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spk07: Hello and welcome to Miriam Pharmaceuticals' first quarter business update. My name is Harry and I'll be coordinating your call today. If you'd like to ask a question during the Q&A session, you may do so by pressing star followed by one on your telephone keypad. It is now my pleasure to hand you over to Ian Clements, Miriam's Chief Financial Officer, to begin. Mr. Clements, please go ahead.
spk05: Thanks, Harry, and good morning, everyone. I'd like to welcome you to Miriam Pharmaceuticals' first quarter 2022 conference call. I'm joined today by our President and CEO, Chris Peets, our Chief Operating Officer, Peter Radovich, and our Head of R&D, Pam Vick. Earlier this morning, Mirim issued a news release announcing the company's results for the first quarter of 2022. Copies of this news release and SEC filings can be found in the Investors section of our website. Before we begin, I'd like to remind you that during the course of this conference call, we will be making certain forward-looking statements about Mirim and our programs based on management's current expectations, including statements regarding Miriam's business plans, development programs, strategies, prospects, market opportunities, and financial forecasts and guidance. Miriam is under no duty to update these statements, and they are subject to numerous risks and uncertainties, and actual results could differ materially from the results anticipated by these statements. Investors should read the risk factors set forth in MIRM's 10-K for the year ended December 31st, 2021, and any subsequent reports filed with the SEC. With all of that said, I'd like to turn the call over to Chris Peaks. Chris?
spk03: Thanks, Ian. And good morning, everyone. The first quarter of 2022 was another strong one for MIRM. In the first quarter, we achieved nearly $13 million of revenue. including nearly $11 million in net sales of Live Marley, a testament to our team's expertise and execution. The exciting pace of building value has existed at Miriam since inception, and we expect it to continue in the years ahead. We'll keep our call brief today with a quick launch and business update, and then take questions. First, for the context of the launch, I'll remind you of the heavy burden of disease and pruritus and algeal syndrome. and the tremendous impact of Livmarly seen in our clinical program. Our launch has been informed by broad clinical experience spanning many years showing durable improvements in pruritus. More recent data have evaluated the long-term impact of Livmarly, suggesting potential improvement in event-free survival over time in allogeal syndrome. The success of our launch has been underpinned by the urgency we see to bring Livmarly to patients. The importance of Live Marley to this community is evident in our commercial launch achievement in the first quarter, namely net product revenue of $10.9 million, continuing to show the progress of our commercial efforts. Our first quarter performance gives us confidence in continued growth throughout the year. And the Live Marley opportunity for cholestatic pruritus and algeal syndrome is only the beginning of what's possible for Miriam. The foundation of our pipeline and Miriam's success is innovative research for rare disease to bring new medicines to patients as quickly as possible. As we continue to execute against the greater than $500 million U.S. market opportunity in Al-Jil syndrome, we are progressing our five other late-stage Litmarli and Belixibat clinical programs, which will generate multiple data readouts over the next two years. While in parallel, we are progressing expansion in global markets of Live Marley for Allergy Syndrome. Now, with that, I'll turn it over to Peter, who will provide an update on our Live Marley launch progress.
spk12: Peter? Thanks, Chris. We are proud of Live Marley's launch success and its role as the first and only FDA-approved medication for pruritus and Allergy Syndrome. Today, I'll share further color about our 10.9 million net Live Marley revenue. what we're seeing in the commercial business, and why we're so excited about the growth trajectory. Before I get into the details of the quarter, I think it's important to note that there is no inventory in our reported product sales. Thus, the revenue number here is a true representation of demand. Now, taking a closer look at the first quarter, revenue was driven by strong demand dynamics, consistent refill cadence, and both broader and earlier than expected support from payers. On this point, in the first quarter, approximately 75% of dispenses were reimbursed. And we expect that rate in Q2 and beyond to be 90% or higher. Regarding payer mix, we continue to see approximately 50% Medicaid and 50% commercial at this stage of the launch. And we have heard very positive feedback on treatment benefits from clinicians and families, observing impressive treatment compliance in the commercial setting. In fact, we are seeing similar compliance from what we saw in our clinical trials in the real-world setting, a testament to the importance of this medicine for patients and families. On adoption dynamics, we are pleased that the majority of our targeted key accounts have prescribed Livmarlin. Further, we have seen that some patients residing in outlying areas often don't travel to a major center in a metropolitan area, and instead receive care from a community-based pediatric GI or liver doctor. Accordingly, we've added a few sales territories to ensure our team can adequately reach patients. Turning to our plans for Live Marley's international launches, The MIRA international team and our partners are preparing for launch following anticipated approval in Europe later this year. Our team is initiating early access programs now while ensuring readiness for launch in key European countries. Further, our seven commercialization partners outside Western Europe are matching our dedication to introduce the Marley to patients around the world with potential approvals starting early next year in each year. And now I'll hand it over to Pam to provide an update on our pipeline. Pam?
