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spk03: Good afternoon and welcome to the Region X BIO fourth quarter and full year 2020 earnings conference call. At this time, all participants are in a listen-only mode. Later, we will conduct a question and answer session and instructions will be given at the time. As a reminder, this conference call is being recorded. I would now like to turn the call over to Mr. Patrick Christmas, Chief Legal Officer for Region X BIO. You may begin.
spk07: Good afternoon, and thank you for joining us today. With us are Ken Mills, Regenexx Bio's President and Chief Executive Officer, Dr. Steve Piccola, our Chief Medical Officer, Dr. Olivier Danos, our Chief Scientific Officer, and Vit Basista, our Chief Financial Officer. Earlier this afternoon, Regenexx Bio released financial and operating results for the fourth quarter and full year ended December 31, 2020. The press release reporting our financial results is available on our website at www.regenixbio.com. Today's conference call will include forward-looking statements regarding our financial outlook in addition to regulatory and product development plans. These forward-looking statements are subject to risks and uncertainties that may cause actual results to differ from those forecasted. and can be identified by words such as expect, plan, will, may, anticipate, believe, should, intend, and other words of similar meaning. Any such forward-looking statements are not guarantees of future performance and involve certain risks and uncertainties. These risks are described in the risk factors and the management's discussion and analysis sections of Regenexx Bio's annual report on Form 10-K for the full year ended December 31, 2020, and comparable risk factor sections of Regenexx BIOS quarterly reports on Form 10Q, which are on file with the Securities and Exchange Commission and available on the SDGs website. Any information we provide on this conference call is provided only as of the date of this call, March 1, 2021, and we undertake no obligation to update any forward-looking statements we may make on this call on account of new information, future events, or otherwise. Please be advised that today's call is being recorded and webcast. In addition, any unaudited or pro forma financial information that may be provided is preliminary and does not purport to project financial positions or operating results of the company. Actual results may differ materially. I would now like to turn the call over to Ken Mills. Ken?
spk01: Thank you, Patrick. Good afternoon, everyone, and thanks for joining us. I hope that everyone is staying safe and healthy. Thank you. On today's conference call, we will provide a recap of our recent progress, advancing and expanding our NAV technology platform, and discuss expected future milestones for the company. Steve and Olivier join us to discuss our pipeline, and VIT will provide an update on financial results for the fourth quarter and the full year 2020. We'll then open up the call for questions. Throughout 2020 and already in 2021, I believe we're making great strides towards achieving our goal of realizing the curative potential of gene therapy. We have advanced and broadened our internal pipeline of programs in several important ways. I'll touch on just a few pipeline highlights before turning the call over to the team. Starting our first pivotal program is an important and exciting milestone that we're proud to achieve. This program is to evaluate our gene therapy candidate for wet age-related macular degeneration, a retinal disease that is a leading cause of total and partial vision loss, affecting more than 2 million people in the United States. Our treatment, called RGX314, is a novel one-time gene therapy that is designed to work by delivering therapeutic genes to the retina of a patient in order to interrupt pathway of the disease. The subretinal delivery technique that we are using in our Pivotal program is an established and targeted route of delivery for gene therapy for retinal disease. The Pivotal program builds on data that we have seen from our ongoing Phase 1-2 study, where we have observed that RGX314 has been generally well tolerated, and durable effects of the one-time gene therapy are now out to three years after dosing patients in the trial. In 2020, we also initiated new clinical trials evaluating RGX314 using a different delivery approach. These trials are the first to evaluate the delivery of any gene therapy to the suprachoroidal space of the eye. This form of delivery is a non-surgical approach that can be administered in an office setting and potentially allow for targeted delivery to the retina. Overall, our RGX314 programs are evaluating these two routes of administration because we believe we can provide these one-time treatments to the largest population of patients with wet AMD and diseases of similar origins like diabetic retinopathy by providing access to gene therapy in all settings of care. Our RGX121 candidate is being studied as a single administration treatment for neurodegeneration associated with Hunter syndrome. This treatment is designed to work by delivering a new gene to a patient's cells in the brain and central nervous