Ionis Pharmaceuticals Inc (IONS) 2014 Q1 法說會逐字稿

Welcome to the Isis Pharmaceuticals first quarter financial results conference call.

Please note this event is being recorded.

Leading the call today from Isis is Dr Stan Crooke, Isis' Chairman and CEO.

Dr Crooke, please begin.

Good morning, everyone, and thanks for joining us on today's call to discuss the -- our first quarter financial results.

This morning Lynn will highlight some of the recent business successes and Beth will walk you through the financial results, and I'll close by focusing on a few of the upcoming events.

Before we get into the call proper, I want to spend a minute discussing Isis SMNRx.

The first thing I want to do is reiterate that we, Biogen Idec and the investigators are all tremendously encouraged by the data that we presented.

And, as we have always planned, we're getting the Phase III studies underway.

We begin those Phase III studies with a very high level of optimism.

We've had some questions about the data, and I just want to see if I can answer some of those questions.

First, there was some confusion on the median age of the 12-milligram cohort.

Just to remind you, we -- the study was staggered.

To assure safety we dosed the 6-milligram infants first.

Then we started the 12-milligram cohort which was almost six months later.

Therefore the median age of the 12-milligram cohort was on April 7 by definition significantly less than the 6-milligram cohort.

One other important point to make is that the 12-milligram cohort was enrolled in the middle of the cold and flu season.

Which is a time of the year that's very problematic for these very fragile infants.

We believe that the continuing evidence that our muscle performance in these infants is encouraging and supports our continued enthusiasm, and so does everyone else.

Obviously as the study matures we'll have the opportunity to talk in more detail about the survival and other characteristics of the infants in this study.

Next, let's talk about the number of SMN 2 genes in these infants.

Only one infant in the study from the protocol efficacy population had three copies of the SMNII gene.

The rest of the infants had only two copies.

For the infants who had just recently enrolled, we've not received the results from the SMN copy number test, but we fully expect that they all have two SMNII gene copies given the rarity of type one infants with three SMNII gene copies and the clinical presentation of these statements.

A third factor that was confusing was the accidental death.

We obviously can't discuss the specifics of the death, but what we can say is that it was in a baby that was 13 and a half months old and that baby was doing very well.

And, as the baby was continuing to do well, an unfortunate very tragic accident took this baby's life.

Before the accident, everyone involved was encouraged by the observations that were being made about this baby in the study.

Now finally, the inclusion -- exclusion criteria for infant study confused.

I think the most important point is that we selected these criteria along with Dr. Finkel to match the characteristics of the type I-B infants in Dr. Finkel's attribution study which we -- with which we are comparing our results.

We think the infants in our study are quite similar to the type I-B infants that were in Dr. Finkel's study.

The exclusion criteria basically meant that the type I-A patients were excluded from our study, and of course they're not included in the curve that we're comparing our study to as that curve is the type I-B infants.

Also it's important to remember that Dr. Finkel's results are quite contemporary, and the infants in our study are being studied at basically the same centers that were contributors to Dr. Finkel's natural history study.

So we do think that as we compare our type I-B infants to Dr. Finkel's type I-B infants, the natural history study that Dr. Finkel has represents a very contemporaneous and reasonably well matched comparator for the infants in our study.

Obviously, as we proceed with our Phase III trial, we'll be doing the control comparison that we've always planned to do.

So I hope that helps clarify some of those questions that have been raised.

To reiterate, we remain very optimistic that Isis SMNRx is likely to bring value to both children and infants with SMA.

So now let's move into the thrust of the call, the financials.

Joining me on today's call are Lynne Parshall, COO; Beth Hougen, CFO; and Wade Walke, Vice President of Corporate Communications and Investor Relations.

And now, Wade, will you read our forward-looking language statement please?

Certainly.

Thanks, Dan.

A reminder to everyone that this webcast includes forward-looking statements regarding the financial outlook for Isis, Isis' business and the therapeutic and commercial potential of Isis' technologies and products in development.

Any statement describing Isis' goals, expectations, financial or other projections, intentions or beliefs including the commercial potential of KYNAMRO is a forward-looking statement and should be considered an at risk statement.

Such statements are subject to certain risks and uncertainties particularly those inherent in the process of discovering, developing and commercializing drugs that are safe and effective for use as human therapeutics and in the endeavor of building a business around such drugs.

Isis' forward-looking statements also involve assumptions that, if they never materialize or prove correct, could cause its results to differ materially from those expressed or implied by such forward-looking statements.

Although Isis' forward-looking statements reflect the good-faith judgment of its Management, these statements are based only on facts and factors currently known by Isis.

As a result you are cautioned not to rely on these forward looking statements.

These and other risks concerning Isis' programs are described in additional detail in Isis' Annual Report on Form 10-K for the year ended December 31, 2013, which is on file with the SEC.

