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spk11: any initial thoughts on a size of a Durham Salesforce that you might plan to be building out? And what kind of spend, particularly direct-to-consumer activities you envision? We're just trying to get a better sense of the cost structure longer term. Thank you.
spk02: Yeah. Hi, Zach. Thank you. You know, I think the latter question, we're a little too far away in terms of projecting what we're going to be spending on a commercial force there. We're just concentrating on getting that program into Phase 3 next year. Your question on Cresuva injection was related to pricing or possible pricing? I missed that.
spk13: Yep. Yeah, there again.
spk02: Yeah, we're just a little early on that. You know, as we've said on this call, you know, consistently, we're in constant communication with CMS. We believe we have a very good relationship with that group, but we are still a ways away from the label, so it's just a little early to get into details. um, discussion on in terms of, of pricing there for pursuit of NJ.
spk15: Okay. That makes sense. Thank you. Thanks Zach.
spk04: Thank you. Our next question comes from Annabelle's Mimi with people. Your line is now open.
spk05: Good afternoon everyone. This is Nick Rubino on for Annabelle. Thanks for taking our questions. Um, two from us. Now that you have the V4 deal in hand, and accompanied capital flexibility. Is there anything that you're doing to accelerate the oral programs, perhaps opening more sites? And then secondly, you mentioned this new trial in chronic brytis. I know you're giving later details, but given the population heterogeneity, I guess, challenges you saw with predialysis population, what's your general thinking in approaching this broad chronic brytis population? And are there similar protocols you might be considering?
spk00: Thank you.
spk02: Yeah, no, thanks, Nick. On the latter question, let me take that first because I didn't want to leave the impression we're looking at broad, nonspecific pruritus of nonspecific origin. So that is not what we're going to be looking at in the next phase two. It's going to be a very defined patient population with a very defined pathology associated with that pruritus. So the rationale there in terms of which patient groups we're looking at, as we've discussed before, ultimately, we believe that our mechanism of action here is going to be broadly applicable. You know, we're not dependent on blocking any one particular cytokine or other pruritogen that pops up associated with one specific pathology here. So we'd like to be able to ascertain that we have efficacy and these various pathologies where we see pruritus as being a real chronic unmet need. And so we kind of satisfied the end organ, if you like, end organ disease associated pruritus with CKD. As you know, we're looking at dermatological associated pruritus with atopic. And there are some other categories there that we'd like to look at specifically so that at the end of the day, when we have that discussion down the road with the FDA, we've satisfied that in each of these pathologies, which are varied, but all have in common a chronic moderate to severe pruritus, which is not treatable with current medications, that we've satisfied that we have efficacy across these various subgroups. So it's not going to be a nonspecific pruritus group we look at. This is going to be a defined pathology for this novel phase 2 trial that we've been looking at for some time with that strategy in mind. And in terms of our overall capabilities, now you're correct. The B4 deal has certainly dramatically strengthened our balance sheet, and we have capability now to push forward with larger trials. I think you're going to see the benefit of that in the Phase 3 trials we plan to initiate in 2021. So there we're hoping to push both CKD predialysis and, assuming positive results, atopic dermatitis. into phase three. So the advantage we see now is that those trials, as you rightly indicate, can be powered in such a way that we can get through those in an accelerated fashion. So whatever is required in terms of clinical sites, we can now employ and push those pivotal trials as quickly as possible once we get into those. So that's where I see the advantage of the the increased capital power that we've achieved post the V4 deal.
spk05: All right. Understood. Thank you for the insights. Thanks, Nick.
spk04: Thank you. And our next question comes from Jason Gerbery with Bank of America. Your line is now open.
spk06: Well, hi. Good afternoon. Good evening. This is Chi. I'm for Jason. Thanks for taking my question. Just one from me on the ongoing atopic dermatitis exercise. Curious if you are actively monitoring interruptions in site visit or dose interruption while the trial is ongoing and blinded. And if so, do you have any sense whether you have observed or the data monitor will have observed any interruption in site visit or dose interruption? Thank you.
