Aldeyra Therapeutics, Inc. (ALDX) Earnings Call Transcript & Summary

December 5, 2024

NASDAQ US Health Care conference_presentation 38 min

Earnings Call Speaker Segments

Yigal Nochomovitz

analyst
#1

Welcome, everyone. I'm Yigal Nochomovitz. I'm one of the biotech analysts here and covering the ophthalmology space among other therapeutic areas for quite a long time. So I'm really pleased to have with me 3 distinguished members of the ophthalmology drug development world. So from Lenz Therapeutics, Eef Schimmelpennink, President and CEO. I hope I said that right. Todd Brady, CEO of Aldeyra and the new CEO of Opthea OPT, Fred Guerard. Thank you so much.

Yigal Nochomovitz

analyst
#2

All right. So a lot to talk about. Each of you have very interesting pipelines and products that are either close to the clinic or in late-stage clinical trials. So why don't we just go through and give a quick introduction what the lead asset is in ophthalmology and where you are as far as your path to commercialization.

Evert Schimmelpennink

attendee
#3

Sounds good. And thanks for inviting us. Always great to be here, definitely better in Miami than in New York on Tuesday. At Lenz, we've developed a pharmaceutical eyedrop that basically restores your near vision. So it reverses presbyopia on a daily basis. So I think of this as an eye drop that you put in, in the morning, and you can actually see a phone up close again, if you like me, most people over 45, you will develop presbyopia, it's a huge market. Everyone gets it. That's why it's 128 million TAM for us. Very late stage. We actually have a PDUFA date for August 8 last year -- next year, sorry. So we've completed our Phase III read that out earlier in the year with stellar results.

Yigal Nochomovitz

analyst
#4

Very good.

Todd Brady

executive
#5

Eef, do you have any examples?

Evert Schimmelpennink

attendee
#6

That's a very, very common question. It's a very, very long list, and the FDA keeps telling us that we're on the review and if they ever catch us handing out samples, that's it. So it's a long answer to say no.

Todd Brady

executive
#7

No one is looking -- no one can hear this. I'm Todd Brady. I'm the President and CEO of Aldeyra Therapeutics. We are -- I tell people, an immunology company that happens to be in the eye. Our first product is called reproxalap. It's for dry eye disease. We also believe we've completed Phase III testing for allergic conjunctivitis, which are 2 of the biggest markets in the front of the eye aside from presbyopia. But we have a robust pipeline behind that. We are -- we're pan eye. So we also work on the retina. We have 2 retina programs, 1 in an orphan disease called retinitis pigmentosa. We have a nascent program for dry AMD, hopefully, starting next year, and we have systemic programs for liver inflammation, metabolism, atopic dermatitis and a few other things ongoing as well.

Frederic Guerard

attendee
#8

So Fred Guerard, CEO of Opthea. So Opthea is developing a biologics or a first-in-class VEGF-C/D trap that is being developed as a combination play with anti-VEGF As to deliver better vision outcomes for patients suffering from wet age-related macular degeneration. This is a very interesting technology simply because we are targeting the existing pathway, which is proven to be the main driver of the disease using, again, a technology platform that has proven to be successful because it's very similar to what Regeneron did with EYLEA, except we are binding to a different form of VEGF. And finally, the market has not progressed over the last 20 years since Lucentis has been launched. None of the drugs in the market today are more efficacious than Lucentis on visual outcomes. So we're very excited. We are now in the middle of our Phase III program, the readouts took 2 large clinical trials, 1,000 patients each and the readout is next year.

Yigal Nochomovitz

analyst
#9

Okay, great. So although each of you are sort of in different -- mainly non-overlapping areas except for your early program in AMD, you're improving on an existing option in the case of presbyopia, in the case of dry eye, where there are many options, in the case of wet AMD, where there are also a few options. So go through -- for each of you, just sort of explain the value proposition, for example, for LENS100, why is it -- how is it advanced versus what was attempted before. What's the value proposition, so people can understand why your asset is interesting.

