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spk03: Good day and welcome to the Lexicon Pharmaceuticals second quarter 2024 financial results conference call. All participants will be in a listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero on your telephone keypad. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then one on your telephone keypad. To withdraw your questions, please press star then two. Please note this event is being recorded. I would now like to turn the conference over to Lisa DeFrancesco, Head, Investor Relations and Corporate Strategy. Please go ahead. Thank you, Betsy.
spk12: Good afternoon and welcome to the Lexicon Pharmaceuticals Second Quarter 2020-2024 Financial Results Conference Call. Joining me today are Dr. Mike Exson, Lexicon's new Chief Executive Officer and Director, Seth Wade, President and Chief Operating Officer, Tom Garner, Senior Vice President and Chief Commercial Officer, Dr. Craig Granowitz, Senior Vice President and Chief Medical Officer, and Dr. Alan Main, Executive Vice President, Innovation and Chemical Sciences. Earlier this afternoon, Lexicon issued a press release announcing our financial results for the second quarter of 2024, which is available on our website at www.lexpharma.com. and through our SEC filing. A webcast of this call, along with a slide presentation, is also available on our website. During this call, we will review the information provided in the release, provide a corporate update, and then use the remainder of our time to answer your questions. Before we begin, let me remind you that we will be making forward-looking statements. Relating to the safety, efficacy, clinical development, regulatory status, and therapeutic and commercial potential of Inpepa, Synquista, LX9211, LX9851, and our other drug programs, as well as our business generally. These statements may include characterizations and projections relating to our commercial launch of Impefa and heart failure, as well as the clinical development, regulatory status, and market opportunity for all of our drug programs. This call may also contain forward-looking statements relating to our growth and future operating results, discovery and development of our drug candidates, strategic alliances and intellectual property, as well as other matters that are not historical facts or information. Various risks that may cause our actual results to differ materially from those expressed or implied in such forward-looking statements, we refer you to our most recent annual report on Form 10-K and other SEC filings for detailed information describing such risks. I would now like to turn the call over to Mike Exson.
spk07: Thanks, Lisa, and good day, everyone. Thanks for joining us on the call. Before we begin our discussion on Lexicon's results for the second quarter of 2024, let me start by saying that even in my first few weeks here as CEO, I can already see what a tremendous opportunity we have to bring innovative new therapies to patients, transform the treatment landscape of multiple therapeutic areas, and indeed transform Lexicon as a company. Now, moving on to our accomplishments for the year, which are indeed incredibly significant. First of all, our in-pepper business continued to grow modestly. We saw progress across all areas of focus in this highly competitive market. Importantly, we also resubmitted our NDA for Zynqvista and have received a PDUFA goal date of December 20, 2024, setting us up for a potential commercial launch in this untapped market in early 2025. Furthermore, our phase three study for sotagliflozin in hypertrophic cardiomyopathy or HCM is underway, with sites already open and beginning to enroll patients. In addition, our phase 2B study for LX9211 in diabetic peripheral neuropathic pain, or DPNP, is on track to meet its timelines and its objectives, with top line data anticipated second quarter of 2025. And finally, our exciting novel drug candidate, LX9851, and oral therapy for obesity and weight management, which we believe has the potential to become an innovative next gen treatment in this large market is progressing into preclinical development. These are all really solid opportunities for Lexicon, not only for next year, but well beyond. So let's take a look at Sotagliflozin in particular. We see a significant opportunity for value and growth with this compound. across additional indications where Sotagliflozin's unique mechanism of action has potential for beneficial effect. Lexagon has taken a purposeful approach in each one of the areas that we're exploring. And as a result, we're now preparing for the next near-term opportunity to commercially launch Zynquista for glycemic control in adults with type 1 diabetes and chronic kidney disease, while working towards a longer-term goal of expanding Sotagliflozin into HCM. Now, in both of these areas, there are no SGLT therapies indicated, and we believe that the dual inhibition of SGLT1 and 2 offers unique advantages. These areas of unmet need are also highly concentrated in terms of treatment landscape, and they're very different from the competitive environment we're experiencing in heart failure, which currently is dominated by two larger players within a complex treatment and reimbursement environment. These are really very exciting near and long-term opportunities for Lexicon, and as we advance this pipeline of current and potential indications for Sotocliflozin, we'll continue to weigh and consider where this unique innovation can have the most impact for patients. Now, as we then go and look holistically at our pipeline, we see similar pipeline and appeal opportunities for our other candidates as well. We have the ability to potentially address unmet medical needs within large markets, with development opportunities beyond their initial indications, whether pursued by Lexicon alone or with a strategic partner. And so, I'm truly thrilled to have joined Lexicon at this pivotal time when we can focus on unlocking the significant value that these opportunities represent. So, with that overview, I'd like to now turn it over to Jeff Wade, President and COO, to discuss in detail the business and financial results. Over to you, Jeff.