system RGX121 is administered directly into the cerebrospinal fluid. We've shown evidence of consistent biomarker reductions and continued neurocognitive development from patients in the RGX121 trial. And we're also encouraged by new data providing evidence that after treatment is delivered to the cerebrospinal fluid, it may be able to address disease in patients in other parts of their body. This includes data from patients who were never treated with the standard of care enzyme replacement therapy prior to enrolling in our trial. And this is exciting to us because we know that Hunter syndrome is a disease that affects nearly every organ. We also recently announced development of RGX202, a potential single administration gene therapy for the treatment of Duchenne muscular dystrophy. Olivier has been spearheading the development of this program, which is based on a novel advanced microdystrophin construct. He'll provide further details, but we're excited to bring this program forward this year. In addition to our pipeline progress and potential, we're well capitalized with the resources to achieve our next planned program milestones. We have completed two recent transactions that have added over $400 million to our balance sheet, and this enables us to continue to advance our programs as well as support investment in our commercial-ready manufacturing platform and the build-out of our own manufacturing facility. Finally, before turning it over to the team, I want to take a moment to acknowledge what's going on in the wonderful background worldwide events that have taken place and messages that have emerged in support of Rare Disease Day, observed yesterday, February 28th, and celebrated across many days recently. On February 26th, last Friday, Regenexx Bio hosted an event that allowed our teams a special opportunity to hear directly from families, caregivers, and advocates in order to continue to enhance our awareness of the needs of those living with rare diseases. Overall, I wish to express my sincere appreciation, especially this year, from me and the Regenexx Bio leadership team to our dedicated employees, clinical investigators, partners, and most importantly, patient communities, for their unwavering support as we work hard to advance our mission. With that, I'll turn the call over to Steve for a more detailed update on the active clinical programs.
spk06: Thanks, Ken. I'll begin with our pivotal program, RGX314, for the treatment of wet AMD, which we announced in January. Our end-of-phase two meeting with the FDA was primarily focused on establishing the pivotal program design, which we believe will support a potential BLA filing in 2024. The Pivotal Program is expected to include two randomized, well-controlled clinical trials to evaluate the efficacy and safety of RGX314, and we expect to enroll approximately 700 patients in total. We have already begun enrolling patients in the first trial, named Atmosphere, for RGX314 using subretinal administration. The key design elements of the trial were informed by data from our Phase I-II-A dose escalation trial of RGX314. Atmosphere is expected to enroll approximately 300 patients across two RGX314 dose arms versus ranibizumab, and will evaluate non-inferiority to ranibizumab based on change from baseline and best corrected visual acuity at one year. We intend to initiate our second Pivotal trial in the second half of 2021, which is expected to be designed similarly to the atmosphere. In addition, we believe we have a clear path to support our CGMP commercial-ready manufacturing plans in the Pivotal program. We have initiated the Pivotal program using CGMP material produced from our existing manufacturing process. And we plan to incorporate our scalable suspension cell culture manufacturing process to support future commercialization upon completion of a bridging study and the pivotal trials. The bridging study is expected to initiate in the first half of 2021. We recently presented additional long-term data from our Phase I-II trial of RGX314 for the treatment of wet AMD and the long-term follow-up study. As we reported earlier this month, RGX314 continued to be generally well-tolerated across all dose cohorts, and patients have continued to demonstrate durable treatment effects up to three years after one-time dosing of RGX314. We are very encouraged by the durability of treatment effects seen in patients dosed with RGX314, including stable vision, and reductions in anti-VEGF injections, which are meaningful endpoints for patients and the clinical management of their disease. Additionally, in January, we announced the completion of enrollment of cohort one in AV8, the phase two trial evaluating suprachoroidal delivery of RGX314 using the SCS microinjector system. for the treatment of wet AMD. We plan to report interim data from cohort one of AB8 in the third quarter of 2021. Cohort two is now enrolling patients, and we remain on track to complete enrollment in the second quarter of 2021. Altitude, our phase two trial to evaluate RGX314 in patients with diabetic retinopathy, is enrolling patients, and we expect to report initial data from this trial in 2021. In our rare disease portfolio, we are pleased with the continued progress and