Akili, Inc.

Q4 2022 Earnings Conference Call


spk08: Greetings, and welcome to the Akili fourth quarter 2022 earnings call. At this time, all participants are in listen-only mode. A question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. I would now like to turn the conference over to your host, Julie DiCarlo, Senior Vice President of Communications.
spk01: Thanks, Joe. Good afternoon and welcome to Achilles Earnings Conference Call for the fourth quarter of 2022. After the market closed today, we issued our earnings release, which can be accessed on the investor relations section of our website. Additionally, we've posted earnings slides on our IR website that we'll reference during today's call. This call is being recorded and a replay of the teleconference will be available on our IR website at the conclusion of today's event. During today's call, we'll make forward-looking statements regarding future events, expectations, plans, prospects, or the financial performance of the company. These forward-looking statements are based upon estimates and assumptions that, while considered reasonable by the company's management, involve certain risks and uncertainties. The company's actual results may differ materially from those expressed or implied by any such forward-looking statements as a result of various important factors, factors that might cause such differences include but are not limited to those risks and uncertainties set forth in our form 10Q filed on November 14th, as well as other subsequent filings with the SEC. Information provided on today's call reflects our views only as of today, March 7th, and should not be relied upon as representative of our views as of any subsequent date. We explicitly disclaim any obligation to update or revise any forward-looking statements or our outlook. Also during today's call, We'll refer to certain non-GAAP financial measures. Management does not intend the presentation of these non-GAAP financial measures to be considered in isolation or as a substitute for results prepared in accordance with GAAP, but as a complement to provide greater transparency. A reconciliation of the historical non-GAAP financial measures to our GAAP financial measures is included in our earnings slides and in our earnings release. If you're following along with the slides, please turn now to the agenda. With me on today's call are Achilles CEO, Eddie Martucci, our President and Chief Operating Officer, Matt Franklin, our Chief Medical Officer, Scott Collins, and our Chief Financial Officer, Santos Schaumbach. Now please turn to slide four as I hand the call over to Eddie for his prepared remarks. Eddie?
spk10: Thanks, Julie. Hello, everyone. Thank you for joining our call to discuss our business performance in Q4 of last year and our overall summary of 2022. Today you'll hear from Matt, Scott, and Santosh on various detailed aspects of our business growth. We're excited about how we're evolving the business and seeing the increasing traction of EndeavorRx and more generally progress of our business model. With moves that we announced in early Q1 of this year to restructure the business, we're now operating with a more efficient capital footprint so that we can execute against our most important business goals and have cash that we expect will fund the business into Q1 2025. With our heightened focus on EndeavorRx and the ADHD marketplace, we'll look to prove out that a digital treatment can indeed scale like a drug. I believe EndeavorRx has the potential to be the first example of this new paradigm, and the entire Akili team is passionate and focused on making that happen. I'm excited with the early impact of our Salesforce investment, where we're seeing a positive increase in most commercial metrics. We're also seeing strong willingness to pay out of pocket by patients. As expected, we haven't seen insurers step up to broader coverage, and this is a continued area of focus for us. And we continue to push the cutting edge of a patient experience in medicine with multiple enhancements to both our treatment product and our caregiver companion product over the last quarter. In terms of getting Endeavor X to all of the ADHD patients we believe can benefit from our product, We were extremely excited to announce positive outcomes from our STARS ADHD adolescent trial earlier than anticipated in January of this year. With the needs around mental health in teens and the ongoing ADHD medication shortage, we're putting urgency around our planned FDA submission this year for review of an expanded label for EndeavorRx to include adolescents over 12 years of age. If successful, that expanded label would essentially double our current addressable market based on our estimates. Overall, I believe we've made good progress to end the year, and I'm even more pleased with our team's increased focus and execution mindset here in the early part of 2023. I'll now turn it over to our President and COO, Matt Franklin, to give you a deeper look into our core business progress. Matt?