spk05: Thank you, Mike. I'd like to begin with our MPEPA results. Net sales for the second quarter of 2024 were $1.6 million and $2.7 million for the first half of 2024. We saw improvements in filled TRX and number of new prescribers, a modest expansion in access, and greater pull-through. This progress is due to the strong efforts of the team assembled by and aligned under Tom Garner since he joined the company last year. Achieving better market access remains the key to more significant growth for MPEPA and heart failure. Our goal has been and remains to achieve formulary access that is favorable for patients and equitable in light of MPEPA's value. And we are continuing to have discussions with payers driven by MPEPA's value and differentiating data. Payer coverage improved slightly in the second quarter to 48%. although most of this coverage still requires step-through of competing therapies, an obstacle that we're focused on eliminating. Some payers have been taking longer to make coverage decisions due to uncertainties associated with the IRA, particularly around the prices to be announced by CMS on September 1st for the first group of products selected for negotiation, a group that includes three major heart failure medications. We expect improvements in coverage as these uncertainties are resolved and as we continue to demonstrate the value of MPEFA for patients, providers, and payers. It's important to note that SHLT use remains highly underpenetrated in heart failure with significant room for growth despite strong recommendations within the ACC treatment guidelines and consensus statements for both HF-REF and HF-PEF. recommendations that are based in substantial part on IMPEPA data, especially as it relates to initiation of therapy after a hospitalization. I'd now like to move to Zynquista, which has the opportunity to be the first-ever oral adjunct to insulin therapy indicated to improve glycemic control in adults with type 1 diabetes. Our approach with Zynquista is part of our overall strategy to expand the use of cytoclose and beyond the competitive heart failure market into high-value opportunities where other SGLT inhibitors are not indicated and in which we believe Cetagliflozin's unique SGLT1 mechanism offers advantages. We've made a lot of progress this past quarter and in the time since. We resubmitted our NDA for Senquesta in June as an adjunct to insulin in adults with type 1 diabetes and CKD. The FDA notified us in July that they considered our resubmission to be a complete response to their 2019 action letter, and they gave us a PDUFA goal date of December 20, 2024. Based on our recent communications with FDA, it is likely we will have the opportunity for an advisory committee meeting. We look forward to the chance to present and discuss with the committee and key stakeholders, including, importantly, the patient community, the opportunity for Zynquista to address the significant unmet need for adjunctive glycemic control in this population. From our preliminary market research, we expect more than 400,000 adults in the U.S. with type 1 diabetes and chronic kidney disease could be eligible for treatment. We've seen strong enthusiasm for an approved adjunct to insulin among the concentrated group of endocrinologists who manage treatment decisions in type 1 diabetes. From our payer research, we expect the market access environment to be considerably more favorable in type 1 diabetes than in heart failure. Our opportunity to be the first adjunct to insulin therapy in a market in which patients are highly engaged and indication that is not subject to extensive management are all important factors for achieving favorable and timely market access. We believe that Sotoclizumab's unique dual SGLT1 and SGLT2 mechanism offers advantages in addressing the challenges in people who have type 1 diabetes and chronic kidney disease. Both are relevant to type 1 diabetes, but the inhibition of SGLT1, the primary transporter for glucose uptake from the GI tract, offers particular benefits. SGLT1 inhibition slows the uptake of glucose from meals, blunting postprandial glucose peaks and reducing glycemic variability. And unlike SGLT2 inhibition, the effects of SGLT1 inhibition do not decline with the reduced renal function that characterizes chronic kidney disease. The focus of our NDA resubmission on people with type 1 diabetes and chronic kidney disease aligns then both with a population in which a better glycemic control is more important, and also with Sotoclopozin's unique mechanism of action. We believe that the greater benefit in this population weighs favorably against the increased risk of diabetic ketoacidosis, or DKA, that has been observed in clinical studies of all SGLT inhibitors, including and type 1 diabetes, and that drove the complete response letter that our resubmission addresses. We are pleased to say that we have initiated our pivotal phase three Sonata trial for HCM with the opportunity to transform the standard of care in this area of high unmet need. We are leveraging outcomes data from our score trial in heart failure KCCQ data from Soloist, and other evidence providing a strong scientific rationale for the potential of Sotagliflozin in this indication. This slide shows the design of Sonata HCM, a pivotal Phase III placebo-controlled study with a targeted