Neil McFarlane
Analyst · Cantor
Thank you, Nichol, and welcome to everyone joining our quarterly call this afternoon. Zevra is a purpose-driven company, redefining what is possible and bringing life-changing therapies to people living with rare diseases. In rare disease, the path is complex. The needs are urgent and the responsibility is significant. The people and families behind these needs at the heart of what we do every day. Progress with the U.S. launch of MIPLYFFA the first approved therapy for Niemann-Pick disease Type C, or NPC reflects the disciplined execution of our strategic plan and the determination, expertise and commitment of our people. Together, we are building a trusted company with the capabilities and resolve to make a lasting difference. I'm pleased to share that total net revenue for the third quarter was $37.8 million, an increase of 45% compared to the third quarter of 2025, and net U.S. product revenue for MIPLYFFA was $34 million. What we're seeing in the market suggests that it may be just the beginning, particularly as we strengthen our understanding of the NPC community in the United States, where an estimated 900 people are living with NPC, of whom 300 to 350 have been diagnosed. These estimates are derived from a study published in 2021 prior to any approved treatment for NPC. In the third quarter, we received 13 prescription enrollment forms, bringing the cumulative since launch to 197. In rare disease, the number of identified patients often grows over time as awareness increases, more patients receive a diagnosis and new therapies are approved. Josh will share more details on how our initiatives are driving patient identification, diagnosis and treatment later in the call. Our commitment to realizing MIPLYFFA's full potential and supporting the NPC community is driving our investment to expand patient access. In the second quarter, we published data from a multicenter open-label pediatric substudy evaluating treatment of NPC with arimoclomol in combination with miglustat in infants 6 months to less than 24 months of age. The substudy assessed safety and tolerability for up to 36 months of treatment and found that arimoclomol was well tolerated with no new observed safety signals. On the heels of this, in the third quarter, we engaged with the FDA in a Type B meeting to explore the potential of expanding the label to include infants less than 24 months of age. Based on the feedback, we expect to file an sNDA in the first quarter of 2027. Importantly, we believe MIPLYFFA is supported by a strong intellectual property portfolio. MIPLYFFA is covered by patents listed in the Orange Book with expiration dates extending to 2041 and has U.S. orphan drug exclusivity for the treatment of NPC through 2031. These provide distinct layers of protection, regulatory-based exclusivity and listed patent coverage. As mentioned on previous calls, we are also pursuing a potential patent term extension through the U.S. Patent and Trademark Office. And based on the current processing times, we now anticipate a decision from the USPTO in 2027. In the EU, the reexamination process for our Marketing Authorisation Application, or MAA for arimoclomol is underway by the Committee for Medicinal Products for Human Use, or CHMP. As part of the reexamination, a new rapporteur and co-rapporteur have been appointed to lead the CHMP's evaluation. Additionally, an ad hoc expert group or AHEG, will meet to review the data and provide their specialized scientific and clinical expertise. This is an important forum for experts in the field to offer perspectives that will contribute to the CHMP's procedural discussions. We believe the totality of the clinical and real-world evidence supports the clinically meaningful benefits observed in patients treated with arimoclomol. The significant unmet need in Europe motivates us to keep working on behalf of people living with NPC, and we expect the CHMP's opinion in the fourth quarter. Due to the proximity of the AHEG and CHMP meetings, we will be brief in addressing questions regarding the ongoing procedure. Turning to our Global Expanded Access Program, or EAP. We remain steadfast in our commitment to the NPC community and supporting access to arimoclomol for eligible patients. Our global EAP has enrolled 134 patients and is comprised of compassionate use and named patient reimbursement programs. As previously discussed, quarterly reimbursement amounts fluctuate based on the timing and cadence of orders. Of note, this past quarter, we expanded the program to include an additional territory and continue to evaluate more opportunities to expand access to patients globally. Moving to our late-stage pipeline. Celiprolol is being evaluated for the treatment of vascular Ehlers-Danlos syndrome, or vEDS. vEDS is a rare inherited connective tissue disorder caused by a change in the COL3A1 gene, leading to fragile walls in blood vessels and follow organs, which can cause arterial rupture or dissection among other complications. With our Phase 3 DiSCOVER trial, we are confirming the ability of celiprolol, our selective adrenoceptor modulator to reduce the mechanical stress on these tissues, thereby lowering the risk of major event. We enrolled six new patients in the third quarter for a total of 72. As a reminder, the trial was designed with an interim analysis triggered at 28 events, and there have been four confirmed events through the end of Q3. We've discussed previously that we're focused on advancing the ongoing DiSCOVER trial and are exploring options to accelerate the program by engaging with the FDA. Following a Type C meeting in the first quarter, we recently held a second Type C meeting to discuss a potential submission strategy with the addition of real-world data sets. While we await formal meeting minutes to confirm next steps, we are developing a statistical analysis plan to include the retrospective data sets with the intent to have a follow-up discussion with the agency in the first half of 2027. Across our business, we remain focused on advancing key opportunities while maintaining a strong financial position. With more than $270 million in cash, cash equivalents and investments as of the end of Q3, we believe we have the flexibility to pursue near-term opportunities with MIPLYFFA in the U.S. and broadening access for patients in global markets as well as advancing our development pipeline. I'll now ask Josh to review our commercial momentum. Josh?