Hansa Biopharma AB (publ) (HNSA) Earnings Call Transcript & Summary

Hi, everyone, and welcome to the Hansa Biopharma Interim Report for Q1 2024. Today's call is being recorded. [Operator Instructions] Speakers, please begin.

Thank you, operator. Good afternoon, good morning, and welcome to the Hansa Biopharma conference call to review first quarter results for 2024. I'm Søren Tulstrup, CEO of Hansa Biopharma. Joining me today is our Chief Commercial Officer and U.S. President, Matt Shaulis; and our Chief Scientific Officer, Hitto Kaufmann. I'm also delighted to welcome Evan Ballantyne as our new Chief Financial Officer. With Evans' deep international experience and successful track record as a CFO at public and private life science companies, I'm confident that Evan will be a strong addition to our team and will help drive our financial strategy, deliver on key strategic priorities and help us build shareholder value. Hansa's Head of Investor Relations, Klaus Sindahl, is also with us. Today, we will discuss the progress we made during the first quarter of 2024 and review our near-term milestones. Presentation should take roughly 15 to 20 minutes, after which there will be an opportunity to ask questions during a Q&A session. Now please turn to Slide 2. Please allow me to draw your attention to the fact that we will be making forward-looking statements during this presentation, and you should therefore apply appropriate caution. Please turn to Slide 3 and an overview of Q1 highlights. I'm very pleased to see a promising start to 2024. In the first quarter, we continued to see strong commercial execution, making it out as performing quarter so far and the second consecutive quarter with solid product sales. This strong sales performance is a continuation of the traction we saw at the end of last year, where key large markets, such as the U.K. and Germany, started to contribute supported by new and [ repeated use ] of Idefirix at leading transplant centers. Matt will cover the commercial performance in more detail during his section of the call. Last week, we announced that additional financing has been secured, extending our cash runway into 2026 through a $34.6 million directed share issue targeting international health care specialist investors. I'm very pleased to see the strong interest in the Hansa equity story from leading U.S. and European specialist investors. This transaction will help finance the preparation for a potential U.S. launch of imlifidase in kidney transplantation, strengthen our ongoing product development in autoimmune indications and allow for the continued clinical development of HNSA-5487, our lead candidate from the NiceR program for repeat dosing. On the clinical development side, I'm encouraged to see our progress in kidney transplantation continue to progress as planned. Enrollment and randomization in our U.S. pivotal ConfIdeS trial is advancing as expected. During the first quarter of 2024, 4 new sites were activated and both screening and randomization of eligible patients have recently accelerated. As previously guided, we expect randomization to complete mid-2024. We've also made significant progress in the European post-approval study, with more than a doubling of the number of patients treated in the trial in the last couple of quarters. As a reminder, the post-approval study is an obligation under the European conditional marketing authorization and will be used to further investigate the long-term graft survival in 50 highly sensitized kidney transplant patients treated with Idefirix. The study will also help generate important clinical experience in leading transplant centers in using Idefirix as a new transformative desensitization therapy in highly sensitized patients. Beyond kidney transplantation, we continue to advance our imlifidase clinical programs in autoimmunity. In our pivotal Phase III trial in anti-GBM disease, our lead autoimmune indication, we reached 50% enrollment in the trial and expect completion in 2025 as previously guided. In our Phase II study in Guillian-Barré syndrome, we expect to share contextualized efficacy data later this year, following promising first high-level data shared in December of last year. Hansa's lead candidate from the NiceR program for repeat dosing, HNSA-5487 continues to progress as planned with expected further analysis around end points to be completed in the second half of this year as previously guided, including selection of a lead indication. In gene therapy, imlifidase is being investigated in a Phase Ib study as a pretreatment to ELEVIDYS, also known as SRP-9001, Sarepta has FDA-approved gene therapy in Duchenne muscular dystrophy. As communicated earlier, Sarepta leads the communication around the progress of this program, and we expect the first high-level data readout towards the end of this year. With this, I'll hand it over to Matt to go through our commercial progress for the quarter. Matt?

