BioXcel Therapeutics Q1 2024 Earnings Call Transcript

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May 9, 2024

Key Takeaways

  • BioXcel is advancing two pivotal Phase III trials for BXCL501: the Tranquility in-care study in Alzheimer’s agitation (60 µg, PEG score at 2 hours) and the Serenity at-home study in bipolar and schizophrenia agitation (120 µg, safety-first design).
  • Commercial momentum for Egalmi continues, with Q1 net revenues of $582 K up 182% year-over-year and 55% sequentially, driven by volume contracting, new customer additions and a permanent J-code.
  • The company completed a $25 M registered direct offering, boosting cash to $74.1 M as of March 31 and extending its runway into the second half of 2024.
  • Intellectual property was strengthened with two new U.S. and Japanese patents, bringing BioXcel’s neuroscience portfolio to 30 granted patents and over 140 pending applications.
  • Enrollment is complete in the BXCL701 plus Keytruda Phase II trial for metastatic pancreatic cancer, with late-breaking ASCO data expected on June 1 and a formal monetization process underway.
AI Generated. May Contain Errors.
Earnings Conference Call
BioXcel Therapeutics Q1 2024
00:00 / 00:00

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Operator

Good morning, and welcome to the BioXcel Therapeutics Q1 2024 earnings conference call. At this time, all participants are in a listen-only mode. If during the conference call you require operator assistance, please press star zero on your telephone keypad. After the formal remarks, there will be a question-and-answer session. If you would like to register a question, you may press star one on your telephone keypad. Just to remind everyone, certain matters discussed in today's conference call and/or answers that may be given to questions asked are forward-looking statements subject to risks and uncertainties related to future events and/or the future financial or business performance of the company. Actual results could differ materially from those anticipated in these forward-looking statements.

Operator

Risk factors that may affect future results are detailed in the company's Annual Report on Form 10-K for the year ending December 31, 2024, which can be found at bioxceltherapeutics.com or on www.sec.gov, and which will be updated in its quarterly report on Form 10-Q for the quarterly period ended March 31, 2024. As a reminder, today's call is being recorded. Speaking on today's call are Dr. Vimal Mehta, Chief Executive Officer, Dr. Vince O'Neill, Chief of Product Development and Medical Officer, and Richard Steinhart, Chief Financial Officer. They will be joined in the Q&A session by Dr. Frank Yocca, Chief Scientific Officer, Matt Wiley, Chief Commercial Officer, and Dr. Rob Risinger, Chief Medical Officer of Neuroscience . It is now my pleasure to turn the call over to Dr. Mehta. Please go ahead.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Thank you, operator. Good morning, and thank you for joining us. 2024 has been an important period of progress for BioXcel Therapeutics, both at the program and corporate levels. Starting with our Neuroscience program, our journey with BXCL501 is well underway to expand the market potential for our agitation portfolio into the retail setting. We are focused on potentially bringing this novel treatment option for bipolar and schizophrenia-related agitation into the home setting. We are also dedicated to expanding into a much larger indication, Alzheimer's-related agitation, both in the In-Care and home setting. We believe these two opportunities are unique, with no known FDA-approved therapies, and represent transformative value drivers for the company and our shareholders. We are pleased to be advancing the plans for both late-stage TRANQUILTY and SERENITY programs.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

While Vince will discuss the details of these programs shortly, I want to point out that we believe SERENITY At-Home may provide us with a nearer-term opportunity to create shareholder value through a potential label expansion for the previously approved 120-microgram dose. The TRANQUILITY In-Care trial is similar in design to our positive phase III TRANQUILITY II trial. We see a larger long-term growth potential with this program. We believe there is a significant upside to be the first to enter this untapped market. In addition to progressing our clinical development programs, we have further expanded intellectual property for our Neuroscience franchise. We were recently granted two new patents in the U.S. and Japan.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

We believe this provides long-term protection for our assets and gives us a solid foundation from which to pursue further development of BXCL501 and potential partnerships in key international markets. Our IP portfolio is substantial. As of April 2024, we have 30 granted or allowed patents and more than 140 additional patent applications in prosecution. We also have eight U.S. patents for our approved drug, IGALMI, listed in the FDA's Orange Book, with two additional recently allowed patents eligible for listing once issued by the U.S. Patent and Trademark Office. Turning to IGALMI commercialization traction, our revised and focused strategy is re-yielding results as we increase net revenue in the Q1 2024 by 55% over the Q4 2023.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

