Zevra Therapeutics Q4 2024 Earnings Call Transcript

Quartr
Provided by Quartr
March 11, 2025

There are 10 speakers on the call.

Operator

afternoon and thank you for joining Zevres Therapeutics Fourth Quarter and Full Year twenty twenty four Financial Results and Corporate Update Conference Call. Today's call is being recorded and will be available via the Investor Relations section of the company's website later today. The host for today's call is Nicole Ochsner, Zevora's Vice President of Investor Relations and Corporate Communications.

Speaker 1

Thank you, and welcome to those who are joining us. Today, we will provide an overview of our accomplishments in the fourth quarter and full year of 2024 followed by a review of financial results. I encourage you to read our financial results news release, which we distributed this afternoon and is available in the Investors section of our website. Before we begin, please note that certain information shared today will include forward looking statements. Actual results may differ materially from those stated or implied by any forward looking statements due to risks and uncertainties associated with Severs' business.

Speaker 1

Forward looking statements are not promises or guarantees and are inherently subject to risks, uncertainties and other important factors that may lead to actual results differing materially from the projections made. These forward looking statements should be evaluated together with the cautionary statements contained in the Risk Factors section and our most recent quarterly report on Form 10 Q, our annual report on Form 10 ks and our other filings with the SEC. I'm pleased to welcome Zebra's management team members participating in today's call: Neil MacFarlane, Zebra's President and Chief Executive Officer, Woodwayne Clifton, our Chief Financial Officer and Josh Schaeffer, our Chief Commercial Officer and EVP of Business Development. Our Chief Medical Officer, Adrian Cortel, will also be available for today's question and answer session. Now, it's my pleasure to hand the call over to Neil.

Speaker 2

Thank you, Nicole, and thank

Speaker 3

you for joining us this afternoon. As Nicole mentioned, today we'll provide our fourth quarter and fiscal year twenty twenty four financial results and share progress on the execution of our priorities for 2025. Our priorities are guided by Zevra's strategic plan unveiled during our third quarter call and categorized under four actionable pillars: commercial excellence, pipeline and innovation, talent and culture and corporate foundation. 2024 was a transformational year for Zevra and bringing my plight for the people living with Niemann Tick Disease Type C or NPC was a crowning achievement. In the past year, we became a commercial stage company that had the opportunity to positively impact the lives of people living with rare diseases.

Speaker 3

The approval of MyPlife last year was an outcome of our long standing collaboration with the NPC community and included contributions from more than two seventy Niemann Pick disease type C patients who participated globally in our pivotal studies, open label extension studies and expanded access programs. The early days of the MyPlifa launch have exceeded our expectations. In the fourth quarter, we received 109 patient enrollment forms, which we believe reflected the anticipation and unmet need in the MPC community. Additionally, by the end of Q4, all active U. S.

Speaker 3

EAP participants submitted an enrollment form and our entire organization has been activated to ensure smooth transition to MyPlifa commercial product. As previously reported, we anticipate that The U. S. EAP will close by the end of Q2. Going forward, our goal is to expand availability of My Plifa outside of The U.

Speaker 3

S. To provide access to as many people living with MPC as possible. With this goal in mind, we are progressing regulatory submissions with the focus on submitting a marketing authorization application in Europe during the second half of twenty twenty five, where we estimate eleven hundred people are living with MPC. Additionally, we will maintain our global expanded access program that currently supports seventy to eighty MPC patients. And we look forward to providing updates in the coming quarters as we seek to expand access to MyPlaza.

Speaker 3

We're leveraging our infrastructure for both urea cycle disorders or UCDs and MPC leading to efficiencies that drive commercial excellence. The launch of Opruva in early twenty twenty four facilitated key learnings as we built our commercial capabilities. During the fourth quarter, we received four Opruva enrollments. As announced in our Q3 call, we refined our strategy to reach the adult onset population for whom Opruva's portability and ease of administration may provide a benefit with a focus on patients receiving payer pushback. I will provide more details related to the performance of our commercial products later in the call.

Speaker 3

Moving to pipeline and innovation, which refers to our ambition to develop products that address significant unmet need. Oliparol is our Phase three investigational clinical candidate for the treatment of Vascular Eilers Danlos Syndrome or VEDS, which is an inherited connective tissue disorder caused by the COL3A1 gene mutation that can result in spontaneous arterial aneurysms and hollow organ ruptures. There are currently no treatments approved in The U. S. Where there are approximately seven thousand five hundred people living with this disease and the prevailing treatment paradigm is only reactive surgical interventions.