Thank you, Soren. Please turn to Slide 4. As Soren mentioned in his introduction, we saw strong commercial performance in the first quarter with SEK 47 million in product sales, which is the second consecutive quarter of strong sales and as Soren highlighted, our best-performing quarter so far. Growth this first quarter was driven by product sales in our largest European markets, including France, U.K. and Germany as well as initial sales in Belgium. At Hansa, we are launching a transformative new therapy in kidney transplantation. It is a paradigm change rather than a product for a well-established use as it enables the treatment of cross-match positive patients. Generating successful early experiences in key early adopter clinics will be highly critical for the long-term market uptake of this innovative product. So ultimately, we must win the acceptance battle both for treatment of the patient type and the subsequent adoption of the product. To measure our progress, we are using a set of key launch metrics, which we introduced back in the fall of last year. These metrics will directly or indirectly impact future adoption and sales of Idefirix as a new transformative therapy. We will continue to revisit these on a regular basis to demonstrate our progress. These metrics include market building and market access activities, patient identification and transplant center readiness and use. Looking at our market access and market building activities first, we have seen Idefirix specific guidelines being implemented on a national level in 7 key markets so far, including Germany and Italy, more recently. These guidelines provide a new clinical practice framework for health care professionals on a management pathway for highly-sensitized patients, and our medical teams are supporting further country-level guideline development in other European countries. In addition, we have now secured pricing and reimbursement in 75% of the European kidney transplant market, including all of the largest 5 markets, and expect to see utilization in new centers, which will support increasing sales growth in 2024 and in the years to come. HTA processes continue to run in several other markets. In fact, we have 11 processes ongoing, including markets such as Portugal and Switzerland, and a dossier was submitted in Ireland during the first quarter. Third, let's look at patient identification. Following the conditional market authorization in Europe, Hansa is running a mandatory post-approval study in Europe in parallel with the commercialization. The post-approval study helps clinicians generate valuable experience in treating and managing patients as we build the foundation for Idefirix to become a new standard of care in desensitization. While in the short term, this study may affect commercial sales and patient uptake, long term the experiences from this study will positively impact sales growth. During the last 6 months, we have seen more than a doubling of the number of patients treated in the trial, and we have now completed approximately 72% of the post-approval study. The post-approval study is on track to complete treatment in 50 patients by the end of 2025 and will support full marketing authorization in Europe. Ongoing patient identification through organ allocation systems, such as Eurotransplant is another critical factor since increased access to organs is critical to [ equitable ] care for highly sensitized patients. On that note, we're pleased to say that the first 2 patients were treated in Eurotransplant's new Desensitization Program during the first quarter of this year, following the increased patient identification and selection at the end of last year, where both the first and second wave patient assessment took place on a large number of patients for treatment with this new Desensitization Program. The new pilot program under the Acceptable Mismatch Program is intended to transform desensitization across 8 European member countries, including Germany, the Benelux and select Eastern European countries. Fourth, scaling up the base of transplant centers with clinical experience is a key commercial metric and while uptake will remain volatile from quarter-to-quarter, even with a growing base due to the unpredictability of organ allocation to highly sensitized patients on waiting list, we are pleased with the continued progress in establishing new centers that use Idefirix. Today, approximately 50 clinics qualifies Idefirix ready to treat patients, while a number of clinics that have treated patients commercially or through our post-approval study has grown steadily. When we received EMA authorization in 2020, only 2 centers had clinical experience by Idefirix. And by the end of the first quarter of 2023, that number of centers had grown to 15. Today, more than 25 centers across both clinical studies and commercial sales have experienced with Idefirix. Furthermore, by the end of the first quarter, the number of centers with the repeat usage had grown to 17. We obviously are very pleased that we achieved 2 consecutive quarters that each represent our best product sales quarter so far. And in addition to continued sales in France, we anticipate further growth to come from the U.K., Germany, Spain and Italy as our efforts continue to have impact into 2024. We also have to reemphasize that as the base of centers grows, we will continue to see more patients identified on the waitlist of these centers for Idefirix, but there will be some volatility in sales from quarter-to-quarter as the timing and number of organs allocated are basically determined by factors that are out of our control. Please turn to Slide 5. With regard to our pivotal U.S. ConfIdeS trial in kidney transplantation, enrollment and randomization continue to advance as expected. During the first quarter of 2024, 4 new sites were activated, taking our total number of activated sites from 17 to 21. Similarly, both consenting and randomization of eligible patients have recently accelerated to 122 patients consentment and 49 patients are randomized out of a target of 64. The ConfIdeS study is designed to evaluate imlifidase as a potential disruptive therapy for highly sensitized patients waiting for deceased donor kidney through the U.S. kidney allocation system. Approximately 2,500 highly sensitized patients in the U.S. with a cPRA score of 99.9% and above fit into this category, yet they are not transplanted today despite prioritization points on the kidney allocation system. As we have previously noted, we expect randomization of this study to be complete by mid-2024 with the BLA submission expected 2025 under the accelerated approval path. And now I will hand over the call to Hitto, who will walk us through the progress of our exciting pipeline projects. Hitto?