Evert Schimmelpennink

attendee
#10

Absolutely. So I've yet to come across somebody that likes to wear reading glasses. So think of it as -- this is an alternative to reading glasses. So you're no longer doing the on and off all day to see how close, but if you put your reading glasses on, you can't see in the distance. So that's how you should think about this eye drop. It's really a convenient way to bring a vision back to what it was before your -- like 45 -- before you used to actually think about your vision, like it was something that was just there, it was granted, you can see up close. So that's the value proposition. What you referred to Yigal, is that AbbVie launched the products with the promise of what our product is actually doing a couple of years ago. If you think about the MOA, it's the simplest of MOAs that I've ever had to explain in any of the companies that I've been part of. Basically, what you want to do is get somebody's pupil to below 2 millimeters. It's been known for decades, if not centuries, that if you create a pinhole pupil, your near vision improves dramatically because you basically increased the depth of focus. So you want to get below 2 millimeters that improves your near vision dramatically. Anything over 2 millimeters doesn't really do that. So the product that [indiscernible] launched a couple of years ago, smallest pupil that, that product got too was about 2.3 millimeters. If you look at the clinical data, only 1 in 4 people saw a little bit of effect and there was a very short-lived. Very different from what the target product profile and what our profile is and what people want. They want a once-a-day eye drop that again works with a full workday. So it needs to work rapidly and needs to work for the full workday. And that's what we've shown in our Phase III study, which is a very large 3 study program. We saw that with half an hour, which was the first time point that we measured. We had 71% of patients hit at least a 3-line gain of near vision that gets people back to 2020, 2032, and it lasted very long at 10 hours, still 40% of people had that gain. The clinically relevant endpoint is actually a 2-line gain. If you get pupil 2 lines of near vision improvement, they're able to go without their reading glasses. We have 95% of patients hit 2 lines in half an hour, still close to 70% at 10 hours. So truly a product that works for almost everyone, works very rapidly and for the full day.

Yigal Nochomovitz

analyst
#11

All right. Todd?

Todd Brady

executive
#12

In dry eye disease, there's no product that works fast today, weeks, months, but not minutes, and that is our product. We have data not only showing that people look better in terms of reduced redness in minutes and -- but also they feel better in minutes and I think that's a paradigm shift. Who wants to take an eye drop for weeks, for months, and then maybe have some marginal benefit. Instead, you'd rather take something and feel better in minutes. And the way we do that is we use dry eye chambers to small rooms where we torture patients by eliminating humidity and blowing air in their face. But it allows you to assess rapidly and that's been the focus of our clinical development program.

Frederic Guerard

attendee
#13

So, for us, there are drugs in the market today to treat wet AMD. And these drugs have been a complete revolution. Patients were, in 20 years ago, given the diagnosis of wet AMD and they were visually impaired or legally blind in a matter of weeks. And these drugs came, Lucentis was the first one, and changed the market. Now patients get diagnosed and actually recover some vision. The remaining unmet medical need is that most patients, even in countries like the U.S., where patients are treated very well, do not go back to fully operating level of vision. So half of patients still cannot drive after even if they get these injections every 4 weeks, half of them cannot go back into driving and if you cannot drive, it means you cannot perform daily activities at home. And wet AMD is a terrible disease because you start -- you start by losing the center of your vision, which is what you use for any precise task recognizing people, reading, operating your house, you need the central vision. It's not a glaucoma where you lose the lateral vision first or the peripheral vision first. So this is what we are trying to solve here is by giving the patients when they're already in the chair and they were already getting their existing anti-VEGF-A is to get on top sozinibercept at every visit and gain better vision. We have Phase IIb data showing that with a statistically significant superiority in visual outcomes at week 24, showing that we can deliver up to a line or a bit more than a line of vision on average into these patients that are extremely hard to treat in wet AMD. So that's why we think this approach is very sound.

Yigal Nochomovitz

analyst
#14

So if you think about commercialization for your 3 markets, I guess I would characterize -- Eef and Todd, sort of in the same conceptual bucket where the market is very big, 128 million. I don't think you referenced the number of dry eye, but it's a lot, and you don't need a large share to command a nice revenue picture. On the other hand, for anti-VEGF, I think the numbers are -- the share of patients on an anti-VEGF amongst the wet AMD, it's very, very high, if I'm not mistaken. So you have sort of opposite issues that you want to achieve that very, very high share to supplement the efficacy. So as you think about commercialization, give us a sense as to how you would attempt to gain share where you don't need a lot of share, but even small shares, many hundred thousands if not millions of patients.