spk09: Thanks, Peter. In the first quarter of 2022, our team has been focused on laying the groundwork for our important upcoming milestones for this year and beyond. Most notably, we expect top-line data from our March PFIC Phase III clinical trial in the fourth quarter. As a reminder, the March PFIC study now fully enrolls includes multiple PFIC subtypes at higher doses than the Phase II indigo study, which was the basis for breakthrough therapy designation. And the MARCH study is the largest randomized Phase III clinical trial ever conducted in PFIC, with more than 90 patients enrolled. Moving to the rest of our pipeline, we have four additional indications under evaluation in cholestasis. By year-end 2022, we're expecting two interim analyses from our Belixibab programs. The first interim analysis will be from our Phase IIb VISTA study evaluating bilixibat in patients with primary sclerosin cholangitis. And the second will be open label data from our Phase IIb OHANA study for patients with intrahepatic cholestasis of pregnancy. And in 2023, we're targeting interim data from our Phase IIb VANTAGE study evaluating bilixibat in patients with primary biliary cholangitis. In addition, we're expecting primary data from our Phase IIb EMBARQ study evaluating Livmarly for children with biliary atresia. Now, Merrim prides itself on its innovative research and for being recognized in well-respected peer-reviewed journals. And with that, I'm very excited to share that our PFIC Indigo Phase II data had been published in Hepatology Communications just yesterday. The authors found that Merrilixibet led to rapid and sustained reductions in serum bile acid levels in patients with non-truncating PFIC II, leading to five-year transplant-free survival. as well as reductions in pruritus and meaningful improvements in growth and quality of life. They further concluded that Mariluxibab appears to be a realistic and effective treatment strategy which benefited the lives of patients and caregivers by relieving disease symptoms, increasing transplant-based survival, and providing a well-tolerated, non-surgical alternative. We're excited about the potential to confirm and hopefully improve upon these results in our March PFIC Phase III readout later this year. In addition, the European Medical Journal also published our recent presentations from ASLV and NASP again. So all in all, we are very excited for what's to come as we build upon the incredible success of Liv Marley, a cholestatic pruritus in patients with algea syndrome one year of age and older. And we will keep you all updated on our progress across the various additional programs and data readouts. And on that note, I will turn the call over to Ian. Ian?
spk05: Thanks, Pram. The press release filed earlier today and the 10Q to be filed later today provide a full financial update. I'll call out a few of the highlights here. Total revenue for the quarter is $12.9 million, including $10.9 million of net product revenue from Viv Marley sales and $2 million in licensing revenue from our partner, Cambridge, in China. Our total operating expenses for the quarter were $45.6 million, which includes research and development expenses of $24.1 million, and SG&A expenses of $19.1 million, and cost of sales of $2.4 million. Mirren remains well-funded, and at the close of the first quarter ended March 31, 2022, we had cash, cash equivalents, and investments of $239.9 million. With that, I'll turn the call back over to Chris for any final comments. Chris?
spk03: Thanks, Ian, and thanks, everyone, for joining today. To close, Miriam continues to make remarkable progress. The nearly $13 million in revenue we achieved this quarter speaks to not only our team's dedication to ensure this medicine is in the hands of patients, but also to Liv Marley's impressive safety and efficacy profile and ability to fill an urgent unmet medical need. We look forward to continuing on this trajectory in the months and years ahead as we both build on this initial launch with Marley and advance the balance of our pipeline to develop meaningful therapies for communities living with rare disease. Operator, please open the line for questions.