Thank you, Matt. Please turn to Slide 6. Our proprietary antibody cleaving enzyme technology platform holds significant potential beyond kidney transplantation in several therapeutic areas, such as autoimmune disease and gene therapy. Our lead indication in the autoimmune space is anti-GBM disease, also known as Goodpasture disease, by Hansa is running a pivotal Phase III trial in an open-label, controlled, randomized multi-center trial, evaluating renal function and need for dialysis at 6 months in patients with severe anti-GBM disease. In this trial, imlifidase is investigated as an addition to standard of care consisting of a combination of PLEX, steroids, cyclophosphamide versus [indiscernible] care only. Anti-GBM is a serious ultra-rare acute autoimmune disease affecting approximately 1.6 people in 1 million, in which antibodies are directed against an antigen intrinsic to the glomerular basement membrane, causing acute injury of kidney and/or lung function. Today's standard of care has been flagged by many leading expert as insufficient and majority of patients unfortunately lose their kidney function, requiring chronic dialysis and/or kidney transplantation. At Hansa, we are excited about the potential for imlifidase and anti-GBM disease, also because it serves as a catalyst to potentially enter several other IgG-mediated autoimmune indications, where our therapeutic enzymes may offer significant benefits as induction therapy and or help manage flare situations, where acute and effective treatment will be needed to stop the severe autoimmune [ attack ]. Such situations could be relevant in ANCA-associated vasculitis, NMO and other indications for the stand-alone or in combination with other IgG depleting treatments. We are very excited by the prospects in anti-GBM disease following very encouraging data from a Phase II trial published in the peer-reviewed Journal of American Society of Nephrology in 2022. Based on the promising generated data, we believe that imlifidase could play a significant role as a potentially transformative and life-saving drug, having thousands of patients suffering from an acute immunologic attack that otherwise would require dialysis and could ultimately lead to death. Please turn to Slide 7. As we discussed in the beginning of this call, we are happy to report that our clinical programs continue to progress as planned. At the end of last year, we initiated the first clinical study with imlifidase in gene therapy together with our partners at Sarepta Therapeutics. In this Phase Ib study, imlifidase is being investigated as a pretreatment to Sarepta's FDA approved SRP-9001, also known as ELEVIDYS gene therapy in Duchenne muscular dystrophy. High level data readout from the Phase Ib program is expected later this year. Another exciting program is our first in-human trial of HNSA-5487, our lead candidate from the NiceR program for repeat dosing. Following positive results demonstrated that HNSA-5487 was based and well tolerated with fast and complete depletion of IgG antibodies at increased doses, further analysis of exploratory endpoints will be completed in the second half of this year and will guide selection of lead indication. In the Guillian-Barré Syndrome Phase II program, Hansa presented positive high-level data in December of last year, illustrating that imlifidase was safe and well tolerated when administered prior to standard of care and that rapid improvement in disease-related efficacy measures was observed in imlifidase treated patients. As previously communicated, a further analysis will contextualize the efficacy data and is expected to be announced later this year. In the investigator-initiated Phase II trial in ANCA-associated vasculitis, 3 patients are currently enrolled, out of a target of 10 patients, with severe ANCA-associated vasculitis and acute respiratory distress syndrome due to pulmonary hemorrhage. Patients will be treated with imlifidase on top standard of care consisting of standard immune suppression as per center protocol and intensive support care. The study in ANCA-associated vasculitis is being carried out at Charité – Universitätsmedizin, in Berlin. In our anti-GBM program, we have recently seen an accelerated uptake in patient enrollment in the global pivotal Phase III study, which has continued during the first quarter as we have expanded enrollment capacity with additional sites. In total, 25 patients, out of a target of 50 patients, have now been enrolled across centers in the U.S., U.K. and EU, confirming that we are on track to complete enrollment in 2025 as previously guided. The primary objective of the anti-GBM study is to assess the superior efficacy of imlifidase in combination with standard of care versus standard of care alone with a 6-month follow-up on renal function. Lastly, we are planning for a potential publication in a peer-reviewed journal of the full data from the AMR Phase II program. Data from this study was announced at the end of last year, demonstrating rapid and significantly superior reduction in donor-specific antibodies within 5 days of treatment as compared to standard of care. With this overview, I will now hand over the call to Evan, who will walk us through a review of the financials of the first quarter of 2024. Evan?