Evert Schimmelpennink

attendee
#15

No, absolutely, great question. And given that we're within a year of going commercial, we're guiding to the fourth quarter of next year, we're obviously very far advanced on our commercial strategy, which basically rests on 3 key pillars. One, we want doctors to recommend us. So that's the sales force. One, patients to request us by name, so that's a DTC effort. And I want to make sure that the journey to actually get the product is seamless. So that's the sampling and then actually go into the retail or e-pharmacy to get the product. So hitting real briefly on those 3, we'll have about 100-person sales force that targets the doctors, really telling them about the products, having a high-frequency call cycle. If you think about those doctors, we just did a massive resurvey, we serve about 430 of our target doctors. On average, they see about 350 patients on a monthly base, 61% or 215 of them are presbyopic. So they're already seeing 215 patients a month, a 1% penetration on the target doctors that we're getting to equals to 30,000 new monthly scripts. So that's on its way to being a blockbuster with a half decent refill rates, 5 packs a year. So with a 1% penetration, you can effectively show that this is a product that can get to that blockbuster status to do $1 billion in revenue. You need about 5.6% of the current patients that they're seeing. That's before we're sending anyone in through DTC, and that's obviously that second pillar. This is going to be a self-pay, I believe branded products. So we're putting everything in place to achieve just that, build that brand, get that patient recognition, send them in on top of the patients that, again, doctors are already seeing.

Yigal Nochomovitz

analyst
#16

And one follow-up there. When I speak with investors on it, given that it is largely a market that will be served by the opticians and the ones that are providing eyewear, people aren't completely clear that you do need a prescription for this product and that you do need to have a retinal exam. So can you just explain that aspect of it that it's not just an over-the-counter product.

Evert Schimmelpennink

attendee
#17

Absolutely. Yes. This is still a script. It's an FDA-regulated drug, not self-pay, but still a script, and we like that because that gets the optometrists and the ophthalmology community engaged. So you go into optometry either, you're seen there as part of the 215 patients and the doctor said, you know well, I've got something else. Here's a 5-day sample, try it, see if you like it. And again, like I said earlier, within 10, 15 minutes, you can decide whether you like or not. I can sort of promise you that you'll be able to see your phone up close. You can decide then do you like it, do you fill the script. Yes or no? The question that we sometimes get and that's maybe what you were getting at is, well, doesn't that conflict what the optometrist is doing is actually selling glasses. Most of the readers are these $2 readers that I have that I literally get a 10 pack sent to my door every 2 months through Amazon. So that's not the revenue that we're taking away from them. We're actually adding revenue. So patients are now coming in because it is a script, they need to come back every year to get that new script. On average, the patient is only seen normally about once every 3 years. So you're increasing that, which means more sitting fees, additional exams, and then on the very last quick point, that retinal exam is recommended. It's not required. But it's a good thing to have a retinal exam. It's also a moneymaker for optometrists. So they'll immediately try to get you on to what's a non-dilated eye exam, which is a $40 co-pay, they get more patients means more exams, means more money into the practice.

Yigal Nochomovitz

analyst
#18

Todd, you just got the acceptance of the resubmission. So you're on the final stretch. So tell us about your commercialization plan.

Todd Brady

executive
#19

Well, we have 9 people in our company. So exactly 11% of our company is on this stage right now. We have a partnership with AbbVie. What I think is the only large pharmaceutical company left in the front of the eye. AbbVie invented dry eye with RESTASIS and thrilled to be part of what they're up to. AbbVie owes us, what amounts to $94 million on exercise of the option, they have 10 days after approval. Our PDUFA date is April the 2nd. If the drug is approved, there's an additional $100 million milestone. And then we have sort of a co-promotion relationship where the P&L is split 60-40 AbbVie, Aldeyra. So our approach is a little different, which is we intend to support AbbVie, I think, the point you make about optometry is interesting. I mean both of us are in markets that are becoming more and more optometry dominated. You don't have that problem yet, but I'll tell you it's coming. And I'm actually from a patient standpoint, thrilled about that. Ophthalmologists make money with surgeries and not everyone needs surgery. I see an optometrist. And so what that means for folks like Eef and me is that we need to have a broad reach, and the way we're doing it is in theory through AbbVie.

