Yaron Daniely
Analyst · Piper Jaffray. Your line is open.
So that's a very important question, and we discuss that a lot, both with KOLs as well as with our investors. And there are some kind of generic rules for treating effect sizes, on kind of a mild, moderate and significant effect sizes. I think that in the world of stimulants, which is the dominating world of ADHD therapies to-date, the use of effect size to kind of compare and contrast different stimulant medications is relatively useful, because the vast majority of subjects, upward of 70% are responsive to stimulant medication, and therefore, the delta between the drug and the placebo groups, in clinical trials, actually do reflect what the clinician may expect to see, as a clinical benefit in their practice. For non-scheduled non-abusable drugs, the only approved one of course for adults is Straterra. That has been more of a challenge, because what Straterra has shown now in more than 10 years of being in the market, is that the response rates for these non-scheduled drugs is lower, it's not 70% or 80%, it's more like 40%. When you have only 40% of your treatment group responding, the effect size of the overall treatment group, is actually not a very useful way of describing the clinical benefit, because out of the 100 folks that get the drug, you are really providing benefit only to 40, and the other 60 essentially dilutes their clinical outcome, that the clinician may see in the clinic. In this case, I think what we end up discussing with our investigators, is what would be the clinical benefit of an approved MDX drug; and I think that we repeatedly here can sense it, that a non-abusable, non-scheduled drug that has distinct profiles for safety and tolerability, is not associated with any of the common or serious side effects of stimulants and approved non-schedule drugs, and has efficacy, meaningful efficacy, even in 40% or 50% of subjects and actually works quickly, let's say, first week or first two weeks. So that you can actually sample free to subjects to check, if they respond or not, before putting them on other treatment, would provide dramatic value and an important room in the arsenal of pharmacological treatments for ADHD subjects, whether they are kids or adults. So I am sorry for the long answer Charles, but it's kind of my way of explaining that, effect size used in powering statistical tests, is more useful for some settings, less useful for other settings. I agree with the latter part of your question, which is the value proposition of MDX would not necessarily be in the absolute effect size of the entire group. We certainly have to hit that statistical significance. But the clinical benefit would come from its distinct profile.