Copies of this and other documents are available from the Company.

Now I'll turn the call over to Lynne.

Thanks, Wade.

I want to apologize in advance, I'm fighting a little bit of a head cold so if I sound a little croaky as we go through this, please bear with me.

But 2014 is off to a great start.

We reported positive Phase II clinical data on both ISIS-SMNRx and ISIS-APO(a)Rx.

We started new clinical studies.

We added new drugs to the pipeline, and our partnerships continue to be vibrant and successful.

These accomplishments have made for a busy first quarter, and they set the stage for another year of growth.

In addition to Stan's comments on Isis SMNRx let me make a few other important points.

We entered Phase III with much optimism for a number of reasons.

First, ISIS-SMNRx has been well tolerated in both infants and children to date.

The increases in muscle function scores we've observed in both the children and infants are encouraging both when you look at averages and when you look at individual patients.

As Dr. De Vivo pointed out, even small changes in muscle function scores can provide significant benefit for these patients.

When we began developing ISIS-SMNRx our hope was to delay progression.

The results we've observed to date have been consistent from mouse to human, infant to children and study to study.

The effects we've observed were does and time-dependent.

The increases in SMN protein we've observed today suggests that ISIS-SMNRx is acting through the mechanism for which it was designed.

All of these reports support our optimism as we advance ISIS-SMNRx into planned Phase III studies in both infants and children with SMA later this year.

We plan to initiate the Phase III study in infants in the middle of the year and the study in children later in the year.

We reported the final data sets from our Phase II studies on our novel triglyceride lowering drug ISIS-APOCIIIRx at three different medical meetings.

In our Phase II studies we consistently observed significant reductions of triglycerides, apoC-III and non-HDL as well as significant increases in HDL.

Even more important than any individual result is the totality of the data.

We observed improvements in the lipid profile of patients irrespective of their incoming triglyceride levels.

Improvements in triglycerides were similar whether ISIS-APOCIIIRx was administered as a single agent or in combination with fibrates.

Also we reported last week we saw a statistically significant reduction of hemoglobin A1c and other measures of glucose control plus trends towards enhanced insulin sensitivity in patients with type 2diabetes, a condition that affects nearly a third of very high triglyceride patients.

These observations are both remarkable and important.

We've shown for the first time that after only 13 weeks of treatment ISIS-APOCIIIRx lowered apoC-III and altered glucose control in these patients.

These results confirm that by lowering triglycerides glucose control improves and diabetes can be better managed.

Adding these potential benefits in glucose control to the significant triglyceride lowering we've observed could provide a benefit to patients with severely high triglycerides.

We are also pleased with the safety and tolerability profile we've observed so far.

ISIS-APOCIIIRx is a newer second-generation drug.

Not only are our newer second-generation drugs are more potent, but these drugs are also showing in the clinics that they have fewer and milder injection site reactions and flu-like symptoms.

We are on track to initiate the first Phase III study of ISIS-APOCIIIRx in patients with FCS in the middle of this year.

And the second Phase III study in patients with triglycerides greater than 880 milligrams per deciliter later in the year.

Our Phase III study on ISIS-TTRRx in patients with familial polyneuropathy is also going well and on track to complete enrollment as scheduled.

We began dosing more than a year ago, and we've already opened the open label extension study so that patients can roll over into this study to continue to receive drugs after they complete their 15 months of dosing in the pivotal study.

In addition to these drugs in late stage development we have a pipeline of maturing products.

This year we have numerous opportunities to showcase the advances in our pipeline and the productivity of our Antisense drug discovery platform.

With 32 drugs in our pipeline and the ability to add three to five new drugs each year, I could spend the entire call discussing our pipeline.

Instead I hope you will be able to join us in New York on May 22 for our R&D day.

During this presentation we plan to provide more detail on development programs as well as highlight the advances we continue to make in Antisense technology.

It's a testament to the efficiency of our technology that we can generate in advance a pipeline with so many drugs in so many different therapeutic areas.

Our partnering strategy is designed to take advantage of this efficiency to create and develop an exciting pipeline of first in class drugs.

Our partnerships provide us with significant value not only when we initiate the alliance and received upfront payments but also as our partner drugs progress.

For example we received more than $40 million in upfront payments from GlaxoSmithKline.

Since we began the collaboration, we've advance four drugs into development and have the opportunity to do more.

This remarkable productivity, which can only be achieved through the power of Antisense technology, resulted in approximately $43 million in milestone payments with the opportunity to receive up to an additional $1.2 billion in license fees and milestone payments as well as tiered double-digit royalties.

Our alliance with GSK also highlights the broad utility of Antisense technology to create a drugs to treat patients with many different diseases.

