Earnings Labs

BioCryst Pharmaceuticals, Inc. (BCRX)

Q4 2016 Earnings Call· Mon, Feb 27, 2017

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Transcript

Operator

Operator

Good day, ladies and gentlemen, and welcome to the APeX-1 Interim Results Call. At this time, all participant lines are in a listen-only mode. Later, there will be a question-and-answer session and instructions will follow at that time. [Operator Instructions]. As a reminder, this conference call is being recorded. I would now like to turn the conference over to Robert Bennett, Vice President, Investor Relations. Sir, you may begin.

Robert Bennett

Analyst

Thank you, Shannon. Good morning and welcome to BioCryst APeX-1 Part 1 trial results call. Today's press release and accompanying slides for this call are available on our website www.biocryst.com. At this time, all participants are in a listen-only mode. Later, we will open up the call for your questions and instructions for queuing up will be provided at that time. Joining me on the call today are Jon Stonehouse, Chief Executive Officer; Tom Staab, Chief Financial Officer; Dr. Bill Sheridan, Chief Medical Officer. Before we begin, I will read a formal statement as shown on Slide 2 regarding Risk Factors associated with today's call. Today's conference call will contain forward-looking statements, including statements regarding future results, unaudited and forward-looking financial information, and company performance or achievements. These statements are subject to known and unknown risks and uncertainties, which may cause our actual results, performance, or achievements to be materially different from any future results or performance expressed or implied in this presentation. You should not place undue reliance on the forward-looking statements. For additional information including important Risk Factors, please refer to BioCryst's documents filed with the SEC, which may be found on our company website. With that, I will turn it over to Jon.

Jon Stonehouse

Analyst

Thank you, Rob. Good morning and thanks for joining us today. We are extremely excited with the interim results from our APeX-1 Phase 2 trial in patients with HAE in which we evaluated our oral kallikrein inhibitor BCX7353 versus placebo in reducing HAE attacks. We have a specifically significant and clinically meaningful result in patients with severe disease as measured by the baseline attack rate of approximately one attack per week. When planning and designing APeX-1 it was critically important for us to show this drug works, the interim analysis clearly does this. That's why we chose to start with the 350 milligram dose. Based on the PK data from our Phase 1 healthy volunteer trial, we anticipated we would over scoop the target range of the drug trough levels we are aiming for, and the PK and the interim analysis confirms this too. Our Phase 1 trial results also showed there is a likelihood of GI adverse events at this dose. Not surprisingly we see some GI adverse events in the interim analysis of patients on the 350 milligram dose. What is surprising, when you look deeper into the efficacy results is the difference in attacks by anatomical region. 7353 has a dramatic impact on reduction of peripheral attacks, triggers an 80% reduction. We did not see the same effect on abdominal attacks. We believe this is due to patients reporting transient abdominal adverse events as attacks. Bill will go into much more detail with the data to explain it further. The interim results also show that over a four week dosing intervals 7353 is generally safe and well tolerated. Bill will go into the detail on the safety and tolerability as a Part 1 of his review of the interim results. Lastly, as I already mentioned, the PK and PD results from the interim analysis confirms what we saw in healthy subjects in Phase 1 for both 24-hour drug level in kallikrein inhibition. On average, the results show that we far exceeded our target range for drug exposure levels during the entire 24-hour dosing interval. With trough levels between 11 and 32 times to EC50, this is very encouraging because it suggests to us that we can get to similar or better results at lower doses. That's because the 250 milligram and 125 milligram doses we still exceed the target range and in the Phase 1 study we saw less GI adverse events at both dose. Bill will explain the rationale and planned changes at APeX-1 to further explore the dose response in this study. Let me conclude my introduction by saying what this means for HAE patients. We now have proof-of-concept for once a day oral therapy to prevent HAE attacks. Patients all over the world tell us over and over again that this is what they're waiting for, the dream of being able to live a normal life. Now I'd like to turn it over to Bill to go over the results.

Bill Sheridan

Analyst

Thanks, Jon. I'm very excited discuss the results of our interim analysis. I'd like to start by thanking the patients, site staff, investigators, and their teams here at BioCryst for their commitment and dedication with this important research. In recent days, we've had the opportunity to work through the analyses with our principal investigator, Dr. Emel Aygören, who is joining us on this call and discuss the findings with other leading HAE experts and their patients' advisors. The feedback has been very positive. Before we get into the results, let's go over the design of this placebo controlled clinical trial. The trial has been conducted in sites in several European countries Australia and Canada. Despite two trial was designed to test several doses in two stages, with study drug dose for 28 days. In Part 1, we wanted to look at 350 milligram once daily and in Part 2 which is currently enrolling, we are looking at 250 milligrams and 125 milligrams daily. The key elements of any HAE study is the qualifying rates with angioedema attacks, for this study we selected a minimum range of two attacks per month or 0.45 per week and we expected to see an average qualifying rate about twice that. Another key element is have the data collected on our test symptomses reviewed as in our previous studies, we had an expert panel of three independent HAE physicians adjudicate the attack diary. Also as in our previous studies subject head to head access to specific medicines to treat HAE attacks hugely either a C1 inhibitor given intravenously or a CAT event given subcutaneously. The most common management strategy for HAE patient in the countries where we conducted the trial is on demand treatment with acute attacks. Other prophylaxis treatments such as Amgen or C1…