spk02: Yeah. No, that's a good question. We actually are using electronics. data capture for that particular trial. So we have very detailed information on dosage and when dosage occurs. And so far, we haven't seen any significant interruption issues there. In fact, as we've talked about before, in Q2, post the COVID lockdown, we've seen a pretty healthy rebound in enrollment rates in that trial. And, you know, we do expect that trial, as I said earlier, to be fully enrolled very soon this quarter. So, no, we haven't seen any significant dose interruption issues for those patients. Okay, awesome. Thank you. Thanks, Chi.
spk04: Thank you. And our next question comes from Alan Carr with Niedermann Company. Your line is now open.
spk10: Hi, thanks for taking my questions. One, Derek, can you give us a sense of the scale of this open label safety phase three trial that you're going to be starting? What sort of database are you going to need for the oral formulation in total for that? And then a big picture question. Obviously, you've made it clear that you plan to look for more indications for oral Corsuba, but I'm wondering in the long term, where do you expect to see CARA? Where do you plan to take it? Do you plan to bring in other drugs or maybe look within your existing early stage library of compounds? Thanks.
spk02: Yeah, thanks, Eric. On the open-label trial, Alan, when we start that trial, we'll be releasing details on the size of that trial. And that's when you're going to see everything you've asked in relation to open-label. But as we've discussed before, the strategy with CKD predialysis patients for oral Kersuva is that we feel as though we should have the ability to reference the already established database with IV pursuiva in CKD patients, albeit end stage, if you like, stage five dialysis patients. So I can give you an absolute answer to that right now, because that's going to come obviously post our end of phase two meeting, but there we'd like to see a reduced overall safety database requirement by virtue of the ability to reference our already established, if you like, ID to receive a safety database. So that's, you know, our strategy there. And again, definitively, we'll have some answers to that post the end of phase two, meaning which we're targeting for the first quarter of 2021. And then, you know, your general, you know, 30,000 foot, where are we going with this is, you know, our first goal is, Obviously, submit our NDA for Cursiva injection for dialysis patients. Second major goal, moving oral Cursiva forward with our chosen patient population into registration trials and getting our first label there and then expanding upon that in terms of, you know, the oral Cursiva application. And then beyond that, if we move that into commercialization, then, yeah, it may make sense down the road that we look to augment that. you know, particular pipeline related to, if you like, dermatologically focused oral Kursuva. And that may involve both other formulations of Kursuva that we might pursue that would be useful for that patient population. And it may also involve looking at, you know, possible in licensing of, again, therapeutics that make sense to partner with an oral antipyretic. But that's a little further down the road, and not something I could discuss with any sort of certainty right now. It's not something we haven't thought about, but that comes after we push oral forward, get it into phase three, and make sure we can get that to a label, first of all.
spk09: Thanks for taking my questions.
spk02: Thanks, Alan.
spk04: Thank you. And our next question comes from our Linda Lee with Canaccord. Your line is now open.
spk03: Good afternoon, and thanks for taking my question. Congrats on the progress, Derek. I just have a quick question on the forthcoming trial design that you might be contemplating for this new undisclosed indication. It sounds like your prior trials in pruritic indications have provided sort of a template Can you give us a size of an indication of what the patient population might be? And, you know, will the trials be similar in scope to what you've run before? And will they have similar features, for example, like a pre-specified interim assessment?
spk02: Yeah. Yeah, thanks for that question. So I think the advantage we have now, as you've indicated, We've established an effective dose range for oral Cursiva. We do understand the PK associated with that and the patients we've looked at. And so, you know, for the new patient population, it's a pretty accurate estimate of where we need to be in terms of exposure level to hopefully see, you know, a signal within that population. So the design is going to be more on a proof of concept type design here. to make sure we can get a signal there based on, if you like, the dose range and data we've already established both in CKD and soon we're going to see data from a topic. So that's going to be the general design. Again, we'll talk about more details when we initiate the trial and talk about that in a little more detail. But the most important thing there is that it's going to allow us to establish efficacy within a different pathology. associated with chronic pruritus, which ultimately I think is going to be useful ammunition, if you like, in our discussions with the FDA on eventually getting that broad label. So the design is going to, you know, use information we've already gleaned from our prior oral trials in terms of those range we're going to employ and how we dose there. And it's going to be more in line with seeking signal there since we've already established, if you like, our appropriate dose range for the oral Corsuba.
