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spk07: Good morning and welcome to the Questis Therapeutics third quarter 2022 conference call. At this time, all participants are in a listen-only mode. After the speaker's remarks, there will be a question and answer session. Instructions will be given at that time. As a reminder, this call will be recorded. I would like to introduce your host for today's conference call, Bennett Watson of Westwick Investor Relations.
spk06: You may begin.
spk08: Thank you, Operator.
spk12: Good morning and welcome to today's call. On today's call, I am joined by Dan Barber, Chief Executive Officer, and Ernie Toth, Chief Financial Officer, who are going to provide an overview of recent business developments and performance for the third quarter 2022, followed by a Q&A session. During the Q&A session, the team will be joined by Dr. Steve Wargacki, Vice President of R&D. Ken Truitt, Chief Medical Officer, and Ken Marshall, Chief Commercial Officer. As a reminder, the company's remarks today correspond with the earnings release that was issued after market closed yesterday. In addition, a recording of today's call will be made available on Equestria's website within the investor's section shortly following the conclusion of this call. To remind you, the Equestiv team will be discussing some non-GAAP financial measures this morning as part of its review of third quarter 2022 results. A description of these measures, along with the reconciliation to GAAP, can be found in the earnings release issued yesterday, which is posted on the investor's section of Equestiv's website. During the call, the company will be making forward-looking statements. We remind you of the company's safe harbor language as outlined in yesterday's earnings release, as well as the risks and uncertainties affecting the company as described in the risk factor section and in other sections included in our annual report on Form 10-K filed with the Securities Exchange Commission on March 8, 2022, and in our quarterly reports on Form 10-Q and current reports on Form 8-K with the SEC. As with any pharmaceutical company with product candidates under development and products being commercialized, there are significant risks and insurgencies with respect to the company's business and the developments, regulatory approval, and commercialization of its products and other matters related to operations. The impact of the ongoing COVID-19 pandemic is highly uncertain and cannot be predicted with certainty or clarity. Given these uncertainties, you should not place undue reliance on these forward-looking statements, which speak only as of the date made. Actual results may differ materially from these statements. All forward-looking statements attributable to a questive or any person acting on its behalf are expressly qualified in their entirety by this cautionary statement and the cautionary statements contained in the earnings release issued yesterday. The company assumes no obligation to update its forward-looking statements after the date of this conference call, whether as a result of new information, future events, or otherwise, except as required under applicable law. With that, I will now turn the line over to Dan.
spk03: Thank you, Bennett. I am pleased to tell you today that during the third quarter and extending into October, we have made significant progress towards navigating the company through these difficult times. Over the last 60 days, we generated over $25 million in licensing payments through three separate licensing agreements across three continents. This was done in parallel to our ongoing cost savings initiatives and limited use of our ATM. In fact, we ended the third quarter with more cash than we had at the end of the second quarter. Let me repeat, we ended the third quarter with more cash than we had at the end of the second quarter. We are committed to continuing our efforts to generate non-dilutive cash, and while there is no guarantee of success or timing, we believe these efforts are critical to the ongoing strengthening of the company's financial position. We believe the sum of the company's parts are significantly more valuable than our current enterprise value. In a market such as we face today, maximizing the value of our different assets is an efficient way of generating the additional cash needed to continue the development of AQST 109, as well as the overall growth of the company. Just as importantly, during this same time period, we continued to simplify and progress the Equestria story. Our lead asset, AQST109 epinephrine sublingual film, progressed rapidly in Q3. We demonstrated positive results from both our epifast 1 and epifast 2 studies. We continue to believe the results