enrollment of 500 patients with obstructive or nonobstructive HCM. We have sites up and running and have commenced patient recruitment in the study. The primary endpoint of the study is change from baseline and KCCQ score, an endpoint that has been accepted by the FDA as the primary endpoint in this and other label-enabling HCM trials, and with which we have previously achieved success in our soloist heart failure trial. Importantly, Sonata HCM is studying a broader patient population than that studied in other ongoing trials in HCM. as we are allowing patients to be on cardiac myosin inhibitors as well as allowing the use of beta blockers and calcium channel blockers. We are also enrolling patients with an injection fraction down to 50%, which is lower than the studies of cardiac myosin inhibitors for which heart failure is a risk. And of course, pseudomplasm is already indicated, as in PEPA, to reduce heart failure, which is the major risk for these patients. We have obtained feedback from FDA that success in this single study could support a broad label for Sotagliflozin in HCM. Once again, an indication in an important area of unmet need that would be unique to Sotagliflozin among SGLT inhibitors. Current estimates suggest that around one million patients in the United States today have HCM. Many are not diagnosed in part because of the nonspecific nature of HCM symptoms, but diagnostic rates have been rising rapidly, a trend which is expected to continue over the next decade with increased focus on the disease. Looking further into our pipeline, we have in LX9211 another opportunity to redefine the standard of care in an important area of need, in this case in neuropathic pain. LX9211 has the potential to be the first new non-opioid treatment for neuropathic pain in over two decades. Our progress phase 2B dose optimization study began enrolling towards the end of 2023 and is well on track for top line data in the first half of 2025. It is important to note that this study, like our proof of concept studies, is placebo controlled and allows patients to remain on stable dose standard of care therapy rather than removing all pain medications, consistent with how DPNP drugs are likely to be used in real-world practice. We learned a great deal in our Phase II relief DPN study, which we are applying to this Phase IIb progress study, with a key hypothesis being that we can improve tolerability by eliminating the 10x first-day loading dose in the prior study. At this point, we feel quite confident about where we are in this study and are very much looking forward to the results next year. Approximately 20 million patients in the United States are suffering with some type of neuropathic pain, of which about 5 million have DPNP, with significant growth predicted in the future. We believe LX9211 could offer a real benefit to patients and to the clinical community who are looking for better options to improve outcomes for patients with DCM. Our newest drug candidate to emerge from our Genome 5000 platform is LX9851 in the exciting area of obesity and weight management. We believe that LX9851 has the potential, like our other assets, to be developed in additional indications and to be used as a combination therapy as well. LX9851 is a small molecule inhibitor of the target acyl-CoA synthetase 5, or ACSL5, that we believe could be given orally for chronic weight management with a target product profile that reduces body fat, spares lean body mass, and favorably affects overall metabolic profiles. In preclinical studies, it has reduced cholesterol and triglycerides, improved insulin sensitivity, and demonstrated potential in additional related indications, such as metabolic syndrome and MASH. The obesity and weight management space is an area of tremendous interest, and we're very excited about the potential for an oral once-daily therapy with these mechanisms that complement and enhance current therapies. We've moved into IND enabling studies and we are very focused on submitting data to upcoming medical meetings. Now we will review some of the key elements of our second quarter of 2024 financial results. You can find more financial details in the press release that we issued earlier today and in our 10Q that will be filed shortly with the SEC. We ended the quarter with $310 million in cash and investments. As indicated in our press release this afternoon, we had $1.6 million in revenues in the second quarter of 2024, almost all from net sales of MPEPA, and had minimal revenues for the same period in 2023. R&D expenses for the second quarter of 2024 increased to $17.6 million from $14.5 million for the corresponding period in 2023, primarily due to higher external R&D expenses as our development programs progress. SG&A expenses for the second quarter of 2024 increased to $39.2 million from $30 million for the corresponding period in 2023, reflecting the investment in the commercial launch of MPEPA. In total, net loss for the second quarter of 2024 was $53.4 million, or 17 cents per share, as compared to a net loss of $44.9 million, or 22 cents per share, in the corresponding period in 2023. For the second quarters of 2024 and 2023, net loss included non-cash stock-based compensation expense of $4.9 million and $3.8 million, respectively. Now I'll turn it back over to Mike for some closing remarks.