Bill Sheridan

Analyst

Thank you, Emel. It is now my pleasure to introduce Professor Bruce Zuraw, who is Division Chief and Professor of Medicine at the University of California, San Diego School of Medicine and Director of the United States Hereditary Angioedema Association, Angioedema Center. We have been privileged to had Professor Zuraw advice us on our HAEA program since it's inception and I would now like to invite Mr. Zuraw to provide his comments on the interim analysis findings.

Bruce Zuraw

Analyst

Thank you, Bill. Let me also echo what Emel said I think that these are very encouraging exciting results. I'd also like to comment that I see a lot of patients with Hereditary Angioedema both at UCSD but as well in terms of meetings with the Hereditary Angioedema Association where we have patient summits and there is a lot of excitement about the possibility of an oral prophylactic treatment so, lot of patients are looking forward to a successful drug. My last comment relates to the difference between peripheral and abdominal attacks where I would agree with your comment that we have no basis for expecting that this, that there should be a real difference in terms of the pathophysiology of the disease and I think that the data for clear absorbable attacks really speaks to where the data lies and how this drug works so as the doses lowered in that Part 2 and 3 I expect that we're going to continued to see excellent and even better results. Thank you.

Jon Stonehouse

Analyst

Great, thanks Bruce. Bruce and Emel will both the continuing on to answer questions that you may have. So let me wrap up the summary from this interim analysis is the drug works and we look forward to completing APeX-1 and moving on to Phase 3. As I said earlier patients have been patiently waiting for such a therapy. We will work very hard and go as fast as possible to get this drug to market so there waiting will be over. Let me wrap up by thanking all employees of BioCryst for their hard work and perseverance and commitment to taking us to a successful future and particular a special thanks to Bill and his team for the great work that they did on APeX-1. Thanks also to our investigators starting with the principle investigator Dr. Aygören and all the other investigators and their teams for the superb execution of this trial. I want to thank the patients and physicians like Professor Zuraw and many, many more who have been encouraging and reminding us of the importance of what we're working on. That completes our prepared remarks. We will now open it up for your questions.

Operator

Operator

Thank you. [Operator Instructions]. Our first question is from Jessica Fye with JPMorgan. You may begin.

Jessica Fye

Analyst

Hey guys good morning. Thanks for taking my question. ApEX-1 Part 2 which sounds like it's underway do you have any indication of GI effects are reduced at the 125 milligram and 250 milligram doses in patients or should we take the evaluation of the 62.5 milligram dose as some indication that you're still team GI events that could be kind of misinterpreted as attacks?

Jon Stonehouse

Analyst

Thanks for the question. The unblinded safety data that we have is what I presented today so everything else is blinded so we really can't comment on any ongoing safety. I think that as you've seen in the previous presentations over the last few months since Protected Zero in fact presented the CSL study data at the Allergy Accounting Meeting in November we have been thinking a lot about whether the trough levels support lower doses and we have really come to that conclusion and I think the interim analysis efficacy here is encouraging us to do that.

Bill Sheridan

Analyst

And just we added a slide at the very back after the Q&A headline slide that is actually a slide taken from our Phase 1 presentation that looks at the adverse events and so you can see very clearly the difference between the 350 milligram group and the 250 milligram and the 125 milligram in terms of GI events.

Jessica Fye

Analyst

Okay, yes understood. I wasn't sure if there was any kind of fold of blinded from Part 2 that would give you kind of some optimism by looking at those lower doses definitely do have in the patients. And also curious if the evaluation of the 62.5 milligram dose are you trying to find ineffective dose or do you believe that that will have some more efficacy of the higher doses?

Bill Sheridan

Analyst

Again thanks for question in Phase 2 drug development, it's very important to try to demonstrate dose response because regulators and obviously the sponsor in five in this case really need to understand whether you can show that. And so with the dose range we are studying here once the study is completed with 350 milligrams, 250 milligrams, 125 milligrams, and 62.5 milligrams we will have the rich dataset of efficacy, safety, PK and PD and we will be looking for dose response in that. So I think that if everything looks great even at that dose that will be a good outcome. If some patients benefited 62.5 milligram that will be a good outcome and we will have the data we need to select doses for Phase 3.