recent expansion of our portfolio of gene therapies targeting rare genetic diseases and look forward to further advancement in 2021. We recently presented encouraging positive interim data at the 17th Annual World Symposium from cohorts one and two of our ongoing Phase 1-2 trial of RGX121 for the treatment of patients with MPS II or Hunter syndrome. As reported in February, RGX121 was well-tolerated in eight patients dosed. Biomarkers in the CNS indicated encouraging signals of I2S enzyme activity following one-time administration of RGX121 and patients demonstrated continued neurocognitive development up to two years after dosing. Patients also demonstrated evidence of I2S enzyme activity in plasma and urine following administration of RGX121. Notably, two patients who were naive to enzyme replacement therapy showed rapid reductions in urine total GAG levels following RGX121 administration. One of these patients had significant reductions in liver and spleen volumes. We plan to evaluate a higher dose of RGX121 in cohort three and expect to begin enrolling patients in this cohort in the first quarter of 2021. We also previously announced plans to expand our RGX121 program to include a second phase 1-2 trial to evaluate RGX121 in pediatric patients with severe MPS2 over the age of five years old. This trial is expected to begin dosing patients in the first half of 2021. In addition, enrollment has begun in our Phase 1-2 trial of RGX111 for the treatment of MPS1. Our other rare disease programs continue to advance towards the clinic. We plan to submit an IND for the intrasternal delivery of RGX181 for the treatment of CLN2 disease in the first quarter of 2021. We also expect to submit an IND or foreign equivalent for a phase 1-2 trial of RGX381 for the treatment of ocular manifestations of CLN2 disease in the first half of 2021. With that, I will turn the call over to Olivier, who will discuss our recently announced RGX202 program for the treatment of DMD. Olivier?
spk09: Thank you, Steve. In January of 2021, we announced the development of RGX202, a one-time gene therapy for the treatment of Duchenne muscular dystrophy, or DMD. DMD is caused by mutations in the DMD gene, which encodes for dystrophin, a protein involved in muscle cell structure and signaling proteins. Without this protein, muscle degenerates and becomes weak, eventually leading to loss of movement and independence, required support for breathing, cardiomyopathy, and premature death. I've been working in this field for many years, and I'm really proud of the work here at Regenexx BIO in pursuit of this program. Our design is based on innovative vector engineering by Regenexx BIO scientists, and it incorporates learning from the laboratory of George Dickson from the University of London, a pioneering figure in dystrophin research. RGX202 is designed to deliver a novel microdystrophin transgene equipped with an extended coding region of the C-terminal domain found in naturally occurring dystrophin, which we believe can bolster key cell signaling pathways and muscle membrane integrity, leading to improved muscle strength and resistance in patients with DMD. RGX202 is the only known construct in development to include this C-terminal domain. RGX202 also has other fundamental improvements, including colon optimization and reduction of CPG content, which have the potential to improve gene expression, increase translational efficiency, and reduce immunogenicity. RGX202 uses our NAVAAV8 vector, which has been used in numerous clinical trials. and a well-characterized muscle-specific promoter to support the delivery and targeted expression of genes through skeletal muscle, skeletal and heart muscle. Proof-of-concept data from clinical studies of RGX202 in the mouse model of DND demonstrate robust microdystrophin expression in muscle, recruitment of key proteins to the muscle cells, improvement of muscle histology, and meaningful increases in muscle strength and function. Using our suspension cell culture manufacturing process, we have already produced commercial-scale CGMP material at a 1,000-liter capacity, and we plan to use that material in the clinical development of RGX202. We are currently completing IND labeling studies and expect to submit an IND to the FDA in mid-2021. With that, I will turn the call back over to Ken. Ken?
spk05: Thanks, Olivier and Steve, for your updates about
spk01: the clinical programs, and the emergence of our new program for Duchenne muscular dystrophy. I wanted to add to Olivier's summary, just to extend that the construction of our new corporate research and CGMP facility here in Rockville, Maryland, continues as planned. We expect to move into our new offices in the coming months, and the new production facility is expected to be fully operational next year. This CGMP facility is expected to allow for production of NAV vectors at scales up to 2,000 liters using our platform suspension cell culture process. We set out to develop a facility that would deliver high-quality NAV vectors at a scale to match clinical and commercial demands of our entire pipeline, and it's exciting to see the construction progress so far. With that, I'm going to turn the call over to Vit for a review of our financials.
