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spk01: Good day and thank you for standing by. Welcome to Achieve Life Sciences first quarter 2021 earnings call. At this time, all participants are in a 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 1 on your telephone keypad. Please be advised that today's conference is being recorded. If you require any further assistance, please press star 0. I would now like to hand the conference over to Janie Sinas, Executive Vice President of Commercial. Thank you. Please go ahead.
spk06: Thank you, Charlotte, and thanks, everyone, for joining us. On the call today from Achieve, we have John Bensich, Chief Executive Officer, Dr. Cindy Jacobs, President and Chief Medical Officer, Jerry Wan, Principal Accounting Officer, and Rick Stewart, Executive Chairman of the Board of Directors. I'd like to remind everyone that today's conference call contains forward-looking statements based on current expectations. These statements are only predictions, and actual results may vary materially from those projected. Please refer to Achieve documents filed with the SEC concerning factors that could affect the company, copies of which are available on our website. I'll now turn the call over to John.
spk00: Thank you, Jamie. On today's call, we will review the progress we've made on the Phase III trial and other NDA-enabling activities. and provide an update on our Q1 financial results. Let's begin with ORCA-2. As a reminder, ORCA-2 is a double-blind, randomized, placebo-controlled Phase III trial that is currently enrolling 750 adult smokers across 17 locations in the United States. The trial is designed to evaluate the safety and efficacy of 3 milligrams cytosinicline dosed three times a day over a period of six and 12 weeks versus placebo. Participants are being randomly assigned to one of three arms and receiving either 12 weeks of placebo, 12 weeks of cytosinicline, or a combination of six weeks of cytosinicline followed by six weeks of placebo. After the 12-week treatment period, subjects are followed monthly out to 24 weeks. Behavioral support is being provided to all subjects throughout the study. There are two independent primary endpoints that will evaluate the rate of smoking abstinence of cytosinicline compared to placebo at the end of both six weeks and 12 weeks of treatment. ORCA2 will be successful if either or both of the cytosinicline arms show an efficacy benefit over placebo. We are pleased to share that ORCA2 has reached over 80% of the 750 subject enrollment target and we look forward to completion of enrollment by the middle of the year. As we discussed on our last call, we experienced slower than anticipated enrollment during the initial months of the study, which was primarily due to the pandemic and participants' reluctancy for in-person site visits. In response, we implemented numerous recruitment initiatives to increase the pipeline of potential subjects to be screened and successfully assisted the sites in finding qualified subjects for the trial. We also onboarded two new clinical sites in Atlanta, Georgia, and Evansville, Indiana, bringing the total number of sites in the study to 17. We are pleased to see the additional recruitment support and new sites have resulted in increased randomizations, and we remain on track to completing enrollment by the middle of this year. Additionally, regarding ORCA2, we have completed two data safety monitoring committee meetings. The committee reviews general safety data and oversees the conduct of the trial. In both meetings, they did not identify any safety concerns nor any study conduct issues and recommended that the study continue as planned. Overall, we are pleased with the progress of the trial to date and the efforts being made by our clinical trial sites across the U.S. As a reminder, the company will remain blinded until the completion of all study follow-up evaluations and until the database has been finalized and locked. We look forward to providing further updates on ORCID II when enrollment is completed. Additionally, we have continued to make great progress on numerous non-clinical NDA-enabling regulatory requirements. We have completed and submitted to FDA both of the required long-term chronic toxicology studies. In addition, we are also near completion of one of the two required carcinogenicity studies and have completed a special protocol assessment with the FDA for the second required study. By next year, we expect that all required non-clinical toxicology studies for an NDA will be completed. Also, in the first quarter, we had two important cytosinicline studies published in leading peer-reviewed scientific journals. First, the results from ACHIE's phase two ORCA1 trial demonstrating superior quit rates for cytosinicline compared to placebo and impressive safety responses, was published in Nicotine and Tobacco Research. As a reminder, this study was instrumental in the selection of the three milligram dose and three times a day administration that we have taken forward into Phase III development. Additionally, the New Zealand RAURA study, showing improved efficacy and lower rates of adverse events when comparing cytosinicline to Chantix was published in the journal Addiction. We expect additional