Conatus Pharmaceuticals Q32018 Phase 3 Clinical Results Arriving Soon

Conatus Pharmaceuticals - Q3-2018 - Phase 3 Clinical Results Arriving Soon

07:20 EDT 2 Nov 2018 | Biotech Watcher


On Thursday, November 1, 2018, Conatus Pharmaceuticals (CNAT) announced its results for Q3-2018 and held a conference call, and filed its quarterly report with the SEC. The company is poised to release its next Phase 3 clinical results before year-end.
ENCORE-PH (Portal Hypertension) – 240 patients with compensated or early decompensated NASH cirrhosisand severe portal hypertension, with top-line results expected before Year-End 2018. These patients are then enrolled into a 24-week treatment extension study.
ENCORE-NF (NASH Fibrosis) – 330 patients with NASH fibrosis. Top-line results confirmed for 1H-2019.
ENCORE-LF (Liver Function) – 210 patients with decompensated NASH cirrhosis, with top-line results expected in Mid-2019. The primary endpoint is event-free survival with all patients treated for a minimum of 48 weeks.

Major Headings

Brief Introduction to Conatus
ENCORE Clinical Program Brief
Conference Call Summary
Financial Summary
Clinical Milestones
Our Thoughts

Brief Introduction

Conatus’s lead drug is emricasan: a pan-caspase inhibitor. Emricasan is a first-in-class, oral drug that inhibits a powerful family of enzymes – the caspase family - that initiates inflammation and cell death. This pan-caspase inhibitor is being tested in liver diseases that involve serious inflammation, including NASH-related fibrosis and cirrhosis. Novartis is collaboratingwith Conatus on the Phase 2b “ENCORE” program.
Conatus has is advancinga second drug to the clinic: IDN-7314, another pan-caspase inhibitor.It is being directed to treat primary sclerosing cholangitis (PSC). While emricasan preferentially selects liver tissues, IDN-7314 appears to have wider dispersion. This could aid in the treatment of concurrent diseases, often co-occurring with PSC.
If you wish to refresh yourself on Conatus, then we refer you to the following:
Key Opinion Leader Symposium on Portal Hypertension + Slides (Sept 27, 2018)
Conatus Corporate Presentation (Sept 7, 2018)
BioWatch’s Q2-2018 Update(Aug 3, 2018)
Financial Summary
Basic Facts for Quarter Ending September 30, 2018
(In thousands, except share and market cap data)
Q3-2018
Q2-2018
Q1-2018
Q3-2017
Collaboration
Revenue
$7,666
$8,744
$9,737
$9,566
  R&D Expense
9,664
10,737
12,081
11,165
  SG&A Expenses
2,660
2,713
2,713
2,449
Total Operating Expenses
12,324
13,331
14,794
13,615
(Loss) from Operations
(4,658)
(4,557)
(5,057)
(4,049)
Net Loss
(4,589)
(4,497)
(5,018)
(4,000)
Comprehensive (loss)
(4,560)
(4,426)
(5,053)
(4,000)
Basic & diluted (loss) per share
(0.15)
(0.15)
(0.17)
(0.13)
Avg. Shares Outstanding
30,190
30,114
30,048
20,004
Recent Price (per share)
$ 4.28
(11/1/18)
$ 4.04
(8/1/18)
$ 3.59
(5/4/18)
$ 4.51
(11/1/17)
Market Capitalization
129M
121M
108M
135M
Cash & Equivalents
13,308
11,369
16,615
14,360
Marketable Securities
36,312
46,079
50,136
70,823
CFO Keith Marshall confirmed guidance for year-end cash of $35M to $40M. With the current Novartis collaboration, Conatus management believes it has sufficient cash through top-line results of the current ENCORE program by the end of 2019 plus funding pipeline expansion. This estimation does not consider any potential milestone payments from Novartis.
Milestones
Conatus Pharmaceuticals - Clinical Milestones
ENCORE Trials – The ENCORE program supports the design of the Phase III program. Each Phase IIb trial explores a different indication. Robust results, however, may support an FDA or EMA filing. The first results arrive in the first half of 2018.
ENCORE-PH – Portal Hypertension – Patients with severe portal hypertension (SPH) that were cleared of Hepatitis C (HCV-SVR) and have NASH cirrhosis. The primary endpoint is a reduction of HVPG(Hepatic Venous Pressure Gradient) after 6 months of treatment, which may later serve as a valid surrogate.Includes a 6-month continuation phase to monitor continuing liver decompensation.
240 NASH Cirrhotic, HCV-SVR, SPH Pts
5mg, 25mg, or 50mg 2x/day, 24 Wks
  Top-line Results
Q4-2018
ENCORE-PH Extension
24-Wks Treatment Extension
Mid-2019
ENCORE-NF – NASH Fibrosis -  NASH patients with fibrosis, but not cirrhosis, are measured according to the NASH CRN Histological Scoring System.  The primary endpoint involves a biopsy-based change in the fibrosis score after 72 weeks of treatment.