spk00: Thank you, Ken. Regenexx Bio ended the year on December 31st, 2020, with cash, cash equivalents, and marketable securities totaling $522.5 million, compared to $400 million as of December 31st, 2019. The increase was primarily attributable to gross proceeds of $200 million received from the monetization of our Zulgenzima royalty rights It was partially offset by net cash used in operating activities and the purchase of property and equipment in 2020. Revenues were $154.6 million for the year ended December 31, 2020, compared to $35.2 million in 2019. The increase was primarily attributable to Zulgenzimo royalty revenue, which increased by $40.8 million in 2020 as compared to 2019. The increase in revenue for the year ended December 31st, 2020 also included an $80 million milestone fee recognized as revenue in the third quarter of 2020 upon the achievement of $1 billion in cumulative net sales of Zulgensma. Research and development expenses were $166.3 million for the year ended December 31st, 2020 as compared to $124.2 million in 2019. The increase was primarily attributable to personnel costs as a result of increased headcount and expenses associated with manufacturing services and conducting clinical trials for our lead product candidates. General and administrative expenses were $63.8 million for the year ended December 31st compared to $51.8 million in 2019. The increase was primarily attributable to personal costs as a result of increased headcount and professional fees for advisory and other services. Net loss was $111.3 million for the year ended December 31st, 2020, as compared to a net loss of $94.7 million in 2019. As of December 31st, 2020, we had approximately 37.5 million common shares outstanding. On January 12, 2021, Regenexx Bio announced the closing of an underwritten public offering of 4.260 million shares of its common stock at a price to the public of $47 per share, as well as exercising full of the underwriter's option to purchase 639,000 additional shares at the public offering price. Including the option exercise, the total gross proceeds received by Regenexx Bio from the offering were approximately $230.3 million before deducting the underwriting discounts and commissions and other offering expenses. Based on our current operating plan, we expect the balance in cash, cash equivalents, and marketable securities of $522.5 million as of December 31st, 2020, as well as the $230.3 million of gross proceeds received from our follow-on public offering of common stock completed in January 2021 to fund our operations, including the completion of our internal manufacturing capabilities and clinical advancement of our product candidates into the second half of 2023. With that, we look forward to a great 2021 and putting a stake in the dumpster fire that was 2020. Now over to Ken for some final thoughts.
spk01: The progress we've made at Regenexx Bio throughout 2020 has been something that's moved us closer to bringing our therapies to patients in need. And we now look to 2021 to further advance the entirety of our internal pipeline and supporting our capabilities for that mission. I think at this stage, we'll turn the call over operator for questions.
spk03: Thank you, presenters. Ladies and gentlemen, if you have a question at this time, please press the star and then the number one key on your touch-tone telephone. If a question has been answered or you wish to remove yourself from the queue, please press the pound key. Please stand by while we compile the queue in a roster. Your first question comes from the line of Josh Michion, with Bank of America. Your line is open.
spk11: Hey, guys. This is Alex on for Jeff. Thanks for taking our questions, and congrats on the progress in 2020. I had one question on the design for the Phase 3 study for 3.14. As you were thinking about the size of the studies and powering assumptions, was there a range of change in visual acuity you would expect based on the published studies for the control arms? And would you expect ILEA to maybe perform slightly better stem lucentis and the additional patients in the second study. And I guess as a follow-up to that, I appreciate that phase 3s have a 52-week cutoff, but I'd be curious to know whether your views have changed at all following the recent subretinal update. Thanks.
spk01: Thanks, Alex. Steve, I think you can probably best handle the powering question about vision for lucentis ilea control arm.
spk06: Sure. Sure. Great. Hey, Alex. Yeah, great question. It's one of the benefits of drug development in this space where there's such a plethora of historical data, including very well-controlled trials with active control arms, including both Lucentis monthly injection as well as ILEA every other month dosing after loading dose. So, To answer your first question, we took that into account in terms of thinking of the powering. And basically, what we look for there is the variability that you expect to see in terms of change in visual acuity from baseline. And that's also relevant in terms of discussions with the FDA, where there's certainly a very good precedent for how to think of non-inferiority and powering in terms of both of those treatment arms if you use those as a control arm. So that's why we were, you know, frankly excited to take this opportunity to, in one study, use Lucentis monthly injection and another to use ILEA. What's interesting is if you think of VA change, They're very close, what you see in terms of every other month dosing with ILEA and what you see with monthly dosing with Lucentis, and pretty similar in terms of the variability that you expect to see with those two treatment arms.
