Lexicon Pharmaceuticals Inc (LXRX) 2013 Q1 法說會逐字稿

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  • Operator

  • Welcome to the Lexicon Pharmaceuticals first quarter 2013 conference call. At this time, all participants are in listen-only mode. There will be a question-and-answer session to follow. Please be advised that this call is being recorded at Lexicon's' request. At this time, I would like to introduce your host for today's call, Alex Albuin, Vice President-Communications and Alliance Management.

  • Please go ahead, Dr. Albuin.

  • - VP - Communications & Alliance Management

  • Good morning. Welcome to the Lexicon Pharmaceuticals first quarter 2013 conference call. I am Alex Albuin, and with me today are Dr. Arthur Sands, Lexicon's President and Chief Executive Officer; Dr. Pablo Lapuerta, Executive Vice President and Chief Medical Officer; Dr. Brian Zambrowicz, Lexicon's Executive Vice President and Chief Scientific Officer; and Jeff Wade, Lexicon's Executive Vice President of Corporate Development and Chief Financial Officer.

  • We expect that you have seen a copy of our earnings press release that was distributed this morning. During this call, we will review the information provided in the release, provide an update on our clinical programs, and then use the remainder of our time to answer your questions. The call will begin with Dr. Sands, followed by a Doctor's Zambrowicz and Lapuerta, who will provide an update of our clinical programs, and by Mr. Wade, who will review our financial results for the first quarter of 2013 and discuss our financial guidance. We will then open the call to your questions. If you would like to view the slides for today's call, please access the Lexicon website at www.lexpharma.com. You will see a link on the Homepage for today's webcast.

  • Before we begin, I would like to say that we will be making forward-looking statements, including statements related to Lexicon's research and development of LX4211, LX1033, Telotristat etiprate, also known as LX1032, and other drug candidates, and the therapeutic and commercial potential of district candidates. This call may also contain forward-looking statements relating to Lexicon's future operating results, financing arrangements, cash and investments, discovery and development of products, strategic alliances, and intellectual property. Various risks may cause Lexicon's actual results to differ materially from those expressed or implied in such forward-looking statements, including uncertainties related to the timing and result of clinical trials and pre clinical studies of our drug candidates, our dependence upon strategic alliances, and ability to enter into additional collaboration and license agreements, the success and productivity of our drug discovery efforts, our ability to obtain patent protection for our discoveries, limitations imposed by patents owned or controlled by third parties, and the requirements of substantial funding to conduct our drug discovery and development activities. For a list and description of the risks and uncertainties that we face, please see the reports we have filed with the Securities and Exchange Commission.

  • I will now turn the call over to Dr. Sands.

  • - President and CEO

  • Thank you, Alex. Good morning, everyone, and thanks for joining us.

  • This morning, we will be discussing the advances we have made in our pipeline over the past quarter and also some of the most recent events in the area of type 2 diabetes as they pertain to our areas of interest in SGLT inhibition. In addition, we will discuss our advancement of our type 1 program, which is also announced this morning as it has progressed into the expansion phase of that trial. Then, provide some general updates with regard to our current understanding of the timing of results that we will have this year and ulcerative colitis and IBS trial. That will be the general outline of the call. Let's move, then, directly into discussion of LX4211.

  • I will turn it over to Brian.

  • - EVP and Chief Scientific Officer

  • Thanks, Arthur. As we all know, LX4211 is a first (inaudible). These will represent two important insulin independent mechanisms of lowering blood glucose levels. SGLT1 component of the 4211 mechanism is what is unique. It provides us multiple opportunities to differentiate from selective SGLT2 inhibitors for both efficacy and safety.

  • A lot has happened in the field since our last quarterly call and I will highlight four of the changes to this slide for today. There will likely be an interest in discussing some of these developments in the Q&A portion of this call. I think most importantly, canagliflozin or INVOKANA, the FDA approved it recently. The SGLT2 inhibitors are now the newest class of oral anti diabetic agents in the United States and it has also given us an opportunity to study their label, which help clarify our opportunities to differentiate with LX4211. Secondly, Bi and Lilly have recently filed their MDA for empagliflozin. We also very recently saw Merck and Pfizer partner around ertugliflozin, a very highly selective SGLT2 inhibitor. I think this indicates that there's both a comfort level and a general acceptance of the importance of the SGLT2 mechanism for the treatment of diabetes.