spk05: Thanks, Eddie. During our third quarter earnings call, we outlined three strategic areas of focus for our business. These are outlined on slide five. The first is driving awareness and adoption of Endeavor Rx with the addition of the first wave of our direct sales force in 13 priority territories covering roughly 20% of the estimated U.S. market opportunity for Endeavor Rx. The second is removing barriers to adoption by driving expanded coverage for Endeavor Rx. And third, we aim to continually improve our treatment experience. In the fourth quarter, we made good progress with expanding adoption and improving the treatment experience. As expected, payers continue to be slow to act, and coverage remains a challenge that we are addressing head on. Let's look at each of these areas, starting with adoption. In the third quarter, we deployed the first wave of our sales team to 13 initial geographic territories of the approximately 70 priority territories we identified in the U.S. We are encouraged by the initial progress we've seen in these territories. Through the end of 2022, growth in sales-occupied territories outperformed white space or unoccupied geographies in overall prescription growth, overall number of active prescribers, and the number of prescriptions per prescriber. We continue to add more than 100 new prescribers per month in Q4, while simultaneously expanding the number of repeat prescribers, meaning prescribers who have written multiple prescriptions over time. This is a key area of focus for our sales team, and we've seen repeat prescribers grow by 60% over Q3 2022. In short, we believe there was a strong correlation between direct sales engagement and accelerated growth across key adoption performance metrics. In addition to seeing the initial impact of our direct sales force on demand for Endeavor Rx, during Q4, we also saw refill prescriptions grow more than 200% over the third quarter of 2022. This growth was driven by the successful transition of EndeavorRx from a 90-day prescription to a 30-day prescription, which was initiated in August. During this transition, we maintained the established $450 list price, which now applies to the 30-day treatment course. Even with this higher effective per month price, we saw only a 25% reduction in prescriptions dispensed from prior quarter, giving us confidence that the 30-day prescription model is working and that EndeavorRx is being as an ongoing periodic therapy. Seeing these early indicators of commercial traction, we are expanding our sales force and expect to be in approximately 15 additional U.S. markets by the end of this quarter. Moving now to coverage. In Q4, we continue to see families willing to pay out-of-pocket for Endeavor X. While this is encouraging, we acknowledge that families need expanded access to new non-pharmaceutical treatment options more rapidly than payers are currently providing. and we continue our work to break down this barrier for them. Finally, on treatment experience, as we shared last quarter, we have the unique opportunity with Endeavor Rx to rapidly iterate the product to drive engagement and compliance. Enabled by the adaptive ability of digital therapeutics and the dynamic nature of video games, we are able to evolve the gameplay experience for patients while preserving the regulated core technology of the product. We also continue to update and optimize the treatment experience surrounding the products, including our companion application for caregivers, Endeavor Rx Insight. In Q4, our enhancements were focused on improving the patient onboarding experience, optimizing core gameplay to maximize player engagement, and implementing progress tracking features to provide caregivers and healthcare providers increased visibility into patient progress during treatment. This is part of our ongoing commitment to deliver amazing experiences to our patients and their families. Turning now to slide six, let's look at the numbers. First, on prescriptions. More than 4,500 prescriptions were written for Endeavor-Rx in 2022. During the fourth quarter, we saw about 1,800 prescriptions written for Endeavor-Rx, a 37% increase over Q3 2022, and a 176% increase over Q4 2021. There were 1,064 new prescriptions written during the period, similar to the number written in Q3 2022, despite eight fewer selling days during the period, representing a more than 100% increase in Q4 2022 over Q4 2021. On refills, as mentioned earlier, we also saw a significant increase in the number of refills on prescriptions written during the period. There were 737 prescription refills written during Q4 2022. up about 200% from Q3 2022 and up more than 400% over Q4 2021. On prescribers, in Q4, the total number of prescriptions were written about 800 unique prescribers, representing a 2% increase over Q3 2022 and an increase of 88% over Q4 2021. The number of new prescribers was down 29% from Q3 2022, but this decline was more than offset by growth in the number of repeat prescribers, a key area of focus for our sales team, which grew more than 60% from Q3 2022. 40% of new prescriptions written in Q4 were dispensed during the quarter, down from 53% in Q3, but up from 33% we saw in Q4 2021. We believe this was driven by two factors, the transition from a 90-day to 30-day prescription and the impact of the December holidays. During Q4, we received payment for 98% of dispensed prescriptions. 96% of dispensed prescriptions were paid out of pocket by caregivers, 2% were reimbursed, and 2% were provided free of charge to qualifying families under our patient assistance program. Now we'll turn it over to Dr. Scott Collins, our Chief Medical Officer, who will provide an update on our clinical programs.