Speaker 3

Although Soliparol is not approved for VEDS in any country, it is utilized as a standard of care in several European countries. In Q4, we enrolled eight patients in our Phase III DISCOVER trial, bringing the total number of enrolled patients to twenty seven. As an event driven trial, the rate of participant enrollment is integral to the program's success. As a result, we are investing in tactics to accelerate enrollment among genetically confirmed patients with providers and clinics that treat COL3A1 positive patients. In addition, we have support from the Vets Foundation Professional Advisory Board on our path forward.

Speaker 3

Moving on to KP-ten 77. As outlined on our Q3 call and following a successful end of Phase two meeting with the FDA, we are exploring strategic alternatives to advanced clinical development and future commercialization. We are focused on maximizing the value of this Phase three ready asset that has regulatory feedback for the potential development in both idiopathic hypersomnia and narcolepsy indications. In 2024, we completed a comprehensive review of our IP portfolio to identify areas for optimization. This review led to a decision to rationalize our in house discovery efforts and out deliver on our key priorities, it's paramount that we develop a high performing culture and attract and retain talent.

Speaker 3

In the second quarter of twenty twenty four, we expanded our executive leadership team with the appointment of Rasaan Thompson as Chief Legal Officer, Secretary and Compliance Officer and Allison Peters as Chief People Officer. Additionally, during the fourth quarter, we consolidated our development and scientific functions under Adrian Cortel, our Chief Medical Officer. We believe these changes optimize Zevra for success with cognitive leadership and the appropriate span of control to achieve our objectives. An important element of executing against our strategy is to build and maintain our position of financial strength and disciplined capital allocation that we refer to as our corporate foundation. This underpins all other pillars and allows us to responsibly invest in our long term transformation.

Speaker 3

In 2024, we refinanced existing debt with a new credit facility and completed a modest secondary offering which provided financial stability. Recently, we entered into an agreement to monetize our priority review voucher for $150,000,000 which upon closing will provide non diluted capital to support our future growth. Building on the momentum from 2024, we are pleased to start 2025 from a position of strength across our four strategic pillars, execute on the tremendous opportunity we have to serve people living with rare diseases. I'll now turn the call over to Josh, who will provide an update on our commercial products.

Speaker 2

Thank you, Neil. Twenty twenty four was a year of significant milestones for Zebra and the rare disease community. In particular, the FDA's approval of MyPlifa marked the first product in The U. S. For the treatment of MPC.

Speaker 2

At that time, we immediately began receiving patient enrollment forms and initiated the benefits verification process. During the fourth quarter, product was available in the last five weeks of the year. While discussing our commercial products, we will provide patient enrollments, the percent of covered lives and net revenue for the quarter. As Neil noted, the launch of MyPlifa has gone exceptionally well and carries significant momentum into 2025. From the time of approval through December 31, we received 109 total prescription enrollment forms.

Speaker 2

And as of the end of the year, we enrolled all of the active U. S. EAP patients. As a reminder, an enrollment is a prescription submitted to our specialty pharmacy initiating the benefits investigation process leading to a decision on reimbursement and paid dispense, which is a thirty day supply of MyPlifa. In the fourth quarter, early enrollees may have received both an initial dispense and their first refill depending on the time of their enrollment.

Speaker 2

We estimate that there are approximately nine hundred people with MPC in The U. S, of whom an estimated three hundred to three fifty have been diagnosed. Put this in perspective, our fourth quarter performance resulted in approximately one third of diagnosed patients submitting an enrollment to receive MyPlifa. MPC is a neurodegenerative progressive and fatal lysosomal storage disorder caused by lipid buildup leading to cell death and ultimately organ dysfunction in the spleen, liver and brain. Because symptom presentation and age of onset are heterogeneous, disease progression is primarily assessed using the only clinically validated endpoint, the Niemann Pick disease type C clinical severity score, including measurements of ambulation, fine motor, speech and swallow abilities.

