Earnings Labs

Mesoblast Limited (MESO)

Q3 2017 Earnings Call· Thu, May 25, 2017

$15.64

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Transcript

Silviu Itescu

Management

Hello, and welcome to this call. Our agenda today is to present our financial results, our operational update, and our upcoming timelines. With me on this call is our Chief Financial Officer, Mr. Paul Hodgkinson. Paul if you wouldn't mind taking the listeners to the financial results on Slide 6 please.

Paul Hodgkinson

Management

Thanks very much Silviu. If you turn to Slide 6 and I will go through the financial results. So first things first, all numbers I'll call today are in U.S. dollars and I’ll cover the highlights. So if we look at the highlights for the - both the three and the nine months period ending March 31, 2017, we basically did as we promised. We looked to operational streamlining and took out a significant proportion of our cost and you can see that in the second and third bulleted which is 24%, 16.4 million out of the cost base and similar percentage in the third quarter 5.1 million in order to fund the Phase 3 trial for CHF that we brought back inside the company. And so if we look at the total burn of the company is the 73.4 million versus 74.3 million last year. So we managed to contain the increased cost with CHF within total burn of the company. If I turn to Slide 7, how do we get those savings? The 16.4 million really came from our two main areas and that was within R&D and we took a reduction in the headcount which we previously announced through labor restructure and we moved cost of consultants and travel and we took back cost based down by approximately 28% headcount over the corresponding period in FY '16. Within manufacturing, we undertook quite a significant reduction predominately we have sufficient material for all our current ongoing trials. And we also had a mild restructuring available within that and other cost containment areas that’s within trouble but we managed to save $11.1 million on that program. And then lastly, the area of management and administration we managed to take another 5% of about $8 million and that allowed us to fund that additional CHF program. If we turn to Slide 8, let’s look at the cash position of the company. So at the end of March, we had cash reserves, which is $69.1 million and that was after a successful institutional placement of 26 million shares raising just under 40 million before costs with our global institutional investments with some new institutional and sophisticated investors also in the mix. And then finally as we always have, we have an equity facility as you're, which we can use, its yet unused, but its available over the next two years, provided additional funds as and when we require. And I think the company is in a very strong financial position. And now like to turn it back to Silviu for an update on the operational performance.

Silviu Itescu

Management

Thanks Paul. We could turn to Slide 10. This slide is an overview of how science and how we are turning that into commercial products. We're using immuno-selective mesenchymal precursor cells highly purified homogeneous cells that have receptors that are able to respond to damage signals and inflammatory signals which are found in the tissues where these cells are placed. So in response to these activating signals, our cells secrete a diverse variety of biomolecules which are then responsible for tissue repair and immunomodulation. The specificity of the triggering signals potentially reduces the likelihood of off target side effects and importantly the specificity of this triggering process in our cells results and this is based on preliminary clinical data in an optimal response in patients who have the greatest and most advanced disease state. If you turn to Slide 11 is the underlying mechanism of action that underpins what we call a led Tier 1 product candidates and you can see here that the lead clinical programs are in very late stages of development. We have three programs in Phase 3 and one in Phase 2 amongst that Tier 1 product candidates have program. Our program MPC-150-IM is in Phase 3 for advanced Class 3 heart failure and is also in patients with Class 4 heart failure with a left ventricular assist device implant. Our product candidate MPC-06-ID is in Phase 3 for chronic low back pain. Product candidates MPC-300-IV has completed a Phase 2 trial in patients with biologic refractory rheumatoid arthritis and our most advanced product is our MSC-100-IV product for acute graft versus host disease. It has already been approved, launched and is currently generating revenues in Japan and in the U.S. is in the final stages of a Phase 3 program. If we turn over now,…

Operator

Operator

[Operator Instructions] Your first question comes from [indiscernible]. Please go ahead.

Unidentified Analyst

Analyst

What I would like to ask you, Silviu, is what is your target enrollment rate in the heart failure trial? You disclosed that it's over half or over 300. And at what sort of patient number would you contemplate maybe an accelerated strategy there?