This growth is being primarily driven by volume contracting, new customer acquisitions, increased utilization from existing customers, and the recently implemented permanent J code for IGALMI. We are seeing this momentum carrying forward into the Q2, with carton volume already exceeding that of the Q1 this year. We are pleased that IGALMI is reaching a greater number of patients and healthcare providers and expect this momentum to continue... Both institutional and home setting markets for bipolar and schizophrenia-related agitation are symbiotic and commercially strategic. We are excited about achieving an uptick in IGALMI utilization and having a clear development path for the home setting. Turning now to the corporate front, we are pleased to have completed the $25 million registered direct offering we recently announced.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

This transaction provides an important bridge to continue advancing our business strategy and clinical trial plans.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

We remain focused on further strengthening our balance sheet and exploring multiple financing options, including potential partnerships, to extend our cash funds. We also continue to optimize operational efficiencies. To wrap up, we believe our business fundamentals are strong. We are advancing two late-stage clinical programs, strengthening intellectual property, and seeing progress with commercialization of IGALMI. These accomplishments are underpinned by a compelling value proposition for driving future growth for the company. With that, I will turn it over to Vince.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Thank you, Vimal. I appreciate the opportunity to review the progress we've made with our late-stage clinical development programs for 501. So since speaking with you in March, we've received the minutes from our meetings with FDA regarding the development plans for the TRANQUILITY and SERENITY programs. Based on that feedback, we have developed and announced the designs of both pivotal phase III trials. We're pleased to have clarity on development paths, which may lead to two potential sNDA submissions, both for Alzheimer's-related agitation and bipolar and schizophrenia-related agitation. As a reminder, in the TRANQUILITY program, we're evaluating 501 as an acute treatment for agitation associated with Alzheimer's dementia. Our TRANQUILITY In-Care trial is designed as a double-blind, placebo-controlled, multi-center study to evaluate the efficacy and safety of a 60 microgram dose of 501 over a 12-week period.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

The primary endpoint is change in PEC score at two hours post first dose. It's important to note that this is the same endpoint used in previous positive TRANQUILITY trials and in studies that supported the FDA approval of IGALMI. In the SERENITY program, we're evaluating the potential At-Home use of 501 for agitation associated with bipolar disorders or schizophrenia. Our SERENITY At-Home trial is designed to be a double-blind, placebo-controlled, multi-center study to evaluate the safety and efficacy of a 120 microgram dose of 501 over a 12-week period. The primary objective is safety, with efficacy measures as exploratory endpoints. Again, we've taken a thoughtful and deliberate approach to our trial designs, with the ultimate goal of accessing the retail setting in mind, and we look forward to advancing our plans.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

The trial protocols have now been finalized and are being shared with the FDA and our CROs for clinical site selection. In our PMR study, we recently completed the enrollment of 22 patients with frequent episodes of agitation for bipolar disorders or schizophrenia in that open label study. It's designed to evaluate whether tolerance, tachyphylaxis, or withdrawal occur following repeat dosing of the 180 microgram dose of IGALMI after seven days of repeated treatment. These trial results can help address the language around limitations of use and warnings and precautions in IGALMI's current label. We're performing data cleaning currently, and look forward to announcing results from this PMR study shortly. I'd like to end my remarks with a few comments about our lead immuno-oncology asset, 701.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Earlier this year, we announced the completion of patient enrollment in the safety portion of the phase II trial of BXCL701 in combination with Keytruda in metastatic pancreatic ductal adenocarcinoma. The trial is being led by Georgetown Lombardi Comprehensive Cancer Center. We are pleased that a late-breaking abstract was selected for presentation at the 2024 ASCO annual meeting and look forward to sharing the data on June 1 with you. We have formally initiated the process for monetization of this asset. I would now like to turn the call over to Rich, who will review our financial results for the first quarter of 2024. Richard?

Richard Steinhart
Richard Steinhart
CFO at BioXcel Therapeutics

Thank you, Vince. Net revenue from IGALMI was $582,000 for the Q2 of 2024, compared to $206,000 for the same period in 2023, a 182% year-over-year increase. Sequential quarterly revenue increased 55% in the Q1 of 2024 from the Q4 of 2023. Increased revenue for both periods was primarily attributable to increasing demand with our existing customer base, the addition of new customer orders, and volume-based contracting. Research and development expenses were $11.4 million for the Q1 of 2024, compared to $27.8 million for the same period in 2023. The decreased expenses were primarily attributable to the wind down of the SERENITY III and the TRANQUILITY II and III trials, as well as decreased professional fees, personnel, and related costs.