Thank you, Hitto. Please turn to Slide 8. Revenue for the quarter totaled SEK 56 million, including SEK 47 million in product sales and approximately SEK 9 million in contract revenue, mainly from the Sarepta partnership agreement. As Soren and Matt noted earlier, product sales for the period reflects Hansa's best-ever quarter. This was the first -- this was the second quarter of strong revenue growth driven by product sales of our largest European markets, including France, the U.K. and Germany as well as initial sales in Belgium. We are very pleased with the strong revenue generation over the recent 2 quarters. It is important to emphasize that quarterly revenue can be volatile given our dependency on organ supply and the allocation of kidneys to highly sensitized patients. That said, we are starting to see a meaningful revenue base being built with increased demand across a number of European markets. Please turn to Slide 9. SG&A expenses for the first quarter of 2024 totaled SEK 91 million compared to SEK 103 million for the same period a year ago. The decrease in expense reflects lower staffing levels following the recent restructuring actions taken by Hansa. Investments in R&D totaled SEK 103 million for Q1 2024, which represents a SEK 10 million increase compared to Q1 2023. This increase was mainly driven by the ongoing U.S. ConfIdeS study, our post-approval commitments in Europe and the ongoing anti-GBM Phase III clinical study. Hansa's operating loss totaled SEK 159 million for the first quarter of 2024 compared to SEK 182 million for the same period in 2023. The improvement in operating loss for the first quarter is mainly driven by increased revenue from product sales. Lastly, the net loss for the first quarter decreased from SEK 259 million compared to SEK 182 million for Q1 2023. The improvement was driven by higher product sales and lower SG&A expenses, partially offset by the impact of negative foreign exchange variances. Please turn to Slide 10. Cash flow used in operating activities totaled SEK 189 million for the first quarter of 2024 compared to SEK 207 million for the first quarter of 2023. Period-over-period improvement was mainly driven by the increase in product sales and lower SG&A expense. As Soren noted at the beginning of the call, we are very pleased with the additional financing Hansa recently secured, extending our cash runway into 2026 through the USD 34.6 million directed share issue, which chiefly target U.S. and European health care specialists. The successful capital raise will help finance the preparation of a potential U.S. launch of imlifidase and kidney transplantation, strengthen our ongoing product development in autoimmune indications and allow continued clinical development of HNSA-5487. I will now hand the call back to Soren for his final remarks.