Speaker 2

The data included on our label shows MyPlaFAA in combination with miglostat halted disease progression through twelve months, demonstrated by more than a two point improvement in patients receiving this combination compared to those receiving miglazat alone, where only a one point improvement is needed to demonstrate a clinically meaningful difference. In a disease like MPC, access to data covering a twelve month duration is critical to establishing treatments as disease modifying. Beyond the pivotal trial, my PLIFO safety profile and long term treatment effect have been evaluated in an open label extension study and through multiple center EAPs, with some patients having as many as five to seven years of experience on therapy. We are pleased with MyPlifos data and its indication for use in combination with Migostat. And our market intelligence suggests that healthcare providers prefer multi therapeutic approach to treating this heterogeneous disease.

Speaker 2

Based on early market experience and feedback, we believe providers will use a disease modifying treatment such as MyPlifa plus Myglastat as the cornerstone of therapy and then potentially add therapies or supplements to provide symptomatic treatment if needed. Many commercial plans have not yet formalized reimbursement coverage, but it's too early in the launch to provide a meaningful market access and reimbursement update in terms of the percentage of covered lives. However, our team is actively engaged with payers and we have been addressing coverage hurdles to gain reimbursement through either direct formulary coverage or via the medical exception process thus far. We will continue meeting with payers and presenting clinical data to support MyPlifa's use as the cornerstone of therapy for MPC and we'll report progress in future calls. As we look forward to 2025, our focus will be to grow enrollments of currently diagnosed and untreated patients.

Speaker 2

We recognize the impact of prompt diagnosis and treatment to halt the progression of disease for people living with MPC and have invested in educational resources and tactics, drive patient identification, and early intervention. As an example, we commenced a media campaign working with local outlets and key opinion leaders to educate about early signs and symptoms of MPC. This program led to the identification of three new patients who have not been previously treated. We're also using advanced analytics to understand where recently diagnosed MPC patients are treated and to ensure new patients have an opportunity to receive treatment. Our rare disease sales and reimbursement specialists are actively engaged in raising awareness of MPC diagnosis and available treatments with my Plaiphoof.

Speaker 2

Our efforts to increase disease awareness are multifaceted. And on February twenty eighth of this year, timed with Rare Disease Day, we launched a disease state awareness campaign entitled Learn NPC Read Between the Signs to educate healthcare professionals unfamiliar with NPC to support the identification and diagnosis of people living with NPC. In addition, we entered into an agreement with a leading diagnostic company to provide genetic testing options for individuals with suspected lysosomal storage disorders, including MPC. We believe this program will lead to the identification of new patients and will allow us to support earlier diagnosis in treatment. Our sales and reimbursement teams regularly meet with prescribers to provide education on the strength of MycLAFA data and to support the reimbursement processes.

Speaker 2

And currently, under the direction of Adrian Cortell, our Chief Medical Officer, our medical liaisons are engaging with key opinion leaders and patient advocacy groups to build a body of evidence demonstrating the need to treat patients early to delay progression and to position MyPlifa as the cornerstone of treatment. Additionally, our medical affairs team is prioritizing our publication strategy to further drive awareness of the need to treat MPC patients. For example, during the twenty first annual World Symposium, including new data assessing the safety and tolerability of Mycoplasma in MPC patients, six months to twenty four months as evaluated in the pediatric sub study of the pivotal Phase III trial. In conclusion for MyPlaFAA, we're encouraged by the initial signs of the launch and are excited to provide future updates on our progress in reaching patients who can benefit the most. Now let's turn to APUVA, our commercial product for the treatment of certain UCDs.

Speaker 2

UCDs are a group of rare inherited metabolic disorders caused by defect in one of the six enzymes or two transporters in the urea cycle leading to an accumulation of ammonia. Elevated ammonia or hyperammoniaemia can be toxic leading to neurocognitive damage or even death. Aprova is a nitrogen scavenger that removes excess ammonia, thus reducing harmful accumulation. The Aprova launch has progressed slower than we would like for this differentiated product. During the fourth quarter, we saw new enrollments increase to four as compared to three in the third quarter and our market access for APUVA remains consistent at seventy six percent of covered lives.

Speaker 2

Zevra launched APUVA a little over a year ago into a mature UCD market. At that time, we were able to build initial demand with clinicians and patients looking for alternative therapies that could improve adherence and better control ammonia levels. However, limited patient pull through and reimbursement support experienced early in the launch necessitated a change to improve the patient experience and we transitioned to a new specialty pharmacy. We also refined our strategy to target specific patient segments who will receive the greatest benefit from Ultruva and who may face fewer reimbursement hurdles. We believe that the adult female OTC deficient carrier population, as well as those UCD patients who may seek additional lifestyle independence, will receive the greatest benefit from the ammonia control on the go that Ultruva provides.