spk03: Okay, great. Derek, I apologize. I forgot to mention this is Ben calling in for our Linda.
spk14: I did realize it wasn't our Linda, Ben.
spk03: I was a little too focused on the question here. My last question, and I apologize if this has been asked before, but with IV Corsuba, at what point in the NDA process Will you get an idea of where this may or may not be DEA scheduled?
spk02: Yes. So obviously, as part of our NDEA submission, we will be submitting a specific document that's going to address that, all the aspects required by the FDA there. So after we submit our document, when we get acceptance of that document, there's a review period there. of a couple of months where the FDA are going to look at that and decide whether ultimately they're going to recommend a drug for scheduling. And then at the end of that review period, if they do recommend a scheduling there, and as you know, we have very strong data that this is a drug that shouldn't be scheduled. And we've talked about that on these calls before. You know, it doesn't have a standard opioid chemistry. It doesn't release dopamine in preclinical studies. All the preclinical models indicate it's not a highly abusable drug. We've run the human abuse liability trial for CSS guidelines. We've run that against a Schedule IV. It didn't look like a Schedule IV. So we'll be presenting all that strong evidence that this should be a non-scheduled compound. But if it is and the FDA decides But it should be scheduled, and the likelihood they are going to recommend that would be a Schedule 5. Then after that review process, there'd be another review process of three months at the DEA to confirm that schedule. So that would come at the end of the priority review process.
spk03: Okay. That's very helpful. Again, congrats on the progress, and best of luck to you.
spk16: Great. Thanks, Ben.
spk04: Thank you, and I'm showing no further questions in the queue at this time. I'd like to turn the call back to Derek Chalmers for any closing remarks.
spk02: Great. Thank you, Jimmy, and thank you, everybody, for participating in today's call. I'd also like to thank the CARA team, our study investigators, and all the patients who continue to participate in our clinical trials, and we look forward to updating you again very, very soon. So thank you very much, everybody, for dialing in today, and have a good night.
spk04: Ladies and gentlemen, thank you for your participation on today's conference. This does conclude your program, and you may now disconnect. you music music Thank you.
spk08: Bye. music music
spk04: Good afternoon and welcome to CARA Therapeutics Third Quarter 2020 Financial Results Conference Call. All participants are now in listen-only mode. There will be a question and answer session at the end. Please be advised that this call is being recorded at CARA's request. I would now like to turn the call over to the CARA team. Please proceed.
spk07: Good afternoon. This is Jack Hildik-Smith with Stern Investor Relations and welcome to CARA Therapeutics Third Quarter 2020 Financial Results and Update Conference Call. The news release became available just after 4 p.m. today and can be found on our website at www.caratherapeutics.com. You may also listen to a live webcast and replay of today's call on the Investors section of the website. Before we begin, let me remind you that statements made on today's call regarding matters that are not historical fact are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Examples of these forward-looking statements include statements concerning the expected timing of the data readouts from the company's ongoing clinical trials, the potential results of ongoing clinical trials, timing of future regulatory and development milestones for the company's product candidates including the company's projected timeline for the submission of its first NDA, the potential for the company's product candidates to be alternatives in the therapeutic areas investigated, the potential benefits of V4 Pharma's marketing IV Korsuva in the United States, and the company's expected cash reach. Because such statements are subject to risks and uncertainties, actual results may differ materially from those expressed or implied by such forward-looking statements. Risks are described more fully in care therapeutics filings with the Securities and Exchange Commission, including the risk factor section of the company's most recently filed quarterly report on Form 10-Q and its other documents subsequently filed with or furnished to the Securities and Exchange Commission. All forward-looking statements made in today's call speak only as of the date on which they were made. Kera Therapeutics undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the day on which they were made. Participating on today's call are Dr. Derek Chalmers, Kera President and CEO, and Kera Chief Financial Officer, Thomas Riley. I'll now turn the call over to Dr. Chalmers.