Silviu Itescu

Management

That's a very good question. So we are substantially above 50% enrolled to date. The interim analysis was performed a lot earlier than we had originally anticipated. The reason for that was strategic in nature. We wanted to make sure that there was a signal in order to continue appropriate funding and resourcing for the program. So the interim analysis was performed when approximately 25% of total events had been obtained. Remember that this is a trial that is event driven. Meaning we are targeting approximately 540 total events. And at the outset of this trial, we anticipated that we would need about 600 patients who are either Class II or Class III in order to accrue that number of events. What we’re now seeing is as this trial is unfolding is in fact this is predominantly a Class III heart failure trial. Majority of the patient are Class III. And those patients have a much higher hospitalization rate and a much higher mortality rate or terminal event rate than to Class II heart failure patient. And as a result of that, we will continue to evaluate the number of events that are being seen, and it may be that the total number of patients may be reduced below the 600 mark as the trial continues to accrue Class III heart failure patients. So little bit early to say that. And I think part of the process now is to have further dialogue with the agency and to have further discussions around precisely what the total number of patients is as we’re seeing a treatment benefit in the hardest to treat patient.

Unidentified Analyst

Analyst

And secondly, I observed that we are getting close to the potentially the 52-week readout for the arthritis trial. Then we do estimate that to occur.

Silviu Itescu

Management

I would expect that occurs early in the third quarter. There was nothing particularly magical about week 52 of the patients. The primary endpoint of the Phase 2 trial was 12 weeks, and we were particularly successful in evaluating the data in that first 12 week period. After the 12 week period, really patients are continued to be followed. But there's less stringency around what additional drugs each treatment may get. Nonetheless, as we reported previously, through week 39, we saw a significant treatment benefit. And I would hope that we are able to report similar consistency through 52 weeks. I think it is clear that we have a durable effect from a single injection, and we will be reporting the week 52 data early in the third quarter.

Unidentified Analyst

Analyst

So lastly if I may just one more. Would you please maybe describe your strategy for the GVHD indication in Europe? To what extent the usage of mesenchymal stent size, at least in academic centers in Europe became the standard of care in the Steroid Refractory population.

Silviu Itescu

Management

I think our strategy is to have European sides within our Phase 3 programs particularly in adults. We have extensive experience already in Europe as well. And I would certainly take your point that there are many academic centers that use autologous MSCc in acute graft-versus-host disease. I think what we are aiming to provide is a very well-characterized homogeneous product with well-defined characteristics, lot to lot potency assays without variability, I think that's been the biggest issue in academic centers, the variability in autologous patient product. So I think the data from both the pediatric and adult trials will be across both the U.S. and Europe, and will provide us with we hope concomitant approvals in both jurisdictions.

Operator

Operator

Your next question comes from Tanu Jain at Bell Potter Securities. Please go ahead. Sorry, your next question comes from Anupam Rama at J.P. Morgan. Please go ahead.

Unidentified Analyst

Analyst

This is Derek in for Anupam. Thanks for taking the questions. So that you’ve talked a bit in the past about how the 21st Century Cures Act opens up potential path to an accelerated approval for regenerative therapies. I’m just wondering if you can talk a bit about how we should be thinking about the age criteria to potentially recognize parts of the pipeline as regenerative therapy, and whether you’ve had discussions with the agency about the potential fallibility of that CHF program in the base of the - of a single Phase 3 study.

Silviu Itescu

Management

Thanks for that question. I appreciate it. As a general rule, we believe that the 21st Century Cures Act provides a pathway that for regenerative medicine therapies that is parallel to the breakthrough designation pathways for non-regenerative medicine therapies in other disease states. Specifically the regenerative medicine component of the 21st Century Act allows for diseases or products that are targeting diseases with high mortality or high disease burden, and provides a pathway for, as you’ve mentioned, a single trial approval process, conditional approvals on the back of single well-designed Phase 3 trial as well as endpoints that are achievable in small data set including certain endpoint. And I think that that's a reasonable way to summarize what the benefits are of this regenerative medicine pathway. You will note that our target population in heart failure is a continuum from Class IV to Class III, the sickest segment of patients with the highest risk of recurrent hospitalizations and mortality. So we are specifically targeting those patients that would meet the criteria for regenerative medicine advanced therapy. And in fact is now president with at least one other company with an autologous cell based product having received designation for this target patient population. We have effectively been waiting for two gating events. One is the positive interim analysis of the current Phase 3 trial in Class III patients, and the other is completion of the Phase 2b trial in Class IV patients which is imminent as I’ve said earlier that’s approximately 160 patients. With those two pieces of data in hand, we expect to be having meaningful dialogue with the FDA over the short period in order to explicitly be in a position to come back to the market with a very specific pathway toward the potential accelerated approval pathway for this particular product, MPC-150-IM.