Yigal Nochomovitz

analyst
#20

And just a follow-up there. You mentioned dry eye, you mentioned AC, what's the thinking there in terms of how you're going to prosecute this marketing pitch? Do you need to talk about both because as we know, the Venn diagram there is nicely overlapping.

Todd Brady

executive
#21

I was just going to say, you always sound smarter when you say Venn diagram. About half of the patients -- there was a guy name Milton Hom, who discovered this optometrist actually, and he surveyed the patients that came into his office that talked about itching. Itching is what you get with allergy. As those of us that suffer from allergy, we claw our eyeballs out. And then he said, "How many of you have dryness?" and about half of them said they were dry, and then you did the same thing with dry patients, how many of you itch perhaps. So the Venn diagram is 50% overlap. There's no drug approved for both of those. So unless you want to take a steroid, which you can only take for a couple of weeks. So our proposition there is interesting from a dry eye standpoint, I think this is a differentiator for the dry eye market, there's something one stop shop for both of those conditions today.

Yigal Nochomovitz

analyst
#22

Okay. And Fred, you have an ophthalmologic challenge but a different one, obviously, with several approved products and there's continued innovation in the space, you're innovating, but you're not the only one. We've seen the bispecific approval with Vabysmo. We've seen the high-dose EYLEA. We're seeing the TKI inserts. But tell us what is your path -- what is your approach to commercialization?

Frederic Guerard

attendee
#23

So we're in a very different situation because we are not competing with any of these drugs. We are going to be adding those drugs. They are all anti-VEGF-As in one way or form. The FDA accepted that fact. And therefore, that's why the clinical program we have, the Phase III is designed with one trial being done in comparison to EYLEA -- in combination with EYLEA. The other one is done in combination with Lucentis because the FDA agreed as well as EMA that it's a class effect. These drugs are all non-inferior to Lucentis. So there has been no progress in the quality of care over 20 years. The new ones last a bit longer on average in the U.S., 7 to 10 days longer, in terms of interval of injection. But this is certainly not -- and now when you add the 7, 10 days, the injections need to be given in the U.S. market around every 55 days. So they are not even every 8-week drugs. So we're not competing with any of them. It will not be fun, knowing how Amgen entered that market a couple of weeks ago, launching a biosimilar of EYLEA in the U.S. you have Genentech and Roche. With Vabysmo, you have Regeneron with EYLEA, that will not be a fun fight. The good thing is we have friends -- we are friends with everybody. We don't fight with anyone. The business model for us to launch is very different to my colleagues. It's a business-to-business model. Four retinal networks in the U.S. makes 70% of the volume of injections in the whole country. So basically, we have 4 customers to convince. Cencora acquired Retina Consultants of America a couple of weeks ago for $4.6 billion. So now it's all almost private equity owned. They have purchasing departments and you basically strive commercial contracts with them. And you get used this way. So it's a very elegant model. We believe we can launch in the U.S. having a team of tens of people, not hundreds or thousands of people. So a very different business model.

Yigal Nochomovitz

analyst
#24

And then just a follow-up on that in terms of how you think about the practice dynamics. And of course, as we know and as we learned even yesterday from one of the experts, efficacy overall today. I mean convenience is good, but efficacy is better. So how do you think about that? I mean, obviously, it's a second injection. Are you -- do you have plans for co-formulations. How are you thinking about that?