Operator

Operator

Thank you. Our next question comes from Charles Duncan with Piper Jaffray. You may begin.

Charles Duncan

Analyst · Piper Jaffray. You may begin.

Hi guys, good morning first of all, congrats on these data especially the roughly 50% peripheral I can't for even rates. And thanks for taking my question; I guess I had a question first of all for one or both of the KOLs and then just a couple of questions for management. For the investigators, I'm wondering if you could provide a perspective, how often it seems like its not frequent but how often could you see clearly an abdominal attack without peripheral symptoms, do you see that at all?

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

Emel let me give it to you and we will pass it to Bruce. Emel Aygören-Pürsün: Yes, thank you. Thank you for that question, it is important to know that really about one-third of the attacks account for purely abdominal attacks and about one-third may be mixed attacks. According to how you look at the attacks this would be data from cross-sectional views. So these attacks will exist purely abdominal attacks and will curtail.

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

Thanks, Emel. Bruce?

Bruce Zuraw

Analyst · Piper Jaffray. You may begin.

I guess I would agree with what Emel said in terms of the frequency of the abdominal only attacks. I would also add that we are used to evaluating or trying to guess whether an attack is real or not and some of the parameters that Bill mentioned like response time, demand therapy if the attack doesn't respond that's often an indicator that maybe we are dealing with another cause for the abdominal distress but in general yes we do see these purely abdominal things.

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

Thanks, Bruce. Go ahead.

Charles Duncan

Analyst · Piper Jaffray. You may begin.

I was going to also ask the investigators whether or not the symptoms that they saw the AEs that were observed, I understand that you may be able show efficacy with improved tolerability but with the AEC could cause them to setting guess whether or not they want to use the drug in their patients?

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

So may be start again with Emel. Emel Aygören-Pürsün: I'm afraid I did not -- I missed the part of the question, could you maybe repeat the question, it is pretty difficult to hear for me.

Charles Duncan

Analyst · Piper Jaffray. You may begin.

Yes, would the tolerability profile cause you to wonder whether or not institute the drug with the patients? Understanding that of course you are going to study a lower dose in tolerability profile could improve.

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

I think what he is asking Emel is the safety and tolerability profile so far, is this the drug that you think you use in your patients? Emel Aygören-Pürsün: Yes we're all looking forward to the further part of the study with lower dosing on, especially in view of the fact that we know that the toxic effect of mostly dose related, so I think this would -- we would expect to be that less important in further study stages and we also have even the hope that may be that the attack or the efficacy would be increased by decreasing gastrointestinal side effect of the drug that might affect the efficacy of the prophylaxis drug.

Charles Duncan

Analyst · Piper Jaffray. You may begin.

Okay, thank you. Emel Aygören-Pürsün: I'm really optimistic about that.

Charles Duncan

Analyst · Piper Jaffray. You may begin.

Great, thank you. And Bruce your thoughts on the safety and tolerability profile?

Bruce Zuraw

Analyst · Piper Jaffray. You may begin.

I would say that from what we saw in this limited amount of data that I wouldn't be hesitant to use the drug. I think that we're all cognizant that it's a short exposure in a small group of patients in a scenario that we have always pay a lot of attention to, so as we get more data if it continues like this, I wouldn't be -- I would be happy to use the drug.

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

Great, thank you. Charles anything else?

Charles Duncan

Analyst · Piper Jaffray. You may begin.

And then just quick question for you or Bill, the trough level seemed high relative to say what we would predicate from the PK wondering if you have perspective on this and maybe what's going on with the drug. It seems positive that you could reduce the dosing and get more tolerability but I'm wondering about that? And then my second or last question is in terms of future study are you just relying on the improved dose response in terms of efficacy versus tolerability or are you going to improve the recording of GI symptoms through possibly reduce this potential compounding variable?

Bill Sheridan

Analyst · Piper Jaffray. You may begin.

So let me start with the last part first. We also had the opportunity to talk with the couple of senior patient advisors about that data and they made a couple of interesting points along the lines of first of all the degree of anxiety and fear that patients have and their commitment to entering clinical studies like this. But you can imagine doing so, you don't know with your own placebo or active drug, you're wondering whether or not things will go well. I think that their point was that with the drug used chronically you learn how to take the drug and you learn how to take on systemic for example. So because we absolutely needed to have serial PK done in a rigorous way in APeX-1 the data has been attended to clinic, we wanted to dose it in the morning, so to get accurate data all of the drug administration is in the morning in this study. And we did instruct them to try to take the drug after food but what you have to -- what is real life, real life is these days, most people skip breakfast or grab [indiscernible] here in Europe or a Chile and may be once a week in the United States on the way to work with your favorite Starbucks or your favorite Sprint or something. So I think there's definitely an opportunity in the future study where we don't need that serial PK and all we need is population PK that can be taken at anytime to instruct subject to take the medicine after a full meal and do it at the same time every day, I think that that's the most obvious. Now we talked about those and as Emel pointed out and Bruce, I mean you…

Jon Stonehouse

Analyst · Piper Jaffray. You may begin.