spk02: Great. Thank you, Jack. Good afternoon, everybody, and thanks for joining us today. on this day, this very special day for our industry and for science in general. We've also been executing on some excellent science through the third quarter of this year. We've made significant advancements related to our clinical development programs for both cruciva injection and for oral cruciva across a range of periodic indications. And I'll summarize those programs shortly. In addition, in October, we were very pleased to announce an important commercial license agreement with V4 Pharma for Kursuva injections for the treatment of CKD-associated pruritus, specifically in U.S. dialysis patients. We see this as an important strategic deal for the company, which we believe will maximize the potential commercial success for Kursuva injection if approved, and I'll cover the terms of this agreement a little later in the call. Additionally, in October, we strengthened our management team by welcoming Thomas Riley on the call with me today as Chief Financial Officer. Tom brings a wealth of experience in biopharma financial strategy from his work at both Allergan and Novartis in the past, and we're very happy to welcome Tom to the team. Due to the ongoing COVID-19 pandemic and in accordance with the FDA's updated guidance for conducting clinical trials, we have implemented numerous clinical and operational measures to prioritize the health and safety of patients, our employees, and study investigators, and to minimize potential disruptions to our ongoing clinical studies. Due to the entire CARA team's continued dedication and hard work in this area, we remain on track to meet our main clinical and regulatory goals for the year, and we continue to enroll patients across all of our ongoing trials. So now let me update you on each of our programs, starting with our lead program for Cresuva injection in hemodialysis patients with CKD-associated pruritus. As a reminder, this is a patient population where there is significant unmet need, with no therapies currently approved in the U.S. or Europe. So we believe Kursuva injection has significant potential to change the treatment paradigm for these patients. Our phase three program for this indication is now complete. In both pivotal phase three trials, the CAM1 and CAM2 trials, Kursuva achieved statistical significance in both the primary and key secondary endpoints, and in both studies, presuva injection was generally well tolerated with a safety profile consistent with our prior clinical trials. All safety databases for our phase three program have been closed with total safety exposures in excess of ICH guidelines to support the NDA submission with more than 1,500 total patient exposures achieved, including more than 700 patients completing at least six months of treatment and greater than 400 patients completing one year of treatment. Through this third quarter, we've been focused on preparing our NDA package, and we remain on track for submission to the FDA a little later this quarter, at which point we'll also be applying for a six-month priority review status as Cursiva injection has breakthrough therapy designation for this indication. If granted priority review, a potential 2021 U.S. commercial launch for Cursiva injection is achievable. With respect to our U.S. commercialization strategy for Cursiva injection, we see a number of key advantages from our recently announced license agreement with V4 Pharma. Most importantly, it allows us to employ V4's already established dedicated nephrology-focused commercial organization including an experienced sales force of some 200 FTEs with existing relationships across large, medium, and independent dialysis organizations. It also enables us to work with the V4 market access team to enhance our reimbursement efforts and to leverage existing wholesale and supply chain agreements already in place to our economic advantage. In addition, with no need to build a CARA nephrology-focused sales force, we expect significant savings in projected future commercial infrastructure costs, which consequently extend our estimated cash runway. And we'll get to that a little later in the call. With those advantages in mind, the financial terms of the agreement also significantly strengthen our balance sheet going forward. This includes an upfront payment to CARA of $150 million, $100 million of that in cash, and $50 million in equity purchase, a US approval milestone consisting of a further $50 million in equity purchase, and potential US commercial sales milestones of up to $240 million. V4 will have the exclusive rights to commercialize Cursiva injection in non-frazenious medical care in North America clinics in the U.S. under a CARA 60% V4 40% profit-sharing arrangement based on profit from net non-frazenious medical care clinic sales. Recall from our original CARA V4 Fresenius License Agreement, which we executed in 2018, we have an established 50-50 profit split arrangement already in place for Fresenius medical care clinics in the U.S. So overall, we see this as an ideal agreement to provide both significant momentum for launch and adoption of Cursiva injection in the U.S. and for CARA, importantly, to retain commercial upside from our profit-sharing arrangement. So moving from IV onto our pipeline programs focused on oral cruciva. And let's start with our lead program in predialysis CKD patients with moderate to severe pruritus. We've previously reported positive top-line results from our 