of receptors. And then a trimer comes along and clusters six receptors or three pairs of dimers. And then you can get additional clustering, and some of this ultrastructure has been published, and some structural studies have been done. What we've come to understand, A, through learning about the cell biology of these receptors, the way these dimers need to multimarize, and the way the epitopes for binding to the receptors need to work, is that the epitope is actually fundamentally important. One of the things we discovered with Nectar 0165 is that it's an epitope that has its own unique properties, and it can signal in a completely cluster-independent fashion. For example, it doesn't need FC. It doesn't even need valency. That's one of the things that's really unique and highly differentiated about the antibodies that we've created. And keeping in mind all of these ultra-structural forms of the receptor, And then the different states that the receptor can occupy is obviously one of the key things that's important for developing a successful acne. Thanks for the question.
spk16: Thank you. And I am showing no further questions from the phone lines, and I'd like to turn the conference back over to Howard Robin for any closing remarks.
spk33: Well, thank you, everyone, for joining us today. As we stated on our call, we really remain focused on executing the development of RESPEG in our immunology-focused research programs. I'd like to thank all of our employees for their very hard work and thank all of our shareholders, new and existing, for their continued support. And we look forward to providing you with updates on our progress. So stay tuned. Thanks for joining us again.
spk16: Thank you. This concludes today's conference call. Thank you for your participation. You may now disconnect. Everyone, have a wonderful day.
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