Together with GSK we're developing ISIS-HBVRx to treat hepatitis B virus, ISIS-GSK4Rx to treat an undisclosed ocular disease, and our Phase III drug ISIS-TTRRx to treat TTR amyloidosis, a severe and rare disease.

Other targets we're advancing within our GSK collaboration represent additional diverse therapeutic opportunities.

We hit a number of successes in our other partnerships as well.

This year we selected a development candidate to treat patients with Huntington's disease.

In less than a year from beginning our collaboration, we and Roche have advanced ISIS-HTTRx into development.

We will begin evaluating this drug in patients early next year once we've completed the necessary studies to support clinical development.

And as I discussed earlier, together with Biogen Idec we've continued to report results on ISIS-SMNRx that support our enthusiasm for this drug and for advancing ISIS-SMNRx into Phase III development.

We're also preparing to start the first clinical study of ISIS-DMPKRx, a generation 2.5 drug to treat patients with myotonic dystrophy type I. And we're making progress in our broad neurological disease collaboration and hope to move at least one additional drug into development this year.

We've also made exciting progress on the cancer front.

Together with AstraZeneca we plan to begin development very shortly on ISIS-ARRx, the second anti-cancer drug from our alliance and the third-generation 2.5 drug in our pipeline.

We're continuing to evaluate ISIS-STAT3Rx in patients with advanced metastatic liver cancer and in patients with advanced lymphomas.

The fact that we and AstraZeneca are each conducting Phase II studies in this program is a reflection of the strong collaborative nature of this relationship.

So, as you can see, we have multiple opportunities to create and maintain value with our partners and also on our own.

So with that, I'll turn the call over to Beth.

Thanks, Lynne.

Good morning, everyone, and thank you for joining us.

I am pleased to report that we maintained our strong financial position by ending the first quarter with more than $630 million in cash.

We received more than $20 million from our partners including approximately $12 million from Biogen Idec to support continued development of ISIS-SMNRx.

These payments illustrate that our business model is consistently generating cash and revenue as the drugs in our pipeline advance.

We also ended the first quarter with a pro forma net operating loss of $23 million.

We are on track to meet our guidance of a pro forma net operating loss in the low $50 million range even though our first quarter net operating loss was higher than our guidance might suggest.

This was in large part because of the variation in the timing of revenue for milestone payments from our partners as our drugs progress in development.

You may recall that in our year-end call in February we projected 2014 revenue of more than $160 million including more than $45 million in amortization of upfront fees and more than $110 million in milestone payments.

Because we are generating such a significant amount of our revenue from milestone payments, our revenue and our pro forma net operating loss will fluctuate on a quarterly basis.

This can also result in year-over-year fluctuations such as we experienced this quarter compared to Q1 last year in which we earned more than $30 million in milestone payments.

These variations in the timing of revenue are consistent with our projections and are the natural result of our large mature pipeline and our partnering successes.

As Lynne mentioned, our partnerships provide us with significant value from upfront payments when we initiate the collaboration but also from milestone payments as our target drugs advanced towards the market.

As our pipeline and partner drugs expands and matures milestone payments we are eligible to receive generally increase in value.

And with numerous partnerships encompassing multiple drugs, we have many opportunities throughout this year to earn milestone payments as our drugs continue to progress.

We will earn an $18 million milestone payment from Biogen Idec when we begin the Phase III study in infants which is planned for the middle of this year.

And a $27 million milestone payment when we begin the planned Phase III study in children later this year.

We are also about to begin the first human study of ISIS-DMPKRx for patients with myotonic dystrophy type I for which we will earn a $14 million milestone payment from Biogen Idec.

And when ISIS-ARRx advances into the clinic shortly we will earn a $15 million milestone payment from AstraZeneca.

And of course we have numerous opportunities to earn milestone payments from GSK as we advance the Phase III study of ISIS-TTRRx, advance ISIS-HBVRx and ISIS-GSK4 Rx as was as add other drugs into development.

I've listed some of the near-term milestones we plan to earn.

Yet there are many more milestones spread out over the year that we believe we can earn as our drugs progress.

For this reason we are confident we can meet our guidance of more than $110 million in milestone payments.

In addition, in the first quarter we earned revenue of $17 million from the amortization of upfront payments which puts us on track to meet this component of our projections.

Our partnering strategy also takes advantage of our dominant intellectual property estate through the success of our satellite companies.

In these partnerships we earn revenue from our partners when they license our technology to their partners.

For example we earned $7.7 million earlier this year from Alnylam for their transaction with Genzyme.

The increase in our pro forma operating expenses in the first quarter was in line with our projections, and, as you'd expect, the primary driver of the year-over-year increase was and will continue to be our maturing pipeline.