spk06: Thanks, Matt. Hello, everyone. I'm excited to be joining my first earnings call since joining Akili on December 1st. Before I get started, a quick note on my transition to the company. I've spent nearly my entire 25-year career studying new treatments for ADHD, including running the Duke University ADHD program for 18 years, and I've grown impatient at the fact that we have not provided new options to patients in decades. The standard of care has not changed since I finished graduate school. With Endeavor Rx, we now have an FDA-authorized product that can change that, and I'm excited to be leading the medical and scientific aspects of Akili as we work to get this product into the hands of everyone who can benefit. Broadly, the current strategy for my team will focus primarily on supporting our commercial efforts by continuing to generate and disseminate high-quality evidence of the effectiveness and safety of Endeavor Rx as an important component of ADHD clinical care. As a reminder, we've made a strategic decision to focus our resources on the growth of our Endeavor Rx product for ADHD, and subsequent clinical development activities will coincide with additional capital raise or business development opportunities. Turning now to slide 7, I'll provide an update on where we are with our ADHD clinical programs. As we reported in early January of this year, we now have top line results from the STARS-ADHD Adolescence Pivotal Trial of EndeavorRx, our label expansion study in 162 patients with ADHD aged 13 to 17. Results strongly support the efficacy and safety of EndeavorRx in adolescents. As you can see on the slide, the magnitude of effect across a range of outcome measures, including objective measures of attentional functioning and ADHD symptoms, were equal to or greater than those we've seen in two previous pivotal studies in younger children. These findings are timely given the current and growing mental health crisis in our country that is disproportionately affecting teenagers. We're in the process of preparing results from this study for presentation to a future scientific meeting and for submission to a peer-reviewed journal. We're on track to use the adolescent study findings to support a 510 submission to FDA this year to potentially expand our label for Endeavor Rx. Referring to our pipeline on slide 8, we also previously reported that we stopped enrollment for STARS ADHD adults, our pivotal study of Endeavor Rx in adults with ADHD. We shared on our last earnings call that this study was recruiting more slowly than expected. Given the strong clinical data in adolescents that I just described, We closed enrollment in this adult study to preserve capital and analyze the data. The study enrolled 223 patients, which was more than the number enrolled in the adolescent study. Data analysis for this adult study is ongoing, and we stated that we expect to have top line results from this adult study in the second half of 2023. We expect to make a decision later this year about our regulatory strategy as it relates to the STARS ADHD adult study. In addition to the completion of our adolescent and adult pivotal studies, we're also actively enrolling participants into a real-world registry that will allow us to collect data to support other regulatory and market access initiatives. As announced in January, outside of ADHD, we've chosen to deprioritize other clinical programs that would require additional significant investment. We are continuing previously launched investigator-initiated and collaborative studies, which include two studies of Endeavor Rx to treat cognitive impairments in patients following COVID infection. Data analysis for one of these studies is in the process of being finalized, and we expect the second study to complete enrollment in Q2. As such, we expect data from both studies to read out by the end of Q2. I'll hand it over now to our CFO, Santosh Shanpeg.