spk07: Thank you. Just as a reminder, if you'd like to ask a question today, please use star followed by one on your telephone keypad now. And our first question is from Jessica Fry of JP Morgan. Jessica, your line is now open. Please proceed.
spk08: Hey, guys. Thanks for taking our questions. This is Nick on for Jess. So first question from us. With revenue of $10.9 million, it seems strong and well below the $8 million floor that you gave last quarter. Can you just talk a little bit about what drove that and the dynamics behind it and how you're thinking about the remaining quarters leading up to the at least $50 million guide for the full year 2022 and maybe how those how that revenue should be distributed?
spk03: Yeah, thanks for the question. I can speak to kind of the full year and kind of guidance question, and I'll pass it over to Peter to talk about the dynamics underneath that. And just to speak to the full year with the at least 50 million number that we spoke about previously, that was provided as a floor, not necessarily a guidance point. And so what we see today, looking forward for the full year, is that we're comfortably above that number as where we expect the year to land. So I wouldn't look at that as a guidance number and feeling like we're tracking to be certainly above it. And I'll let Peter speak to kind of what drove the demand in the quarter and some of the dynamics out in the field.
spk12: Yeah, sure. In terms of the Q1 performance, I think we saw really strong demand dynamics as well as refuel dynamics. as I mentioned in the prepared comments. Also, from the payer perspective, our team has kind of executed really well, and now we're expecting going forward that 90% of our prescriptions will be reimbursed, and that kind of came in a little faster than other rare launches that we've looked at, which is what informed our expectations for the prior thoughts.
spk08: Great. And maybe just one quick follow up on that 90% drug reimbursed by year 22. Where do you currently stand now? And should we expect you to achieve that 90% in Q4? Or could we potentially see that leading maybe before that in Q3?
spk12: We think Q2 and going forward would be the expectation for the 90%.
spk08: Great. Thanks so much for taking our questions.
spk12: Thanks.
spk07: Thank you, Nick. And our next question is from Mani Saurah from SVB. Mani, your line is now open if you'd like to proceed with your question.
spk02: Hey, good morning. This is Rick on the call from Mani. Congrats on the quarter, and thanks for taking our questions. So we're just looking for some additional color on the Live Marley launch. I guess first, as far as the expanded access patients in the U.S. goes, have those patients really been transitioned to commercial product at this point, or is that still an ongoing process?
spk03: Yeah, thanks for the question. So the expanded access and, you know, clinical study patients, the conversion was pretty rapid, actually. So we saw them convert over to commercial drug in the fourth quarter. so that first launch quarter.
spk02: Okay, got it. I guess also thinking about later this year with the potential launch in Europe, could you just maybe discuss a little bit how you see the timeline to reimbursement across the EU and maybe some of the target countries for the initial launch there?
spk12: Sure. You know, at a high level, following email from Google, you know, The first country we'll launch in is Germany, where shortly after launch, we'd have the opportunity to launch. And then I think variable timelines, our focus has been primarily Western European countries. Italy, hopefully UK as well.
spk03: Yeah, and I'd add on that, in addition to those kind of Miriam territories where we're going to be the folks on the ground actually launching the product through some of our partner and distributor markets, we'll see, expect to see approvals kind of starting early next year leading to launches in some of those partner markets.
spk13: Okay, fantastic. One more question from us, I guess, is
spk02: Also thinking through, you know, potential company updates for the rest of the year, could we potentially see any guidance revisions as you get more color on the Marley launch across the year? Or do you think you're currently happy with the floor guidance and don't see that being updated for the rest of the year?
spk03: Yeah, at this point, you know, we're not providing, continuing to not provide point guidance, but just to reiterate, you know, very comfortable that we are above that number. So I would not look at that $50 million as a guidance number at all, frankly. And so we're still early in the launch, and things continue to track well. We do expect quarter-over-quarter growth throughout the year. And as we get closer to year-end, we'll evaluate whether we provide a formal guidance when we get closer.