12-week phase 2 trial. evaluating the safety and efficacy of three tablet strands of oral preserva, 0.25 megs, 0.5 meg, and 1 meg once daily. Based on the data, we identified the 1 meg tablet strand as a dose level to take forward into phase three. To that end, we plan to launch the safety portion of the phase three program in CKDAP in the fourth quarter of this year, prior to a planned end of phase two meeting with the FDA in the first quarter of 2021, which will enable a projected pivotal phase three trial initiation in Q2 2021. Moving on to atopic dermatitis, our ongoing care phase two dose ranging trial is designed to randomize AD patients across, again, three tablet strengths of oral prosuva, 0.25, 0.5, and 1, taken twice daily versus placebo. In Q2 of this year, we completed a planned interim conditional power assessment conducted after approximately 50% of the originally targeted patient number completed the designated 12-week treatment period. Based on the independent data monitoring committee's recommendation to maintain conservatist testicle power for both our primary and secondary endpoint of approximately 80%, we increased the target trial size by, again, approximately 28%. I'm happy to announce that based on current patient screening rates, we expect this trial to be fully enrolled at approximately 400 patients a little later this quarter, likely within the calendar month of November. We're also enrolling patients in our ongoing proof of concept phase two trial in PBC patients, primary biliary cholangitis, with moderate to severe pruritus. Pruritus is a common symptom of cholestatic liver diseases, with 20 to 30 percent of those patients experiencing pruritus, but with a prevalence of up to 70 percent in patients with PBC. Our 16-week trial is designed to evaluate the safety and efficacy of a one-meg tablet of oral Cruciva taken twice daily. versus placebo in approximately 60 patients. Primary endpoint is a change from baseline in the weekly mean of the daily 24-hour worst-edge NRS score at week 16 for that trial. And we did enter report top-line data from this study in the first half of 2021. Finally, in relation to oral Kursuva, with the goal of further establishing the broad antipyretic applicability of Kruzuva across patient populations. We're currently planning to initiate a fourth phase two trial of oral Kruzuva in an additional patient population where chronic pruritus remains a significant unmet need. And we'll provide more details on this study and the targeted patient population a little later this quarter. So overall, we're pleased with the progress made across all of our development programs in the third quarter, and we're looking forward to achieving significant regulatory and clinical milestones through the end of this year and into 2021. So with that, I'll now turn the call over to Tom to cover the financial results for the quarter. Tom.
spk01: Okay, great. Thank you, Derek. Before I begin the financial review, I'd like to say I'm very excited to have joined the CARA team. I'm really looking forward to contributing to the financial strategy of the company as we continue to advance our pipeline and focus on several key upcoming milestones that will enhance our long-term value. Now to the financial review. As a reminder, the full financial results for the third quarter 2020 can be found in our press release issued today after the market closed. For the third quarter of 2020, we reported a net loss of $16.5 million or $0.35 per basic and diluted share compared to a net loss of $32.8 million or $0.74 per basic and diluted share for the same quarter of 2019. In the third quarter of 2020, we recognized revenue of $9.3 million related to the V4 Fresenius Collaboration Agreement compared to $5.8 million during the same quarter in 2019. For the third quarter of 2020, we reported R&D expense of $21.1 million compared to $36 million in the same period of 2019. The lower R&D expenses in the third quarter 2020 were primarily due to a decrease in clinical trial costs, a 2019 $8 million upfront payment upon entering the license agreement with Interis Biopharma Inc., and partially offset by a $2.5 million milestone earned by Interis in 2020. G&A expenses were $5.2 million during the third quarter of 2020, compared to $4.2 million in the same period of 2019. The increase in 2020 was primarily due to insurance costs, franchise taxes, payroll-related costs, and commercial costs, partially offset by decreases in consultants' costs. Other income was approximately $0.4 million in the third quarter of 2020, compared to approximately $1.3 million in the same period of 2019. The decrease is due to the lower interest income on our investments in marketable securities. As of September 30, 2020, our cash, cash equivalents, and marketable securities totaled $131.4 million compared to $218.2 million as of December 31, 2019. The decrease in the balance of cash and cash equivalents and marketable securities primarily resulted from cash used in operations. Turning to our financial guidance. Based on projected costs for our clinical development plans and timing expectations, we expect that our current cash, cash equivalents, and marketable securities as of September 30, 2020, with the additional funding of $150 million from the V4 Pharma License Agreement in October 2020, will be sufficient to fund our operations into 2023. not accounting for any potential milestone payments under existing collaborations. With that, I'll turn the call back over to the operator for Q&A.