efficacy analyses from Raura in the coming months and look forward to sharing that with you when available. Finally, this quarter, we announced the appointment of two new directors to Achieve's board, Dr. Bridget Martel and Dr. Cindy Jacobs. Dr. Martel is board certified in both internal and addiction medicine and is an experienced executive leader in the pharmaceutical industry. Dr. Jacobs serves as Achieve's president and chief medical officer, and in addition to her board duties, will continue in her current role leading Achieve's regulatory and clinical development efforts. The appointment of Drs. Martell and Jacobs strengthens both our board diversity as well as our clinical and regulatory expertise. At this time, I'd like to turn the call over to Jerry to discuss our recent financial results. Maybe having an issue with Jerry's connection, so let me jump in. I'd like to provide an update on our cash balance as of March 31st, 2021, and our operating expenses for the first quarter of 2021. As of March 31st, the company's cash, cash equivalents, short-term investments, and restricted cash were $29.6 million compared to $35.9 million as of December 31st, 2020. We believe our cash balance is sufficient to provide runway into the middle of 2022. Turning to the statement of operations, the company incurred a net loss of $8 million for the quarter ended March 31st, 2021 as compared to a net loss of $3.3 million for the same quarter of 2020. Total operating expenses in the first quarter of 2021 increased to $8 million as compared to $3.4 million for the same quarter of 2020. As expected and highlighted during our call in March, operating expenses were elevated in the first quarter as enrollment in the ORCA2 trial increased. We anticipate our operating expenses to remain elevated during 2021 as we continue to execute on the ORCA2 trial. In closing, we continue to make excellent progress on advancing cytosinicline through the required clinical and regulatory development process. In the first quarter, we saw significantly increased interest and momentum in ORCA2 and look forward to the completion of enrollment in the middle of this year. Additionally, we continue to execute on the required NDA-enabling activities and publication of key data to expand awareness of cytosine acclaim's potential across new audiences. That concludes our prepared remarks. Thank you again for joining us. We will now open the line to questions. Operator?
spk01: As a reminder, to ask a question, you will need to press star 1 on your telephone keypad. That's star 1 to ask a question. To withdraw your question, press the pound key. Please stand by while we compile the Q&A roster. Your first question comes from Michael Higgins. Your line is now open.
spk05: Thanks, operator, and congrats, guys. Great to hear the 80% enrollment. Looks like you're on track for mid-year enrollment. Just want to ask a bit, if I could, on that pace. Typically, you see kind of a hockey stick shape in the enrollment. However, with smoking cessation in January and news resolutions are so impactful, can you comment on the recent trends, the recent pace of that enrollment? Thanks.
spk00: Sure. Thanks, Michael. Yeah, I think in terms of enrollment, you know, we actually didn't see that uptick like we had anticipated out of the gate in the first part of the year. We actually saw that, you know, uptake really happen kind of late February into March and April. And so, you know, what we continue to see on the ground is is encouraging and more in line with where we had anticipated to be a bit earlier in the year. So I think everything we're seeing continues to indicate we're on track for completing enrollment in the middle of the year.
spk05: That's great. And then just maybe more of a comment possibly, but just a few weeks ago, JAMA had a publication about COVID, the last year for smokers trying to quit. Uh, national America quit line had a publication out in March saying the, the calls, uh, dropped significantly last year. Uh, so it seems like, uh, people were smoking quite a bit. Um, this has been a topic the last six plus months or so we've talked about is trying to get a handle on that. And there's anecdotals that would suggest that it's, uh, uh, reduced a bit and maybe the smoking rates were, um, we're up a bit rather. Has that impacted enrollment in any way, and what do you think of that? What do you think of the market opportunity?
spk00: Yeah, I think overall the market opportunity hasn't changed for us. I think the pandemic has created some challenges, and we saw it in the trial, and I think it's really been the result of people being more reluctant to leave their homes. So we clearly saw that, and I think that's played out across across the space as people have been more reluctant to go in to make quit attempts or to even access some of the behavioral support that's available. And I think to your point, we may very well see an uptick in the number of smokers when 2020 is reported. So I think it's been an unusual year. It's clearly a great time to quit because of the pandemic, which is a respiratory disease. And we know that smokers have worse outcomes if they do get the virus. But I think it's been a challenging year for people to actually make those quit attempts.