Thank you, Evan. Please turn to Slide 11. I want to reiterate that Hansa has entered 2024 with a promising start following strong commercial execution in the first quarter, which is a continuation of the traction we saw at the end of last year. In transplantation, our key focus is to continue to successfully launch Idefirix in Europe with a particular focus on our core markets. Second, we aim to complete randomization in our U.S. ConfIdeS trial by mid-2024, as previously guided. In our autoimmune franchise, we intend to complete and announce the full data from the Phase II trial in Guillain-Barré syndrome and then interact with the regulatory authorities to determine the best path forward for this indication. In our anti-GBM program, our goal is to complete enrollment by 2025. And as discussed, we have seen the strong momentum from the end of last year continuing into 2024. In gene therapy, we expect the first high-level data towards the end of the year on the Phase Ib study with imlifidase as pretreatment to Sarepta's gene therapy ELEVIDYS in patients with Duchenne muscular dystrophy. In our second gene therapy program, following successful completion of preclinical work Hansa and Genethon expect to initiate the first clinical trial later this year of imlifidase administered prior to the dosing of GNT-0003 Genethon's gene therapy in Crigler-Najjar syndrome. Last, in relation to HNSA-5487, we will assess further immunogenicity data from the Phase I trial in healthy volunteers and select the lead indication to be pursued. Now please turn to Slide 12. With this overview, our presentation is now concluded, and we would like to open the call for questions. Operator, please begin.

[Operator Instructions] The first question will be from the line of Christopher Uhde from SEB.

Chris Uhde from SEB. I was just wondering, first, in terms of the trying to get a handle on the volatility, what can you tell us about the next market access steps to unlock, yes, sort of more of the opportunity? That's my first question.

Yes, sure. Thank you very much. I will turn over to Matt for this. But essentially, we have gotten our access in all the top 5 countries in Spain and Italy, where we got access most recently. We're still in the process of pushing the reimbursement down to the regional level. And we've seen very solid progress in Italy, actually. And it's moving a little bit slower as usual in Spain, but that is certainly very promising. And then we have a number of smaller countries, where we have submitted HTAs, and the process is on the way, right. But I don't know, Matt, if you want to add some further color to this.

I think those are really the principal ideas at play here, right? The largest markets are secured, and we're going regional in Spain and Italy. And we anticipate that with that access and our continued commercial efforts, we'll see further growth during 2024 in the U.K., Germany, Spain and Italy. So the bigger parts of our growth for the future are going to come from that base of reimbursement that we've already begun to establish. Now there are other opportunities, we mentioned Portugal, Switzerland, these markets will have some volume, but they will take a bit of a back seat to the larger markets.

And come later.

Yes, yes.

Okay. And any kind of indications on sort of the timing of that gating?

So I would say, as I said, in Spain and Italy, the process is underway as we speak. So we're getting regions by the month more or less. And then you have smaller markets, like Portugal and so on, Ireland potentially as well. That is more like Q4 events, right.

Second half, yes. No.

Right. Okay. And then a question on the gross margin then. It's in the 60s percent. What do you expect the steady-state margin to be now that you have a bit more clarity on -- yes, the shelf life versus the time, yes, in channels. And my last question is sort of on NiceR. When do you expect to say more about what -- yes, what your plans are?

Yes. On the gross margin, I mean, we're not going to give you a specific number there, but maybe Evan add some color to this development.

Yes. Given I've only been here 1.5 months, I'm going to tell you, I think we can get the gross margin up to between 80% and 90%.

And then on NiceR. So as we said, we currently collect the additional data in the healthy volunteer study, and we should have the data including the 12-month data at the other end of summer. So in the second half of this year is when we expect to be able to communicate more around this.

The next question will be from the line of Douglas Tsao from H.C. Wainwright.

Can you hear me?

Yes.