spk00: Thank you, Scott, and hello, everyone. Now on to the financials on slide number nine. We continue to see quarter-over-quarter growth of Endeavor Rx revenues. And as Matt mentioned earlier, we're also seeing the positive impact of the first wave of our sales reps in the field. As you see on the slide, in the fourth quarter of 2022, Endeavor Rx revenues grew to $111,000, representing a 35% growth over third quarter of 2022 and a 76% growth over the fourth quarter of 2021. Similarly, full-year 2022 Endeavor Addicts revenues grew to $323,000, up from $186,000 in 2021. Note that the total revenues in 2021 and Q4 of 2021 included an additional $352,000 and $98,000, respectively, of revenues associated with the Shinogi collaboration. From an expense perspective, we incurred approximately $91 million of GAAP total operating expenses and about $78 million of non-GAAP total operating expenses in 2022. The growth of expenses compared to the third quarter of 2021 was primarily driven by expenses related to the commercial launch support of EndeavorRx, the ADHD label expansion studies, and also the costs associated with the business combination and operating as a public company. Similarly, we incurred approximately $22 million of GAAP total operating expenses and $20 million of non-GAAP operating expenses in the fourth quarter of 2022. The growth in expenses compared to the third quarter of 2022 was primarily driven by business expenses related to commercial launch support of Endeavor Rx. And last but not the least, from a capital perspective, we ended the year with approximately $136 million of cash, cash equivalents, and short-term investments. Now on to guidance on slide number 10. We are reaffirming our expense guidance from January that we expect our 2023 non-GAAP total operating expenses to be between 55 and $60 million. This represents a reduction compared to the 2022 non-GAAP total operating expenses of approximately 78 million. In support of our 2023 operating plan, the company underwent a reduction in workforce impacting approximately 30% of employees across the organization. We estimate that we will incur about 1.5 to 2.5 million of severance and termination-related costs related to this action and expect to record these charges during the current quarter Q1. Please note that these severance and termination-related costs, in addition to stock-based compensation, are excluded from the projected full-year 2023 non-GAAP total operating expense guidance. This brings me to our capital plans. We are also reaffirming the cash runway guidance that we previously announced in January. We expect our cash position at year-end 2022 of approximately $136 million to be able to fund our current and planned operations into the first quarter of 2025. I'll close on the financial update with this. Our 2023 operating plan allows us to, one, focus our resources primarily on Endeavor RX commercialization and ADHD label expansion, and two, preserve capital, especially in these current capital market conditions. With that, I'll hand it back over to Eddie. Eddie?
spk10: Thanks, Santosh. If you'd all like to turn to slide 11, you can see our key takeaways from this quarter. Overall, I think we had a strong quarter. We're excited by the increasing traction we're seeing with EndeavorRx. We announced positive top-line data from our first pivotal trial designed to expand the EndeavorRx label, and we're moving forward with the regulatory submission. And obviously, as noted, we've structured the business to give us cash runaway into 2025. With that, I'll hand it back to the operator, and we're happy to take questions.
spk08: Thank you. Ladies and gentlemen, if you would like to ask a question, please press star 1 on your telephone keypad, and a confirmation tone will indicate your line is in the queue. You may press star 2 if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, while we poll for questions. Our first question comes from the line of Judah Frommer with Credit Suisse. Please proceed.
spk02: Hey, guys. This is Nick on for Judah from Credit Suisse. Thanks for taking our question. Congrats on the progress. I was hoping if you guys could provide some incremental insight on refills. Are you able to share, just for those patients that are getting refills, how many refills are they getting on average, and is there any time gap between prescriptions? Thanks.
spk05: Hi, thanks. This is Matt. Appreciate the question. A couple of comments there. First, as we announced, we made two significant business changes in Q3 and Q4. First was the change from 90-day to 30-day prescription and the addition of our direct sales force where we're engaging in discussions around refill prescriptions. So with those two significant business changes, we'd love to give it a little bit more time to see how the refill patterns evolve, so we're not at this point providing specific guidance. I can state, however, and share that the vast majority of prescriptions that are written are written with multiple refills. So a new prescription for a child is often written with an initial cycle of treatment, and that includes multiple refills. It could be two, three, or more over time. So we do expect to see continued increases in refills over time.