And I just reinforce what Bill is saying; when we started with 350 milligram we are going all the way down to 62.5 milligram that's how we definitely believe we overshot.

Operator

Operator

Thank you. Our next question comes from Liisa Bayko with JMP Securities. You may begin.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Hi guys. Thanks for taking the question. Just to drill into the abdominal attacks a little bit more. Can you may be talk about little bit more about the timing of the attacks and that first period of time when you are trying to get up to steady state versus the sort of two to four weeks from off steady state. And then also just maybe a little more color on the kind of quality of the attacks, was it kind of obvious that maybe it was pain, was it relieved by a bound, I'm just giving an example versus something that really was more reminiscent to that or should you attack?

Bill Sheridan

Analyst · JMP Securities. You may begin.

Sure. Yes thanks for the question Liisa. I think if you go to Slide 14 and 15 you can see the pattern of attacks by study day, so the first seven days is the first week obviously and there abdominal, if you look at the differences in just the overall pattern, the abdominal symptoms do happen in all the weeks of the study. To give you some color and why did the adjudicators note that these things are atypical. In some occasions there was a record an attack not being treated and lasting an extremely short amount of time and that's really compatible with the real abdominal attack of hereditary angioedema. So somebody would record I had swelling and pain but I didn't treated in vein an hour. And for example another example is the other extreme is here are symptoms recorded for four days in a row with abdominal symptoms only and the subject reach for their attack medicine which is perfectly reasonable ahead of dose didn't do anything. The symptoms persisted and they keep taking the study drugs. So those types of atypical features are really not compatible with angioedema and may be Emel and Bruce might like to comment on that. Emel Aygören-Pürsün: Yes I can only agree with what you said, Bill. They are attacks that aren't unanimously recognized as abdominal attacks and the differentiation is you're really done by either patient or giving acute therapy and seeing more of the therapeutic factor. So the differentiation is not always very easy that's what I can just say from clinical life.

Bill Sheridan

Analyst · JMP Securities. You may begin.

Bruce? Thank you, Emel. Bruce?

Bruce Zuraw

Analyst · JMP Securities. You may begin.

Yes I would add that having served on some adjudication panels that as an adjudicator we are trying to be conservative and we would perhaps if we can't rule out an attack, so we say yes it could be an attack but it doesn't mean that the adjudicators believe that nearly was a true attack. I just would make that distinction.

Bill Sheridan

Analyst · JMP Securities. You may begin.

Thank you and I would add in talking with a patient they said you can go out to dinner, have a bad meal and start to feel something and you worry it might be an attack and so you don't want it to get worse so you grab for your medicine. So it is -- it sounds like it is hard to differentiate.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Okay, great. Thank you. And then one thing you didn't really talk about at all was rash which was seen in some of your earlier studies, could you may be comment on if you observed any frequency differences between placebo et cetera?

Jon Stonehouse

Analyst · JMP Securities. You may begin.

There were no rashes reported in this dataset.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Okay.

Jon Stonehouse

Analyst · JMP Securities. You may begin.

I don't think we can conclude that the rate is different but I think the good news is it doesn't look like it went up after four weeks of treatment right.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Yes, great. Thank you. And then just final question obviously what you are going to try to do now is lower the dose, so you can kind of maybe lower the rate of the just side effects without lowering the overall efficacy and that's what we want to see. Just curious when those data for next cohorts, I know you are unwilling but when do you expect that we might can you give us some guidance of when we need to look for that data? Thank you.

Jon Stonehouse

Analyst · JMP Securities. You may begin.

Yes so if you look at Slide 20 Bill went over that Part 1 is fully enrolled and Part 2 has eight randomized and six in screen. So our confidence level is high that we will report out the Part 1, Part 2 total in the second quarter.

Liisa Bayko

Analyst · JMP Securities. You may begin.

And would that be like Yache or would that be just be press release or what are you thinking?

Jon Stonehouse

Analyst · JMP Securities. You may begin.

I think we would do it like we did this. That that would be my sense, yes, looking certainly presenting more data.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Two, you've the data there or just curious.

Jon Stonehouse

Analyst · JMP Securities. You may begin.

No this relates I think that comes in March and so for the interim we can certainly consider doing something for that. But we'll absolutely take advantage of medical meetings and publications because we think this data is exciting.