spk07: Yeah, thanks, Jeff. In summary, the next 18 months for Lexicon includes several important planned catalysts. First of all, we've got the potential to launch Zynqvista in the early part of next year, which for us is an exclusive opportunity and importantly, a much-needed additional treatment option for the type 1 diabetes community. Secondly, we've initiated our Sonata phase 3 study of Sotagliflozin in HCM, and that presents a new and promising area of focus. Thirdly, our progress phase 2b study of LX9211 in DPNP is on track, with top line data in Q2 of next year. And then finally, we've commenced IND enabling studies of LX9851 in the rapidly evolving area of obesity and weight management, where current treatments are primed for next gen and combination therapies. So each of these opportunities have a lot in common. They're all in large markets, There's significant areas of unmet need where there's white space with the true need for new innovative therapies. And within each of these areas, we have the potential to be the first or only truly exclusive in our approach, unlike what we're experiencing in Hartfelley currently. And each of these opportunities is supported by thoughtful clinical developments. It is informed by discussions with the FDA and designed to incorporate real world elements of how the drug would actually be used in the market. So as we enter the back half of the year, we're currently evaluating our strategy and our resourcing in order to ensure that we are optimized for success across these programs. We believe that we'll have the opportunity over the next 18 months to significantly improve treatment paradigms, transform Lexicon as a company and create significant value for all of our stakeholders. most importantly, including the patients that we serve. So with that, I'd like to turn it back to the operator to open up the Q&A.
spk03: We will now begin the question and answer session. To ask a question, you may press star, then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star, then two. At this time, we will pause momentarily to assemble our roster.
spk04: The first question today comes from Yasin Rahimi with Piper Sandler.
spk02: Please go ahead. Great. Thank you so much, team, for all the updates. A few questions on CENTQUESTA. Did you mention, I think it sounded like in the prepared remarks that you guys were preparing for an adcom. I guess you could maybe talk about whether an adcom is expected, when it could occur, what could be possible topics. That's sort of like big bucket one. And then bucket two is if you could talk about commercially how you're thinking about sort of do you need to add more salespeople? Is there any, you know, as you will be focused on patients that are under the care of endocrinologists. What would the launch trajectory look like in a more endocrinology focused setting versus a cardiovascular focus? Would appreciate any color around that as well. And I'll jump back into the queue for any other questions.
spk07: Okay. Thanks a lot, Yasmeen. I heard two big buckets. Not sure if you had a third, but let me pass the first one to Craig. for the adcom and what we're thinking of timing and expectations, et cetera.
spk06: Yeah, thank you for the question, Yaz. And, you know, at this point, we expect that we will get an adcom from the FDA. And it really would focus on the risk benefit of treatment. And I think we've shared at prior calls and at other meetings and communications that, you know, we've really worked hard to find a population where the risk benefit is more favorable. We currently are committed and the FDA has been committed to our target action date of December 20th of this year. I think I'll just take a moment on the risk benefit in that, you know, we believe that this group of patients with chronic kidney disease are at much higher rate of disease progression to end stage disease across a range of underlying diseases such as end stage kidney disease, heart failure, stroke, myocardial infarction, severe retinopathy, and other diseases. So, glycemia is actually a marker for that. And the indication we're seeking as a reminder is a glycemia control indication with that group of patients with underlying chronic kidney disease. So, we're not seeking an indication right now for preventing necessarily progression of the chronic kidney disease, but that is a marker of patients that are going to have much more rapidly progressive disease across a range of complications of type 1 diabetes. So I think in that regard, you know, we've gotten great feedback from the patient and physician community on the need for this therapy. I think in prior communications from FDA, some which publicly that they acknowledge that insulin alone is not enough in type 1 diabetes patients. They've acknowledged that those that don't have tight glycemic control are at risk of progression of more rapidly progressive disease. So, you know, we look forward to the opportunity if there is an ADCOM that we'll be able to share all of this with both the FDA and the medical community.