In addition to our Phase III study of Isis TTRRx, we are preparing to begin a total of four Phase III studies split between ISIS-SMNRx and ISIS-APOCIIIRx.

We are also conducting Phase II studies on eight drugs, and we've advanced our earlier stage drugs as well as added new drugs to our pipeline.

We've planned to end 2014 with three drugs in Phase III development and nine drugs in Phase II development plus numerous earlier stage drugs.

This represents a significant expansion and maturation of our pipeline.

Nevertheless, we continue to keep our spending increases consistent with our projections.

Our achievements to date have positioned us for continued financial strength.

As such we remain on track to meet our financial guidance for the year of a pro forma NOL in the low $50 million range and year-end cash of more than $575 million.

And now I'll turn the call over to Stan.

Thanks, Beth.

We're off to a good start in 2014, and we've had I think important clinical successes already.

We think the value of the technology and the pipeline continue to increase, and there's still a great deal of opportunity to better -- have investors better understand the value that our pipeline and technology represent.

We have resources we need to continue to advance the drugs in our pipeline, add new drugs to our pipeline and to continue to advance Antisense technology.

So let me just focus first on Phase III events that we have coming up.

As we discussed, we continue to be encouraged by the results from our Phase II studies evaluating SMNRx in infants and children with SMA.

And a Phase III study in infants with SMA is planned to begin in the middle of the year, and the other Phase III study in children is a bit later.

Of course both the multiple dose Phase II trials in infants and children are continuing, so later this year we'll have an opportunity to update you on both of those studies.

Second, ISIS-APOCIIIRx continues to perform remarkably well.

We've observed statistically significant decreases in hemoglobin A1c and positive effects on lipid parameters such as triglycerides, apoC-III and HDL.

These data confirm and support our optimism for ISIS-APOCIIIRx, and, as you know, we're getting ready to begin the Phase III program with the first study to begin in patients with FCS.

Next the Phase III study of IISIS-TTRRx is enrolling well with patients with familial polyneuropathy.

We are on track to complete this enrollments -- the enrollment in the study in 2015.

And if positive we believe this study should support registration of ISIS-TTRRx.

We also continue to work with GSK to finalize development plans for patients with the cardiac form of the disease.

Now let's shift focus to the numerous Phase II events we have coming up.

We plan to report Phase II data in the first half of this year from our novel drug targeting factor XI.

Which is designed to more effectively reduce thromboembolic events.

Next this will be a very important year for our type 2 diabetes franchise.

We have three drugs designed to treat type 2 diabetes in Phase II trials.

The most advanced drug in this franchise is ISIS-GCGRRx or the glucagon receptor Antisense drug.

We've completed enrollment for this drug and a Phase II study in patients with type 2 diabetes and plan to report the results of that study shortly.

The next drug in our metabolic program is likely to have important Phase II data is our ISIS-GCCRRx, or our glucocorticoid receptor drug.

This is a drug that we hope to develop for patients with Cushing's disease and patients who have type 2 diabetes driven largely by glucocorticoid stimulus.

Finally, we plan to report Phase II data from our novel and we believe safer insulin sensitizer ISIS-PTP1BRx later this year or very early next year.

We plan to initiate a Phase II study in fact on ISIS-GCCRRx in Cushing's syndrome.

Cushing's syndrome is an orphan disease caused by prolonged exposure to high levels of corticoids.

And as such we believe ISIS-GCCRRx could provide patient benefits to these patients.

We look forward to getting get getting a study underway.

We are planning to start the Phase II program in ISIS-APOARx.

We believe there are substantial achievable commercial opportunities for this drug that do not require outcome studies.

We also plan to start a Phase II program in ISIS-HBVRx which is partnered with GSK.

On our earlier stage pipeline we have a number of drugs in which we plan to initiate clinical trials this year including ISIS-DMPKRx, ISIS-PKKRx and ISIS-ARRx.

DMPK you've heard for myotonic dystrophy.

PKK is targeted through a severe and rare disease, and androgen receptor is targeted to the treatment of androgen dependent or androgen responsive prostate cancer.

Some of these drugs are partnered and will provide us with significant milestone revenue this year.

And of course we continue to grow the pipeline.

Now, before I turn the call over for questions, I wanted to remind everyone later this month we're hosting an R&D day in New York City.

During this event we plan to provide an update on later stage drugs and highlight some of our earlier stage drugs as well which often get very little time and get lost in such a large diverse pipeline.

We also plan to discuss important advances that we've made in our technology.

Using our Antisense discovery and development technology we can develop drugs to multiple targets within the body including liver and bone marrow, fat cells, tumors, kidney and muscle.

We could administer Antisense drugs to a variety of routes including systemically, intrathecally and locally.

And, of course, we've shown in multiple therapeutic areas that Antisense drugs can provide a positive effect on disease.