Liisa Bayko

Analyst · JMP Securities. You may begin.

And then actually just one more question I do have. We've been benchmarking what our expectations are quite a bit against what we have seen for Dyax. I was looking what the data you can see that there is a difference in baseline attack rate that's fairly significant. Can you comment on how that may -- how we should be thinking about these two data sets I know that there are different studies but just as a way to kind of look at everything is that difference in baseline attack rate meaningful in you view and how that, impact of things?

Bill Sheridan

Analyst · JMP Securities. You may begin.

No, so just to mention what they are. So the baseline of attack rate studies about one attacks per week. Kind of memory tells me correctly in the Dyax Phase 1b it's about 0.34 or something round about attacks per week and maybe we could ask our principal investor in Protected Zero to comment on whether that's a meaningful difference. Emel Aygören-Pürsün: Yes, clinically speaking it's of course clinical meaningful difference and it does make sense to assume that its yes, how to achieve prophylactic effect in more in the affected patient group. So it's hard to compare and we have to wait for the results are coming now.

Bill Sheridan

Analyst · JMP Securities. You may begin.

Yes, thanks Emel. Bruce?

Bruce Zuraw

Analyst · JMP Securities. You may begin.

Yes, it's something that it clearly indicates this would be a more severe group. I think that's all you could conclude from that.

Liisa Bayko

Analyst · JMP Securities. You may begin.

Okay.

Jon Stonehouse

Analyst · JMP Securities. You may begin.

Yes. Then your question back to us was this is a drug. We have in effect, I've said all along and we showed you the data that Lynne had done with her team about the desire to have an oral drug in the preference. And so this is the drug with the data that we have. If we improve the results and we start seeing the lower doses and improved efficacy, I mean sky is the limit so.

Operator

Operator

Thank you. Our next question comes from Brian Abrahams with Jefferies. You may begin.

Unidentified Analyst

Analyst · Jefferies. You may begin.

Hi, this is Marianne [ph] for Brian. Just wondering through the GI AEs versus attacks if there is a way to help better quantify differences may be with the biomarker in a future arm or study.

Bill Sheridan

Analyst · Jefferies. You may begin.

Hi, that's a very interesting though. We've tried to think a something along those lines and haven't come up with anything yet. But I think that that the types of strategies that we've talked about before in future studies like taking the drug with a full meal, I think will be quite beneficial. And if you think about just a drug if you had prescribed post July even a short course of antibiotics has been tolerated on a full stomach. So I think that’s a definition element. I'm sure dosing will help, I'm sure just experience with the drug in individuals will be an important thing.

Unidentified Analyst

Analyst · Jefferies. You may begin.

Okay.

Jon Stonehouse

Analyst · Jefferies. You may begin.

Let me just interpret once second Hey Bruce I know that you have to leave at the hour so, just want to say thank you for your participation and appreciate you joining us such an early morning or early time this morning in the West Coast.

Bruce Zuraw

Analyst · Jefferies. You may begin.

Okay, well yes pleasure thank you. Let me just make one comment as I leave if I could certainly to that last question I mean that's a point that as an investigator we would love to be able to look at that data but the challenge for us is getting patients when they have a symptom to come in. And so if we could measure biomarkers at the time people report a possible attack it would be fantastic but it's not very practical and in terms of doing this study at least in my experience. Okay, thank you much and look forward to future results.

Jon Stonehouse

Analyst · Jefferies. You may begin.

Thanks Bruce. Sorry to interpret go ahead with your rest of your question.

Unidentified Analyst

Analyst · Jefferies. You may begin.

Sure. Thanks, Bruce. Forward the ALT patient he will remain on the study I was wondering if you can provide any additional details on that patient if the ALT elevation persisted and how long it took to resolve.

Bill Sheridan

Analyst · Jefferies. You may begin.

So the observation was made at the day 29 clinic visit and in that particular subject as a there were elevators, levels of baseline so just by the way of explanation, this is not a normal healthy subject study. So you have to allow some little room for abnormalities in clinical chemistry in the like at the screening test otherwise you end up having no patients on the study. So we allowed up to two times the upper limit, it has been less than two times upper limit of normal at a screening visit. One of the interesting phenomenon we have in this data set is just the variation overtime which is random fluctuation in clinical chemistry parameters like liver enzymes. So we saw quite a few subjects at the sites one visit on day one. So that's two or three weeks out the screening visit actually had increase over baseline liver function test values and I think on the graphics slide we put down what proportions were something like 36%, 28% something like that. Anyway that's quite a lot so approximately a third of the people coming into the study had significantly elevated liver enzymes with baseline. In this sample size before I get on to other comments in general with would regard to the resolution yes in the cases we serve elevated liver enzymes resolved and you would typically follow that in one or two weeks and if it's still elevated follow it for another couple of weeks there was a schedule day 42 safety follow-up visit in all cases and that elevated enzymes results. I think that we have to be cautious in interrupting all of this because it's a small study and because of the confounding factors we obviously can't rule out drug affect and in…

Bill Sheridan

Analyst · Jefferies. You may begin.