from both studies are compelling. AQST109 showed rapid absorption and uptake with a median time to maximum concentration, or Tmax, of 12 minutes and maximum changes to both systolic blood pressure and heart rate at under 10 minutes, which are potential indications of therapeutic effect. We also know that in the instances where a second dose must be given, we have an even faster median Tmax for the second dose at only eight minutes. We continue to make regulatory progress on AQST109. In October, We received an end of phase two written response from the FDA regarding our chemistry and manufacturing components. We were pleased with the FDA's responses and believe we have a clear path forward. We will be meeting with the FDA in an end of phase two clinical meeting later this quarter and should be able to announce the results of this meeting prior to the end of the year. We have presented our full clinical plan to the FDA and, at this meeting, expect to receive significant agency feedback. The market opportunity for AQST-109 is compelling. Last year, more than 3.5 million scripts were filled for epinephrine autoinjectors, representing an estimated $1 billion in net sales. From the data we have, We estimate that almost a third of these scripts are written by allergists here in the U.S. If you add in pediatricians, we know that around half of all scripts come from these two specialty areas. We also believe that allergists are significant influencers of the remaining 50% of scripts that are written by other physicians, such as general practitioners. The allergy call point is smaller in size and scope than the neurology call point that we managed with Simpizen, our recently outlicensed product. Put another way, we know that we can build and maintain the expertise to manage a reasonably sized commercial launch that directly targets a significant portion of the market. As we progress through 2023, we plan to provide more details about our intended strategy to launch AQSP 109 in the U.S. as early as 2024, if approved by the FDA. Now that we have outlicensed Simpizen, we are refocusing our commercial leadership onto the launch of AQSP 109. Over the last five years, this leadership has built the necessary infrastructure within Equestis to launch and manage a commercial product. We will maintain certain commercial expertise while we progress AQST 109, thereby enabling us to properly launch AQST 109 if approved by the FDA. We have already begun the early outreach into the allergy community. We established our scientific advisory board last month and have assembled an outstanding group of advisors who have already been extremely helpful through our development process. We have submitted abstracts to upcoming medical meetings in the allergy field and plan to present three abstracts at the upcoming American College of Allergy, Asthma, and Immunology annual meeting. We will launch our publication strategy and increase advocacy awareness as we progress into 2023. Turning to Libervin, we continue to actively engage with the FDA to ensure that we have a defined hurdle to lifting the orphan drug block. We have provided the FDA with our proposed protocol for a head-to-head study and are awaiting their feedback. Once we hear back from the FDA, we will provide you with more details. In the meantime, we continue to actively explore outlicensing opportunities for this asset. Our ultimate decision on outlicense versus launch will be driven by multiple factors including the timing of an AQST 109 approval and launch, our findings from our continued interactions with the FDA on Libervin, and the capabilities and economics associated with potential out-licensing deals and partners. In parallel, we continue to see strong performance in other areas of our business. Our manufacturing operation continues to see solid orders for the production of Suboxone on a global basis, on Dancitron in Brazil and Symphizant in the U.S., while also preparing for the launch of Vrilazol in Europe. All of these businesses represent valuable components of Equestiv, and we continue to drive performance in each area. In conclusion, we recognize the headwinds that we are facing, and we are focused on continuing to manage our way through these turbulent times. This means maximizing our opportunities to generate non-dilutive cash with our existing levers. We will continue to rapidly advance AQST 109, and we are looking forward to the upcoming FDA End of Phase II clinical meeting. We will also continue to drive business performance across all elements of the company. The requested product portfolio is backed by proven science, solid clinical results, and a compelling commercial need. I will now turn the call over to Ernie to touch upon the financial highlights.