Based on previous studies in HCV patients, Conatus management expects the 5 mg dose to be as effective as higher doses in fibrosis patients. The 50-mg dose is being positioned for patients with cirrhosis and the 5-mg dose for patients with fibrosis.
330 Nash Fibrotic Pts - 5mg or 50mg 2x/day, 72 Wks
  Top-line Results
1H-2019
ENCORE-LF – Liver Function – NASH Cirrhosis + Clinically Significant Portal Hypertension (CSPH) – Pts have compensated cirrhosis and portal hypertension, and will examine the long-term impact of treatment. The ongoing liver cirrhosis trial results will inform the design decisions (e.g. sample size).
The endpoints include: MELDor CPTto measure mortality risk in patients with liver disease; biomarkers (e.g. bilirubin, albumin). Event-free survival serves as the primary endpoint. Analysis is conducted after a pre-specified number of events occur. These events include: all-cause mortality, new decompensation events, or a progression of ≥4 points in the MELD score
210 NASH Cirrhotic Pts w/ Portal Hypertension
5mg or 25mg 2x/day, 48+ Wks
  Top-line Results
Q3-2019
Post-treatment Follow-up – Observational study for patients from POLT-HCV-SVR, ENCORE-NF, ENCORE-PH, and ENCORE-LF. Patients treated with placebo and emricasan will be followed to estimate the event rate for liver cancer, and to confirm safety.
 Final ResultsAbout 800 patients will be enrolled.
2021*
HCV Fibrosis Recurrence Post-Transplant (POLT-HCV-SVR)
These patients have fibrosis in their transplanted liver after being cleared of a hepatitis C viral infection. A diverse range of patient severity with Ishak Fibrosis Scores ranging from F2 (early stage fibrosis) to F6 (cirrhosis). The primary endpoint is the change in the Ishak Fibrosis Score. Conatus received an orphan designation from the FDA.
 Phase IIb Efficacy (60 Pts) – 25mg 2x/day, 24 months
 Detailed Results
AASLD
Nov. 9-13, 2018
IDN-7314 – Like emricasan, this is also a pan-caspase inhibitor. As a liver treatment, it falls within the current Conatus-Novartis agreement.
Primary Sclerosing Cholangitis(PSC) – The company recently received orphan designation from the EMA(European Union) and the FDA (United States).
Preclinical Animal Models
Ongoing
Our Thoughts
Q4-2018Topline ResultsENCORE-PHHVPG (Surrogate endpoint)
1H-2019Topline ResultsENCORE-NFCRN Fibrosis Score ↓ without steatohepatitis
Mid-2019Topline ResultsENCORE-LFEvent-Free Survival(Direct endpoint)
The next set of results arrive from ENCORE-PH. It utilizes a surrogate endpoint: portal vein hypertension. You may wish to review the webcast and slides of KOLs on portal hyptension. Furthermore, biopsy-based endpoints can contain more noise and variability than HVPG measurements. For example, there’s no guarantee that the biopsies between patients are extracted from the same location in the liver. With strong HVPG results, an accelerated approval could be a possibility.
The ENCORE-NF trial results are veryimportant. This primary metric involves: biopsy-based improvements in the CRN Fibrosis Score without worsening of steatohepatitis. It recognized as an approvable endpoint. Clinical significance would motivate Novartis to push emricasan into Phase 3 as a monotherapy and combination therapy.
The ENCORE-LF metric represents another direct and approvable endpoint. It Conatus receives significant results from this trial alone, we think the management will continue to develop emricasan.
Although each of the 3 ENCORE trials uses approvable endpoints, CEO Steve Mento does not expect that these results will be enough for registration.
Positive results in the ongoing trials will lead to the design of a pivotal study. We also think positive ENCORE results will spur Novartis to launch a small Phase 2 trial, to test emricasan as part of combination therapy.
It will take a couple years or more before Conatus has enough Phase 3 results to submit emricasan for regulatory approval.
(At the time this post was written, one or more BioWatch staff held a position in CNAT)
This blog post is from The Biotech Watcher:
And about us, see http://alanhobbes.blogspot.com/2014/12/welcome-to-my-personal-thoughts-about.html

More From BioPortfolio on "Conatus Pharmaceuticals - Q3-2018 - Phase 3 Clinical Results Arriving Soon"