Thank you. So obviously we'll continued to do the comprehensive site monitoring that we need to do during our clinical development program and click the data we need. Emel Aygören-Pürsün: Exactly.

Unidentified Analyst

Analyst · Jefferies. You may begin.

And one last question Joe. I just wonder if you could provide an update on the formulations work that you're doing to get to one, yes. Could you expect to do any [indiscernible] work with that?

Jon Stonehouse

Analyst · Jefferies. You may begin.

So given the does that we're studying our expectation is that we'll able to have one capsule in the -- they of formulation that we're using in the clinical experiments, simple powdering a capsule. It will be slightly more sophisticated than that I guess so that not in a dosage form and yes, I think reaching PK study is all we need, sure that we get the exposure in a similar way.

Bill Sheridan

Analyst · Jefferies. You may begin.

Yes, size of a capsule is very manageable compared to our previous program, so lot of good progress there.

Operator

Operator

Thank you. Our next question comes from Tazeen Ahmad with Bank of America. You may begin.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Hi, good morning, thanks for taking my question Bill I just have one clarification question on slide 17 here. The patient that have the ALT elevation greater than three times the upper limit of normal is that the same patient that has the gastroenteritis?

Bill Sheridan

Analyst · Bank of America. You may begin.

No, it's not. They are two different individuals. So patients who needs more than the three times upper limit of normal noted on day 29 was a patient with rather complex medical history of colitis with unspecified nature that's been going on for some time treated with an oral medicine. Fatty liver is a common observation in the general population as well; she has that and a long history of androgen used that has stopped three years previously. No, I think that that's not a lot of literature out here on the what happens when you stop androgens. I have asked several key opinion leaders about that and obviously it's a common elevated liver enzymes or call it any people currently taking androgens, we also know that they can patients can develop structural mover abnormalities like curiosis hepatitis and [indiscernible] and in rare cases carcinoma with the liver from long-term androgen administration and she doesn’t have evidence of those particular disorders, it does have a disorder study. The case with gastroenteritis is in the -- is a different case and that discontinued patient developed typical gastroenteritis symptoms and then later on in the course of that had an elevated ALT of 1.9 times up when the normal study drug was discontinued.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Okay. Thanks for that color. And then now that you're looking at the 62.5 mixed dose when do you think we could see the Part 3 data?

Jon Stonehouse

Analyst · Bank of America. You may begin.

I think that's one is hard to predict since we haven't even screened anybody for that yet. So I would rather give you the results of Part 2. We should be well along understanding how what the pace is for Part 3. So we will give you that update when we give you the results of Part 2.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Okay. And maybe a last question, I know one of the KOLs has left but I just wanted to get a sense, I know with just limited data of short duration but based on the evidence that you presented so far and either Jon or Bill may be you could provide some color, how are physicians kind of looking at the profile of your drug overall versus what patients get from Sunrise?

Bill Sheridan

Analyst · Bank of America. You may begin.

Well that is a great question for Emel; I will let you take that one Emel. Emel Aygören-Pürsün: Yes I think we cannot compare both. We have different thoughts of administration which is never important and I think we have very limited data on 7353 at the moment, it is still too early to really to compare, I think they are apples and pears, and you cannot compare them.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Is it the same profile that makes them apples and pears or is it just not enough data? Emel Aygören-Pürsün: They are contextually different. We have C1 esterase inhibitor concentrated plasma derived one in one case and we have an orally given drug small equal in the other case and we have only very limited data concerning efficacy at the moment. I think I'm really looking forward to receiving the result of the whole study to see how the lower doses work. I think we have to see it also from a practical point of view, from a patients perspective an oral drug would -- I would say of course be preferable, this is what I hear from my patients. Although we have to admit that many patients get along their thing with IV injection but I think we have people show how these patients will receive an oral drug. So it's a big chance for the patient community and as Bruce pointed out they do see it as a big chance.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Okay.

Jon Stonehouse

Analyst · Bank of America. You may begin.

Again it's patient choice, it's patient choice at the end of the day which I think is really important.

Tazeen Ahmad

Analyst · Bank of America. You may begin.

Okay. This then in line with the patients' choice comment though the desired drug is expected to have some late stage data released later this year. So how would you kind of introduce that and for the mix relative to what you have down again I appreciate that this data is early but for example the SubQ injections are not known to have GI related side effects, how do you think that would have patient preference?

Jon Stonehouse

Analyst · Bank of America. You may begin.