Unidentified Analyst

Analyst

And maybe actually just picking up [indiscernible] question earlier. Just strategically thinking about accessing the EU market with the CHF program, I mean, right now it looks like most of your sites are - you are predominantly recruiting from North American side. I am just wondering when you kind of look to potentially kind of boost the in non-introductory here, how are you thinking about potentially bringing on EU sites?

Silviu Itescu

Management

This is a really, really important question. So we specifically limited the study to date to the U.S. for particular reason and that’s really cost containment. We needed to make sure that we saw a positive signal which we now have in the interim analysis before we expanded the trial into Europe. Now that we've seen a therapeutic benefit at this early stage of the disease, you’re absolutely right, we need to accelerate by increasing the number of sites. To simultaneously have European approval, in the sense that we probably have to have up to 40% of patients being recruited in Europe, and so we’re currently planning, expanding this program into multiple Europeans sites.

Unidentified Analyst

Analyst

Great. That’s very helpful. Thanks for taking the questions.

Operator

Operator

Thank you. Your next question comes from Tanu Jain at Bell Potter Securities. Please go ahead.

Tanu Jain

Analyst

Just a couple quick ones for me. We see MPC-150-IM, the Phase 2b study, assuming that it passes the criteria of 21st Century Cures Act RMAT designation even otherwise week 159 patients are double-blinded placebo controlled trial, do you think given the severity of disease you could use this as your registrational trial?

Silviu Itescu

Management

It’s a very good question, Tanu. This is about a sick population as you can get, right. These are patients beyond Class IV. This is Class IV end-stage heart failure. The mortality rate in these patients is 80% to 90% of 12 months if you do nothing. They must have an artificial heart, an LVAD implanted just to be alive and just to have the chance of being bridged to let say a transplant, right. So this bridge to transplant is an indication in and itself for patients who are more than 65 and get it LVAD put in, they have it as it – what’s called a destination therapy because they are too old to have a potential transplant. The current market in the U.S. is about 5000 LVAD implanted and of course we know that no more than 3000 patients undergo heart transplant. There are about 60,000 patients in Class IV heart failure today in the U.S. So, the current options are very limited. The objectives of this trial are to see whether an injection of our cells into the left ventricle at the time of an LVAD placement improves cardiac functions sufficiently over a 12 month period to allow physicians to turn off the artificial heart and as a result of the cardiac, the native heart being able to maintain circulation in enhanced way. That’s the primary end point. Secondary end point relates to overall survival and hospitalization rates, because even though patients may survive with these LVAD implants, the quality of life continues to be suboptimal, the recurrent hospitalizations, high evidence of inflammation and bleeding and infections complications. So, if we see anyone of those outcomes being materially impacted by single injection of ours cells as in fact we saw in the Phase 2 trial published in circulation a couple of years ago where we had a twofold increase in the number of patients who were able to sustain the systemic circulation without LVAD, and a significant reduction in hospitalization rates. If we were to see that that, then I think is a dialogue to be had with the agency around a potential conditional approval on the basis of this single trial given that there are no other alternatives to this very sick patient populations. So, let see how this trial involves. We expect to complete enrollment imminently and then we’ll be having those kind of discussions with the FDA.

Tanu Jain

Analyst

You’re right. And just if I go back to the Boston Children’s Hospital trial, now that again trying to measure the same thing, where your cells can improve cardiac function in the pediatric population, can you give us a sense of timelines around when you might see data from that and whether you would have that in hand as well on your discussions with the FDA?