spk10: And, Nick, I'll just add, you asked a question at the very end about kind of sequential nature or how quickly. As we've said before, EndeavorX is meant to be an ongoing episodic treatment, right, something that's used ongoing and may come sequentially or immediately or may bounce in and out. We are seeing that in the market. So without getting into specifics and metrics, we do see some immediate refill behavior, and then we do see, in terms of refills, patients who come back after a gap in time and when they're reassessing their symptoms with their doctor. So I think this is something that will evolve, given this is a really new treatment modality with new dynamics. It will evolve as we continue to scale.
spk02: Got it. Thanks again, and congrats on the progress. Great. Thanks.
spk08: Our next question comes from the line of Michael Cherney with Bank of America. Please proceed.
spk04: Evening, and thanks for taking the question. Maybe if we can dive into a little bit more of the prescriber dynamics, especially as you think about retrenching the business, focusing on the core product candidates. How do you think about that strategic balance of going after new docs versus going after existing docs? And what is... I guess you don't have 23 revenue guidance per se, but what is incorporated in terms of your expectations for how each one of those gets penetrated, retention on the returning docs, et cetera?
spk05: Hey, thanks, Michael. Again, it's Matt. I'm happy to take a first crack at that. So I appreciate the question. Q4, as we deployed our sales force, as you can guess, our initial focus here is on driving overall prescription growth. So one of the areas that we focused on initially with the sales team is engaging with those prescribers in those newly populated territories, going back and re-engaging with those historical providers. So we did intentionally place an emphasis on re-engaging historical providers, and you saw the benefits of that strategy. We saw a significant increase, 60% growth in repeat prescribers. We saw that 200% jump in refill prescriptions. So we were pleased with the results of that initial strategy. Now that the team has been in the field for a quarter, we've taken a more balanced approach. So balancing the time we spend servicing existing writers and balancing that with engaging, educating new providers. And we do expect to see new prescriber and new prescriptions grow over time.
spk04: Thanks. And if I could just dive in a bit on the coverage side, how do you think about the milestones you're looking for as you continue to focus on coverage expansion, given that you obviously have candidates in the pipeline relative to coverage from the commercial side, but also you're having to redefine a new model given that digital therapeutics in general doesn't necessarily have broad coverage within the current payer landscape.
spk10: Sure. Thanks, Michael. This is Eddie. So I think you're right that this digital therapeutics, prescription digital therapeutics as a class model kind of hasn't seen broad coverage yet, absolutely. We're pleased with the interactions we have. When we have our teams dig in with payers, we're seeing engagements We're seeing that the clinical data is sufficient, and generally we get feedback that they're impressed with the level of clinical data, obviously, because we've run multiple prospective trials for this clinical program. So we're not guiding on, you know, and we don't announce individual coverages. We're not guiding on you know, expectations on number of coverages or covered lives or things like that. From our perspective, the milestones are really doing the work to essentially educate this payer landscape on this product. I think broadly what I see is that payers here are like very generally surface level aware. More and more they are going deeper product by product into the data. And that's where we believe we're going to start to see the success because of our investment in our data, because of our outcomes to date. So it's really doing internal milestones is really stacking up those meetings, doing the work to go deep with each of these payers, which takes time.
spk04: Okay, thanks.
spk08: Our next question comes from the line of Rahul Rakit with LifeSci Capital. Please proceed.
spk07: Hey, guys. Thanks for taking the questions. You know, given the pretty impressive adolescent data, I was wondering what the feedback was from your existing prescriber base. And also that feedback, how do you think that will ultimately shape adoption amongst adolescent patients? you know, upon clearance and commercial launch.
spk06: Hey, Rahul, this is Scott. So, you know, it's early. We've just announced them. We haven't presented the data yet or published, but the general reaction from providers as well as, you know, everybody else that we talk to is very positive. I mean, this is a very underserved population. It's going to double the number of kids that can get access to an effective treatment. So, you know, the reaction has been overwhelmingly positive.