Speaker 2

Another resource we have added includes field reimbursement managers who work with physician teams to assist with reimbursement challenges. We've also identified payer plans that have moved other therapies to the exclusion list and are working with payers to provide a smoother reimbursement process for ALPRUVA. These efforts are in early stage and we look forward to reporting our progress in future calls. Finally, we are proud to highlight our sponsorship of the National Urea Cycle Disorders Foundation, Spectamonia Campaign to raise awareness of the critical importance of recognizing the signs and symptoms of hyperammonia anemia and the need to treat early and persistently. Patients remain at the center of what we do and supporting the rare disease community through patient advocacy organizations like NUCDF is one of our highest priorities.

Speaker 2

I will now turn the call over to LeDwayne to discuss the fourth quarter and fiscal year twenty twenty four financial results. Thank you, Josh, and good afternoon, everyone. In addition to the financial details included in today's call, we encourage you to refer to Zebra's annual report on Form 10 ks for more detailed information, which we intend to file within the next few days. In the fourth quarter of twenty twenty four, we reported net revenue of $12,000,000 which includes $10,100,000 in MyPlifa revenue, $100,000 in Opriva revenue, 1.1 in net reimbursements from the French EAP for Eremacamole and 0.7 of royalties and other reimbursements under the Astarus license. This was a record level of quarterly product revenue for Zebra.

Speaker 2

For our commercial products MyPlifa and Opruva, we recognize revenue when shipments are received by the specialty pharmacy. For MyPlifa, Q4 was a partial period and revenue included initial patient dispensers, refills for some early enrollees and target supply levels at the specialty pharmacy. French EAP reimbursements were reduced during Q4 due to a true up in program access fees and we continue to expect net reimbursements will continue to be approximately 2.1 per quarter. Our operating expenses for the fourth quarter were $24,500,000 which includes non cash stock compensation expense of $4,000,000 of which $2,100,000 was accelerated vesting expense related to severance arrangements and severance expenses of $1,600,000 recognized within R and D expenses. R and D expenses for Q4 twenty twenty four were $8,400,000 which was a decrease of $3,000,000 compared to Q4 twenty twenty three due primarily to a decrease in third party costs upon completion of the KP-ten 77 Phase II trial, offset in part by an increase in personnel related costs.

Speaker 2

SG and A expenses were 16.1 for Q4 twenty twenty four, which was an increase of 1.4 compared to 14.7 for Q4 twenty twenty three, due primarily to an increase in personnel related costs as our full team was in place and actively engaged in commercial launch activities for the entire quarter. Net loss for the fourth quarter twenty twenty four was $35,700,000 or $0.67 per basic and diluted share compared to $19,600,000 or $0.51 per basic and diluted share for the same quarter a year ago. For our full year 2024 results, net revenue was $23,600,000 which included $10,100,000 of MyPlaza net revenue, $100,000 of Opruva net revenue, $9,100,000 in net reimbursements from the French EAP for Aramarkamal and $4,300,000 in royalties and other reimbursements under the Asarris license agreement. Our full year operating expenses were $97,000,000 which includes $14,900,000 of non cash stock compensation expense. R and D expenses were $42,100,000 which was an increase of $2,300,000 compared to full year 2023 due to an increase of $6,300,000 in personnel related costs offset by a decrease of 3.6 in third party costs, primarily as a result of the completion of the KP-ten 77 Phase II trial.

Speaker 2

SG and A expenses were $54,900,000 for 2024 compared to $34,300,000 for 2023 and this reflects the commercial team fully in place and actively engaged in our launch activities. For fiscal year 2024, net loss was $105,500,000 or $2.28 per basic and diluted share compared to net loss of $46,000,000 or $1.3 per basic and diluted share for 2023. As of 12/31/2024, total cash, cash equivalents and investments were $75,500,000 which was a decrease of $20,000,000 compared to the end of Q3 twenty twenty four. Total long term debt was approximately $60,000,000 And as announced on February 27, we have entered into an agreement to sell the priority review voucher we received with the MyPlifa approval for $150,000,000 Upon closing, we expect to receive net proceeds of approximately $148,300,000 net of fees and our pro form a balance of cash, cash equivalents and investments will be approximately $223,800,000 This non dilutive capital adds a significant strength to execute on our strategic priorities with our immediate focus on executing the commercial launches of MyPlifa and Opruva, investments in Soliperol and our other development programs and building our corporate foundation while we earn the right to make disciplined growth investments in the future.