spk13: Great. Thank you so much for taking our questions. Thank you.
spk07: Thank you. And our next question is from the line of Josh Shimmer of Evercore. Josh, your line is now open. Please proceed.
spk06: Great. Thanks for taking the questions. So you emphasized growth throughout the year. To what extent is that, do you expect that to be driven by additional patients in the U.S. compared to contribution from other territories? And you're on a fairly torrid growth trajectory thus far in terms of addressing the eligible unmet medical need. How long do you think you're going to be able to sustain this type of growth?
spk03: Thanks for the question, Josh. Looking at the dynamics and as we look at the growth for this year, we're seeing it largely driven by the U.S. So XUS contributions will be very modest in the calendar year. We do expect some of it to come online, but as we talk about our growth expectations and that full year number, we're looking primarily at the U.S. And maybe I'll let Peter chime in a little bit on kind of what the dynamics in that over the year will be. Yeah. Yeah.
spk12: And I think within the U.S., you know, we're really pleased with where we're at today in terms of adoption, you know, tracking ahead of, you know, comparable rare launches that we look at. But, you know, still see, you know, more addressable LGL patients that haven't received with Marley than those who have. Kind of the typical pattern we see is our accounts may be prescribed with mildly or more severely affected algeolas in our patients, kind of gain experience, gain comfort, and then broaden. So we expect to see, you know, kind of those dynamics continue to play out throughout 2022. Great.
spk06: And then R&D spend has ticked down nicely over the past couple of quarters. How should we think about that line going forward?
spk05: Yeah, so from an R&D spend perspective, I think that one would anticipate fairly flat, I think, is the way that I'd look at it. We're not giving kind of formal guidance on that OPEX for the year. But clearly, as we look at some of the studies that are kind of coming off, other studies are starting to ramp up. So you see some of the, for example, the March PFIC study kind of as we come towards the end of that, that'll wind down a little bit. But conversely, obviously, we look at the ramp up under the Lixabat studies to replace the expenses there. So I'd characterize it as kind of flat from that perspective.
spk06: Great. Thanks for the color. Next question.
spk07: Thank you. Our next question is from Yasneem Rahimi from Piper Sandler. Yasneem, your line is now open. Please proceed.
spk01: Good morning, team, and congrats on a great quarter. Two questions for you. Maybe the first one would be, you know, there's a competitor product that's going to read out in phase three, and I would love to, in the fourth quarter, what activities are going to be put in place, you know, sort of into the second half of the year to really, you know, ensure that, you know, positions continue to build strong brand awareness with Love Marley and and continue to really keep their patients on this product and not be enticed to switch over. That's one. And then the second question is on the Advantage study that's going to read out. So the interim analysis is – oh, sorry, the VISTA study. That's what I meant to ask. In the VISTA study, can you kind of give us a little bit of color of like what the interim – cut off or that would qualify the Phase IIb to then transition into like a Phase III? And what type of information you would be sharing with us? And thank you again for taking my questions.
spk03: Great. Thanks, Yaz. And to speak to the first one, then I'll pass it over to Pam to speak to VISTAs. I was looking at the impact of Live Marley Analogical Syndrome and the data we have there, that's really the focus of what we're doing this year is making sure we roll out and get access for as many patients as possible as urgently as we can and get some of the data that we've generated from Live Marley Analogical Syndrome published. Pam mentioned the journal article that highlighted some of the long-term event-free survival data. Building awareness of that and showing what has been so exciting from the clinical program more broadly all plays into how we see the year playing out. I'll let Pam speak to VISTAs.
spk09: Yeah, thanks, Yaz, for the question. So just at a high level, for the list of programs altogether, we're really excited about these studies and the opportunity that it presents across these cholestatic indications. And particularly for the VISTA study, to answer your question, we're currently enrolling and expecting to complete a blinded interim analysis this year. And this interim is blinded, so we won't be reporting out any data. And we need to keep it blinded so that we can retain those patients to use them in the part two registrational portion of the study. And what we plan to learn from that interim is we'll be making a dose selection, so that data will inform for dose selection, as well as determine sample size for the second portion of the study, so determining if they need to upsize the trial or not. And then we'll feed that into the potentially registration portion of the study, so we'll keep you updated when we get to that portion of the study.