spk04: Thank you. As a reminder, to ask a question, you will need to press star then 1 on your touchtone telephone. To withdraw your question from the queue, please press the pound key. Please stand by while we compile the Q&A roster. Our first question comes from David Amselin with Piper Sandler. Your line is now open.
spk11: Hey, thanks. This is Zach Satchar on for David. Thank you for taking my questions. Just a couple for me. I know you've asked this in a couple different ways before, but could you maybe just give us a sense of your updated thoughts on pricing for the IB form and maybe help us in your thought process regarding what comparators might make sense to you? And then quickly on the Could you provide any initial thoughts on a size of a Durham force that you might plan to be building out? And what kind of spend, particularly direct-to-consumer activities you envision? We're just trying to get a better sense of the cost structure longer term. Thank you.
spk02: Yeah. Hi, Zach. Thank you. You know, I think the latter question, we're a little too far away in terms of projecting what we're going to be spending on a commercial force there. We're just concentrating on getting that program into phase three next year. Your question on Cresuva injection was related to pricing or possible pricing. I missed that.
spk13: Yep. Yeah, there again.
spk02: We're just a little early on that. As we've said on this call consistently, we're in constant communication with CMS. We believe we have a very good relationship with that group, but we are still a ways away from the label, so it's just a little early to get into detailed discussion in terms of pricing there for Cresciva and J.H.M. Okay, that makes sense.
spk15: Thank you. Thanks, Zach.
spk04: Thank you. Our next question comes from Annabelle Samimi with TFL. Your line is now open.
spk05: Good afternoon, everyone. This is Nick Rubino, on for Annabelle. Thanks for taking our questions. Two from us. Now that you have the V4 deal in hand and accompanied capital flexibility, is there anything that you're doing to accelerate the oral programs, perhaps opening more sites? And then secondly, you mentioned this new trial in chronic pritis. I know you're giving later details, but given the population heterogeneity I guess, challenges you saw with predialysis population. What's your general thinking in approaching this broad chronic pruritus population? And are there similar protocols you might be considering?
spk00: Thank you.