Speaker 2

Based on our execution to date, our Form 10 ks will not include a going concern disclosure. And our current operating forecast combined with existing resources extends our cash runway into 2029. Our cash runway guidance does not include the potential proceeds from the sale of the PRV, but it does include anticipated net revenue from MyPlifa and Opruva sales, net reimbursements from the French EAP for Aramarkamal, royalties under the Astarus license agreement and continued investments into our development pipeline programs. Our financial results for 2024 reflect the solid execution of our strategic plan and demonstrates our commitment to our mission to serve patients and generate meaningful value for shareholders. We are pleased with the opportunities we have in 2025 and beyond to drive value creation through disciplined investments where we can win.

Speaker 2

Now, let's open the call to questions. Operator?

Operator

We'll take our first question from Kristin Kluszka with Cantor. Please go ahead.

Speaker 4

Hi, everyone. Congrats on a really strong start out of the gate, especially around the holidays. I think speaks to how much these patients really wanted that therapy. So congratulations. A few questions from me.

Speaker 4

I think this is the first time that you've provided us more specific guidance on the European filing timelines. So can you give us a sense of the last dialogue that you had with the agency there and the plan? And then when we think about the European market, which is more mature, partially due to the fact that Miglustat has been there for over a decade. How do you think that drug becoming available and used for patients will and how that identified more patients over time can translate to some of the efforts in The U. S.

Speaker 4

Now that you have the approval there?

Speaker 3

Thanks, Kristin, and thanks for the comments. It's been a great 2024 and transformational for sure. But as we mentioned in the remarks, the prepared remarks with Niemann Pickett Sea is definitely a crowning achievement. Let me quickly touch base on a little bit of the market dynamics for Europe and then I'll ask Adrian to talk a little bit about briefly about our regulatory interactions. In Europe, we see about eleven hundred patients in Europe based on a prevalence number and miglostat has been approved there for well over a decade.

Speaker 3

So our current label in The U. S. And we are still working through what this filing would look like for our MAA in Europe, as you know have MyPlifa and MyPlaustat in combination in order to be able to halt the progression of the disease versus Myglostat alone having an approximate two point progression over twelve months based on our clinical study. So based on the fact that there has been Myglostat in the market, we believe the European market is more mature. There are more patients diagnosed and treated because of decades worth of work that has been done.

Speaker 3

And now bringing a product that has the potential in Europe under the MAA filing to actually halt the progression of the disease based on the label that we have and the data we had in our Phase three program. We feel like this is a great opportunity to go after in Europe. In regards to the European filing, probably not ready to talk too much about all of the intricacies of the European filing, but to be able to state that 2020 for the second half of twenty twenty five, we believe that we're going to be able to file. Adrian, you want to talk a little bit about our last interactions?

Speaker 5

Yes. So the last interaction with the EMA obviously happened to the office, I mean, about four years ago when we reviewed the application based upon the complete response letter that we received from the FDA and some of the comments that we received from the EMA in regards to the filing that we had in Europe. We're now obviously in a much better position with long term data available. We are currently consulting with the copper consultancy group to how to specifically address some of the problems that they had during the original filing. And as said, we are planning to file in the second half of this year.

Speaker 5

We're confident that the filing will be accepted by the EMA.

Speaker 4

Okay, thanks. And then thanks for providing the cash runway guidance, which I understand excludes the PRV for now. But can you just maybe high level give us a sense of like how conservative are you being with launch projections into this? Does this include if you do get an approval in Europe adding that territory there? Just any high levels would be really helpful.

Speaker 4

Thank you again.

Speaker 2

Yes, of course. Yes, we did not include the PRV proceeds to yourself. And I would just say, we have been conservative as we looked at that cash runway. We have to continue executing and continue into 2025 with the plans that Josh and the team have got in place. And so that's definitely where our focus is.

Speaker 2

But yes, it is safe to call that a conservative appropriate conservative estimate.

Speaker 4

Thanks, everyone.

Operator

Thank you. And we'll next go to Jason Butler with Citizens JMP. Please go ahead.