spk07: Yeah, great. Thanks, Greg. We feel very confident going into that ADCOM and look forward to presenting all of our and independent data at that time. I'll throw it to the second question, the second big bucket to Tom, the Chief Commercial Officer, which is really focusing on the commercial footprint for Zinqvista and particularly around Field Force. Tom, if you could take that question. Absolutely.
spk01: Thanks, Mike, and thanks for the question. I think, as you're well aware, we've spent significant amounts of time and effort really building a highly capable commercial infrastructure, and that crosses field sales, access, and going as deep as kind of patient support programs as well. I've taken some time since I joined the company as well just to make sure that we're focusing all of our efforts in the right place with eyes on Impefa, but kind of with knowing that Zygwister is probably going to be coming down the track at some point in the future as well. I think as you're very well aware, and Jeff mentioned this, this is going to be a somewhat more concentrated marketplace than what we see for heart failure. So we estimate that there's going to be between 3,000 to 4,000 endocrinologists who treat the lion's share of these patients. So given that existing infrastructure that we have in terms of commercial, and as you know, we have around 150 representatives in PEPFAR at the moment, our plan is that we're going to try and leverage that team as far as possible to to make sure that we can kind of really deliver on the value that we know we can unlock with Zynqvista very quickly, just given the unmet needs that I think are very clear here, while at the same time making sure that, you know, for MPEPA as well, we continue to support where needed as well.
spk04: Thanks, Tom. Thank you so much.
spk03: Thanks. The next question comes from Andrew Tsai with Jeffrey. Please go ahead.
spk10: Hey, thanks. Appreciate you taking my questions. Maybe just on the adcom, actually, going back to the adcom, would it be safe to presume that you're preparing for hypothetical voting decisions or questions around the risk-benefit as well as the risk mitigation strategy of Zinquista, or is there anything else you're specifically preparing for? And then secondly, do you think then, based on the comments so far today, that then Cuesta's launch could be stronger than what you're seeing with N-Pepha right now. Thanks.
spk07: Right. Same order.
spk06: I'll throw it to you first, Craig, then Tom. Thank you, Andrew. Again, we really feel strongly that based on all of the discussions that we've had with the FDA over this past number of months, that they really are going to focus on the risk-benefit. You know, I think what we've talked about is that, In this subgroup, which has much higher risk of progression to the complications of diabetes, that tight glycemic control was even more important. And the data has shown convincingly, both overall in the entire in tandem program, nearly 3,000 patients, but also in that renal subgroup, that you have similar and highly significant control of glycemia, whether on baseline insulin or optimized insulin therapy. and that that tight glycemic control will be associated with less progressive disease. And we've also shown and published that the risk of diabetic ketoacidosis seems to be similar in that subgroup of patients with underlying CKD than in the overall population. So we feel quite strongly that the primary questions that FDA will ask is about overall risk benefit. Great. Thanks, Craig. And Tom, to you.
spk01: Absolutely. Thanks for the question, Andrew. So as we think about Inquista for T1D versus MPEFA for heart failure, I mean, the first thing I would say is that this is going to be a very, very different space to what we encountered with heart failure. You know, as Mike mentioned during his remarks, this is going to be a space that's basically untapped. We know there is some small amount of off-label usage of SDLTs at the moment, but largely speaking, this is not a market that has really been brought to the fore. So we believe that given the unmet need, given the fact that we know we have a group of endocrinologists who have been kind of at the starting line of wanting to be able to use these products for quite some time, there is clearly untapped potential there that we think we're going to be able to capture very quickly. The other thing that I would point out to you that is going to be markedly different from heart failure is just the pair dynamics. The challenge that we faced within PEPFAR is the fact that heart failure is a tightly managed category and we are up against some very big competitors who have some very significant rebate dollars that they're paying. We're continuing to push very hard, but As we started the same dialogue with those pairs as it relates to zinc sequester, I can tell you that the feedback that we're already getting on the profile, on the potential utilization management, and how they view just the general management of this category, in particular for T1D patients, is going to look and feel very, very different to what we faced with heart failure. So I think yes is the answer to your question. We do see that this will potentially be a space where we can make a very meaningful impact pretty quickly, just given the concentrated market that we're going into.
spk07: Just if you allow me, Andrew, to just add to that, is that in fact, that's how we see the rest of the pipeline. I think as we go through this strategic review, I think we see that each of our assets offers this opportunity for a pipeline in a pill, which is multiple indications. And those indications are in spaces where Lyfers and Quista will be the first and only player, either as an adjunct or standalone therapy. And as you're aware, that provides, as Tom explained, very different payer dynamics, very different dynamics at the provider interaction. And so we feel very, very confident that Zynquista has the opportunity to be a very significant medicine for Lexicon. So thank you.