spk02: Yeah, no, thanks, Nick. On the latter question, let me take that first because I didn't want to leave the impression we're looking at broad nonspecific pruritus of nonspecific origin. So that is not what we're going to be looking at in the next phase two is going to be a very defined patient population with a very defined pathology associated with that pruritus. So, and the rationale there in terms of which patient groups we're looking at, as we've discussed before, ultimately, we believe that our mechanism of action here is going to be broadly applicable. You know, we're not dependent on blocking any one particular cytokine. or other pruritogen that pops up associated with one specific pathology here. So we'd like to be able to ascertain that we have efficacy in these various pathologies where we see pruritus as being a real chronic unmet need. And so we kind of satisfied the end organ, if you like, end organ disease associated pruritus with CKD. As you know, we're looking at dermatological associated pruritus with atopic And there are some other categories there that we'd like to look at specifically so that at the end of the day, when we have that discussion down the road with the FDA, we've satisfied that in each of these pathologies, which are varied, but all have in common a chronic moderate to severe paralysis, which is not treatable with current medications that we satisfied that we have efficacy across these various groups. So I'm going to be a non, specific pruritus group we look at is going to be a defined pathology for this novel phase two trial that we've been looking at for some time with that strategy in mind. And in terms of our overall capabilities, now you're correct, the B4 deal has certainly dramatically strengthened our balance sheet and we have capability now to push forward with larger trials. I think you're going to see the benefit of that And the phase three trials we plan to initiate in 2021. So there we're hoping to push both CKD predialysis and, assuming positive results, atopic dermatitis into phase three. So the advantage we see now is that those trials, as you rightly indicate, can be powered in such a way that we can get through those in an accelerated fashion. So whatever is required in terms of clinical sites, we can now employ and push those pivotal trials, you know, as quickly as possible once we get into those. So that's where I see the advantage of the, the increased capital power that we've achieved post the V4 deal.
spk05: All right, understood. Thank you for the insights. Thanks, Nick.
spk04: Thank you. And our next question comes from Jason Gerbery with Bank of America. Your line is now open.
spk06: Well, hi. Good afternoon. Good evening. This is Chi. I'm for Jason. Thanks for taking my question. Just one from me. On the ongoing atopic dermatitis exercise, curious if you are actively monitoring interruptions in site visit or dose interruption while the trial is ongoing and blinded? And if so, do you have any sense whether you have observed or the data monitor will have observed any interruption in site visit or dose interruption? Thank you.
spk02: Yeah, that's a good question. We actually are using electronic data capture for that particular trial, so we have very detailed information on dosage and when dosage occurs. And so far, we haven't seen any significant interruption issues there. In fact, as we've talked about before, in Q2, post the COVID lockdown, we've seen a pretty healthy rebound in enrollment rates in that trial. And, you know, we do expect that trial, as I said earlier, to be fully enrolled very soon this quarter. So, no, we haven't seen any significant dose interruption issues for those patients. Okay. Awesome. Thank you. Thanks, Chi.
spk04: Thank you. And our next question comes from Alan Carr with Niedermann Company. Your line is now open.
spk10: Hi. Thanks for taking my questions. One, Derek, can you give us a sense of the scale of this open label safety phase three trial that you're going to be starting? What sort of database are you going to need for the oral formulation in total for that? And then a big picture question. Obviously, you've made it clear that you plan to look for more indications for oral Corsuba, but I'm wondering in the long term, where do you expect to see CARA? Where do you plan to take it? Do you plan to bring in other drugs or maybe look within your existing early stage library of compounds? Thanks.
spk02: Yeah, thanks, Eric. On the open-label trial, Alan, when we start that trial, we'll be releasing details on the size of that trial. And that's when you're going to see everything you've asked in relation to open-label. But as we've discussed before, the strategy with CKD predialysis patients for oral Kursuva is that we feel as though we should have the ability to reference the already established database with IV pursuiva in CKD patients, albeit end stage, if you like, stage five dialysis patients. So I can give you an absolute answer to that right now, because that's going to come obviously post our end of phase two meeting, but there we'd like to see a reduced overall safety database requirement. by virtue of the ability to reference our already established, if you like, ID to receive a safety database. So that's, you know, our strategy there. And again, definitively, we'll have some answers to that post the end of phase two, meaning which we're targeting for the first quarter of 2021. And then, you know, your general, you know, 30,000 foot, where are we going with this is, you know, our first goal is, Obviously submit our NDA for Cursiva injection for dialysis patients. Second major goal, moving oral Cursiva forward with our chosen patient population into registration trials and getting our first label there and then expanding upon that in terms of, you know, the oral Cursiva application. And then beyond that, if we move that into commercialization, then yeah, it may make sense down the road that we look to augment that. you know, particular pipeline related to, if you like, dermatologically focused oral Kursuva. And that may involve both other formulations of Kursuva that we might pursue that would be useful for that patient population. And it may also involve looking at, you know, possible in licensing of, again, therapeutics that make sense to partner with an oral antipyretic. But that's a little further down the road, and not something I could discuss with any sort of certainty right now. It's not something we haven't thought about, but that comes after we push oral forward, get it into phase three, and make sure we can get that to a label, first of all.