spk05: Thank you, Dan, and good morning, everyone. By now, you will have seen our financial results in our 10Q and earnings release that were filed last evening. As we typically do, we will address most of the discussion related to the third quarter 2022 results in the Q&A. During the third quarter, we continued to manage the company for success as we raised additional non-dilutive capital and reduced expenses going forward to extend our cash runway. During the third quarter, we received $10.5 million, including the $7 million upfront cash payment due under the terms of the licensing and supply agreement with Hisco for extra van for ALS treatment in China. and $3.5 million upfront cash payment under the terms of the licensing and supply agreement with PharmaNovia for the exclusive license of liver band buccal film for the treatment of prolonged or acute convulsive seizures across all ages in certain countries, including the European Union and the United Kingdom. Under both agreements, we will receive additional milestone payments as well as manufacturing fees and royalty fees. On October 26th, we entered into a license agreement with Assurdio to license Simpizan oral film for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome in patients aged two years of age or older. Under the terms of the license agreement, we granted an exclusive worldwide license of our intellectual property for Simpizan to Assurdio for an upfront payment of $9 million. We also entered into a long-term supply agreement with Assertio for Simpizan. Under the terms of the license agreement, Equestiv will receive a $6 million milestone payment within 30 days of notice from the U.S. Patent and Trademark Office of allowance for an additional patent application for Simpizan and payment of related allowance fees, both of which were completed on October 27, 2022. In addition, we will receive royalty fees from Assertio on the sale of Simpazan during the term of the license agreement. The licensing of Simpazan will bring in near-term non-dilutive capital of $15 million to support company operations, eliminate the cash burn of Simpazan being a standalone product without the benefit of real revamped U.S. market access, reduce our commercial headcount, while retaining payer and distribution expertise for AQST 109 and allow us to focus on our most important value drivers. Total revenues were $11.5 million in the third quarter of 2022 compared to $13.3 million in the third quarter of 2021. For the third quarter of 2022 compared to the prior year period, we saw a 15% increase in Simpavan net revenue and a 15% increase in license and royalty revenue, offset by a reduction in manufacturer and supply revenue due to ordering patterns, as well as a reduction in co-development and research fees. Total revenues were $37 million for the nine months ended September 30th, 2022, compared to $39.8 million for the nine months ended September 30th, 2021. Excluding the chem farm milestone of $2 million, as well as the deferred revenue of $2.1 million from the terminated license and supply agreement with Fortovia Therapeutics that were recognized in 2021 but did not reoccur in 2022, total revenue increased by $1.3 million, or 4%. Our net loss for the third quarter 2022 was $12.5 million, were 23 cents lost per share. The net loss for the third quarter of 2021 was $14.6 million, or 37 cents lost per share. The change in net loss was driven by lower revenue, as mentioned earlier, a decrease in research and development expenses, marginally higher operational expenses, including severance-related expenses, a decrease in interest expense, and a decrease in non-cash interest expense related to the KINEMOBI monetization transaction. Our net loss for the nine months ended September 30, 2022, was $42.1 million, or $0.90 loss per share. The net loss for the nine months ended September 30, 2021, was $41.6 million, or $1.12 loss per share. The change in net loss includes severance related costs of $2.7 million. Non-GAAP adjusted EBITDA loss was $7.7 million in the third quarter of 2022 compared to a loss of $5.3 million in third quarter of 2021. Non-GAAP adjusted EBITDA loss was $25.7 million for the nine months ended September 30th, 2022 compared to a loss of $15.6 million for the nine months ended September 30, 2021. This year-over-year change in EBITDA loss, again, included severance-related costs of $2.7 million. Cash and cash equivalents were $18.6 million as of September 30, 2022. As outlined in the press release issued last night after market close, We are reconfirming our full year 2022 financial outlook. Our full year financial expectations are total revenues of approximately $46 million to $49 million and non-GAAP adjusted EBITDA loss of approximately $37 million to $43 million. In summary, our 2022 guidance for full year non-GAAP adjusted EBITDA loss reflects continued strong performance of our manufacturing and supply operations, business development activities, and continued focused R&D investments related to the advancement of AQST 109. In addition, we will continue to implement expense reductions to reduce our cash burn while preserving the continued development of AQST 109. With that, I will now turn the line back to the operator to open the line for questions.
spk06: If you'd like to ask a question, please press star 1-1. Our first question comes from Gary Notchman with BMO.
spk07: Your line is open.
spk01: Hi, good morning. This is Dennis Resnick. I'm for Gary Notchman. Thank you for taking our question. Just a couple for us. Could you go into more detail about where you are in the process regarding out-licensing LiberVant in the U.S., and then to clarify what some of the deal terms might look like? Also, regarding LiberVant, the licensing deal being completed, can we see that occurring before you receive alignment with the FDA on the head-to-head clinical trial, or is that something that has to come first? Thank you so much.