We continue to develop the next-generation technology that enhances the therapeutic profile of our drugs as well.

Our generation 2.5 technology is now incorporated in three drugs in our pipeline.

All of these drugs will be in clinical development this year, and we would expect them to be significantly more potent than even our very potent generation 2 drugs.

It is the broader portability of our technology and the large safety base of well over 9000 subjects treated with Antisense drugs and the clinical demonstration of activity that have allowed us to maximize the value of our drugs and our technology.

And we intend to continue to pursue this course.

We hope that you'll be able to join us for this event.

And with that, then, Emily if you could set us up for questions?

(Operator Instructions).

Alethia Young, Deutsche Bank.

Congrats on the forward movement with SMA.

I have one question and a follow-up.

So on SMA I wanted to talk a little bit more about in the Phase III design like how you're incorporating the learnings that you've got - received from other studies for example I think you mentioned about the cold and stuff.

And then although at the loading period looks a little faster so just give me some color on that that would be great.

Thanks.

I think as we said at our SMNRx conference, we've learned a lot.

And these are pioneering studies.

And from them in the infant I think the things that are most important -- the most important lessons are one, we need to be as aggressive as possible in getting these infants into the studies as quickly as possible.

These are really very fragile babies, and they're deteriorating steadily.

So the sooner we can enroll these infants and the sooner we can treat, the better opportunity we have to bring benefit.

The second thing that we know is that we have a really well-tolerated drug to date.

And this allows us then to be even more aggressive in introducing this drug into these infants.

And we think that's going to have an important benefit because again, these infants are very fragile and deteriorating at an unfortunately rapid rate.

If we look at the benefits that we're seeing with the dose schedule that we have, we're certainly optimistic that with the new schedule we'll see even better.

And then third, these infants typically die because they can't breathe.

They have very weak respiratory muscles.

And, as a consequence as they deteriorate, they get colds and flu's and other mucus problems that normal babies have, and they recover from.

With these babies all of those things are potentially lethal events.

So being as assertive as possible and getting these patients into good care in the hands of good physicians aggressively treating their lung health, making sure that their lungs are as clean as possible.

And then managing whatever infections they have I think is another important thing that has been brought home to us as an important step that we will be taking in the Phase III program.

There are other lessons that we've learned from the children and other important lessons about the infants, but I think those three lessons about infants are probably the most important things to summarize.

Great.

Thanks.

And one follow-up on hepatitis B, I'm wondering the data that you presented at EASL with the Scripps Institute is that the same molecule that you'll be using in Phase I?

I'm not sure.

I think it is -- I'm almost certain it is, Alethia but I'll have to check on that.

The reason I think so is that I think it's the same virus, and I believe it's the same molecule.

Often we'll make a species specific -- I want to take that back.

I think that may have been an earlier molecule, now that I think about it.

And I think the molecule we have in the clinic is a similar, but a slightly different sequence, slightly different position, slightly different chemical.

Sorry.

I now remember.

Thanks.

No problem.

Great.

Thanks for the color.

Jim Birchenough, BMO.

It's Nick in for Jim this morning.

Just carrying on on the theme of SMA.

At the meeting I had a chance to speak to Dr Chiroboga however you pronounce her name and her poster and she described to me this little 2-year-old that had lost the ability to crawl.

And then began to creep and then crawl and stand and is now taking a few steps.

And I'm wondering if the current tools such as the Hammersmith tool you think fully capture the potential for SMN to transform functionality beyond anything that people could have imagined?

And then just on type I, how feasible is it that you can do a trial with newborn screening to get these babies basically diagnosed in -utero?

Thanks.

Let me answer the first question.

And Lynne, maybe, you can talk -- you can deal with the second.

First of all, when we talk about the magnitude of effect that we've observed with ISIS-SMNRx, I don't think we do justice to the observations.

It's not simply that the means have shifted positively, which they have, but it's some of the remarkable observations in for example the child you just described that are very encouraging.

And I thought that Dr De Vivo did a wonderful job of helping put real faces and bodies and aspirations associating all of those with these numbers.

And, as he said, a small change in Hammersmith, two points or three points can have a profound consequence on children.

And what we are -- so the Hammersmith is an effective and valid tool, but you're right, Nick.

It's a rather blunt instrument, and it doesn't begin to describe the value that some of these patients are experiencing.

And we are working to create finer instruments, and some of those will be the six minute walk test, not create but use some of these like the six minute walk test and the upper arm strength measures to further validate.

And then of course I think the individual patient descriptions will be of great value in understanding what the drug is doing.

And I think they will be of value in dealing with the regulatory process as well.

So -- and I look at that as a very high-quality problem.

We started with the hope that we would delay progression.

It is remarkable what we're observing to date.