spk05: Yeah, no, that's, I think, well said. And then just to switch it up a bit, but also kind of a topical story is we've seen the last few weeks and months the current administration being much more aggressive against smoking on some of the products that are out there, et cetera. I'm wondering if that is going to have any impact on the potential for an e-cig study. to have that funded by NIH and others, because this administration seems to be a bit more aggressive about kind of attacking, so to speak, the cigarette industry. Any updates on that from you guys? Thanks.
spk00: Yeah, on the e-cigarette grant application, we don't have any update to provide yet. We still remain on track for getting an answer back by the end of this quarter, and so we That's something we continue to be excited about because that's a segment of the market that's grown leaps and bounds over the last 10 years, and we think there's a real opportunity to go to market and make a difference there. So hopefully this administration, you know, is providing some additional support internally behind the scenes, but it's always a difficult thing to actually monitor from the outside. So we remain hopeful, and we'll keep everyone posted.
spk05: That's great. We'll stay in the silence here, hoping for the best there, too. One last question. You mentioned a Bayesian analysis. Actually, I think I read this in the press release. A Bayesian analysis, the primary efficacy outcome is ongoing. Any updates for us as to when we'll see more from Dr. Walker's study?
spk00: Yeah, we're still waiting on that, as you are. And I think it's something that we would expect to see in the second half of this year. So I think as soon as we get additional details on that, we'll be happy to share with everybody.
spk05: Thanks for all the feedback. Thanks, guys.
spk00: Thanks, Michael.
spk01: Your next question comes from Francois Brissonboy.
spk03: Yep, thank you for taking the question. Just a quick one here. I was just wondering... John, is there any thought about doing another head-to-head trial here with Chantix, or is the safety potential advantages here enough to give this a good commercial push?
spk00: Yeah, thanks for the question, Frank. From our perspective, you know, the going-in position has always been a product with at least as good of efficacy as the market leader with significantly better safety and a shorter course of treatment. is going to be sufficient to garner market share in this indication. I think we continue to get more data points, you know, both from Rauara, and we'll get, obviously, further data points out of ORCA2, you know, that could potentially set up a future head-to-head trial against Chantix that we would run. I think at the moment, we don't see that as something that's going to be commercially necessary. Obviously helpful if we were to do it, but I think, you know, for us, The current planning remains the same, which is placebo-controlled trials to get this thing to approval.
spk03: Okay, great. Thank you. And then in terms of the timing, so middle of the year, complete enrollment, can you just remind us between completion and enrollment and data, what's that timeline like? And then when you added sites here, is there any issue in a trial like this with added variability between sites, or is that not a big issue here?
spk00: Thanks for the question, Frank. I'm going to turn this one over to Cindy to take that.
spk07: Sure. First, for the timing, enrollment by mid of the year would put that all subjects would be completing the six-month follow-up by the end of the year. Obviously, then we need time to close and lock the database and analyze, so we'll be close to the end of the first quarter, beginning of the second quarter most likely. As far as the two sites, no, we don't think adding two sites, so the total is now 17 instead of 15, will have that much effect on the variability. Most of the sites are at least doing 30, 40 subjects, so there are a few sites that are doing better than others and some that are just going to be doing 30 or 40. So it will be a good distribution between the 17 sites.
spk03: Okay, great. That's it for me. Thank you very much.
spk00: Thanks, Frank.
spk01: Your next question comes from Vernon Bernardino.
spk02: Hi, guys. Thanks for taking the question, and congrats on the progress so far. John, I was just wondering if you could remind us, the makeup of the clinical sites. What kind of sites are they?
spk00: Yeah, so these are predominantly professional clinical trial centers. We've got two academic centers as part of those 17. It's ASU as well as Harvard Mass General. But otherwise, these are professional sites that have at least some experience in smoking cessation programs in the past with behavioral support counselors on staff. So that's the mix of sites that we're using.