Congrats on all the progress. So just -- it sounds like a lot of the growth is going to come from some of the new markets and the larger markets. I'm just curious when you think about how things should proceed in some of those key markets, especially markets like U.K. and Germany. Do you expect the uptake to be a little faster than what we saw in some of the smaller markets in the early going? Do you just feel like they're better prepared to sort of incorporate imlifidase into their sort of treatment paradigm? I mean, obviously, they have more patients and more volume, so that should lead to the growth. And I'm just curious if you have a sense that they're sort of more ready and willing and able to [ sort of use ] the product.

And I'll hand it over to Matt, but I would say that in general, the U.K. is traditionally a pretty conservative market where you don't see very, very fast uptake. Germany tends to be the same, depending a little bit on the therapeutic area. But clearly, we have significant volume in these 2 countries, right? So that's going to be an important factor. And then you have markets, like Italy and Spain. Overall, in Italy, we are quite encouraged by what we've seen, including engagement from even patient associations and so on. Spain is really a very, very well organized market in Europe looking at the organ allocation system and so on. So I don't know if you want to add something to this, Matt?

I think that's a great characterization, Soren. I think that there is some level of conservatism in the U.K. and also in Germany. But we're encouraged that we've seen initial patient treatment in both of those markets. I think the other encouraging factor is that there is the desensitization program as part of Eurotransplant that's at play in Germany. That is protocol-driven. And while it lends itself to identifying a large number of patients, it moves through the waitlist at multiple different centers in a very steady and methodological way. So that particular market doesn't lend itself very well to sort of greater acceleration beyond the pace of that particular protocol. I think that in Italy, we're making progress on getting region level pricing and reimbursement into place. That should have some good volume. I wouldn't necessarily say that, that's going to be faster perhaps than, say, France, but should move at a good pace. I think one opportunity for us later in the year will be in Spain. We have numerous centers that are part of the post-approval study in Europe that have been identifying patients. Spain has a fairly good concentration of those centers. And we anticipate that later this year, some of those centers will run their course of having been a part of post-approval study. And then the patient volumes in Spain and in some of those locations will then pivot to being commercial led by necessity. So I hope that was a reasonable commentary. I think that more of the growth will come from having multiple markets on board at the same time. It won't necessarily come from individual markets accelerating faster than, say, France.

Yes. That's really helpful. And then just sitting here in April of 2024, we're encouragingly not that far away from completion of the U.S. ConfIdeS trial and then potentially a filing. So when we think about commercialization, it's not too far away. At what point do you start to think about sort of increasing your market presence and sort of doing some market building work. Obviously, sort of maybe activating sort of like patient advocacy groups just to ensure sort of equitable distribution of kidneys and making sure that highly sensitized patients start to get access when in the past or even today, right, they're not necessarily getting that same treatment.

Again, I'll hand it over to Matt. But fortunately, we already have good presence in U.S. Matt is not just President of the U.S., he's also our Chief Commercial Officer, and he's based in the U.S. The Global Head of the Transplantation franchise is also based in the U.S., the Global Head of our Market Access team is based in the U.S. We have some MSL presence in the U.S., [ ClinOps ] and so on. So we have a pretty good setup already. And of course, as you know, the ConfIdeS trial is essentially the best prelaunch activity you can engage in. But I will hand over to Matt for this.

Sure. Thank you, Soren, and it's a great question. I really appreciate it. I can add some color to this. Certainly, the study, we're really pleased to see the way that the number of sites have increased and also the way the consenting and randomization have progressed. And that is, in fact, a substantial opportunity for us in the U.S. We're currently at 21 sites. We believe that we'll get to 24 or potentially 25 and that compares very favorably to the 2 centers that had clinical experience at the time that EMA authorized Idefirix at the end of 2020. So that's a substantial improvement and is a form of market development. As Soren outlined, we have some personnel in the United States. This includes clinical operations and medical affairs people, and they've been engaging with the clinical trial sites, those 21 centers as well as an additional 3 or 4. They also are doing profiling and engaging with additional centers beyond the footprint of the clinical trial. And I think that's an important part of our development and presence, which, of course, complements some of the things that we're starting to do with patient activation. So you'll see some of that take place through the remainder of this year and into next year. We also see some increased interface with the organ procurement organizations in the U.S., that's an opportunity for us, again, as we end '24, and we start to get into 2025. And then lastly, in addition to things like medical engagement, it will include medical education activity at various congresses. We'll also be working with various thought leaders and stakeholders to ensure that we have clinical guidelines in place before the time of the launch. We're quite pleased that there's a pan-European guideline in place with ESOT. And then 7 different markets have country-level guidelines in Europe. That's an important model for us to replicate in the United States, and there are really influential physicians that are part of our clinical study that have voiced their belief that this is important. We think that those and other stakeholders will be very important partners in helping to get that going.