spk03: All right. Your next question comes from the line of Matthew Harrison with Morgan Stanley. Your line is open.
spk08: Hello, everyone. This is Costason for Matthew. Two questions from us on the RDX202 program. One is, what do you need to do prior to IMD filing in mid-2021? And the second one is around the improvement in the micro dystrophin transgene that you described. Can you please give some color around how do you expect these improvements to differentiate 202 in clinic versus other investigational treatments? Thank you.
spk05: Thanks, Costas. Olivier, this sounds like great questions for you.
spk09: Yes, great question. Thank you. So before we file our IND, we need to, we're in the final phase of analyzing the preclinical data package that we have. So, so far we have pretty much done everything and finalizing that. We're also in the final phases of designing our clinical file. But apart from that, it's a lot of, yeah, it's a lot of pasting together all this in a nice IND package. In terms of the molecule itself, the microdystrophin, So again, we're having a microdystrophin which is slightly, which is actually bigger than the other microdystrophins out there being tested in the clinic because it has an extra domain at the C-terminal And this extra domain allows for recruiting additional proteins at the membrane, and this is key to the full function of dystrophin. Dystrophin can work without this domain, and it can work as something which is just a simple shock absorber that preserves the integrity of the muscle membrane upon contraction. it will lack a number of key functions where dystrophin triggers a number of other proteins, including N-osynthase or calcium channel, that are very important in the way the muscle recovers after repairing this stress. So how does it translate exactly? In animal models, there are ways you can measure force of the muscle that shows you that the muscle that has been treated with such a micro dystrophy is actually more resilient. That is, it breaks down less after being submitted to several trains of stress and contraction. Now, this is something that we will eventually We hope to see in the clinic, and this is also where our clinical design is coming into play, exactly what endpoints we're going to look at. This will be discussed when we file the IND. But this will be about, you know, resistance to, sorry, to the way patients experience eventually fatigue after exercise. And that's measuring this amount of fatigue that will be key in differentiating our product from eventually others. Although we're not going to do that. In this trial, we're not going to compare directly. So I'm talking about a point that will definitely come later in the development of the product.
spk05: Thanks, Olivier.
spk03: Your next question comes from the line of Esther Ajagalou with UBS. Your line is open.
spk04: Thank you, guys. Thanks for taking my question. First, as a follow-up to the angiogenesis data, can you talk about the BCVA-OCT distinctions between cohort three and cohort four? It looked like cohort three had better BCVA but not OCT, so I'm trying to understand that. And then I also wanted to confirm that the three-year OCT data from cohort three is not available yet.
spk06: Yeah, I can take that one, Steve, here. So, yeah, at Angiogenesis, we were excited to present the latest results we had in terms of 1.5-year follow-up for NC5, as well as the three-year data for cohort three. You raise a good point of how we look at both visual acuity response, but also anatomy in terms of central retinal thickness changes. One of the aspects in trials of this size where you have 6 to 12 patients per arm, as in this study, is you can have slightly different baseline levels where there can be less of an ability to have a significant decrease, for example, in CRT, basically a ceiling effect if you start off with a little drier retina, so to speak. So that's what we believe explains the distinction between what you see in C3, for example, in terms of the fact that we see almost a three-line improvement in visual acuity, while the anatomy, the central retinal thickness, stays relatively stable. The other aspect there may be the possibility that having stable anatomy without the typical peak and trough variability that you have with traditional bolus repeat injections may translate into better visual outcomes than what you'd anticipate based on anatomy. But I think that really would need to be borne out in larger trials. The other cohorts that started off with higher baseline CRT levels, central retinal thickness levels, we did see those levels come down over time, and we've seen them continue to be stable at those decreased levels even with a dramatic reduction in treatment burden. And that's really why we were excited and continue to be excited with the continued maturation of the data with that range of doses from C3 upward in terms of all of the efficacy signals that we've been looking at.
spk03: Thank you. Your next question comes from the line of Jenna Wang with Barclays. Your line is open.
spk12: Hi, this is David on for Gina. Thank you for taking my questions and I want to congratulate your progress in 2020 as well. So a couple of questions on RGS314 gene therapy subretinal injections. First question is regarding the phase three trial. Could you remind us the retrieval criteria for your phase three trial design?