spk02: Okay. And I missed it. What is the distribution of the sites again?
spk00: So currently, I believe all of the Cindy can correct me, but I think we don't have any duplicate centers across the state. So we're really across 17 different So they are geographically dispersed, you know, really across the U.S., I think, maybe with a focus perhaps through the south and up the eastern seaboard.
spk02: Are they predominantly in major cities?
spk00: Yeah, not necessarily all major cities. They're around, you know, urban centers, but not necessarily large cities.
spk02: And then the last question, what, again, if you could remind us, is the most periodic way that the clinical trial sites interact with the study participants.
spk07: Cindy, you want to take that one? Are you saying as far as once they're in the study, or are you talking screening?
spk02: Once they're in the study, because I'm wondering how closely the participants are monitored.
spk07: Sure. They come in weekly into the clinic while they're on treatment, and then afterwards they come in monthly for follow-up and completing it six months.
spk02: And anecdotally, sorry, a follow-up, are you seeing any change in their behavior because of the pandemic and the restrictions, you know, as far as the monthly visits?
spk07: No, I think that's where we had a slower enrollment at the beginning in January and February because subjects were not willing to come weekly into the clinic. We definitely saw that easing up in March, April, and then this month. So that has been a lessening of an issue as far as the weekly clinic visits for the first 12 weeks.
spk02: So other than the hesitation, you're satisfied so far with their participation in the study?
spk07: Right, because when they sign the informed consent, it's pretty clear all that they're expected to come in and do as far as testings and their parts. So in signing that consent form, it's laid out exactly when they come in and what is happening.
spk02: Okay. Okay, thank you for taking my questions and the insight into the study. Appreciate it.
spk00: Thanks, Varun.
spk01: Your next question came from the line of Ted Yu. Your line is now open.
spk04: Thank you very much. Hello, John and team. This is Ted Yu sitting in for John Vandermusten today. Thank you for taking my question. During the last update, Achieve indicated that it was seeking non-dilutive funding to support a trial in vaping. Any advancements on that front?
spk00: Yeah, thanks, Ted. Yeah, we're still waiting for feedback. This is a grant application we submitted at the very end of last year. And based on the timelines, we're expecting to get an answer back by the end of this quarter. So stay tuned on that front.
spk04: Okay, best of luck on that. And just out of curiosity, how large is the vaping segment of nicotine users? Are the majority of nicotine users still smokers, or is it starting to go 50-50, or what does that breakdown look like?
spk00: Yeah, good question. So we look at the rates of smoking in the U.S., combustible cigarettes, that is. It's been roughly 14% of the population. It actually hasn't shifted in over three years since 2017. The number of smokers has remained flat at roughly 34 million. Now, over the last decade, we've seen an expansion of the market with e-cigarette use. And recent estimates we've seen are upwards of 14 million U.S. e-cigarette users. Now, some of these do overlap. We do know that A number of folks that have moved over to e-cigarettes weren't able to quit smoking, so now they're dual using both products. You've got a handful of folks just using e-cigarettes alone as well as a large segment of youth who have picked up those products in large part because of the popularity of products like Juul. So I think overall there's been what I would call a likely market expansion compared to where we were three or four years ago. So it hasn't been an erosion There has been some shift, but I think largely it's expanded.
spk04: Okay, so it does sound like many of the e-cigarette users actually just added to the population of nicotine users. Okay, well, thank you very much. That does it for me today.
spk00: Thanks, Ted. Appreciate it.
spk01: As a reminder, to ask a question, you will need to press star 1 on your telephone keypad. There are no further questions at this time. I will now hand the call back to John Bensick for closing remarks.
spk00: Thanks, Charlotte. Thanks, everyone, for joining us today. We appreciate everyone's continued support of the company. It's been an exciting time as we've been moving forward. With enrollment, I look forward to completing that here in the middle of the year and continuing to provide updates to everyone as they come in. So thanks again for taking the time.
spk01: This concludes today's conference call. Thank you for participating. You may now disconnect.
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