spk03: And I think just to kind of reiterate and recap the point on the VISTA study design, And we discussed it with FDA and incorporated all their feedback for this to be the pivotal study once it moves into the second part, so part two.
spk01: Team, just to clarify, so let's say the announcement comes and says you don't need to increase the sample size and you're going to go with, let's say, the highest dose. And does that mean that the committee that looked at the data saw really quite remarkable improvements in pruritus that gave them the confidence that it has a high statistical powering TOS to hit by transitioning into a pivotal study. I guess what I'm trying to get at is how strongly confident can we be on that announcement that the efficacy was really astonishingly strong and predictability of the phase three?
spk03: Yeah, you're thinking about it the right way. So there's a pre-specified threshold that does mean that if the results remain blinded, there's an effect in there. And so that's exactly how we designed the study. And if that's not the case, we'll have an open analysis and share the findings with you.
spk01: Got it. Thank you so much.
spk07: Thank you, Yasneem. And our next question is from the line of Ed Hark of HC Wainwright. Ed, your line is now open. Please proceed.
spk11: Great. Thanks for taking my questions. And congratulations on an impressive quarter. First, I wanted to ask about what you're seeing. I know you've spoken about, in terms of the commercial progress early in this launch, on several aspects, including on the payer side. But I'm wondering if you could speak about the dynamic between the physicians and patients and sort of the push and pull there that is also underlying the strong demand that you're seeing. And I guess in a related question, some companies have been reporting impact from the Omicron wave this quarter, especially in January, February. Any thoughts or commentary around that as well? And I have a follow-up. Thanks. Yeah, thanks, Ed.
spk12: I'll ask Peter to speak to that. Yeah, thanks for the questions, Ed. So, yeah, I think the, you know, the dynamic between physicians and patients, the pruritus and allergy L syndrome is really debilitating and I think it's recognized as one of the major needs in the management of these patients. So I think, as I mentioned, what we see is, particularly physicians that weren't part of the clinical program, they want to get familiar with the Marley. So they'll trial it on a couple of their more severely affected patients and just gain comfort with this new medicine and then broaden over time. The Omicron wave is a really good point. I think now that we're past that, we are kind of back in person in most of the country. But I think COVID, and especially the staffing issues in a lot of these clinics that have kind of come up around the pandemic, have been a pretty big challenge for a lot of new product launches. A lot of patients haven't seen their hepatologist in a couple years. their scheduling and logistical backlogs to get them in to clinic and be seen, which is generally when clinicians would look to start a new chronic medication. So I think, you know, there have been challenges there for us, but I mean, obviously, despite those challenges, you know, the performance has been, you know, very, very strong. And I think that's, you know, another thing is those issues kind of work out, work themselves out and come out of the pandemic, I think there's reason that we could see continued growth as those dynamics work out.
spk11: That's great. Thank you. And then I just wanted to ask sort of as you continue to build on this commercial platform that is growing quite rapidly and with the additional live Marley indications, obviously, strongly overlapping in terms of call points and just thinking about how you could leverage what you're building now for future indications and thinking about how you can, you know, how would you communicate the efficiencies there that you could gain in future indications? Thanks.
spk03: Thank you. I had a couple points to make on that. First, within Liv Marley, you're spot on that there's 100% call point overlap between the indications. In particular, allogel syndrome probably is the broader call point of the three, just given the dynamic of the indication and number of patients out there. So that sets us up well to have a highly leveraged organization here as we launch the additional with Marley indications eventually, and then expand into adult pathology. I'd say already the commercial business is highly performing. In the first quarter, if you just look at the net revenue and commercial expenses, we're already breakeven as a commercial organization. So see this as a really attractive business model as we go and push further into the LGO launch and add the additional indications.
spk11: Great. Thanks so much, and congrats again.
spk07: Thanks, Ed. Thank you. Before we take our next question, just as a reminder, if you would like to ask a question, please press star followed by 1 on your telephone keypad. And our next question is from Brian Scorney of Baird. Brian, your line is now open. Please proceed.