Richard Steinhart
Richard Steinhart
CFO at BioXcel Therapeutics

Selling, general, and administrative expenses were $13.3 million for the Q1 of 2024, compared to $23.6 million for the same period in 2023. The reduced expenses were primarily attributable to a decrease in personnel and costs associated with the commercialization of IGALMI, compared to the Q1 of 2023. The reduced expenses were partially offset by increased professional fees during the Q1 of 2024. BioXcel Therapeutics had a net loss of $26.8 million for the Q1 of 2024, compared to a net loss of $52.8 million for the same period in 2023. The company used approximately $17.7 million in operating cash during the Q1 of 2024. Cash and cash equivalents totaled $74.1 million as of March 31, 2024.

Richard Steinhart
Richard Steinhart
CFO at BioXcel Therapeutics

This includes the $25 million from the registered direct offering announced on March 25, 2024. This investment extends our cash runway beyond our previous guidance of mid-2024 into the H2 of 2024. Now I'd like to turn the call back to Vimal.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Thank you, Rich. I'd like to add that in the coming weeks, we plan to attend several upcoming investor healthcare conferences and look forward to continuing our discussions. We would now like to open the call for questions. Operator?

Operator

Thank you. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue, and for participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. Please ask one question and one follow-up question. Our first question is from Colin Bristow with UBS. Please proceed.

Colin Bristow
Colin Bristow
Managing Director of Biotechnology at UBS

Hey, good morning, and thanks for taking the questions. So I think the major questions investors are wrestling with are: what is the timeline for the data and approval in Alzheimer's agitation? And what do you expect the cost of this program to be? And then just as a kind of follow-up on that, with regards to this path to approval in Alzheimer's agitation, can you say what FDA has specifically said regarding the need for the 12-month safety data? Thank you.

Operator

Hi, can you please check and see if the speaker line is muted? We're not able to hear you. Once again, we're not able to hear the speaker line.

Matt Wiley
Matt Wiley
Chief Commercial Officer at BioXcel Therapeutics

It's on. It's not working. It's on.

Operator

Hello, we can hear audio now. Are the speakers there?

Matt Wiley
Matt Wiley
Chief Commercial Officer at BioXcel Therapeutics

Mine's on mute. It's hard to mute.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Can you hear us now?

Operator

Yes, we can.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Okay. So sorry, we have a technical glitch on this side. So Colin, thanks for the question. Just to try and answer that, and sorry for the delay. We can't give specific dates today, this morning, but what I can say in terms of the TRANQUILITY II in Care study, look to TRANQUILITY II, the very similar trials in design. So we would anticipate a timeline and a cost very similar to the TRANQUILITY II study.

Colin Bristow
Colin Bristow
Managing Director of Biotechnology at UBS

Okay, and on the FDA requirement for 12-month safety?

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Yeah. So I think as we've said, we will re-approach the FDA to discuss specifically the details around the long-term safety trial, but the need for that trial is clearly not in doubt. That has to be done, and that would form part of the package for the TRANQUILITY In-Care sNDA.

Colin Bristow
Colin Bristow
Managing Director of Biotechnology at UBS

Okay, thank you.

Operator

Our next question is from Ram Selvaraju with H.C. Wainwright. Please proceed.

Operator

Proceed.

Ram Selvaraju
Managing Director and Senior Healthcare Analyst at HCWainwright

Hi, thanks so much for taking my question. Back to IGALMI. Can you offer us some additional color regarding the status of the group contracting discussions and when you anticipate, the impact to net revenue to, to manifest itself in the coming quarters? Are there any important, GPO purchasing, contracting decisions expected in the coming months, please?

Matt Wiley
Matt Wiley
Chief Commercial Officer at BioXcel Therapeutics

So, yeah, good morning, this is Matt. So yes, the answer to the question is we continue to negotiate contracts. We had multiple contracts in Q1. We continue to execute the plan, and over Q2, we've seen, excuse me, an increase in unit volume. In fact, as Vimal said in the prepared remarks, we've already seen unit volume increase more than what we posted in Q1 so far in Q2. So the contracting strategy, the volume contracting strategy is working. We see that existing customers continue to order, and we also see the acquisition of new accounts, which I think is really important for continued growth throughout the year.