Speaker 6

Hi. Thanks for taking those questions and let me add my congrats on the quarter as well. Great spot for the MyPlisa launch. Can you maybe give us any more qualitative color on the MyPlisa sales during the quarter in terms of the supply amount to specialty pharmacies or what proportion of patients got a refill? And then my second question is, how should we think about the launch term here in terms of net patient adds?

Speaker 6

You've obviously successfully converted the EAP patients. But should we expect consistent, steady net patient adds or could it be more volatile from month to month? Thank you.

Speaker 3

Yes. Jason, I'm going to see if I can parse that to Duane to be able to answer the original questions around inventory and we're not going to get into specifics, but he'll be able to answer that. And then we'll hand it off to Josh to be able to talk a little bit about this bolus of patients that we've seen and what the future may look like. Lloyd?

Speaker 2

Yes. So with My Plifo revenue, again, we reported $10,100,000 in Q4. That would have included product to handle the initial patient dispenses. Some early enrollees may have received a second refill late in December. And then we did allow for an appropriate level of stock to continue to service patients.

Speaker 2

It's actually at the target level that we would expect to maintain at this point. And so Josh, I'll turn it to you. Yes. Jason, your question about new patients going forward, I think it's really important for us to kind of reflect on how quickly we were able to get to 109 patients and how quickly we were able specifically to convert those patients who were in our expanded access program to enroll into MyPlifa. And so we had all those patients plus some patients who had previously not been exposed to MyPlifa all within the fourth quarter.

Speaker 2

And so we were really pleased with how quickly we were able to do that. I think it speaks to the demand that there is in the marketplace. I think it also speaks to the execution of the team. And as we look forward into 2025, our focus now is really to be able to find those patients who have been diagnosed that aren't currently treated as well as those patients who have not yet been diagnosed. And so that's really going to be the focus as we continue into this year.

Speaker 5

Great. Thank you.

Operator

Next, we'll take our next question from Sumant Kulkarni with Canaccord. Please go ahead.

Speaker 7

Good afternoon. Great to see all the progress and thanks for taking my questions. My first one is a bit of a follow-up on the last question. In terms of your sequential delta and patient enrollment forms from MyPlaza, that was 2019. What are the key variables that we should keep in mind that might influence this trajectory as we look to the next quarter versus this one?

Speaker 2

You're absolutely right. We went from 90 at the October to 109 at the December. Again, this really reflects many of these patients were really sort of queued up ready to go from our expanded access program. As we move forward into this quarter, as I just mentioned, we're really focused on trying to expand beyond those expanded access sites to where we know that these patients are being treated, have been diagnosed and we're going to continue to deploy our sales teams into those offices. As we continue to do on each of these quarters, we'll be providing enrollment numbers, percent of covered lives and net revenue.

Speaker 2

And you can expect that we'll continue to do that as we move forward into subsequent quarters.

Speaker 3

Yes. Sumant, it's Neil here. I think it's important as we try to answer this question with a follow-up also to the previous analyst questions as well. When we talked about the transition of our EAP patients, traditionally, we would see that over about a twelve month period. And the team based on all of the work they did prior to launch into launch and then a combination, I've been able to exceed every expectation we had internally on the conversion of those EAP patients, not over a twelve month period, but actually over a one quarter period.

Speaker 3

And I think that's a true testament as we mentioned previously to the built up demand and as well as the unmet need in this patient population. So as we go through this trajectory and it has been a rocket ship trajectory, we expect that over the next phase of launch for us to be able to then take this momentum into Q1, into Q2 executing on all of the tactics and the phased approach that Josh mentioned in his prepared remarks. So I think there's an important perspective here for us to be able to show that this has been an outstanding performance on the conversion and on the launch trajectory. We now are going to take this into executing Phase

Operator

II.

Speaker 7

That's a point well made and taken. So on the 03/1950 or so diagnosed and treated patients with MPC, roughly how many are treated at Centers of Excellence versus not?

Speaker 2

Yes. Many of these patients have some diagnosis that takes place at these centers of excellence. But keep in mind, there had previously been no treatments approved for Niemann Pick. So many of these patients would be diagnosed and then go back to their local neurologist to continue being monitored. We're finding now that those patients are coming back to these centers of excellence as they're made aware of Myklyfa being approved.

Speaker 2

And so the vast majority of them have some connection either being treated at the centers of excellence or some sort of referral to the centers of excellence.