And as I've said multiple times these studies are uncontrolled, you have to weigh that carefully.

But it's very hard not to be encouraged that the Phase III studies -- as we begin the controlled Phase III studies.

Did I answer that first question okay?

Yes.

You did.

Thank you.

And Lynne?

Just one more sentence on Hammersmith which is we've spent a lot of time looking at the Hammersmith and other measures.

And we think the Hammersmith is actually a very robust tool to look at all but the very healthiest of these patients and the very sickest of these patients.

When you get to one end or the other of the Hammersmith score, you find that there just aren't very many things that the child is capable of doing or improving on.

But the good news is most of the SMA patients are in fact type II.

And that is -- and for the more severe type IIIs, Hammersmith is also great.

And even for the less severe type IIIs, it is a useful instrument augmented as Stan said by some other estimates that we are looking at.

And we've been pleased in the early data that all of these instruments are pointing at the same direction so the consistency of what we've seen.

With regard to newborn screening, great idea.

And we are looking at implementing a study exactly like that.

It's on the drawing board so we're working with our partners at Biogen Idec to consider that.

Long-term the goal has got to be in all of these patients, to institute treatment as early as possible.

And certainly we, the investigators, our friends at Biogen Idec are aligned in that effort.

Great.

Thank you very much.

Nicholas Bishop, Cowen & Company.

Good afternoon and thanks for taking the question.

I have a question on the apoC-III program.

Just curious as to whether you have already completed the requisite meetings for the FDA to vet the Phase III program and just in general, what remains between now and starting up those Phase III trials?

And then I have a follow-up.

We don't like to comment in detail about our regulatory interactions.

But what I can tell you is that we're in the process of dotting Is and cross Ts and finalizing the protocols for both of the Phase III studies at this point.

And we're encouraged by the supportive attitude of the regulatory agencies that we've experienced so far.

Yes.

Okay.

Is that a sufficient non-answer to your question?

Yes, thanks for that.

Follow-up is just a little bit on some of the pipeline programs you didn't mention too much today.

Just curious when we might see an update on four programs specifically, and those are the STAT3 program, EIF4e, the CRPRx and FGFR4.

F4 we'll update at our R&D day.

STAT3 we think later this year it -- of course, we have to work in concert with AstraZeneca, but we're certainly -- we certainly continue to be encouraged by what we're seeing.

FGFR4 is in a holding pattern right now, because we're waiting to get a particular study started that looks at metabolic consequences.

And so we'd be that study will get started a little later this year we hope.

It's a very specialized study that has to be done in basically one center.

And as soon as a we get everything organized and can manage that, we'll do it.

And CRP, we're finishing analysis of a study in atrial fibrillation.

And it would be a while, because the analysis is very complex.

And then once we have all that done, we'll decide where we want to take apex CRP next.

Okay.

So just on the EIF4e answer, we'll see some data at the R&D day?

Is that what you meant on that?

Yes.

You will.

Thank you.

You bet.

Chad Messer, Needham and Company.

I was wondering if you could discuss a little further your strategy for moving forward and potentially partnering the diabetes programs.

You have several of them.

I assume that insofar as large Phase III trials would be needed as next steps for some of these programs, they are probably more amenable to partnering rather than keeping yourself as you have with apoC-III.

Is the preferred strategy one-off at a time after proof of concept to look for partners, or might you consider some kind of global diabetes kind of partnership particularly given that we have several data readouts that are proof of concept stage near-term?

So, you're correct.

These three drugs all fall in the bucket of drugs that we would prefer to partner after a step up in value that would come from a well done Phase II study.

And you're also right that we're going to have data on all three within a few months of one another, within six months of one another anyway.

The only slight difference to that would be glucocorticoid where we can see at least one and perhaps several indications that might not require large Phase III and large outcome studies.

One being cushionoid, and then there some other glucocorticoid driven lipid dystrophies.

And we have quite a bit of interest in those -- in that group of drugs.

And so we are certainly considering opportunities that would include putting all three of those and others into a partnership.

There's some benefits to that, but in the end what we're going to do is look at the numbers and make the best financial decision that we can make.

Thank you.

Prakhar Verma, Stifel.

How should we think about the timing of additional Phase II SMA data from 6- and 12-milligram cohorts?

Have you guys established any disclosure timeline internally?

Thank you.

We have not disclosed the timing for that.

So all that I'm able to say today is that there should be additional updates this year.

Thank you.

Cory Kasimov, JPMorgan.

This is Whitney on for Cory this morning, or this afternoon I guess.

Wanted to follow-up on the last question.

Have you guys said whether you'll present the SMN update at a conference, or will it be a press release, or how will we get the next update?

We haven't said.

And of course we are not in absolute control of that, because it depends on whether conferences are available and so on.