Yes, listen I think, I don't think there is a perfect drug out there and so let's see what the data show, I think we look at the CSL pivotal study as kind of the goal standard and again it's not a perfect drug. And so from Emel's point let's see how the rest of the data unfolds in APeX-1. As I said before, I think with the profile we have some interim analysis, we have a drug, it's an oral it's once a day way more convenient than anything else and clearly some patients benefit from it. If that's benefiting recently and the assay profile improves then it's going to apply to more people. And so let's see how the program unfolds before reacting to say interim data.

Operator

Operator

Thank you. Our next question comes from Christopher James with Ladenburg Thalmann. You may begin.

Christopher James

Analyst · Ladenburg Thalmann. You may begin.

Hi guys. Thanks for taking my questions and congrats on completion of Part 1, just a question on Part 3 based on your previous PK work with 125 milligram dose specifically do you consider the 62.5 mgs still 2b dosing or does the exposure level you've seen 125 you thought you might do DND?

Bill Sheridan

Analyst · Ladenburg Thalmann. You may begin.

No, I'd say once daily.

Jon Stonehouse

Analyst · Ladenburg Thalmann. You may begin.

Yes, I think the difference is that blue range that we have, the green what kind of endogenous C1 you have, it might be a little too high.

Christopher James

Analyst · Ladenburg Thalmann. You may begin.

Got it. Okay. And I know just a follow-up on previous question about the rashes, you said no rashes but were there any hypersensitivity reactions --

Jon Stonehouse

Analyst · Ladenburg Thalmann. You may begin.

No.

Christopher James

Analyst · Ladenburg Thalmann. You may begin.

And if so what grades?

Jon Stonehouse

Analyst · Ladenburg Thalmann. You may begin.

No, there were none.

Christopher James

Analyst · Ladenburg Thalmann. You may begin.

Okay. And then I guess finally, what's the peripheral filing and abdominal attack to patients generally if doses all together or what generally happens when?

Bill Sheridan

Analyst · Ladenburg Thalmann. You may begin.

I think that's another telling point here is other than the two discontinuations with study drug was stopped at about, I think end of the second week approximately and in the other case day 23. Other than those essentially everybody took all of their capsules everyday whether or not they had abdominal symptoms. So I think that speaks to the motivation of the patients who enrolled in our study to help develop an oral medicine.

Operator

Operator

Thank you. Our next question comes from Serge Belanger with Needham & Company. You may begin.

Serge Belanger

Analyst · Needham & Company. You may begin.

Hi good morning. Just a couple of questions. One related to this issue with attack related symptoms and abdominal HAE attacks, is that something you saw in the overall SAP program, anything similar to that came up in that study?

Bill Sheridan

Analyst · Needham & Company. You may begin.

So I went back and looked at the overall proportion of patients in the other two studies who reported at least one of abdominal attacks during the study it was very similar in the placebo and active. But your question is actually very interesting one because what isn't confusing to patients and we were taught that when we spoke to some leading patient association colleagues is diarrheal and flatulence. So when and that comes out straightway in adverse event title. So wasn't confusing to patients, pain, nausea and vomiting is what they perceived as heralding an attack. So to give you a bit of color on this in the old days before there were effective acute treatments and these attacks went untreated. These abdominal attacks could become very, very severe to the extent requiring OP and analgesic in the emergency room and volume replacement therapy with intravenous crystalloid fluids because they were so much leakage of fluid, angioedema fluid into the small value and into the peritoneal cavity. And they could be extremely severe and particularly life threatening and in many cases there are people you hadn't yet been diagnosed with their disease result in unnecessary surgery for what the emergency room physician talk as an acute abdomen. So once you diagnose with the disease you really don't want to have any more of those. So if you get an abdominal symptom that you think might be heralding an attack and this is the case around the world whether or not you take any cross life therapy, patients the guidelines, statements that have been written in the United States and in Europe specify and encourage patients to treat as early as possible. And we know from excellent studies that both the Emel and Bruce have been participating in and leading…

Serge Belanger

Analyst · Needham & Company. You may begin.

Okay. When you look at placebo rates in APeX-1 here any surprises obviously placebo rates are a little different for the cohorts with abdominal attacks but excluding those ones do the placebo rates are they in line what you were projecting?

Bill Sheridan

Analyst · Needham & Company. You may begin.

Absolutely so our screening attack rate minimum was two attacks a month and we anticipated about one attack per week average qualifying attack rate which is what we got and on study we got a roughly a 0.9 attack rate per week in total, just look at the total for placebo. So it's right in line with and I think that -- this is an internally valid experiment because of the randomized blinded nature of the experiment. So no there is nothing surprising here.

Operator

Operator

Thank you. [Operator Instructions]. Our next question comes from Rahul Jasuja with FBR & Company. Your may begin.