spk10: Right. Congratulations on executing on that front as well as everything else.
spk04: Thanks so much. As a reminder, if you have a question, please press star and 1 to enter the question queue.
spk03: The next question comes from Joe Pantginnis with HC Wainwright. Please go ahead.
spk00: Everybody, good afternoon. Thanks for taking the question. First, I wanted to focus on the HCM program. It's good the program's up and running. And I wanted to sort of talk about your views about the evolution of the space. So when you recently had your R&D day, you know, you positioned sodagliflozin sort of in between, you know, the beta blockers, et cetera, on the front end and the CMIs on the back end. And your current study you're going to be also including for the CMIs, but I guess, how do you envision sotogliflozin fitting in as of this point, since you can also include the CMI population?
spk07: Yeah, great question. I have it to you again, Craig.
spk06: Yeah, so, you know, again, I think they have different mechanisms of action that are complementary. And since we are enrolling patients that are symptomatic, they're symptomatic regardless of their underlying therapy. So whether they're on nothing or a beta blocker, calcium channel blocker, or a CMI or all combinations thereof, the inclusion criteria is those with a KCCQ score of less than 80. So we think that it provides the maximum flexibility to providers to manage the symptomatic relief in these patients, which is the key reason why patients with HCM present in general. and why they require treatment and the goal of treatment. And as a reminder, the other agents that are in development right now, particularly in non-obstructive disease, FDA has also allowed KCCQ as the primary endpoint, just like the endpoint, primary endpoint of the Sonata HCM trial.
spk00: That's very helpful. Thank you. And then, oh, sorry. Just curious about the potential timelines. I don't know if, you know, you're ready to think about that now since it's just started in disclosure. And the second question, maybe for Mike, you know, you mentioned in the prepared comments and in the press release and in one of your answers, you know, talking about strategy and resources and strategic review, obviously you're not prepared now to show your hand, but wanted to sort of get a sense of, you know, what potential outcomes or, you know, goals are you looking for as part of that?
spk07: Yep. No, fantastic. Craig, firstly for the timeline of HCM?
spk06: Yeah, I think we've shared in general some of the timelines previously. And again, as a reminder, we got this study up and running extraordinarily quickly. And we're really looking at having a final data towards the end of 2026, early 2027. So I think that's the timeline that we're looking at as a reminder. And as Jeff Wade showed in his slides, we really have a treatment duration that's quite quite a bit shorter because the drug has already been proven in a number of heart failure-related indications. So we're looking at a 26-week treatment duration, not a 52-week treatment duration, which will accelerate timelines quite a bit.
spk07: Great. And maybe, Joe, if you allow me just to pile on a little on to the first question because, yes, while we foresee Sotagliflozin potentially being adjunct to all indicated therapies for HCM. Clearly, there's a huge timeline gap between initiation of basal therapies, CCBs or beta blockers, through to CMIs just because of the complexity and the logistics that the centers face in initiating those later therapies. And where we have a demonstrated safety profile, an easy oral therapy, we see that it can form a place within that position in the treatment paradigm as the team has explained previously, but not exclusively so. And I think that gives us a unique position actually across the HCM. Now, I appreciate the question on the strategic review. We're well into it. I've started that with my team pretty much immediately when I started. and we're getting great insights as a part of that. What are we looking to achieve? It's overall a very simple equation, and that is we have a lot of opportunities, actually, more than what a company our size probably deserves or has, and yet we need to be very thoughtful at how we deploy our resources across those opportunities to maximize them all. because they're all fantastic medicines in unique indications. And so that's really the answer that we're searching for is across the sort of current therapies, across our pipeline therapies, you know, where do we place our resources and effort to maximize the return for the organization? And that's where we're at. And you're right, I'm not going to do it on my hand quite yet.
spk00: Absolutely. No, thank you very much for all the details.
spk04: No, I appreciate it. Thanks.
spk03: The next question comes from Rowena Ruiz with Lee Ring Partners. Please go ahead.
spk11: Great afternoon, everyone. So maybe continuing with questions about the Phase III Sonata trial in HCM, I was curious, what has the feedback been from trial sites and investigators so far as you're kicking it off? And could you remind us about what standards you plan to use to ensure tight execution of that trial as well?