spk04: Hey, good morning, everyone. Really impressive launch. But it would really be great to get any sort of qualitative insight into sort of the penetration of the identified ALGS market so far in the U.S. It's obviously off to a quick start, but I guess from the field, can you give any sort of thoughts on what the penetration is looking like into sort of a low-hanging fruit of patients who are in a sort of warehouse or have prior experience with Mariluxabat and in and under care versus kind of when would we expect to get to a point where you're looking at pulling in patients who maybe are not under active care, identifying patients not in the system yet. Thanks. Thanks, Brian.
spk03: Just from a broadly speaking, it's been a great fast start, but we do see opportunity and more patients to go deeper here. So we are still early in the launch. Maybe I'll ask Peter to speak to some of the things we're doing to kind of expand and kind of go further into the launch.
spk12: Yeah, sure. And one comment also, I think algeal syndrome has a very high diagnosis rate. So I think the vast majority of patients out there who have the disease are identified in the system. And we have noticed that some patients, for example, choose not to travel to a major metropolitan area, and they prefer to get management from their local pediatric GI doctor. There's still not that many pediatric GI docs in the country. So that's kind of one area we've been able to expand. But I think the take-home point is, as Chris mentioned, there's still more addressable patients that haven't received the Marley that have. So we do, you know, foresee continued growth.
spk04: Great. And then maybe if I could ask another question on the March PFIX study. I think you're dosing at 570 micrograms per kilogram BID. versus the Livmarly label, which is a 380 QD, but titrated up from 190. So just wanted to see, could you give us a reminder of the clinical experience that you have at this dose to date, and any thoughts on sort of this higher level of dosing and expectations for how much this could further impact bile acid reductions and pruritus here? And given the Livmarly pricing, if it is on the same level, Milligram bases would seem like a pretty substantial step up. Would you be able to offer two brands with differential pricing?
spk03: Thanks Thanks Brian on the pricing front and we're still it's too early to kind of talk about a pricing strategy and we'll Finalize that as we get to the potential label expansion bus Pam to speak to some of the clinical questions Yeah, thanks.
spk09: Thanks for the question. So We're really excited about this. We're, first of all, very excited about our recent publication yesterday on the indigo study. And at that dose, as you mentioned, which we started with a lower dose of 280 micrograms per kilogram per day. And when we doubled that dose in that phase two study, we saw a greater proportion of patients then having a response, driving more bile acids out of the body with higher doses. So we think that by going even higher than that, which is doubling that double of the dose in this phase three study, that we're hopeful that we can even drive greater bile acids out of the hepatocytes and the systemic circulation. I'm hoping that translates to greater response rates in the non-truncating PFIC2 population, and we're looking forward to see how that translates into all of the other subtypes in the 90 patients that we enrolled in this study.
spk04: Great. Thank you for taking my question.
spk05: Thank you.
spk07: Thank you. And our final question is from the line of Steve Seedhouse of Raymond James. Steve, your line is now open. Please.
spk10: Good morning. This is Ryan Deshner. I'm for Steve. I'm just wondering if you guys are still actively seeking collaborators to potentially help candidates with alternative mechanisms like your past relationship with VIVIT to broadly address PFIC, additional PFIC genetic subtypes.
spk03: Thanks, Ryan. Overall, we do have what I'd say is an active corporate development effort. And the overall objective here is to continue to grow Mirum and really grow in a way that is back to the roots of how the company started, finding underappreciated programs that need the attention to bring them to patients. So we look at opportunities kind of broadly across pediatric rare disease and orphan liver. That's it with the team here, the expertise that we have in-house from a development regulatory standpoint, and then also the commercial team that has broad experience across rare and liver disease. So still active and looking broader than the current indications that we have. Excellent.
spk10: Thank you very much.
spk07: Thank you. And we have no further questions at this time. So my pleasure to hand back to Chris Peets for any closing remarks.
spk03: Great. Thank you, operator. And thanks, everyone, for joining us. Thanks for your continued support of Miriam. We look forward to sharing our progress with you next quarter. Goodbye.
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