spk03: Morning, Dennis. Thank you for the question. From an out-licensing standpoint with Liberbin, first, let me be really clear on where we stand with Liberbin. We have not wavered on our view on the value or the benefits of Liberbin for a second. We believe in the products. We believe in the benefits to the patient. We remain surprised that the FDA is not allowing the first oral product in this space into the market based on the existing orphan product that is in place. Having said that, we believe at this time that when you look at where the company is going and the focus on AQST 109, as well as the continued progression of our financial position, it makes sense to look at, explore the opportunities to out-license livermen. We have had some of those conversations in the past. All we're doing today is saying, That is now something that we'll be front and center for and we'll be very active on. In terms of what the deal terms look like, we're not providing guidance on that today. What I would say to you, though, is because we believe in the value and the benefits of the product, we will have deal discipline. We will be focused on ensuring, one, that if we do find an appropriate partner, they are the right partner to bring that to patients and ensure access to the product. And two, that the requested side of things, that the company here has the right upfront component as well as milestone and royalty components. So we will make sure that that process is run the right way. In terms of timing, whether it's before or after a readout on a head-to-head study, I think you should look at this as a continuum. We are going to pursue our discussions with the FDA as we are right now. as fast as we can, and we will continue to work diligently to change the FDA's orphan drug block. Whether a deal comes before or after that will simply be a case of the discussions we're having externally and the speed at which our discussions with the FDA move.
spk08: Great. Thank you.
spk07: Our next question comes from Jason Butler with J&P Securities. Your line is open.
spk13: Hi. Thanks for taking the questions, and congrats on the progress. Just one on Lebrevent. The feedback you're expecting from FDA on the protocol, will this feedback be specifically focused, do you expect, just on the trial design, or do you think you'll get any feedback from FDA on whether the strategy could be sufficient to overturn the orphan blocks?
spk03: Sure. Yes. So, Jason, we're, of course, pushing to make sure that we understand the orphan drug block component. In our minds, the FDA's guidance on food effect is very clear, and it is agnostic to the delivery method. So, one delivery method should not get a pass on food effect compared to another delivery method. So that's the spot we're, of course, focusing on in our discussions. I have to believe that given the mandate of the FDA and the way the review division works, that they will understand the importance of that fact. And in our design, we will be looking to, or we are, in the design we've given them, looking to highlight that difference. We're hopeful that in the feedback from the FDA, we will not only get the typical guidance on our protocol on things they'd like to see or changes they think are appropriate, but also a confirmation from them on the importance of their own guidance and why that should be followed.
spk13: Got it. And then just a quick follow up there. I think you've said previously that this food effect study could take a few weeks to a couple of months. Based on the protocol you submitted, is that still the case?
spk03: Yes. The protocol is, as we have put it to the FDA, a relatively straightforward study to run. I actually do have our chief medical officer here with me today, Ken Truitt. I'll let him comment on the ease or difficulty of actually running the study. Thanks, Dan. So, as Dan alluded to, this is a comparative food effect relative bioavailability study. It's a very simple, straightforward design. There is some length involved simply because diazepam has some long-lived metabolites that need to wash out. So, there probably will be a period of several but it's a simple design.
spk13: Got it. Thanks. And then just last one for me on AQST 109. You talked about the fact that you are doing and you will continue to do some work towards commercial preparation. Can you talk about any research you've done with payers so far or how you think about reimbursement and patient access for the products?
spk03: So, first, I just want to point out, and I will hand it over to Ken Marshall, our Chief Commercial Officer, in a second here, but I do want to point out one of the benefits of the deal we announced last week where we're out-licensing Simpazin is I now get to watch Ken Marshall and his management team, that the expertise we've kept in-house, move their significant experience and brainpower from Simpazin on to 109. So you will see us be much more active in thinking about the commercial side going forward. But with that, I'll let Ken comment on your specific question. Thanks, Dan. Hi, Jason. We've done some early work with payers, so we have a little bit more to do. And they'll point towards the generics and their pricing, which is actually a pretty high price. It's around $300 per two-packet net. and suggest that as long as you're in that range, you should get very good access. And as you may or may not know, this is going to be largely a commercial market, so we won't have to deal with the same types of complexities we did in CNS, where we had about a 50-50 market split between Medicaid and commercial. Our pricing strategies will be
spk13: Great.