Frederic Guerard

attendee
#25

So the way the drug is administered in the clinical trials that are ongoing is there are 2 injections given at the same time when the patients are in the chair and they get their anti-VEGF-A injections. We are monitoring the increase of intraocular pressure between the 2 injections, but we inject a 50-microliter injections for sozinibercept and the anti-VEGF-As are also 50 microliters. So the total volume we will inject at the same time would be 100 microliters. And that volume has been approved by the FDA for the geographic atrophy drugs. So we know already our precedents, the volume is safe. We are indeed working. So that's the way it's going to be administered at launch. This is not disrupting the flow of the clinic because the patients are already in the chair. Even if the intraocular pressure is being measured between the 2 injections, it doesn't take a very long time. And normally, you can inject the patients within a minute between the 2 injections. We are already working on a co-formulation to make it easier, so that it's only one needle in the eye instead of two, and we are now in stability testing. It's actually quite complex because we are mixing 2 biologics in one vial and it's -- the stability obviously is a real challenge. So we're already working on it. I want to say that with the fragmentation of the anti-VEGF-A market where before we only had until recently branded products, so very cheap drugs were on the market. We now have a vast number of biosimilars that have launched or will launch in the years to come. It may not be a commercial benefit to necessarily have a co-formulation in the U.S. market because there may be financial incentives for the clinics to use a certain biosimilar with which they have better commercial terms than using a co-formulation with us. So it's an option we want to provide, but it may not be the solution for all the patients. What patients dislike is they're not necessarily the injections, they really dislike the visits, to have when you're 80, 90 or 100 years old to go every 4 weeks, if you're on a very high frequency of injection. Some patients get even more frequently than every 4 weeks. You have to go, find someone to drive you, you're not only visually impaired because anti-VEGF-As in half of the cases do not restore your vision. You cannot drive there. You need someone to get there. It takes time to get your vision measure to get your OCT done, to get the eye prepared, to get injected, time-consuming when your independence is limited, the real burden is the visit. It's not the injection itself.

Yigal Nochomovitz

analyst
#26

That's a good point. Eef, do you want to talk a little bit more about your direct-to-consumer initiatives as well as how you're targeting eye care professionals. I mean you're going to be using a lot of channels to get the message out. You can't speak to all the details on the label yet, but you can -- you're doing some market awareness in terms of getting people to understand that they even have presbyopia because they may not actually realize that it's a disease or condition. So maybe talk a little bit more about that and you're using leveraging social media and potentially some influencers eventually to do this?

Evert Schimmelpennink

attendee
#27

Yes. No. A lot of that in that question. One thing is for sure, we'll never use the word presbyopia towards patients or we call them consumers. Nobody knows what that is. When I was asked for this company, and they were telling me presbyopia, I had to Google it. I was, "oh, that's what I have." So how you talk to them is about, you talk about blurry vision or the things that they can no longer do. There's a million different instances on a daily basis that makes you realize that your near vision is no longer there. So that's how we'll approach the consumer with a true DTC campaign. So what that looks like in our mind is not what we read it, even though it was very effective, they doubled the amount of scripts when they turned on DTC. Their version of that was putting commercials on the Hallmark Channel, which we feel is not your target population. That's not whether people that will buy this drug, mostly live. It's also not very effective. So if you think about our DTC strategy, it's much more targeted, much more digital. We know where these people all live on their TikToks, and the Facebooks and the Instagrams, YouTubes. We'll obviously use, as you would do nowadays, the right influencers, think about the big names, that we're bringing in there and Sean here, keeps asking me what he can hire, no he can't. So a lot of people that are hired in our list to bring in and get that word out. That's on the DTC consumer end, what we're already doing now on the doctor end, that obviously, this is all unbranded because we're not approved yet is -- we have our MSL team out starting to have those doctor-to-doctor interactions. We've also started an unbranded campaign earlier in the year. Eye Am Selective, all spelled out in words. We were talking about the importance of pupil size and being below 2 millimeters that you can get the best with a pupil selective myotic, that's what these active ingredients are called. And then we're starting to highlight what some of the target populations are. It's one thing to have 128 million population out there that you can target, that's very broad. So you want to bring people in, we want to focus them on what we initially see 3 groups of early adapters. People have had refractive surgery, AKA LASIK, people are wearing contact lenses or people that go to a beauty spa. So I think about your Botox users. Each of these groups alone is well over $100 million. So that's why we're targeting campaigns.

Todd Brady

executive
#28

I thought [ RFK ] was getting rid of DTC. Isn't that -- aren't you guys concerned about that?