spk06: Right. Another one for you, Craig. Yeah, Rowena, it's a great question. And, you know, the feedback, I have to say, has been really positive. We've identified all of the sites that we need for the trial. in a number of countries around the world. I think you've seen or can see on clintrials.gov that the trial activated around the end of June and that we're operating in a large number of countries. But the single largest contributor of sites will be the United States. And we really have a top notch group of HCM centers around the country that are participating. And I think the things I really like about the trial are many of the topics that Jeff already covered. is that it's a therapy that has very little friction to get patients on, can be used either alone or on top of existing therapies. It's oral once daily, has an ejection fraction down to 50%. You don't require all the echoes. It has a pragmatic and straightforward and relatively easy to administer endpoint of a KCCQ. You don't have all the CPET and all the other things. So the feedback on trial execution from a study site standpoint is, been very positive because it's a whole lot easier to include patients on. I think there's also a general expectation that there's this sort of understanding that, yeah, I think this drug is going to work. I mean, the most common thing I hear from investigators is, yeah, it makes sense. It's going to work. And especially because many of them in obstructive disease where they said, well, gee, you know, if you remove the obstruction, does that solve the problem? But when they think about it, Many of those patients in a few years are back with symptomatic disease again, and that's why we included both obstructive and non-obstructive as the underlying genetic default in pathophysiology between the two is far more similar than dissimilar. So that's really where including both obstructive and non-obstructive on top of or instead of other therapies with an EF down to 50% KCCQ score as the primary endpoint, a relatively shorter duration of therapy with an agent and class that they're familiar, I think really all stack up in a very favorable way.
spk07: Rana, you know, you talked about what controls or mechanisms do we have to see that it gets executed appropriately. I think, in fact, Craig and his team has shown their execution excellence in clinical trials with 9211. and have really been able to demonstrate in a study that obviously was coming from another study that had some issues. But here we're on track with recruitment and that's powering along. And the timeline that Craig and his team met to get Sonata up and running was incredibly tight. And so the ability to recruit the number of sites that they have ever since the protocol was finalized is pretty amazing. So we are running with this very, very fast and look forward to updating on progress in the near future.
spk11: Got it. And a quick follow-up for me. I wanted to ask about the obesity program as well. Could you just elaborate a bit more what excites you about LX9851 and how this product profile could layer into the treatment paradigm in the future? assuming that there could be more products approved by them and more combo regimens.
spk07: Yeah, absolutely. So I'll turn it over to Alan in the first instance to give a little bit of background on his baby. I mean, 9851. And so, Alan, why don't you take us through and then a couple of others may lay some other opinions on top.
spk08: Yeah, absolutely. Absolutely. You know, obviously, the weight management field is incredibly exciting. Treatment is evolving. But despite the success of the GLP-1 agonist, I think there's still some important questions. Cost and ease of use, reduction of lean body mass, and tolerability. And, you know, with LX9851, we think we're addressing all of those issues. You know, it's a small molecule. relatively easy to manufacture. It's an oral product. In our preclinical studies and our knockout studies, we've seen a very nice reduction of fat only with no change in lean body mass. And tolerability in our preclinical studies, so far we've never seen any evidence of diarrhea. And that includes our knockout mice. And if you think about it, the enzyme is inhibited 100% for their entire lives. And we haven't seen any diarrhea or anything like that in mice or any of the other preclinical species we've looked at. So we're very excited about this agent. It's a totally new mechanism that was discovered by our gene knockout work. To our knowledge, nobody else is working on this. And we think it really addresses a lot of the current issues in terms of treatment of weight management.
spk07: Maybe I'll ask Craig to just throw some comments from a clinical perspective, what he views within 9X51.
spk06: I think the other important point, and Alan touched on it, but just to put a finer point on it, this enzyme is expressed really in only two tissues. It's in the apical part of the GI tract, particularly the ileum, and in the liver. And I think all the effects that we're seeing is really related the weight management and this ileal break concept, which is really driven by the gut. And then also some of the data that Alan has previously shared, looking at favorable effects on lipid profile and progression of plaque in the coronary arteries of susceptible animals and also in liver fat overall, I think are indicative and reflective of the narrow distribution of the expression of this enzyme. So, you know, we're excited that it is a unique mechanism, but also one that's really tailored in the tissues where a lot of these disease processes are taking place.