  • Finally, Novartis recently moved dual SGLT1 and 2 inhibitor LIK066 into Phase 2 clinical development. I think this really indicates that our work has created interest in dual inhibitors and specifically the SGLT1 mechanism action in particular. It is exciting that 4211 is first in class with these agents.

  • With that, I will turn it over to Pablo Lapuerta.

  • - EVP and Chief Medical Officer

  • Thank you, Brian. We are please to make progress in our placebo controlled study in type 1 diabetes. This is a study that will help us establish key (technical difficulty) proof of concept (technical difficulty) 4211 in type 1 diabetes. Our focus in this study will be on the total daily amount of exogenous insulin require. Our vision of the product profile is that administering LX4211 in type 1 diabetes will allow a reduced insulin regimen that is simpler and that may allow patients to spend less time in hypoglycemia. Our secondary objectives will be to assess the effects of LX4211 individually on bolus insulin and individually on basal insulin and other parameters of glycemic control.

  • Next slide. As described in our press release, we completed an open-labeled pioneer group of three subjects. These three subjects came into clinic and had reductions and their insulin dose and had LX4211 put on board. We're fortunate that this is done safely and gave us some vision for moving forward with confidence. Now, we can go forward into an expansion group where we will have up to 30 subjects randomized to either placebo or LX4211 400 milligrams at approximately four sites in the United States.

  • The next slide provides the study schematic, the patients enter the three weeks before into a screening period where labs are checked and medical assessments are performed. Then, one week before randomization, they are equipped with continuous glucose monitoring and we start recording their outpatient glucose values. Then at day minus one, they come into the clinic and they spend several days in the clinic where we go even more carefully over their insulin doses, their glucoses, and for the first time, we give them LX4211. This will be done in the expansion cohort in a randomized way, either LX4211 or placebo, and it will be done in a carefully controlled setting. It will be done at breakfast with sequential measures of glucose immediately after the meal. We take further time during that inpatient stay to make sure that we have the right insulin regimen for the patients to enter an outpatient period. The patient is finally discharged and spends four weeks in an outpatient setting with their usual activities, providing very careful data to the site on glucose values. The patient then comes back to the clinic and terminates treatment on day 29 with an inpatient stay to make sure that if insulin needs to be restored, it is restored properly to their usual baseline regimen.

  • On slide 8, we have an update of our ongoing renal impairment study. As described previously, we are interested in this area because of the high prevalence of renal impairment in people who have type 2 diabetes. Also, there is a high end net need because so many medications are contraindicated in this setting. It is an opportunity for LX4211 to differentiate because SGLT2 selective inhibitors have limited benefit in renal impairment, but LX4211 with meaningful SGLT1 inhibition could help patients through its unique mechanism of action.

  • At our last earnings call, we describe the study having 20 patients and completing in the first half of 2013. We have seen the opportunity with good enrollments to increase the sample size up to 30 patients with type 2 diabetes and moderate to severe renal impairment. We are taking advantage of this opportunity in order to provide more robust data to differentiate LX4211, but in particular, we are interested in seeing a good enough sample of patients with more moderate to severe renal impairment so that we can look at LX4211's activity across a broad range of levels of renal impairments. The patients are treated with 400 milligrams of LX4211 or placebo for seven days and have a mixed meal tolerance test to evaluate their impact of postprandial glucose. We are expecting to complete the study around the end of the second quarter and we will be able to provide results in the third quarter of 2013.