Thanks, Matt. So clearly, given the fact that at the time of launch, we expect a very significant number of the leading transplant centers to have experience with imlifidase and essentially to have protocols in place, it's going to be a much faster uptake we expect in U.S. compared to Europe overall. Another differentiating factor is the fact that in the U.S., you're actually allowed to engage in communication with payers prior to actually getting authorization, right? So again, we expect that there's going to be an uptake significantly earlier in the U.S. post approval compared to Europe.

The next question will be from the line of Alexander Krämer from ABG.

My name is Alexander Krämer, from ABG. And I would like to touch upon a topic that you have mentioned already, which is about the European post-approval study. When do you expect to start to see a patient flow into the number of commercially treated patients like basically when the post approval study is finished? Like when do you see the first impact on patients actually going like more into the commercially treated population? Do you expect is still in '24? Or is it more something like more into '25?

So thank you for that question. So clearly, as we said, we're very pleased to actually see the significant number of patients that have been treated as part of the study over the past 2 quarters, which again is an indicator of the ability to find these patients and actually have them transplanted. And what we're seeing and what we expect to see is that some of the centers that participate in this study will start using commercial products going forward and that will be an increasing number of centers. So we do expect certainly already this year to see some of these centers contribute to commercial sales of the product, I mean certainly in 2025. And as you know, we need to conclude the study by the end of '25. That's also going to happen. So thanks for the question.

Okay. And I also have 2 other questions. One related to the Eurotransplant Program. So in Acceptable Mismatch Program, you had only 2 treated. What are the reasons for the slow uptake in that program? Why doesn't this accelerate?

I will, I think, hand over to you, Matt, to take this one.

Yes. Yes. So I think the 2 patients, we consider encouraging. This Acceptable Mismatch Program with a desensitization protocol within it is a very systematic way of looking at things. And so this program started by looking at some of the patients that have been on the waitlist the longest and taking that approach doesn't necessarily reveal the patients that are necessarily the best fit for the therapy. So I think what we've essentially seen is that first initial pass based on that particular criteria that hasn't yielded a really large number of patients, but it has been encouraging that even amongst that cohort, there have been some patients that are suitable. We believe that there'll be opportunities in the future for more patient identification through this approach.

And my last question is on the Sarepta on the Phase Ib trial. Like when do you expect to communicate the next milestone for this one in terms of patient recruitment?

So as you know, this is a study that's being run by Sarepta. And so it's up to Sarepta to communicate. We're certainly not going to communicate details on a quarter-by-quarter basis here. What we have said, of course, is what Sarepta has said themselves, namely that the study has been commenced. And so -- the setup of this study, it's a limited number of patients, single digit. There is a readout after 12 weeks looking at neutralizing antibodies as well as gene expression. So we certainly hope and would expect that there could be data from first patients at least towards the end of this year.

The next question will be from the line of Eric Yeung from William Blair.

Eric, on for Matt Phipps. I was just wondering on the NiceR program. Can you disclose what data you will show publicly in the 2024 update? And relatedly, how long are you following patients to take immunogenicity samples?

So we are following these patients through month 12, essentially. And what we're looking at is, again, [indiscernible] antibodies, we're looking at IgG levels and so on. And again, as I said initially, when we have the full data set, we will communicate our conclusion around this. And also, certainly, this year, we'll make a decision as to the lead indication. I don't know if you want to add anything here to this?