spk07: Got it.
spk06: Okay.
spk07: That's helpful. And then, you know, I know you guys are expanding your sales territories. I guess in terms of advising which territories to expand into, you know, is there any thinking around going into the areas with existing reimbursement coverage or are you just trying to, you know, cast as wide of a net as possible in terms of driving script growth?
spk05: Yeah, hey Raul, it's Matt. Yeah, a number of factors that we consider. I would imagine it's similar to other pharmaceutical biotech medical device launches. We look at overall opportunity in terms of addressable patient population. We look at prescriber Density, we look at geographic boundaries as well, making sure that these are small enough where we can get to these physicians on a frequent basis, right, to really maintain that reach and frequency. So, you know, I think we're looking at it in terms of opportunity. The one thing we do do is we do integrate our market access with our sales strategy. So we are engaging with the commercial plans. in those areas that we have existing sales force. So we're able to pull it through. For example, you know, last call we talked about Highmark. We do have active sales presence in Pennsylvania. So just an example, again, how we're integrating all of these different aspects of our commercial team.
spk07: Got it. That's really helpful. Appreciate it. And I guess just one more from me. I was wondering if you could kind of touch on the proportion of new patients that are coming through the telemedicine platform through your website. you know, versus your sales force on the ground.
spk05: Yeah, we haven't provided specific guidance. You know, telemedicine continues to be what I would say a modest but meaningful contributor to our prescription volume. We're pleased that we have that capability, think it may be more important as we expand into the adult population. So, you know, more to follow on that.
spk07: Got it. Really appreciate it. Thanks again, guys.
spk08: Thanks. Our next question comes from the line of Vikram Parohit with Morgan Stanley. Please proceed.
spk09: Hey, good afternoon. Thanks for taking our questions. Two from our side, both on your commercial efforts with EndeavorRx. So I guess first, what is the typical profile of patients that are demonstrating receptivity to EndeavorRx in terms of their pre-treatment status and the status of their condition overall when they present to their providers who eventually end up prescribing them Endeavor Rx? And secondly, which aspects specifically of your commercialization and messaging efforts do you think are helping to drive the quarter-over-quarter increase in Scripps that you reported in 4Q? I mean, when you reflect on the initial phase of your commercialization effort, what's resonated and what do you think really hasn't so far?
spk05: All right. Hey, again, it's Matt. Thanks for the question. I'll do my best to address that multi-part question. Keep me honest. Make sure I don't forget any. I think first on the patient profiles, one of the things that I really appreciate about Endeavor Rx and the investment that the team has made in the clinical pipeline is that it has been studied and been demonstrated to be effective as both a standalone treatment as well as combination with medical therapy, and it can fit seamlessly into any child's treatment plan, right, in you know, in conjunction with the physician and the caregiver's, you know, input. So it's very flexible. With that said, we do see in our early engagements two patient profiles really stand out. The first is newly diagnosed patients. So those who have recently been diagnosed who are interested in exploring or a caregiver is interested in exploring non-pharmaceutical treatments. So that's the first. Second area that we're seeing a lot of demand is For those patients that are not well controlled on medical therapy, they may be experiencing side effects that often come with these prescription drugs, these stimulants, and are looking to explore alternate non-pharmaceutical options. So those are really the two areas. Those use cases, if you will, or patient profiles, as we discussed those with physicians, have been an area of interest and uptake. So I think going through the clinical data, demonstrating The flexibility demonstrating the impact of our treatments in conjunction or as a standalone therapy have been very compelling. So I would just highlight those are sort of the initial feedback we're getting from the team.
spk09: Got it. Thank you.
spk08: Our next question comes from the line of Marie Thibault with VTIG. Please proceed.
spk03: Hi. Thank you for taking the questions this afternoon. Wanted to ask my first here on the conversion rate. I know that you mentioned a couple headwinds here in the fourth quarter that drove that rate down to 40%. Wanted to understand, you know, are you expecting that to improve in Q1? I know certainly we won't have the holidays like we did in Q4, but then the 30-day refill the 30-day prescription factor is still there. And I also wanted to understand how you're thinking about conversion rate in the refill space. It certainly looks like that's a nice high, 90% or so by our math. Just how should we be thinking about conversion for refills going forward?