spk08: Helpful. Thanks for taking the questions.
spk07: Our next question comes from Francois Brisebois with Oppenheimer. Your line is open.
spk11: All right. Thanks for taking the questions. Just a couple here on the AQSD 109. On the commercial side, you kind of talked a little bit about A third of the targets here might be allergists and pediatricians. Can you just maybe break down a little? I know you're probably going to share more of your research down the road, but for now, just to be clear on who exactly your target docs are and why this is such a smaller call point and much more manageable than the neuro side.
spk03: Thanks, Frank. And I'll again turn it over to Ken Marshall in a second here. What else is is what we're very focused on is making sure people understand that while epinephrine may be prescribed across a wide base, including a PCP call point, there is a significant market that is concentrated with this particular product. But I'll let Ken expand from there. Sure. Thanks, Dan. Yeah, allergens are going to be very important, and that is a very small call point. There's about 3,500 allergens. in the U.S. We haven't done the physician-level deciling yet, but you can always be certain that there'll be that 80-20 type of rule that seems to be present just by every market. So some of those allergies will be more important than others, for sure. So there'll be a very efficient allergy call point. And then you say the same thing with pediatricians. And I think Dan referenced that that accounts for about a third of prescriptions. To get you to about 50% of that market, you need those high-decile pediatricians. 50,000 in the U.S. Certainly not all of those will be important to us. There'll be a very small subset of them that write a significant portion of the balance of those prescriptions to get you to 50%. And then as Dan suggested, you get into a lot of onesies, twosies in primary care. They generally are executing a treatment plan outlined by an allergist, so they do a lot of refills. You'll find some high-volume but I think those will be few and far between.
spk11: Okay, great. And then any thoughts, and this might be a little ahead of it, but any thoughts on DTC here just because it's such a known issue?
spk03: Sure. I think, look, we would love to have DTC like anyone else launching this product. I think what you'll see us focused on, though, is making sure that we can launch the right way
spk02: on in the short term thank you our next question comes from Thomas flatten with Lake Street your line is open hey good morning thanks for taking the questions Dan I was curious if you could maybe provide some more detail on the CMC feedback that you received on 109 if there's anything that you guys need to adjust in your manufacturing process anything that you need to overcome prior to submitting, you know, hopefully by year end next year.
spk03: Sure. Morning, Thomas. I'm going to pass that. I actually have Steve Wargacki, our head of R&D, here with me today, so I'll let him walk you through the findings from that interaction.
spk04: Sure. Thank you. And so, Thomas, to your question, the feedback we got was very much aligned with our plan and allowed us to proceed through with our registration batches with good alignment to ensure that the package that we ultimately produce is going to be aligned with the agency's expectations. And there was nothing there that set us back.
spk02: Great. And just a quick question maybe for Ernie. Given the cost reductions that are possible from the Simpazan sale, is there any – is it a straight removal, so to speak, given that the product was nearing break-even, or is there a significant component of allocated overhead that stays in the P&L? I'm just trying to adjust SG&A to reflect the sale.
spk05: Well, as we had mentioned, especially at my script, the Simpazan P&L did include some expertise for – for payer and commercial knowledge that we would keep for 109. So the entire CIPAZAN cost structure is not leaving us, but most of it would be. So we've got to be retaining, you know, as we've talked about a couple of different ways here, the payer expertise, distribution expertise that we need for 109.
spk08: Great. Appreciate you taking the questions. Thank you.
spk06: Our next question comes from Andreas Argaras with Wedbush.
spk07: Your line is open.