Ram Selvaraju
Managing Director and Senior Healthcare Analyst at HCWainwright

Secondly, with respect to the earlier stage Neuroscience assets, are you exploring strategic options for these, or is the aim to effectively continue to develop them in-house? Thank you.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

... Ram, this is Vimal. Our focus, as I mentioned, is primarily on the two late-stage clinical program, SERENITY At-Home and TRANQUILITY In-Care. We are dedicating all our resources to those programs, but early programs certainly will be explored if there is interest for potential partnership, and that we plan to explore.

Operator

Our next question is from Alec Stranahan with Bank of America. Please proceed.

Alec Stranahan
Alec Stranahan
VP of Equity Reseach at Bank of America

Hey, guys. Good morning. Thanks for taking our questions. Just two from us. Maybe both on the metastatic PDAC data we should be expecting at ASCO. I guess maybe just high level, walk us through how 701 is designed to treat these patients. And then as a follow-up, what would we typically expect with Keytruda monotherapy in this line of treatment in these patients? Thanks.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Sure. Morning, Alex, this is Vince. So I'll take the second part of your question first. Keytruda is not active as a monotherapy. I think that's generally accepted. Pancreatic cancer is a very, very cold tumor, really the definition of a cold tumor. The only exception would be MSI-High pancreatic cancer. Keytruda has a separate label to cover tissue-agnostic MSI-High patients. So that's approximately 1% of pancreas. So Keytruda is not active there. Our approach is to combine with Keytruda, so 701 plus Keytruda in a combination. It's second-line refractory pancreatic cancer, approximately 40 patients in total, Simon two-stage, stage one, about 20 patients, followed by another 20 patients. So that's the general gist of the approach.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

The reason we're doing the study at all is because we have very strong and encouraging preclinical data for the combination which we've presented. And just lastly, on the point that pancreas is a cold tumor, it's also surrounded, as you'll know, by a fibrous layer, which again, makes it very difficult to treat. We've now published data that show that 701 essentially makes that collagen disappear. So there's multiple reasons to anticipate encouraging results, and you'll see those results in June at ASCO.

Alec Stranahan
Alec Stranahan
VP of Equity Reseach at Bank of America

Great. Thank you.

Operator

Our next question is from Avantika Joshi with Mizuho Securities. Please proceed.

Avantika Joshi
Avantika Joshi
Equity Research Associate at Mizuho Securities

Hi, can you hear me?

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Yes.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

We can.

Avantika Joshi
Avantika Joshi
Equity Research Associate at Mizuho Securities

Okay. Hi, this is Avantika for Greg. Our question is, between TRANQUILITY In-Care and SERENITY At-Home, which trial would you say is the priority for you guys? And, would you run these studies concurrently, or would it make more sense to run them one after another? Thanks.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Thanks, Avantika. Strategically, we would prefer to run both trials in parallel. As I indicated, both are, big value drivers for the company. There are no approved FDA therapies, and they represent the transformative value drivers. SERENITY, on one hand, is a near-term opportunity, through label expansion for the 120 microgram approved dose, while TRANQUILITY is a much larger and longer-term opportunity with a significant upside and being first to market. So to answer your question, we prefer to run both. If we have to, then we will take the decision of prioritizing one over the other or a step-wise approach.

Avantika Joshi
Avantika Joshi
Equity Research Associate at Mizuho Securities

Thank you.

Operator

As a reminder, it is star one on your telephone keypad if you would like to ask a question. Our next question is from Sumant Kulkarni with Canaccord Genuity. Please proceed.

Sumant Kulkarni
Sumant Kulkarni
Senior Analyst of Biotechnology at Canaccord Genuity

Good morning. Thanks for taking my questions. I have three. So on... how would you frame the capital needs that you for running TRANQUILITY and SERENITY as they stand now, relative to your current cash and the additional $25 million that you'll need to raise in November to conform to your financing agreements? That's the first.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Hi, Sumant, this is Vimal. As Vince indicated, TRANQUILITY In-Care trial is very similar to the TRANQUILITY II trial, where we had the positive data. We are trying to have another, well-controlled Phase III trial for confirmation of efficacy and safety. So we expect the trial cost to be very similar to the TRANQUILITY. So we have very good, like, you know, idea about what the per patient cost is. And in terms of, timelines, it will be pretty much similar. While when we think of the SERENITY At-Home, it's much smaller number of patients, almost 100 patients, so that is, recruitment is much faster what we have observed in our previous 3 trials, SERENITY one, two, and three, and cost is much lower, almost, 50% of what it would be in a TRANQUILITY.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

So we are trying to look at both opportunities, and as you know, with SERENITY, we can be potentially, if we can complete the trial, file as NDA in 2025. So, and it's very synergistic because we already have a commercial product. So I would say that we have very good handle, and based on our current cash, which was reported at $74 million, we are laying out what the trial cost is and what the capital requirement is and how to finance the trials, and previously answered, then we prioritize or we use a step-wise approach.