spk09: Thanks for taking my questions.
spk02: Thanks, Alan.
spk04: Thank you. And our next question comes from Arlinda Lee with Canaccord. Your line is now open.
spk03: Good afternoon, and thanks for taking my question. Congrats on the progress, Derek. I just have a quick question on the forthcoming trial design that you might be contemplating for this new undisclosed indication. It sounds like your prior trials in pruritic indications have provided sort of a template Can you give us a size of an indication of what a patient population might be and, you know, will the trials be similar in scope to what you've run before and will they have similar features, for example, like a pre-specified interim assessment? Yeah.
spk02: Yeah, thanks for that question. So I think the advantage we have now, as you've indicated, we've We've established an effective dose range for oral Cursiva. We do understand the PK associated with that and the patients we've looked at. And so, you know, for the new patient population, it's a pretty accurate estimate of where we need to be in terms of exposure level to hopefully see, you know, a signal within that population. So the design is going to be more on a proof of concept type design here. to make sure we can get a signal there based on, if you like, the dose range and data we've already established both in CKD and soon we're going to see data from a topic. So that's going to be the general design. Again, we'll talk about more details when we initiate the trial and talk about that in a little more detail. But the most important thing there is that it's going to allow us to establish efficacy within a different pathology. associated with chronic pruritus, which ultimately I think is going to be useful ammunition, if you like, in our discussions with the FDA on eventually getting that broad label. So the design is going to, you know, use information we've already gleaned from our prior oral trials in terms of those range we're going to employ and how we dose there. And it's going to be more in line with seeking signal there since we've already established, if you like, our appropriate dose range for the oral Corsuba.
spk03: Okay, great. Derek, I apologize. I forgot to mention this is Ben calling in for Arlinda.
spk14: I did realize it wasn't Arlinda, Ben.
spk03: I was a little too focused on the question here. My last question, and I apologize if this has been asked before, but with IV Corsuba, at what point in the NDA process Will you get an idea of where this may or may not be DEA scheduled?
spk02: Yes. So obviously, as part of our NDEA submission, we will be submitting a specific document that's going to address that, all the aspects required by the FDA there. So after we submit our document, when we get acceptance of that document, there's a review period there. of a couple of months where the FDA are going to look at that and decide whether ultimately they're going to recommend a drug for scheduling. And then at the end of that review period, if they do recommend a scheduling there, and as you know, we have very strong data that this is a drug that shouldn't be scheduled. And we've talked about that on these calls before. You know, it doesn't have a standard opioid chemistry. It doesn't release dopamine in preclinical studies. All the preclinical models indicate it's not a highly abusable drug. We've run the human abuse liability trial per CSS guidelines. We've run that against a Schedule IV. It didn't look like a Schedule IV. So we'll be presenting all that strong evidence that this should be a non-scheduled compound. But if it is and the FDA decides that it should be scheduled and the likelihood they are going to recommend that would be a Schedule 5, then after that review process, there'd be another review process of three months at the DEA to confirm that schedule. So that would come at the end of the priority review process.
spk03: Okay. That's very helpful. Again, congrats on the progress and best of luck to you.
spk16: Great. Thanks, Ben.
spk04: Thank you, and I'm showing no further questions in the queue at this time. I'd like to turn the call back to Derek Chalmers for any closing remarks.
spk02: Great. Thank you, Jimmy, and thank you, everybody, for participating in today's call. I'd also like to thank the CARA team, our study investigators, and all the patients who continue to participate in our clinical trials, and we look forward to updating you again very, very soon. So thank you very much, everybody, for dialing in today, and have a good night.
spk04: Ladies and gentlemen, thank you for your participation on today's conference. This does conclude your program, and you may now disconnect.
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