spk07: Rohana, you can tell that we're excited by this asset because we all want to have a say, including myself. Just commercially, of course, we don't know where the obesity weight management, space will be in the years to come. However, I think it's reasonably easy to predict that there'll be combination therapies beyond the incretins. And as you know, a lot of the new medicines that are being developed are incretin-based, different formulations, et cetera. And other somewhat similar metabolic conditions have shown us that new mechanisms of action are always appreciated as combination therapies, diabetes being an obvious choice here. So we're pretty excited by it, and we're going to learn a lot more about the clinical development, a lot more about the biology over the coming years, and, yeah, look forward to continuing to update you all.
spk04: Yep, sounds good. Looking forward to more updates. Thanks. Thanks. The next question comes from . Please go ahead.
spk03: Hi, guys.
spk09: This is . Thanks for taking my questions. I just wanted to ask a follow-up on the last questions related to the obesity program. It sounds like on the safety front, you believe that this program might be differentiated on diarrhea. But I'm curious if you have any sense of what maybe the nausea profile might look like And to the same, a similar question on safety. You know, I think one of the things we're wondering about is that these obesity drugs seem to be, it may be necessary to dose very chronically for long periods of time. So, I'm curious how long in terms of duration of therapy you've explored in your, in these sort of preclinical models, especially on the safety side. Thanks.
spk07: Great. Yeah. Thanks very much. So, Alan, over to you for the question on nausea. and then duration of therapy, particularly from a safety perspective.
spk08: Sure, thank you. So nausea, as you probably know, that's rather difficult to look at in preclinical studies. But what I would say is, you know, it's important to note that the inhibition of this enzyme doesn't completely reduce the absorption of free fatty acids. What it does is it delays absorption so that it can go further down, the fatty acids can go further down in the GI and then trigger, you know, what Craig mentioned, the ileal break mechanism. So, you know, obviously, to really look at nausea, you would have to do, you know, we have to look to the studies in phase one. So far, I think most of our studies have been only about one month duration. And we'll be doing the IND-enabling tox studies, which will also be one month duration in two species. But we do have plans on the preclinical side, exactly as is suggested, to do studies of much longer duration for three and six months. Got it.
spk09: Thank you.
spk07: No, if you allow us also, you got to elaborate a little bit more. Some evidence beyond our group that might suggest that nausea is not an issue. Craig, maybe you want to talk a little bit about that.
spk06: Yeah, it's a great question. And the beautiful thing is we have the knockout mouse models and the tolerability and safety of those over the life of both the mice. But also there is more recently some limited human genetics data of knockdown and knockout variants. of ACSL-5, and those individuals seem to live a full and normal life without any issues. The only issues you see is very early in life, there is a modification of diet that is needed for the first couple weeks, but after that, these children seem to grow on and develop normally into normal adults. So, you know, I think we feel that both from the knockout side with the animals, and some of the human genetics that have been identified that we have something that is probably going to be able to be dosed for very, very long periods of time comfortably. And again, as Alan said, we need to do all the long-term toxin, the animals, and then the actual human clinical program with this particular inhibitor will need to be done. But I think we have a high degree of confidence based on what we know that they can be dosed safely for long periods of time.
spk09: That's super helpful. If I could ask one more quick one on the same topic. I'm just sort of thinking about how this mechanism, if this mechanism has applicability in areas outside of diabetes, but maybe in related areas. We know that GLP-1s are in diabetes as well, and I think more recently some of the larger players have even talked about heart failure. I'm just wondering if this mechanism has any relevance there as well for maybe obvious reasons. Thanks.
spk07: Yeah, the answer is yes. And I could turn to Alan, where we've actually shown data in a number of metabolic conditions, as you would assume, from reducing body weight and obesity. Some of it is incredibly exciting. And we're looking to present that data at medical conferences in the near future. So the short answer is yes, there's There's opportunity within lipidology, opportunity within other metabolic conditions as well. So looking very, very interesting mechanism here.
spk04: Got it. Thank you very much. Thanks a lot.
spk03: This concludes our question and answer session. I would like to turn the conference back over to management for any closing remarks.
spk07: I'd just like to thank you all for attending today's Q2 earnings call. We're incredibly pleased with the progress that has been made today. We've got a busy back half of the year and into 2025, but that provides us many, many opportunities that we're really looking forward to. So, look forward to continued dialogue, and we'll speak to you all soon.
spk04: The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.
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