Rahul Jasuja

Analyst · FBR & Company. Your may begin.

Hi guys good morning. Just a couple clarifications and question I have so obviously going forward only to rectify the issue with the abdominal or GI safety and tolerability is lower the dose. But in the event that's not a constant and this is a patient reporting issue would you be conducting this trial any differently in terms of how patient report this issue.

Jon Stonehouse

Analyst · FBR & Company. Your may begin.

Yes, I think that's a great question, Rahul, and so what will be -- the way we develop the diary is to work with HAE expert end with a patient focus group and you have to be -- I mean, there's always an urge for a desire to try to collect a mountain of information in your diary and you can't do that. It has to be user friendly and it has to be a valid instrument. So but it's a very good question and we will be reviewing that to see if we can collect a little bit more information that would treat this out, for example you could say if it's are they symptoms typical to your illness or not and if they are not typical gives a bit more information. We haven't decided what to do yet but that's something that will certainly work through to help set up that Phase 3 program.

Rahul Jasuja

Analyst · FBR & Company. Your may begin.

Okay, that's great. And the question that I have I think -- I'm not sure if I this information is out or maybe I just don't know it, is there a formally data that shows that there is no food effect, there is a food effect with 7353?

Bill Sheridan

Analyst · FBR & Company. Your may begin.

Yes, so again good question. So we did do a pilot food effect evaluation in the Phase 1 at the 250 milligram dose level and it was crystal clear. So the very regulated type of studies and there is something called a standard fatty meal which you probably don't want to eat, which has a lot of fat in it and it's specified in the regulation. So we had got our fasting and then we got those subjects back and go to the standards fatty mail and did it again. And in the fasting the only real difference we saw was as you might recall there was a double peak in the fasting represented internal [indiscernible] circulation of the drug some of it coming out in the wall and getting reabsorbed. So when you eat that slows that process down. You see a single peak bit later on and overall appropriately exposure was slightly higher after fatty meal but certainly no evidence that there would be less exposure after reading.

Jon Stonehouse

Analyst · FBR & Company. Your may begin.

Yes and I think that actually leads to another answer to your first question is we are really making sure that people have a full stomach when they take the drug could have some effect on the adverse event profile as well. So recognize, as Bill said, for PK sampling purposes we have to do it in the morning and you have piece of toast and coffee and that's it and that's probably not a full stomach right so, we'll see if we can make adjustment on that in future study.

Rahul Jasuja

Analyst · FBR & Company. Your may begin.

Okay that make sense. And then my final question here so looking at dosing and looking at future trials and the real work so to say obviously if you got, acute patient and have to have a certain number of attacks within this 28-day period. But going forward as you look at the whole repeater of HAE patients are we looking at clinical trial down the road that goes across three or four doses and different doses with different kind of patients given that fact that you only looked at the most acute right now and the real world probably somewhere in the middle.

Bill Sheridan

Analyst · FBR & Company. Your may begin.

Yes, I think it's a very interesting question I think after we have the full results from this study we will work out our proposed Phase 3 and discuss it with regulators and it's the guidance responses on Phase 3 trials strongly encourages sponsors to have more than one dose in a Phase 3 study. And we would be quite happy to take a couple of doses into Phase 3. Another potential thing to consider is how might Doctors use the drug in the real world, we think of that too. The main job of the Phase 3 is to confirm efficacy, rigorous experiment that's negotiated with the regulators so that we can secure the efficacy plans we need in our label.

Jon Stonehouse

Analyst · FBR & Company. Your may begin.

So I think you pointed good one which is the Phase 1C inhibitor level carry depending on the scenario of disease. And so this study clearly they had very little gas in the tank and so used the analogy before and somebody’s got more perhaps they need a lower dose we will explore that later and we'll certainly get more information from that part 2 and part 3.

Rahul Jasuja

Analyst · FBR & Company. Your may begin.

Great, that’s all I had. I look forward to part 2.

Bill Sheridan

Analyst · FBR & Company. Your may begin.

Great. Thanks, Rahul.

Operator

Operator

Thank you. I’m showing no further questions at this time. I will turn the call back over to Jon Stonehouse for closing remarks.

Jon Stonehouse

Analyst

Great. So Emel thank you so much both for participating in the call with us today been our principle investigator and just the extremely important study for both the company and for patients and for spending time with us last week, taking time away from your busy practice to go through the data we really, really appreciate your support, so thank you. And then lastly I'd like to say thanks to all the investors. We appreciate your interest in BioCryst and we look forward to continue in this program forward and sharing all results with you. Have a good day.

Operator

Operator

Ladies and gentlemen this concludes today's conference. Thanks for your participation. Have a wonderful day.