So what I'd ask is that everybody hang on.

We understand there's meaningful interest, and we have the keen interest in providing additional information as it's developed.

And so we'll do our best to find a good forum sometime a little later this year.

Got it.

And then on TTR in cardiac disease you mentioned discussions still ongoing with that trial.

What are the rate limiting steps or points of discussion point of discussion before getting a trial there up and running?

Well, those are discussions between us and GSK.

And I'd leave it at that for the moment.

Lynne, do you, do you want to add or subtract anything?

Yes.

We and GSK are finalizing a plan for what we think the study should be.

It also I think it's important that we do have cardiac measurements in our ongoing FAP trial.

Got it.

Thanks for taking the questions.

For us I think the most important thing is to move very aggressively on the first indication.

And we are pleased that the Phase III studies is enrolling as well as it is, and we're certainly pleased with the tolerability that we're seeing and so on in that study.

You'll be hearing a bit more about that.

Navdeep Singh, Goldman Sachs.

Just a quick follow-up on SMNRx.

You've accrued a good amount of data in terms of the Phase II trials for SMNRx.

Do you believe that you can potentially obtain breakthrough designation of a compound from FDA?

Then I have a quick follow-up.

We think we probably could.

We've got such great working relationship with the FDA right now on this program.

I'm not sure what extra it would get us.

It might get us some benefit from Wall Street, but we think -- we're working closely with the agency on this program.

And so I don't know that it would really help with anything.

Okay.

Thanks, Lynne.

And a quick question on the pipeline.

So you're planning to release Phase II data for the Factor XI in patients undergoing total knee replacement and Phase III data for GCGR in patients with type 2 diabetes.

What kind of data are you going to be providing Wall Street, and what would you consider a successful outcome for both Phase II assets?

Thanks.

So the first answer -- the answer to the first question is in this quarter we'll provide top line data for both those drugs, both those studies.

We are very hopeful that we will then follow that up with a much more detailed presentation of the data at the American Diabetes Association meeting in June and probably ASH in November.

And we want to preserve the opportunity for those presentations, and so we'll limit our comments to top line data.

With regard to the glucagon receptor drug, remember that in animals, it was perhaps the most effective agent for type 2 diabetes that we've seen.

And it was an agent that could work at very late stage diabetes.

It appeared to work both by reducing glucagon drive and increasing glyph one and seemed to preserve the pancreas.

So this is a 13 week study.

And obviously our drugs at 13 weeks have not reached their maximum.

They don't really reach their maximum effect until about 26 weeks.

So at 13 weeks we would be very happy with half a milligram percent hemoglobin A1c improvement at 100 milligram and maybe greater at 200 milligrams.

With regard to Factor XI, this is a study that compares two doses of Factor XI, 200 milligrams and 300 milligrams of Factor XI a week.

Two, 40 milligrams of enoxaparin in patients who have a very prone thrombotic event that has total knee replacement.

And what we hope to demonstrate with Factor XI is at least equal to enoxaparin efficacy in deep vein thrombosis and less bleeding.

And obviously if we got performance that was in some way better than enoxaparin, that would be a great thing, but the study is designed to show equivalence.

Okay.

Thanks a lot, Stan.

(Operator Instructions)

Yaron Warburg, Citigroup.

This is actually Kevin in for Yaron.

First of all, congratulations on moving SMNRx forward.

Just had a quick question about the entry criteria again for the infant study.

So I was wondering if you could just one more time go over the pulmonary entry criteria, certain infants between your study and Dr. Finkel's study.

And perhaps give us a little clarity as to what percent of infants this excluded.

And then I had a quick follow-up question about perhaps end points.

I'll try, and then, Lynne, you step in and fill in the blanks.

The whole purpose of the exclusion entry criteria that were developed by our team with Dr. Finkel was to match as closely as possible the I-B patients that were in -- that are in his current natural history study.

And I think the most important thing for people to hear is that we think that the babies who are in our study as closely as possible match those studies that have -- that form that I-B curve with a median time to either permanent ventilation or death of about two and half months.

The exclusion criteria then were designed to exclude I-As.

And basically these are infants that are in very desperate condition and typically will succumb before they could even get through the process of getting enrolled in the clinical trial.

And beyond that, just the exclusion criteria meant that almost all the other babies qualified.

I think Dr. Finkel said that in the conference, so I don't have the exact number, but I think it's very, very few, if any, babies were excluded.

So again, so far as we know, today, both in terms of the babies that were enrolled and the centers that enrolled them, we were as close to Dr. Finkel's I-B group of babies as we could make it.

I just want to reiterate what Stan said.

We worked closely with Dr. Finkel to design the criteria for entry into the study to make sure that we were as close as you could be creating an apples to apples comparison.

We were also aware of differences in management of pulmonary function in infants.