Silviu Itescu

Management

Well, that’s also very important study. It’s at the other extreme of life, of course, children with congenital heart disease with – who are born with a left ventricle that is hyperplastic and is unable to maintain systemic circulation. They undergo a range of surgical procedures to correct this. But really at the end of the day only about 30% of children are able to end up maintaining a systemic circulation to left ventricular function. So the objective here is, as you say, to see whether single injection of MPC-150-IM to the hyperplastic left ventricle is able to increase the number of patients who can undergo appropriate surgical procedures because they are able to then maintain the left ventricular circulation. The objective of the study is - its [pilot] in nature. It’s a very rare condition. But from Mesoblast's perspective, not only are we hopeful of seeing a positive outcome, but it provides us with the kind of safety data in the pediatric heart failure population that is necessary in any event for full product approval to demonstrate that we have evidence of safety and efficacy all the way from end-stage elderly through to the early pediatric population. This is an investigator-led study and I don't think I can give any specific time lines at this point in time.

Tanu Jain

Analyst

And just one last one from me. Just on the rheumatoid arthritis trial. Now if I recall for the 12-month data readout we are looking for some kind of imaging data as well. Can you just take us through that?

Silviu Itescu

Management

We are being collecting radiographic data at six months and we’ll be collecting it through 12-month. And we would hope that we can see evidence of differences in progression between the treated and control patients which will parallel the effect on underlying disease activity scores. If we see that we’ll be extremely excited about it.

Operator

Operator

[Operator Instructions] Your next question comes from Kevin DeGeeter from Ladenburg. Please go ahead.

Unidentified Analyst

Analyst

This is actually [Jay] for Kevin. Thanks for the question. So with the Mallinckrodt agreement is there plans for any additional interim analysis on the back pain or graft-versus-host disease programs prior to the run out of the option period?

Silviu Itescu

Management

No. I don't think it will be any further interims prior to completion of the option period. Does that address the questions?

Operator

Operator

Thank you. Your next question comes from Tanu Jain at Bell Potter Securities. Please go ahead.

Tanu Jain

Analyst

Just a follow-up from me. Just on your partnership fronts starting with Mallinckrodt, can you just give us an update on how conversations are going there? And also then potentially talk about what your strategies around CHF over 300 IV product in terms of looking for a partner at the time lines, the ideal time to partner et cetera?

Silviu Itescu

Management

Look we are in advanced discussions with Mallinckrodt as you would expect on the areas that are part of the option arrangement and those discussions are progressing well. I think there’s a good cultural fit between the two companies and I would expect to update the market in due course on how those partnership discussions are evolving. We also continue to be in discussions on both, our heart failure program, heart failure product candidate as well as our rheumatoid arthritis product candidate with a number of major pharmaceutical parties. And those discussions are progressing. We will also hope to update the market in due course. Our overall strategy of course is to have one or more partners for several of these lead product candidates because at the end of the day they all require substantial resourcing both to complete clinical development but more importantly to successfully launch and be in a position to have distribution channels and commercial capabilities. And I think we are looking for potential partners who have strengths in the areas for each of these product candidates, as does Mallinckrodt in the areas of inflammation, immunology and pain.

Operator

Operator

Thank you. Your next question comes from Jason McCarthy at Maxim Group. Please go ahead.

Jason McCarthy

Analyst

I’m actually on for Jason Kolbert who is travelling. In the RA study, I know the 12-month data is coming up, how are you positioning Mesoblast for a pivotal study, like HUMIRA and the Biologics are really going out to 12-month. How do you considered what your end point in the pivotal program would be? And are you thinking about the ability to redose since you are using only a single IV injection, infusion?

Silviu Itescu

Management

Look, these are critical questions. I think the way to think about the results that we presented is to compare them probably to rituximab in this space, in the biologic, TNF-refractory patient population. Rituximab is used as an induction therapy with one or two doses I think within the first two weeks. And then demonstrated the primary benefit outcome at week 12 and a sustained benefit through 26 weeks. And then for product use in commercial I think the clinicians are able to then assist disease activity in these very hard to treat patients, TNF-refractory patients and potentially redose after 26 weeks as they see fit based on a whole range of biomarkers. I think we’re seeing a very similar type of outcome when you consider the MPC data. So that we’ve seen that a single induction therapy of 2 million per kilo has given us the best outcome through 12 weeks, has maintained a durable response through 39 weeks. And I think where we’re at right now is to consider potentially and even higher dose as induction or potentially an additional dose at some point down the track whether it’s a week 26 or week 39 or something like that. And I think a Phase 3 program would have a design that would be somewhat adaptive that would evaluate higher induction doses, 2 million or higher at induction and potentially have an arm that looks at a repeat dose. But the primary end point is sufficiently to be 12 weeks as with other biologic agents and we would aim to have a durable effect at to least 26 weeks and probably beyond.