  • On the next slide, we have our strategy for late stage development and commercialization of LX4211. We have a plan that we have assembled that takes into account the unique dual mechanism of action of LX4211 through inhibition of both SGLT1 and SGLT2 with a good safety profile. That Phase 3 program will involve a very broad population of patients with diabetes. We will look at LX4211 alone or in combination with other agents. We have a dedicated diabetes renal impairment study that we will plan based on the results of this initial renal impairment study. We do plan to assess and more in depth the opportunity in type 1 diabetes as part of our Phase 3 activities. During Phase 3 we will be able to establish as well mechanistic synergy between LX4211 and DPP-4 inhibitors and the potential for LX4211 to be added onto other products. We're making sure that we have the potential to demonstrate cardiovascular benefit in the program, and we still plan to initiate Phase 3 with a corporate partner in 2013.

  • On slide 10, I have an update on Telotristat etiprate, a peripherally acting serotonin synthesis inhibitor. As you know, this compound is absorbed into the peripheral circulation. It does not cross the blood-brain barrier. It inhibits tryptophan hydroxylase and therefore reduces serotonin that is produced by carcinoid tumors. For the treatment of carcinoid syndrome, we have fast track an orphan drug status and our Phase 3 trial in carcinoid syndrome is underway. We also have pre clinical data to suggest potential utility in ulcerative colitis and a Phase 2 proof of concept underway for that indication.

  • A little bit more information on slide 11 about our Phase 3 study in carcinoid syndrome. This is a single pivotal study with 12 weeks of placebo-controlled treatment and both a 250 milligram and 500 milligram TID doses of telotristat etiprate. It will have approximately 105 patients and will be oriented to show a reduction of the number of bowel movements in patients with refractory carcinoid syndrome. Enrollment is on going, we're in the process of activating a large number of sites. The progress is going well.

  • On slide 12, the telotristat etiprate, we're in Phase 2 in ulcerative colitis. That proof of concept study is also looking at the safety profile of telotristat etiprate in this condition. It is targeting 60 patients with mild to moderate ulcerative colitis. We're getting close to the finish. We have over 50 patients in that study. We will anticipate completion of enrollment in this second quarter. As previously discussed, presents top line results in the third quarter of 2013.

  • On slide 13, I have an update of LX1033. This is our next generation serotonin synthesis inhibitor. It is locally acting, not absorbed into the bloodstream. Therefore it is appropriate for irritable bowel syndrome that's diarrhea predominant, IBS-D. Our Phase 2 trial is ongoing and we have fast-track status granted by the FDA.

  • On slide 14, of a more specific update, we are targeting 360 patients with irritable bowel syndrome diarrhea. We have surpassed 300. We remain on track with enrollment to produce top line results in the third quarter of 2013.

  • With that, I will turn the call over to Arthur.

  • - President and CEO

  • Thank you, Pablo. As you can appreciate, there has been a considerable amount of progress and work done to move our pipeline forward into Phase 3 on these three leading programs that we discussed. The most recent, I think, new event is the good news about the ability to progress with a safe profile into type 1 diabetes.

  • If we turn to slide to 16, this is our latest view of the results we can anticipate in the second half. We do see all of these as results of events occurring. The sequencing of them depends on the final stages of enrollment, but this is our current view as to order in which we think we will be able to complete and release top line data. The first, most probably, being the ulcerative colitis data. Then, we believe the renal impairment study should read out. Then followed by the IBS study, which, of course, is a much larger Phase 2 program.

  • Finally, we believe we should be able to get results by the fourth quarter for type 1 diabetes, as we are just now moving into that expansion phase of the trial. All of these events, of course as I said, our enrollment dependent. Pablo gave you the update. The numbers look good. We think we should be able to achieve these results events in the second half. Very exciting second half in front of us.

  • With that, I think we will move into the financial report from Jeff Wade.

  • - EVP of Corporate Development and CFO

  • Thank you, Arthur. I will provide a brief financial update.