Evert Schimmelpennink

attendee
#29

Yes. So if you can overcome the first amendment, then that would be an issue or a potential. I think it's been tried before and it's not something that we foresee happening soon. Even if it goes in that direction, this is a self-pay product. This is not probably the first one that you would go after. I think you would target the Medicare type products. But again, we don't see that going anywhere anytime soon.

Todd Brady

executive
#30

Well, it is an effective modality in dry eye too. We've all seen dry eye ads, and it's used because it works. It'd be interesting to see how that evolves over the next 4 years.

Yigal Nochomovitz

analyst
#31

Todd, maybe talk a little bit more because you said at the beginning, you're an immunology company with applications in the eye or something to that effect. So can you go back and talk a little bit more about aldehydes and aldehyde biology, just at a high level? And what you're doing beyond dry eye. You mentioned retinitis pigmentosa as well. So talk a little bit about that. I mean I think we understand you've got a very good partner in AbbVie. So that box is checked.

Todd Brady

executive
#32

Right. We have a new target. We call it RASP, reactive aldehyde species, which is actually one of the few nonprotein targets. It's very difficult to think of any drug that doesn't directly target a protein or receptor or an enzyme or something related to that nature. And it's kind of interesting. I tell the KOLs we work with, optometry, ophthalmology, they're the first which should be the first physicians or health care providers anywhere to use this approach in humans on a commercial scale. So it's exciting. I think proteins are great. It's -- we're good at targeting them. We need to move on and target other things. And so RASP for a family of small molecules, broad implications of immunology, but also metabolism, RASP [indiscernible] so maybe one day, we could have a drug that reduces inflammation, makes you a little thinner and reduces ocular redness at the same time.

Yigal Nochomovitz

analyst
#33

And Fred, maybe -- can you talk also a little more about MOA and not -- everyone is pretty familiar with the A and the B isoforms, but VEGF, C and D, how do you think about them in terms of driving the disease.

Frederic Guerard

attendee
#34

So the disease is characterized by the abnormal blood vessels that grow in the back of the eye and they start leaking. So you have this vascular permeability that is increased. And therefore, you have accumulation of fluid in the back of the eye. I think like a blister when you burn your finger, you have that on your retina. And of course, the longer the fluids stay there, the more likely the photoreceptors are going to die and the user impairment becomes irreversible. So this pathway -- the vascular endothelial growth factor pathway has been very well described for decades. And that's the main driver for that phenomenon of neovascularization and vascular permeability. The existing drugs on the market, all targets VEGF-A or VEGF-B or PLGF. Basically, all -- everything that binds to the first and the second receptor of the VEGF pathway, but they leave VEGF C and D entirely free to bind also in the second receptor, but also in the third receptor of the pathway. So by combining anti-VEGF-A and C and D, you're basically on target block the stimulation of these 3 receptors and [ completely ] shut down the main driver of the disease. In animal models, it is actually really, really interesting. You see the VEGF-C does everything VEGF-A does. It increases these abnormal vessels -- increasing this opening of the walls of these blood vessels. Very interestingly, when you have AMD, you have a natural elevation of A and C -- VEGF-A and C. And when you start treating the patients with anti-VEGF-A, you have a further upregulation of VEGF-C. So the reason why some patients actually do not respond very well to anti-VEGF-A or do not respond completely to anti-VEGF-A or respond for a while and then there is some sort of an escape mechanism at some stage, which you see in clinical trials. Maybe because of this elevation of -- this countermeasure elevation of anti-VEGF-C. So for us, with sozinibercept, we track C and D, remove them and refrain them from stimulating the second and third receptors, and we should be able to better control the disease. That's what we saw in Phase IIb. We saw not only better visual acuity for the patients, but better resolution of the anatomy of the eye, reduction in the retinal thickness, reduction in presence of fluid in the retina, subretinally, the reduction of the Choroidal neovascularization area in the back of the eye as well as a reduction of the lesions in the back of the eye. So the totality of the anatomy of the eye was better with the combination drug as opposed to the traditional monotherapy.

Yigal Nochomovitz

analyst
#35

You have a very extensive Phase III program to the coast and the shore, one with EYLEA, one with Lucentis. So just a few follow-ups there. I mean, obviously, you did the Phase II with Lucentis. You made the point that these are very similar -- the basic VEGFs are very similar -- anti-VEGFs are very similar in how they behave. So just help us understand how you think about the outcomes here and also remind us when the data because they're coming pretty soon, right?