spk06: Sure. So going into our controlled phase three program, we felt it was important to have standardized retreatment criteria across the board and to do this based on objective measures and specifically best corrected visual acuity, which is done in a masked fashion, and also anatomy, central retinal thickness change, which is also done in a mass fashion by a central reading center. So to be very specific, our retreatment criteria for our pivotal study are a worsening in visual acuity of at least five letters compared to the average of the prior two visits, or a decrease of 10 letters compared to the best prior visits, And a similar concept in terms of anatomy, a worsening in retinal thickness of 75 microns compared to the average of the prior two visits, or 100 microns worsening or increased compared to the best prior CRT level prior to that visit. And those measures and those criteria fit somewhat in the mix of what you see across some of the other precedents that are out there in terms of some of the other programs that are looking at attempting to increase durability of treatment effect. The difference here being that this is an attempt at a one-time treatment option to potentially obviate the need for retreatment.
spk03: Thank you, ladies and gentlemen. Just a reminder, you may press star 1 to have a follow-up question or if you have any questions. Thank you. Your next question comes from the line of Manny Foroher with SVB Learning. Your line is open.
spk10: Hey, good afternoon. This is Rick online for Manny. Thanks for taking our question. So my question focused on the DMV program. Since you first announced RGX202, there was a clinical update from Sarepta's gene therapy program. We were wondering if you could comment on any potential learnings from the clinical readout of your competitor and if it was able to help inform any aspect of trial design for your upcoming trial, such as patient selection, selection of endpoints, or goals for the initial dose escalation.
spk01: Yeah, Rick, we're not going to comment on data from someone else's study. Obviously, we wouldn't have that available to us in a way that would be meaningful to help interpret compared to what Olivier has already described as a really robust preclinical program, as well as work that's gone into preparing for a trial design that we think will be important to illustrate not only elements of things that have been demonstrated by microdystrophin as a class, but also differentiation potentially along the program for the advancement of this novel construct using the C-terminus domain. And, of course, we're using a proprietary, you know, manufacturing platform as well. So, you know, there's not much that we're going to learn from sort of top-line results from, you know, a study that someone else is running.
spk03: Thank you. Our next question comes from the line of Luca EC with RBC. Your line is open.
spk02: Oh, great. Thanks for taking the question. This is Lisa Walter on for Luca. Just wanted to ask about your suprachoroidal program. It looks like for the phase two trial that you are starting at the highest dose ever tested for the subretinal, and you are also doubling that dose in cohort two. Can you provide any color on why that is the case and also maybe more broadly what some of the key dosing considerations are when switching from subretinal to supracroidal? Thanks.
spk06: Yeah, so this really takes advantage of all the learnings that we had from our subretinal program. So there you'll recall, Lisa, we had the benefit of a full dose ranging where we started super low with a dose where we didn't see anything and then saw progressively more clear signal as we went up with a plateau from our perspective once we got to level three onward. This is a new route of administration. However, I think it is important to note that it still achieves the goal of getting the infusate very close to the target tissue of the RPE and the photoreceptors, particularly compared to other routes of administration like . So since we had very good safety and tolerability in the full range of doses with subretinol, we chose to go from a position of equipose and start with the dose level five that we had from subretinol And we were pleased that our preclinical package, both our pharmacology studies as well as our GLP package, gave us that opportunity to start from that standpoint. We were also pleased to be able to start with a design where we do not include prophylactic steroids for either of our initial supracoroidal delivery studies. So, yeah, I think a good question. It's always a key aspect when you're thinking of starting dosing where you start. And I think we just had the benefit of a lot of prior experience with subretinal delivery with the same exact transgene and the same exact AAV vector to take advantage of that to start with a dose to evaluate not only safety and tolerability, but potential signal.
spk03: Thank you. There are no further questions at this time. I'd like to turn the call back over to Ken for closing remarks. Go ahead, sir.
spk01: Thank you very much, and thanks, everyone, for joining us today. We look forward to providing further updates soon and throughout the year, and have a great night.
spk03: Ladies and gentlemen, this concludes today's conference. Thank you for your participation and have a wonderful day. You may all disconnect.
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