spk05: Yeah, thanks, Marie. We have not provided guidance or forecasts regarding the conversion. As you mentioned, there were two business changes, the biggest being that migration from 90% to 30-day prescription while holding the pricing constant. That was an impact. The seasonal holidays, another impact. Of course, that will not persist again in Q1. With that said, this is also an area of emphasis for our sales team. So, in those areas where we have the ability to engage with clinicians, we're talking about the importance of follow-up and making sure that patients and caregivers are prepared. We are doing our best to continue to message and educate around the importance of fulfilling those prescriptions, but as far as giving guidance, we're not prepared to do that at this time.
spk03: Okay, just on the refills, I know it is early, but given that those are sort of built into the initial prescription, should we expect something around that high, you know, high 90s is a reasonable range?
spk05: Again, early days, and we just made these business changes, so we're hesitant to provide guidance on that.
spk03: Okay, fair enough. And then maybe I'll ask a further question sort of on the sales force. As you're thinking about adding this next wave here in the first quarter, how should we think about the maturation of the sales force? Is this kind of a six-month, a year-long process for these sales reps as they enter new territories? And what is kind of the – key learnings on who is the right prescriber profile, who is the right kind of caregiver profile to target?
spk05: Yeah, thanks for that question. And consistent with any product launch, particularly in a situation where we're defining a new category, as we are with Endeavor Rx, there's absolutely a learning and experience curve. We're still relatively early days. The team has really been in the field several months with that said we are very pleased with the progress we're seeing as as we mentioned we're seeing uh accelerated growth on all of their critical uh commercial and adoption metrics in those sales territories so pleased with what we're seeing uh initially we will continue to see we expect continued improvement there so um i wouldn't say we're there yet we're continuing to learn and grow um but that learning curve we're working through that um effectively um as As far as the physician profile, yeah, consistent with our initial indication, 8- to 12-year-olds, not surprisingly, we're focused on pediatric specialty, so pediatric psychiatrists, pediatric neurologists, in addition to general pediatricians that see a large number and are responsible for monitoring a number of these patients over time. So really focused on sort of those integrated behavioral health centers their multidisciplinary practices, dealing with these complex cognitive impairments on a day-in, day-out basis. So that focus was consistent from our initial perspective and remains a point of emphasis for us.
spk03: Okay, thank you.
spk08: And our next question will come again from the line of Judah Frommer with Credit Suisse. Please proceed.
spk02: Hey guys, it's Nick on for Judah again. Just wanted to go back to the adolescent data. Any initial thoughts on why the effect on attention was higher in that population versus the initial eight to 12 year olds? And was it something to do with trial design or just this specific population? And how do you think that efficacy might translate into adults? Thanks.
spk06: Hey, Nick. This is Scott. Thanks for the question. Yeah, it's a very good one. We have a couple of broad hypotheses about why we might have seen the greater magnitude effect in adolescents. The first is that maybe it had something to do with the composition of the sample compared to the pediatric population. That's pretty easy to look at, and at least in the top line, it doesn't look like things like the gender differences, the breakdown in racial or ethnic subgroups is going to make much of a difference. But we are going to interrogate that further. Where I would think we're likely to uncover some understanding of that effect is with looking at the way that the participants engaged with the treatment, older kids might just be more motivated and be more engaged with the treatment and therefore derive more benefit. So that is an area that as we prepare the data for presentation and publication that we're going to be diving into further. And as far as how we think that might extrapolate, it's unknown, and we'll know when we get top-line data from the adult study. Got it. That's helpful. Thanks.
spk08: Thank you. Ladies and gentlemen, this concludes our question and answer session, and this will conclude today's conference. You may disconnect your lines at this time. Thank you for your participation.

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