Jason McCarthy

Analyst

Okay. Great. Thank you very much for taking the questions.

Operator

Operator

Thank you. Your next question comes from Alethia Young from Credit Suisse. Please go ahead.

Unidentified Analyst

Analyst

This is actually [indiscernible] on for Alethia. My first question is, can you give more detail on what’s your partnership discussion going now for the heart failure program? And my other follow-up question, its probably early, but can you talk a bit about what’s your commercial manufacturing preparation and what are the efforts you have done there? Thank you.

Silviu Itescu

Management

Sure. Maybe I’ll take your second question first. With respect to commercial manufacturing we’ve invested substantially in particular the MSC-100-IV product which is the most advanced, so that we have -- are ready for providing all the documentation in line with the clinical data for BLA filing. So we will be -- we will have the full commercial package on manufacturing in line with the clinical outcomes. And we worked very hard with Lonza at their plant in Singapore to have a GMP-qualified and FDA-complaint process in time for commercial launch. For our MPC products we have produced sufficient quantities of product for all that clinical programs and depending on which ones move fastest towards marketing. The back-pain product is probably the closest to commercialization. We are beginning to lock-in final product formulations for commercial processing. Your first question was partnering discussions on cardiovascular disease. And again I think it's reasonable to say that we are in dialogue with a number of leading cardiovascular companies globally and regionally. And I think the very important gating event was the interim analysis that we’ve just performed. And having seen a positive treatment benefit in this very hard to treat patient population Class III heart failure, this was more than just the futility analysis. This was an interim analysis that was both for futility and to see whether there was a therapeutic benefit on the basis of a treatment to placebo delta. And having seen that I think those discussions will continue to progress in a favorable way. We of course the second important factor here’s the LVAD trial, roughly 160 patients which is about to complete enrollment and how that gets positioned with respect to the agency as a potential launchable program. So those discussions with pharma companies in the cardiovascular space continue being particularly enhanced by the recent interim analysis and we’ll be updating the market in due course.

Operator

Operator

Thank you. Your next question comes from Dennis Hulme at Edison. Please go ahead.

Dennis Hulme

Analyst

I'd like to follow up on your answer to the previous question, where you mentioned in the interim analysis, you're able to see therapeutic benefit versus placebo. Can you tell us a little more about that, what you saw there or what was seen there?

Silviu Itescu

Management

Look, I’m not able to go into the specifics, but there was a predefined threshold of benefit between treatment and placebo that was defined as the minimum requirement for continuing or discontinuing the trial and we were successful in achieving that.

Dennis Hulme

Analyst

Okay. So that was a predefined threshold, which has been past your review to median, they informed you that you created that threshold?

Silviu Itescu

Management

Correct.

Dennis Hulme

Analyst

Thanks very much. And also, are you able to give an update of when you expect recruitment to be complete in the heart failure Phase 3 trial?

Silviu Itescu

Management

Well, as I answered earlier, this trial was originally plan to enroll 600 patients and that was in line with the requirements to gather about 540 total heart failure MACE events. What we’re seeing that in fact we are recruiting patients who are sicker than we have previously anticipated more Phase 3 patients than – sorry, more Class III patients than Class II patients and those Class III patients had substantially higher rates of heart failure MACE events than Class II patients. So it is possible the total number of patients may come down from 600 patients to say at this point in time. But nonetheless we’re aiming to complete enrollment during 2018.

Dennis Hulme

Analyst

Okay, 2018.

Silviu Itescu

Management

Second half of 2018.

Dennis Hulme

Analyst

And you mentioned potential expansion sites into Europe. Has that commenced? Or is that just something that's in planning at the moment?

Silviu Itescu

Management

It’s something that’s being very actively planned as we speak.

Operator

Operator

Thank you. That brings us to the end of today's call. I’ll now hand back to Dr. Itescu for closing remarks.

Silviu Itescu

Management

Thank you very much for our listeners. I'm pleased to have provided an update on our financial's and operational highlights for the quarter. Thank you very much.