  • As indicated our press release today, we had revenues for the 2013 first quarter at $0.4 million, which was an increase of 20% from $0.3 million in the prior-year period. Our research and development expenses for the 2013 first quarter decreased 12% to $20.3 million from $23 million in the prior-year period. The decrease was primarily attributable to decreases in external manufacturing clinical research and development costs, facility costs, and personnel costs. In connection with our acquisition of Symphony Icon, we made an initial estimate of the fair value of our liability for the base and contingent payments. Changes in that liability, based on the development of the programs and the time until the payments are expected to be made, are recorded in our consolidated statements of operations. The associated increase in fair value of Symphony Icon purchase liability was $1.3 million in the first quarter and to $2.1 million for the prior-year period.

  • Our general and administrative expenses for the 2013 first quarter were $4.3 million, a decrease of 5% from $4.6 million in the prior-year period. Our net loss for the 2013 first quarter was $26 million or $0.05 per share, compared to a net loss of $29.9 million, or $0.06 per share in the prior-year period. For the 2013 first quarter, our net loss included non cash, stock based compensation expense of $2.1 million compared to $1.7 million in the corresponding period of 2012. Finally, as of March 31, 2013, we had $197.2 million in cash and investments as compared to $223.2 million as of December 31, 2012.

  • Now, let's turn to our forward-looking financial guidance for 2013. We continue to expect contractual revenues from existing agreements in 2013 of around $1 million. We are engaged in partnership discussions for LX4211, as you know, and are also in conversations about other potential collaborations and alliances. Consistent with our past practice, however, we are not including forecasted revenue from potential new collaborations and alliances in our guidance. We continue to expect that our operating expenses in 2013 will be in the range of $110 million to $120 million. Non-cash expenses are expected to be approximately $16 million of that total, including the $7 million in stock -based compensation, $6 million in increase in fair value at Symphony Icon purchase liability, and $3 million in depreciation and amortization.

  • Taking into account cash received under existing contractual relationships only, we continue to expect that our 2013 net cash used in operations will be in the range of $92 million to $97 million. I should note that these operating expenses and net cash use expectations reflect costs of preparations we are making for Phase 3 development of LX4211, as well as certain supportive non clinical and clinical activities, but they do not reflect the cost of a full-scale Phase 3 clinical trials for that program given our expectation of a partnership around those activities.

  • I will now turn the call back to Arthur.

  • - President and CEO

  • Thank you, Jeff. We can now take questions.

  • Operator

  • (Operator Instructions)

  • Cory Kasimov.

  • - Analyst

  • It is actually Matt Lowe in for Cory today. Firstly, on 4211, if you could update us on the partnership talks -- the level of confidence you have that a partner will be in place before Phase 3? Maybe the potential timing of Phase 3 initiation?

  • Secondly, on the importance of the type 1 diabetes data -- how meaningful is that data towards ongoing negotiations? Thank you.

  • - President and CEO

  • Jeff, do you want to start off with that?

  • - EVP of Corporate Development and CFO

  • I will take the first part of that question. We're continuing to make progress in our partnership discussions, and our objective remains to move into Phase 3 with a partner this year.

  • - President and CEO

  • The second part of the question was regarding type 1. Pablo, would you like to address that, regarding the importance of the data?

  • - EVP and Chief Medical Officer

  • Yes. We recognize that this is only a few patients, but for us, it has really helped us develop a vision for the product profile in type 1 diabetes. We're excited about that profile. We believe that LX4211 could offer improved glycemic control, reduced and simpler insulin regimens, and have patients spend less time in hypoglycemia. We think that is relevant to people who are in development of agents for type 1 diabetes.

  • - President and CEO

  • Then, I think, just the last half of that question, Matt, with regard to the implications for partnership -- we have viewed type 1 diabetes as an opportunity for Lexicon to take the lead role in a highly specialized indication. I think this is important in that regard because it does allow us to outline a path forward. Having seen the initial safety and initial efficacy in these three patients, we are able to move our program forward. I do think it does have some important implications for our partnership opportunities and our ultimate commercial opportunities.

  • - EVP and Chief Medical Officer

  • If I could say one last thing, it's that the type 1 is very well suited for LX4211 because of the SGLT1 mechanism. Even though both mechanisms are insulin independent, and both could offer value to type 1 patients, in particular, by inhibiting SGLT1 in the GI tract, you reduce the absorption of glucose. Therefore, you have the reduction in postprandial glucose. That, we believe, has an ability to reduce the needs for bolus insulin in patients with type 1 diabetes, allowing lower dosing. I think that is a unique opportunity where LX4211 has a special fit.