Frederic Guerard

attendee
#36

So -- the first trial, the aflibercept comparator trial will read out in the early second quarter of next year. The Lucentis 1 will be middle of next year. So it's really around the corner now. We indeed do not have data in wet AMD with aflibercept. We only have data with ranibizumab. Aflibercept was developed as a non-inferior product to ranibizumab. So we have very good data from the VIEW 1 and VIEW 2 pivotal trials that Regeneron did 15 years ago, where you either were comparing ranibizumab 0.5 milligram given every 4 weeks to aflibercept 2-milligram given every 8 weeks or lower dose of aflibercept or aflibercept given more frequently. And so we have that data. So we know how these 2 drugs behave when you compare them head to head. And the comparison was that they were just not inferior to each other. They were exactly the same. So -- and this is basically been proven again and again in real relevance data when you -- very large trials were conducted comparing Avastin, Lucentis and EYLEA. And you could see that over a 2-year period, there were maybe one injection difference over 2 years in terms of frequency. There was no difference in terms of visual outcomes. So we're very confident that the Lucentis data will translate into a similar results with aflibercept.

Yigal Nochomovitz

analyst
#37

And then one question I get -- I don't get it as much these days, but I did get it early is obviously, with the Phase II, you had a great result with the 2.0 milligram with the 0.5, it didn't really differentiate much from just Lucentis. So I mean, the answer I've heard is -- well, I mean, it's normal, right? I mean you got to do dose exploration, and that wasn't a high enough dose. But I guess when some people see the picture that they just wonder a little bit. So maybe just help us understand that.

Frederic Guerard

attendee
#38

Yes. So it was a dose-ranging trial. So the idea was to find the right dose. The 0.5 milligram was not statistically different from the Lucentis monotherapy. The combination with Lucentis and 0.5-milligram was not different to Lucentis alone, statistically on vision, but it was actually better on the anatomy. So the 0.5 milligram had some activity, you could see it on the resolution of the anatomical parameters, but it was probably not enough to drive better vision. As you may know, there has never been a very strict correlation between one anatomical endpoint and visual acuity. That's why the FDA never accepted to move from BCVA as -- a primary endpoint in these trials to anatomical measurement, which will be a lot easier to do a lot cheaper. But sadly, we have to go for functional endpoints in clinical trials. So, to answer your question, the 2-milligram is the dose and that's the one we are moving within pivotal program.

Yigal Nochomovitz

analyst
#39

And then just to wrap up, give us just a quick over the next 3 or 4 quarters, what are the key milestones? I mean you mentioned the PDUFA date, but what other data sets or presentations of medical meetings or other milestones that we should be aware of from you as everyone anticipates the launch, which I assume would be late 3Q, early 4Q next year.

Evert Schimmelpennink

attendee
#40

Yes. So key things are really focused on us getting ready for the launch. So obviously, on the regulatory side, we continue to have very productive discussions with the FDA, all working towards our August 8, PDUFA date on the manufacturing end. We already produced our clinical trial material at commercial level. So we'll continue to scale that up. We're saying our solid production for commercialization in the second quarter. And then as I've said, we already have the MSL team out there currently talking to doctors, explaining what our product is, increasing on the unbranded campaigns, and I'm truly getting ready for launching this product in the fourth quarter, having the sales force ready to do so, so we're currently hiring the sales force. We'll have them ready by the middle of the year and then Q4 is all about the launch.

Yigal Nochomovitz

analyst
#41

And Todd, quickly, your milestones.

Todd Brady

executive
#42

April 2.

Evert Schimmelpennink

attendee
#43

You're beating me to this?

Todd Brady

executive
#44

How is that? Yes, barely. April 2. So that's our PDUFA date for dry eye. Hopefully, we'll have an sNDA later next year. Behind that, it's skin, liver, and retina. So atopic dermatitis, metabolism and dry AMD.

Yigal Nochomovitz

analyst
#45

Awesome. All right. Good luck, everyone. Thank you.

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