Not much. Thanks, Soren. And I think you have -- just to mention these are exploratory endpoints, where we basically take [ serum ] samples 6 and 12 months, and that [indiscernible] time horizon. And in in-vitro assays, we do all kinds of experiments that will inform us about our hypothesis that we can dose a second time 6 to 12-month [indiscernible].

[Operator Instructions] The next question will be from the line of Johan Unnerus from Redeye.

Thanks also for good previous questions. So we have some additional stuff. And the cost base, I presume we should expect R&D to increase somewhat during '24? And also other OpEx to reflect the efficiency and the saving program and as the results come down somewhat.

I think I'll hand over to you, Evan, on the expenses and other types of things.

Well, as you're aware, Hansa initiated a restructuring program in Q4 of last year. Full effect of that restructuring program won't be felt until the Q3 and Q4. But during the next Q1 and Q2, I would expect expenses to improve and to be really recognized the full impact of the R&D or restructuring program in Q3 and 4.

And what about R&D? I presume that the U.S. study, for example, will push that a bit.

I'm going to guess that R&D expenses are going to remain somewhat constant only because the ConfIdeS trial is slowly coming to an end, as are some of the other trials. So I would expect it to be somewhat constant.

And perhaps some reflection on the financing side. You had a successful directed share issue just recently, and you have a runway to '26. These are different options that you could consider. You have the NovaQuest relationship and you may also have some options to engage with additional partners.

Yes. I mean look, the company is very excited about the capital raise we just completed. I think you noticed we did the capital raise without a discount to the market price, which in this particular market is very impressive. We had really solid participation from some very high-quality funds. And to your point, completing the capital raise gives the company a lot of optionality over the next 18 to 24 months. And again, very excited to have completed it.

And finally, also, you have had a good momentum in both the U.S. study and in the post-approval study in Europe. And the post-approval study activity has been combined and with a good -- much improved sales momentum. It looks like the post-approval study could be possibly completed earlier than initially thought, perhaps.

Potentially, it could. Again, we have an obligation essentially to complete it by the end of 2025, right? With the current momentum, it could conclude earlier, but it's too early to say, right? It's difficult to predict. But it's certainly very, very encouraging again to see the inflow of patients here. And as we've said previously, this is a great way to help generate experience. And we do expect commercial sales to come out of the some of the participating sites already this year.

And you're not in the business of providing quarterly guidance, but could we get some feel for, if it's possible to come in with sales from around the same level? Or should we expect somewhat lower, yet now enjoy 2 good quarters?

Well, you said it yourself. We're not going to give the quarterly guidance, right, because it is going to be volatile. So I will not step into that minefield. But I think as you can hear from the tone here and what we've seen over the past 6 months, there is good momentum. We are seeing large countries starting to contribute. Last year, we saw that the year was backloaded. Given again, the momentum and what is ahead of us, we're comfortable that we're going to see a year that, compared to last year, it will reflect significant growth. So that's what I can say. But I'm not going to provide you any guidance, certainly not on a quarterly basis.

The next question will be a follow-up from the line of Eric.

Eric, on from Matt Phipps from William Blair. Just a question related to the GBS program. Can you guys disclose your thoughts on next steps for GBS development after the results of the comparative efficacy analysis later this year?

So the next step is, of course, to engage in a thorough interaction with regulatory authorities and discuss the design of a potential Phase III trial. So that's essentially the next step. We're very encouraged, as we said, by the fact that we've seen very early recovery in these patients clearly, earlier than you have seen reported for IVIg in relation to [ parameters ] like ability to walk unaided and so on. So hopefully, this will be further proven and documented in the comparison with patients from the patient registry, and that's certainly going to act as a key input in our dialogues with regulatory agencies.

As no one else has lined up for questions, I'll hand it back to the speakers for any closing remarks.

Well, thank you very much, operator, and thank you, everyone, for your interest in Hansa Biopharma. As I said, we've had a good start to 2024, and we look forward to seeing that positive start continue throughout the rest of the year and updating you on the further progress. Thank you very much.