  • - Analyst

  • Okay. That is helpful. Thank you.

  • Just a quick follow-up for the Phase 2 data for both UC and IBS. Maybe if you could just briefly outline what you are looking to see in those readouts to consider the trials a success, and for the drugs to represent differentiated products in those two indications? Thank you.

  • - EVP and Chief Medical Officer

  • For telotristat etiprate in ulcerative colitis, one thing we have to keep in mind is that this is a proof-of-concept study of 60 patients -- 25 on the high dose of telotristat etiprate, 25 on a lower dose, and only 10 on placebo. As a result, we do not expect a significant difference in formal comparison of treatment groups. What we want to see is we want to see a reasonable rate of a clinical improvement in remission on telotristat etiprate with a high dose. We want to see good safety. We want to see, overall, a relationship between 5-HIAA reduction that telotristat etiprate provides and clinical improvement.

  • The other question was about IBS, I believe?

  • - Analyst

  • Yes.

  • - EVP and Chief Medical Officer

  • For LX1033 in IBS, we have a primary endpoint of [reduction] in stool consistency. That is based on our experience with this class. We believe that our data will be robust, in order to test that. We want to see, as well though, a clear path forward for our biomarker. We have talked about the use of a biomarker in this setting. We want to be able to make a decision for Phase 3. Do we just go forward in treating all subjects with the improvements in stool consistency and other patient-reported outcomes? Or do we do this where we use a biomarker, perhaps, to evaluate continuity of treatments or to adjust dose?

  • - Analyst

  • Okay. That is helpful. Thank you.

  • Operator

  • Phil Nadeau.

  • - Analyst

  • First, could you give us an update on the carcinoid enrollment? Specifically, does it still seem like the data are on track for 2014 in the Phase 3 trial?

  • - EVP and Chief Medical Officer

  • Yes, we believe we are on track to complete enrollment in 2014 for Phase 3 in carcinoid syndrome. We are still in the part of active site start-up, and at the last earnings call, I had described a recent investigator meeting in Europe. Now, we're seeing a big bolus in European sites getting on board.

  • - Analyst

  • Okay. Great. That is very helpful.

  • Second, on the Phase 2 in type 1 diabetes, could you give us some sense of what change in insulin would be meaningful, in your eyes? Second related question, are you handling basal and short-acting insulins the same in the program point, or is there a differential way put on the two different types?

  • - President and CEO

  • I will handle that one. First, the primary endpoint is total insulin. But with respect to the significance, given, on bolus versus basal, I think given the unique mechanism of LX4211, as Pablo pointed out, on the postprandial glucose effect, I think we would anticipate bolus insulin will be more effective, which could have very positive implications for the lifestyle of the type 1 diabetic as they navigate their day.

  • Now, with respect to what is significant, we are really not getting into predictions about the numbers yet with regard to insulin use and what could be considered significant, because that, of course, has to be considered in context of what happens with their blood glucose control. So, it is really both parameters that we will need to look at in order to gain confidence about significant impact on the disease.

  • Then the last point being safety. This is a fairly fragile population with respect to insulin controls, and so that also will be taken into account in terms of determining overall significance. I can tell you, we are encouraged, very encouraged, by the first three patients we have seen. You can learn a lot from those case studies, and I think we have.

  • - Analyst

  • Okay. Could you give us some sense of what reduction in insulin those three patients had?

  • - President and CEO

  • Again, we are not going to be quantifying it because it is only three patients. We do think this trial will complete in, really, a short order, overall. Then we will be able to give you a better feel. Especially since the three patients were open label, and baseline controlled versus real placebo control, so we really can't give you a quantification till we have that placebo group. We needed to do the open label to establish safety, so that we could run a placebo group side by side effectively.