spk10: Good morning. Thanks for taking our question. So for 109, have you considered exploring biological signals aside from PK pressure and pulse? How are you exploring PK profiles across age groups such as in children? Do you think sublingual would be restricted to older age groups since children have issues with swallowing?
spk03: Thanks. So, Andres, I want to make sure I have that last part clear. Your question was, do we think it will be restrictive to older, you're saying would it be restrictive to older pediatric patients because of the sublingual?
spk00: Correct. Yeah. So, I'll answer the last part first, and then I'm going to turn it Ken Truitt to answer the rest of it.
spk03: In the work we have done, so obviously we've been working on film for almost 20 years now. The work we've done on other products as well as this product, we have spent time with pediatric subjects down to the age of, I'll look at Steve, two or three? Three. And we have done multiple placebo studies for a variety of different disease states, And we do not see a difference in the data we have in how children who are 3 versus children who are 9, 12, or 15 interact with a sublingual product. So I don't think we see that from the data we have, and also the human factor work we'll do for 109 are doing will prove that out from a filing perspective. But let me pass it over to Ken to talk about
spk02: in that we continue to focus primarily on the cardiovascular parameters so heart rate systolic blood pressure diastolic blood pressure etc so that is what we're focusing on as proxy for therapeutic benefit there was also a question about approaching PK in pediatric population and this would be done by an approach that's fairly typical of where one developed a PK model based on adult data, stepped down with a sparse sampling strategy in children, because that's really what's practical to get the data one needs, and then continue matching as we step down in age.
spk03: So that's how we would characterize the PK in children relative to what we've demonstrated for adults.
spk08: Fantastic. Thank you.
spk07: As a reminder, to ask a question, please press star 1-1.
spk06: Our next question comes from Laura Suriel with Alliance.
spk07: Your line is open.
spk09: Hello, this is Laura Suriel calling in for Jim Malloy. Thank you for taking our questions. So going back to the potential out-licensing of LibriVent, and especially with the recent out-licensing of Simplizant, How would you characterize the current out licensing environment as of now and any potential indications of interest of possible partners for this candidate that are interested, you know, of its rights within the United States?
spk03: Thank you. So, our finding, our observation and what we have seen talking with a variety of people throughout the marketplace is while the Equity markets may seem challenging or be challenging for a lot of companies. The licensing process, at least from our perspective, remains strong. With our Sympathen process, we saw strength in that process, and we felt very good about how that process unfolded. We have, as I mentioned earlier, been in the market – levels of interest or or timing I would say we have seen signs of and we believe there will be strong demand for for the process here the last thing I would say though is we will be disciplined in this process and we will make sure that we either maximize the product by holding on to it if that becomes the right path or if the right partner comes along with the right economics and footprint for the patient population entering into the out licensing arrangement.
spk09: Understood. And I also understand that there's most efforts are being placed on liver vent and 109, but do you have any updates regarding your 108 candidate and a possible timeline for an IND submission?
spk03: Sure. So, we, as I said, guys, said in the last few calls, we really like the concept of 108, and we do continue to do work in-house on determining whether it can be the next pipeline product for us or not in an open, official way. The however part is, where we sit right now as a company, the three priorities are AQST 109, continuing to strengthen and clean up to some degree our financial position, and driving a removal of the orphan drug block on Liberman. So while we're focused on those three, 108 will be a somewhat limited activity. Once we've cleared some of the hurdles on those first three, that's where 108 and our pipeline in general will become more of a central theme.
spk09: Got it. Thank you for taking my questions.
spk07: There are no further questions at this time. I'd like to turn the call back over to Dan Barber for closing remarks.
spk03: Thank you. Well, we appreciate everyone's time this morning. As we've discussed today, we remain excited by the opportunity that AQST 109 represents for us and patients. We will continue to focus on progressing 109, while at the same time continuing to focus on reducing our debt and strengthening our financial position. With that, I will turn the call back over to the operator.
spk07: Ladies and gentlemen, thank you for participating in today's conference. This does conclude the program and you may all disconnect. Everyone, have a great day.
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