Speaker 7

And last one before I hop into the queue back. On Ultuva, roughly how many quarters are you giving yourselves for the new patient targeting strategy to see a potential inflection?

Speaker 2

Yes. We haven't really put any timeframe on that. We know that Ultruva can provide benefit to patients. We have revised our strategy to be able to bring that to specific patients who will benefit from the portability and the personalized dose. And these are the adult patients and in particular those where there's some reimbursement challenges.

Speaker 2

So we're continuing to monitor this. It's early in kind of assessing the impact of that. But we also know that there's great synergy within our sales team, within our broader commercial team in having both of these products. It's opening a lot of doors for MyPlifa. It's allowing us to foster relationships across the entire commercial spectrum.

Speaker 2

So we're watching this very

Speaker 3

closely and we're allowing some time to see the impact of this change in our strategy.

Speaker 2

Thanks.

Operator

Oren Livnat with H. C. Wainwright. Please go ahead.

Speaker 8

Thanks. I have a couple on my slide. Can you just characterize that initial bolus of 90 patient referrals that came in really fast in that first month? Can you get the lion's share of MPC patients in a concentrated group of centers? And so now you're more gradually expanding to a broader set of treaters and centers to penetrate those?

Speaker 8

Or was that 90 including, I guess, just a fraction of the patients at a broader set of sites, if you understand my question? Just trying to figure out, like, what the heavy lifting is here going forward? And also, I think on the last call, you had mentioned that thirty percent of those initial ninety had already been approved, which is really fast in the first month, either I assume via some formal coverage or more likely medical exemption. Do you have any updates on those percentages for the initial wave, continuing approval rate or the cumulative approval rate for this entire 109 through December? And I do follow-up.

Speaker 8

Thanks.

Speaker 2

Yes. So I'll take your question about the 90. So as we reported in our last call, of those ninety, sixty nine of them were from the expanded access program and twenty one were from other sites that were naive to My Plifer had not previously received My Plifer. Majority of those patients were still treated within one of those centers of excellence. As we move forward now to 01/2009, we've gotten the remainder of those EAP patients.

Speaker 2

We have also expanded beyond the centers of excellence to find other prescribers and patients. And we're going to continue to do that as we move into this next phase of launch. Your second question was around the percent of patients that had received authorization for payment and at the time of our last call, it was thirty percent. We're continuing to see improvement in that And what we're seeing is that many commercial payers have not yet made decisions around policy, but the vast majority of our patients are able to get reimbursed either through direct formulary or through a medical exception process. And importantly, our team is out in front of these payers talking about the clinical benefits of MYCIFA, sharing with them the new data that's been generated since the approval.

Speaker 2

And so we expect that's going to continue to improve as we move down the launch.

Speaker 8

And as you have these reimbursement conversations, can you just maybe give us more color on on how that's going? If there's any pushback, it's obviously ultra rare. So I would assume that's somewhat limited. But obviously, we're talking about both two expensive drugs in combination. So just maybe a little more color there.

Speaker 8

And are you able to give us a sense of what your, I guess, average net dollar per patient per year expectation is going forward?

Speaker 2

So in terms of the conversations that we're having with payers right now, we are really getting in there and we're talking about the benefits that MyPlaza offers to these patients. We're talking about the halting of progression of disease after twelve months. We are the only product that has been approved with based on a clinically meaningful endpoint and the 2.1 improvements in that endpoint. So that's really where the conversations are taking us and we're continuing to drive that message home. And as I mentioned, most of these patients are getting covered either through formulary or through some sort of medical exception process and that's really continuing.

Speaker 2

So that's really the tone. A lot of additional doors are being opened for continued clinical conversations. As it relates to the net pricing, I'm going to turn that over to Duane here. Yes. Oren, I would just say we don't generally discuss or comment too much on the gross to net details.

Speaker 2

But at this point in time, I would say our strategy is still underway in terms of how we get the data story in front of payers. It's not clear yet if we need to even be that aggressive in that concept. So I think it's early days there, but I expect that gross to net is going to be we're going to have sorry, gross to net is going to be in a solid place and I don't expect we'll be very aggressive there at this point.

Speaker 5

Okay. Thank you so much.

Operator

Our next question comes from Sami Corwin with William Blair. Please go ahead.