And so we tried to be sure that we were in centers that handled pulmonary lung care in roughly the -- as close to the same way as Dr. Finkel.

What's difficult to match is parents.

And you have to put yourself in this horrible situation that these parents are in, and you want to make sure that parents who enroll in the study as much as possible are committed to being aggressive in managing the babies health.

But there are parents who quite appropriately make the decisions that the interventions are -- that the baby is suffering.

And so those are things that you can't match.

And try as you will in a study, you'll have some parents that aren't -- that are not quite ready for a clinical trial.

And in the Phase III study, we hope that that will be reasonably balanced.

And again, the overlap of the sites between Dr Finkel's natural history study and our Phase II study was intentional.

Because the range of standard of care -- obviously the range of counseling is the same.

And the range of standard of care should be similar, because they're in the same centers with the same physicians.

Again to emphasize, it's not controlled.

This is a -- we are comparing this to a contemporaneous natural history study.

And we've done everything we know how to do to make sure that the centers and the babies are as matched to the I-B curve that Dr Finkel reported as possible.

And we think they are.

Terrific.

Thank you.

I think that will help alleviate some of the concern here.

And then just a quick follow-up I was wondering if you could comment on perhaps the amount of ventilation assistance that's given the infants?

And perhaps the number of hospital visits that these infants required?

Because I think that somewhere that you could really show benefit.

Yes.

There's a lot that we could discuss that gives us a great deal of encouragement.

And we've tried to be very careful about how much we share, because it's not controlled.

What we can -- we had a 13 and a half-month-old baby who had an accident and died.

That, we haven't discussed, but that baby was 13 and a half months old and doing really well.

We've had many experiences of babies who became -- who got a lung infection and got better and all kinds of other anecdotes that we could share.

I'm not going to do any more of that than what I just did, because I think it encourages more speculation.

And what I think we've tried to do is present all the caveats and the issues that we face and all the data.

So that any rational person can look at the information and draw the conclusions to see if they agree with the conclusions that we have.

We think the infant study is highly encouraging.

And we are confident that the infants in our study are closely matched to type I-B babies in Dr Finkel's study.

And certainly the muscle performance data, the developmental milestones and other things that we're observing give us a substantial encouragement.

Lynne, have I -- I just don't feel that it's appropriate to go into any more detail than that.

Thank you so much.

I really appreciate it.

And congratulations again on the advancement.

Jim Birchenough, BMO.

Just in relation to attendance at AACR, I understand that the Hodgkin's disease cohort of the STAT3 trial that there may have been evidence of pseudo-progression, which obviously is a phenomenon that occurs at the immune checkpoint inhibitors.

So I'm wondering if there is ongoing work either at Isis or at AstraZeneca on combining STAT3 inhibition with immune checkpoint inhibitors?

Thanks.

There's quite a bit of interesting information both from animals and human studies that have to do with STAT3's role both in the tumor and in stromal cells and stromal tumor interactions and then the immune system interaction.

And so there's a great deal of conversation about all that and a lot of thinking going on about what ought to be the development focus as we go forward with STAT3.

And I can't predict exactly how that's going to turn out.

Obviously AstraZeneca will make the final decisions, but my suspicion is that it will -- the development plan will represent trying to take advantage of both the direct tumor-cidal effects and the stromal effects.

And there will be a variety of combinations that look at questions like the one you just raised.

Great.

Thank you very much.

Josh Schimmer, Piper Jaffray.

Apologize if you've addressed this, but for the apoC-III Phase III trials on hyper triglyceridemia.

Can you give us a sense of what those trials might look like the duration of follow ups, the number of patients enrolled and entry criteria?

We plan to do that after we get the studies started.

But in brief, the FCS study will be a randomized comparative trial that looks at patients who are clearly FCS.

The -- and it will be randomized I think one to one.

And I expect it will treat six months to a year and with the primary endpoint being triglyceride reduction.

And of course it will be a number of stochastic analyses, what fraction get to 500 or what fraction get to 1000 and so on.

And the other trial for 880s will be very similarly designed.

In addition, we'll be doing quite a number of other studies in other patient populations to flesh out the profile of the drug to take advantage of its potential benefit in diabetes and the like.

But we'll share the designs of the study with you in great detail once we get it underway.

We don't want to do that until we finalize the study, and we know that the study is agreed by the regulatory agencies and so on.

Great.

Thank you.

If there are no more questions then I think we'll bring the call to an end.

Again, thanks, everyone for participating and also thanks for the questions.

I think the questions on SMN were particularly noteworthy, because they focused on some of the confusions that I think have led to some misunderstandings.

And hopefully we've helped clarify those.

Thanks.

The conference has now concluded.

Thank you for attending today's presentation.

You may now disconnect.