  • - Analyst

  • Okay, great. One last question for me. Thanks for the update on the SGLT partnership. Did you learn anything from the recent SGLT2 partnership that was signed? Do you feel like the landscape has changed at all, either because of that partnership was signed, or because the advances in development that you noted in the SGLT2 field since the last call?

  • - President and CEO

  • Jeff, do you want to lead off on what we learned from the Merck-Pfizer?

  • - EVP of Corporate Development and CFO

  • I think that does demonstrate greater acceptance of the SGLT2 mechanism. It does add another competitor to the selective SGLT2 space, although it appears that they are focused largely on third-line combination therapy. I would say that based on the data that we have seen, the profile of that compound looks very similar to the profile of the other selective SGLT2 inhibitors. I think clearly our compound, with the SGLT1 mechanism of action, has a quite different profile. Although we share the SGLT2 mechanism, the effects of the SGLT1 mechanism put 4211 in a fundamentally different class.

  • - President and CEO

  • I think the only thing I would add to that is that this new deal has no direct impact on our partnership process, although it most likely will have an indirect positive impact on our process.

  • - Analyst

  • Thank you for taking my questions.

  • Operator

  • Alan Carr.

  • - Analyst

  • Now that you have got the carcinoid trial well underway, can you give us an update on your sense of the commercial opportunity there?

  • - President and CEO

  • Jeff, would you like to address that?

  • - EVP of Corporate Development and CFO

  • Sure. We think that it is a substantial opportunity. There is a significant area of need among carcinoid syndrome patients. They are treated now with somatostatin analogs and principally in the US with Octreotide. That provides benefit for some period of time, but then that benefit -- it ceases to be adequate. A very high percentage of carcinoid patients end up not adequately controlled with somatostatin analog therapy, although they continue to live for a substantial time afterwards. We think that the opportunity there, from a patient perspective, is more than 50% of the overall carcinoid syndrome population that is now treated with Octreotide, which is -- as you know, is a pretty substantial drug.

  • - Analyst

  • Any changes in number of patients or anything like that? Any clues to that, considering that you are enrolling patients now? Any surprises either way in terms of number of patients?

  • - President and CEO

  • No. It is early still, but I do not think that we have any surprises in terms of the population because we did have some good experience in two Phase 2 trials, both in the US and Europe.

  • - Analyst

  • Okay. Thanks very much.

  • Operator

  • Liana Moussatos.

  • - Analyst

  • Are there any oral meds for type 1 diabetes? Do you have any thoughts about commercializing any of the pipeline? You had mentioned carcinoid syndrome before. Can you give us your thoughts on that?

  • - President and CEO

  • Do you want to take the oral meds in type 1 diabetes? That should be a short answer.

  • - EVP and Chief Medical Officer

  • The answer is -- there are no oral medications for type 1 diabetes. That is why we believe this could be such a game changer, and we are so excited about the opportunity.

  • - President and CEO

  • Liana, there has been some work done with the [GLP] injectables in type 1 diabetes. There is some publications on that, that shows there is some efficacy of this whole GLP mechanism to aiding insulin. Of course, it is another injection. I do believe it is perhaps noteworthy that Novo Nordisk has initiated a large Phase 3 trial in type 1 diabetes with Victoza recently. I think that is important. Again, it is an injectable, but it is important in that our SGLT1 mechanism, sharing this GLP pathway through an oral effect, I think, bodes well for the whole theory of SGLT1 helping in the type 1 diabetes space.

  • Brian, did you want to add anything about --?

  • - EVP and Chief Scientific Officer

  • Sure, canagliflozin and empagliflozin are also doing -- there is some studies being done in type 1 with those agents. However, we think the primary utility of 4211 in type 1 diabetes, as we've described, comes from its SGLT1 mechanism, and the profound postprandial effects on blood glucose. I think it would, again, look very, very different.

  • - Analyst

  • Thank you. Any thoughts on commercializing the pipeline yourselves? You mentioned carcinoid syndrome in the past.