Speaker 9

Hi there. Congrats on the great quarter and thank you for taking our questions. I guess I was curious what the average time you're kind of seeing from the start enrollment form to the approval of reimbursement? And then as you're kind of thinking about expanding your targeted population and going beyond the three hundred to three fifty patients that are currently seeking treatment,

Speaker 1

I guess to what extent do you

Speaker 9

think you can further expand that and penetrate into the estimated nine hundred pebble in population? Thank you.

Speaker 3

Hey, Sami, it's Neil. I'm going to kick this one off because I think we're really pleased so far with what we've seen, not just in those patients who were diagnosed, but in our prepared remarks, we talked about the fact that one of the areas we've been investing in has been media. And those three patients that we talked about were actually patients who were diagnosed but not treated. And this gets back down to this expanding the market population. And we believe that as we continue to get a treatment in the market and multiple treatments in the market for that matter, Physicians that actually have NPC or have other diseases that will start to think about NPC in their diagnostic cascade in these rare diseases that will really allow us to be able to then increase that number from the three hundred to three fifty into nine hundred.

Speaker 3

And then if Europe has a marketplace of the eleven hundred patients from a prevalence perspective and the miglostat growth has happened over a decade plus, we think it's a great information it's great information for us to inform what our market possibility is in The U. S. So, Josh, you want to talk a little bit about enrollment time to reimbursement and those things? Sure. And I was just

Speaker 2

going to add to this that as we mentioned in our prepared remarks, we've employed a number of other tactics to really identify these patients, including some collaboration with the genetic testing, education around the Niemann Pick, all of which is going to lead to some market expansion. In terms of the average time from enrollment to reimbursement, it's too early into the launch to be able to really give you specifics on that. But I wouldn't mention again that in the fourth quarter in those five weeks from the time that we shipped drug until the end of the year, we did have a number of patients who not only received their first fill, but also refill in that period of time. So I think that really speaks to how quickly our team was able to get some of these patients reimbursed and reauthorized. And I anticipate that those that's just going to continue as we work our way through those patients who are pending approval now.

Speaker 9

Great. That's very helpful. And a quick follow-up. Have you had any patients that have submitted an enrollment form that have been ultimately denied? And do you have any clarity as to what the rationale behind any ultimate denial is?

Speaker 2

Yes. So of course, in any rare disease, there are some initial denials and we work through those with patients to make sure that we can help them navigate and work through those denials through appeals and other parts of pathways through the medical exception pathway. We've only had a couple of patients who have been denied, But again, we continue to support those patients. We're continuing to help them work through the reimbursement challenges and any patient who is experiencing those challenges. We have a very robust patient services plan and patient assistance plan so that no patient would go without drug.

Speaker 1

Got it. Thank you. Perfect.

Operator

We'll next go to Eddie Hickman with Guggenheim Securities. Please go ahead.

Speaker 6

Hi, good afternoon. I'll add my congratulations on a really nice quarter. What can you tell us about how we should model discontinuation rates so far? And then going forward, do you expect the rate to meaningfully change as we get further outside of the EAP? And then of these sort of current bolus of patients, like how many of them do you expect to retain sort of in the long term?

Speaker 6

Thanks.

Speaker 2

Yes. Thanks for that question. I think it's just it's way too early in the launch to be able to address or answer that question.

Speaker 3

Yes. Eddie, maybe I'll give you a comp though that you can actually think about. As we look at our EAP data and we think about the patients and the continuity, we have patients that remain in our EAP five years and patients went through OLE to EAP now on to commercial product five, six, seven years. You heard that also in the open public forum during our advisory committee. So what we've seen and continue to see also in our European expanded access program is a really high level of continuity of care once patients are on MyPlife and Miglostat.

Speaker 3

Again, we're just a few months in. We're reporting on five weeks of patient shipments in Q4. So it's going to be a little early to talk about discontinuation rates. But if history repeats itself, once patients are on with the side effect profile that Myclyfa and Miglostat have, we see longevity.

Speaker 6

Great. I appreciate all that color. Thanks guys.

Operator

Thank you. I'd now like to turn the call back over to Neal McFarland for any closing remarks, please.

Speaker 3

Thank you, operator. Thanks for joining us today to review what was the transformational 2024. We're pleased to start 2025 from a position of strength and look forward to executing on our mission to serve people living with rare diseases. Have a great day.

Operator

Thank you. And this does conclude today's program. We thank you for your participation. You may disconnect at any time.

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Earnings Conference Call
Zevra Therapeutics Q4 2024
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