Sumant Kulkarni
Sumant Kulkarni
Senior Analyst of Biotechnology at Canaccord Genuity

... Got it. And then I'll ask you a second and third question in one shot here. So in TRANQUILITY In-Care, what's the general target percentage of patients you expect to enroll that might already be on Rexulti as a chronic treatment for agitation and in Alzheimer's? And, going back to cost, do you think that the operating expense base at the company, as it stands currently, is optimized relative to the things you need to execute on?

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

On Rexulti, I'll ask my colleague, Dr. Risinger, to come in here. I don't think we exclude or-

Rob Risinger
Rob Risinger
Chief Medical Officer of Neuroscience at BioXcel Therapeutics

We do not exclude patients who are on Rexulti or any other antipsychotic. I'll point back to the TRANQUILITY II data, which demonstrated about 50% of patients are on concomitant antipsychotics.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Your last question, Sumant, I'm sorry, can I ask you to repeat it?

Sumant Kulkarni
Sumant Kulkarni
Senior Analyst of Biotechnology at Canaccord Genuity

Yeah, sure. Do you think the operating expense base at the company, as it stands currently, is optimized relative to all the things that you need to execute on in the near to mid-term here?

Richard Steinhart
Richard Steinhart
CFO at BioXcel Therapeutics

Yeah. Thanks so much. It's Richard. How are you? The answer is we continue to evaluate the operating overhead, and we continue to look at ways to make it more efficient and optimize it. So that's an ongoing process here.

Sumant Kulkarni
Sumant Kulkarni
Senior Analyst of Biotechnology at Canaccord Genuity

Thanks.

Operator

Our next question is from Samir Devani with Rx Securities. Please proceed.

Samir Devani
Managing Director at Rx Securities

Hi, guys. Thanks for taking my question. I just wanted to come back to the comment about the 12-month safety study that would be required for the TRANQUILITY In-Care trial. I just want to confirm that that would be required before you make the sNDA. And also, now that you've essentially completed these discussions with the FDA, what's the trigger left now to initiate that trial? Thanks very much.

Vince O'Neill
Vince O'Neill
Chief of Product Development and Medical Officer at BioXcel Therapeutics

Sure. Morning, this is Vince. So, I think as we've said, we will go to the FDA and discuss the... not the need, of course, for long-term safety, that's clear, but the details, and that will fundamentally be around the data that we collect in the study. So it's going to be a protocol discussion, which of course is why, you know, typically why we go and discuss things with the FDA. In terms of the, I think your question was maybe around the numbers and requirements. I mean, those are obviously set by ICH guidelines, so 300 at six months and 100 at one year. We would need the long-term safety data to support an sNDA submission.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Samir, to answer your question, when do we expect to initiate this study? As Vince mentioned, that now we are sharing the protocol with the FDA and giving it to the CROs for site selection, and once we have the financing in place up to the data readout, we will initiate the studies. We are getting the technical readiness right.

Samir Devani
Managing Director at Rx Securities

Great. Thanks very much.

Operator

We have reached the end of our question-and-answer session. I would like to turn the call back over to management for closing remarks.

Vimal Mehta
Vimal Mehta
CEO at BioXcel Therapeutics

Thank you, everyone, for joining us today and for your continued interest in BioXcel Therapeutics. Have a great day.

Operator

Thank you. This will conclude today's conference. You may disconnect your lines at this time, and thank you for your participation.

Executives
    • Matt Wiley
      Matt Wiley
      Chief Commercial Officer
    • Richard Steinhart
      Richard Steinhart
      CFO
    • Rob Risinger
      Rob Risinger
      Chief Medical Officer of Neuroscience
    • Vimal Mehta
      Vimal Mehta
      CEO
    • Vince O'Neill
      Vince O'Neill
      Chief of Product Development and Medical Officer
Analysts
    • Alec Stranahan
      VP of Equity Reseach at Bank of America
    • Avantika Joshi
      Equity Research Associate at Mizuho Securities
    • Colin Bristow
      Managing Director of Biotechnology at UBS
    • Ram Selvaraju
      Managing Director and Senior Healthcare Analyst at HCWainwright
    • Samir Devani
      Managing Director at Rx Securities
    • Sumant Kulkarni
      Senior Analyst of Biotechnology at Canaccord Genuity
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