  • - President and CEO

  • Yes. We are still on that track, and have that goal of commercializing carcinoid syndrome ourselves. I will say we have had significant partnership interest, as we have now moved into Phase 3, to help us in the process. But our goal is to commercialize that drug ourselves. It is a very focused effort. I think a very realistic one. Then, we would also like to consider, in these specialty types of indications, the ability for Lexicon to perhaps play some commercial role in type 1 diabetes, but we have to see a lot more data as that evolves through Phase 3.

  • - Analyst

  • Thank you very much.

  • Operator

  • (Operator Instructions)

  • Stephen Willey.

  • - Analyst

  • I guess it is certainly good to see the rest of pharma embracing SGLT1, but I'm just wondering if at any point you have any competitive intelligence on the Novartis compound that you referenced, which also is looking to replicate the dual activity here?

  • - President and CEO

  • Brian?

  • - EVP and Chief Scientific Officer

  • Sure. What we know is they have had their compound LIK066 in Phase 1 without identifying its mechanism of action. Recently, on a conference call, they indicated it was a dual inhibitor of SGLT1 and SGLT2. They have also recently moved that into Phase 2 clinical development, and you can find that at clinicaltrials.gov.

  • I think the key is that one of the most challenging aspects of SGLT1 inhibition is achieving a sustained inhibition in the gastrointestinal tract. That is due to the intrinsic nature of the GI in that there is motility and movement of materials along it constantly. This is the problem that GSK ran into with their highly selective SGLT1 inhibitor. They could not produce sustained inhibition of SGLT1. That's what I keep my eyes on because 4211 has some unique attributes that allows it produce sustained inhibition over the course of the day. We believe this will continue to differentiate LX4211 as other SGLT1 or dual inhibitors move forward.

  • - Analyst

  • Do you know if the Novartis compound is primarily excreted through the kidneys?

  • - EVP and Chief Scientific Officer

  • There is no information on that yet.

  • - Analyst

  • Okay. Going back to an earlier question, how would you compare the postprandial control you see with 4211 versus what has been documented thus far with the GLP-1 agonist? Is it relatively equivalent, or do you think that there is other kinds of SGLT1-mediated efficacy that you are not seeing entirely captured within the GLP data?

  • - EVP and Chief Scientific Officer

  • I think it is generally, relatively equivalent because they have a primarily postprandial effect. Where it will really differentiate, I think, is in type 1 because without that insulin available, GLP-1s are going to be very limited in the efficacy they can produce because they require insulin to get their strong postprandial effect. One of our strongest components on the postprandial effect is our inhibition of glucose uptake from the GI. Although we would anticipate similar effects on postprandial glucose in a type 2, in a type 1 I think it is going to be quite different, with 4211 looking very good.

  • - President and CEO

  • Regarding the injectable agents -- I also think that being an oral agent is an advantage. Less injections, I think, are probably desirable if you are a type 1 diabetic and constantly having that burden of injections.

  • - Analyst

  • Lastly, you may have already mentioned it, but the Phase 3 or the proposed Phase 3 study that you will be running in renally impaired patients, will that be head to head versus an approved SGLT2 inhibitor?

  • - President and CEO

  • Brian?

  • - EVP and Chief Scientific Officer

  • At some point. I do not know necessarily that it would be our first Phase 3 study in renal impaired, but that is one of the components of the INVOKANA label that really stands out, is that they were approved only at 100 milligrams in patients with GFR of 45 to 60. They are not approved at all for below 45 GFR. Importantly, at 100 milligrams, what they have reported is a 0.3% reduction in A1C. One of the really nice things about our Phase 2B data is it suggested that are SGLT1 component of our mechanism alone produced a minimum of a 0.4% reduction in A1C. We think that, in combination, will get an additional effect with SGLT2, makes it a very attractive [head to head] at some time.

  • - Analyst

  • All right. Thanks.

  • Operator

  • At this time, there are no further audio questions.

  • - President and CEO

  • All right. Well, thank you very much for participating. We look forward to keeping you updated in the future. Bye bye.

  • Operator

  • Thank you. This concludes today's conference call. You may now disconnect.