Axsome Therapeutics - Q4 2022
February 27, 2023
Transcript
Operator (participant)
Good morning, welcome to the Axsome Therapeutics conference call. Currently, all participants are in listen-only mode. Later, there will be a question and answer session, and instructions will follow at that time. If you have any need to require operator assistance during the conference, please press star zero from your telephone keypad. As a reminder, today's conference is being recorded. I would now like to turn the conference over to your host, Mark Jacobson, Chief Operating Officer at Axsome Therapeutics. Please go ahead.
Mark Jacobson (COO)
Thank you, operator. Good morning. Thank you all for joining us on today's conference call. This morning, we issued our earnings press release providing a corporate update and details of the company's financial results for the full year and the fourth quarter of 2022. The release crossed the wire a short time ago and is available on our website at axsome.com. During today's call, we will be making certain forward-looking statements. These statements may include statements regarding, among other things, the efficacy, safety, and intended utilization of our investigational agents, our clinical and non-clinical plans, our plans to present or report additional data, the anticipated conduct and the source of future clinical trials, regulatory plans, future research and development plans, our commercial plans regarding Sunosi, Auvelity and our pipeline products, revenue projections, and possible intended use of cash and investments.
These forward-looking statements are based on current information, assumptions and expectations that are subject to change and involve risks and uncertainties that may cause actual results to differ materially from those contained in the forward-looking statements. These and other risks are described in our periodic filings made with the Securities and Exchange Commission, including our quarterly and annual reports. You are cautioned not to place undue reliance on these forward-looking statements, which are only made as of today's date, and that company disclaims any obligation to update such statements. Joining me on the call today are Dr. Herriot Tabuteau, Chief Executive Officer, Nick Pizzie, Chief Financial Officer, Lori Englebert, Executive Vice President of Commercial and Business Development. Herriot will first provide an overview of the company and then review progress made during 2022 and in the fourth quarter, as well as upcoming milestones.
Following Herriot, Nick will review our financial results, then Lori will provide a commercial update, including details on the first quarter of Auvelity sales and our second quarter with Sunosi. We will then open the line for questions. Questions will be taken in the order they are received. With that, I will turn the call over to Herriot.
Herriot Tabuteau (CEO)
Well, thank you, Mark. Good morning, everyone, and thank you all for joining Axsome Therapeutics year-end and fourth quarter 2022 financial results and business update conference call. 2022 was a transformative year for Axsome as we successfully transitioned to commercial stage and delivered on our goal to become a leading CNS-focused biopharmaceutical company. Now, with two differentiated products, Auvelity and Sunosi commercialized, encouraging early launch metrics for Auvelity, a broad and advancing late-stage pipeline, and a strong financial position, Axsome is well-positioned to continue to deliver significant value to patients and shareholders. The fourth quarter was an important milestone for Axsome as it is the first quarter with sales for both Auvelity and Sunosi. Total net product sales in the quarter were strong at $24.4 million. Later, Nick and Lori will provide further details on our financial and commercial performance.
To preview some of these updates, I'd like to start by talking about the topic that brings us all here, which is making a difference for patients. In just more than a quarter, Auvelity has already been prescribed to thousands of patients. We have seen repeat prescribing by HCPs and refills by patients. Lori will provide additional perspective later. These observations suggest that the unique mechanistic and clinical profile of Auvelity is having a positive impact on the treatment landscape for major depressive disorder and making a meaningful difference in the lives of MDD patients. With just half a year of Sunosi sales after the Axsome relaunch efforts, we've seen steady growth both in the U.S. and overseas. We view the potential for Sunosi in the current indication as largely untapped, leaving room for significant potential future growth.
Just last week, we announced an important licensing deal for Sunosi, providing our new partner, Pharmanovia, commercial rights to Sunosi in Europe and certain countries in the Middle East and North Africa. Pharmanovia shares our excitement and commitment to maximize the potential of Sunosi for patients worldwide. Their strong commercial platform is well suited to expand the availability of, and access for, this important treatment in the licensed regions. In addition to our commercial progress, our broad late-stage CNS pipeline continues to advance, positioning us to drive further significant value creation in 2023 and beyond. Our leading CNS pipeline includes AXS-07 for migraine, AXS-05 for Alzheimer's disease agitation and for smoking cessation, AXS-12 for narcolepsy, AXS-14 for fibromyalgia, and solriamfetol for ADHD.
Subsequently, we made significant progress in our Alzheimer's disease agitation program with AXS-05, including the announcement of positive top-line results for the ACCORD trial, advancement of the ADVANCE-2 trial, and obtaining FDA feedback on our development plan for AXS-05 in this indication. With regards to ADVANCE-2, our parallel group trial. Based on recent enrollment trends, we now anticipate completion of this trial in the first half of 2024 versus our prior guidance of mid-2025. Given all the progress in Alzheimer's disease agitation program, we recently sought and received feedback from the FDA on the registration filing. The FDA requested generation of additional safety experience with AXS-05 in this elderly population, including placebo-controlled safety information from the ongoing ADVANCE-2 trial, as well as long-term safety data in the target patient population consistent with ICH E1 guidelines.
Based on this feedback, the company intends to submit an NDA for AXS-05 after completion of the ongoing ADVANCE-2 and open label safety extension trials. In parallel, we expect to initiate a phase II, III trial of AXS-05 in smoking cessation in the fourth quarter of 2023. With regards to AXS-07 for the acute treatment of migraine, manufacturing activities related to the planned resubmission of the NDA for this product candidate are ongoing, and we expect the resubmission to occur in the second half of this year. For AXS-12, our product candidate for the treatment of narcolepsy, enrollment in the pivotal phase III SYMPHONY trial is progressing, and top-line results are expected in the first half of 2023. As a reminder, AXS-07 has been granted Orphan Drug Designation by the FDA for the treatment of narcolepsy.
Our AXS-14 product candidate for fibromyalgia is also progressing, with manufacturing and other activities related to the preparation of a planned new submission ongoing. We expect to submit the NDA for this product candidate in 2023. With regards to solriamfetol for Sunosi for the treatment of ADHD, we are preparing to initiate a phase III trial of this indication in the first half of 2023. In the fourth quarter, we also shared positive top-line results from the SHARP trial, demonstrating improvement of cognitive function with solriamfetol treatment and highlighted new mechanistic data for solriamfetol on trial one. These results further highlight the clinical potential and differentiated pharmacology of this molecule.
As you can see, the Axsome team is busy and continues to be excited as we prepare to deliver ongoing commercial success and potentially hit on multiple pipeline milestones, including clinical trial readouts and initiations and filings within the next 12 to 18 months. I will now turn the call over to Nick, who will review our financial results.
Nick Pizzie (CFO)
Thank you, Herriot. Good morning, everyone. Today, I'll discuss our fourth quarter and full year results and provide some financial guidance. Total revenue in the fourth quarter of 2022 was $24.4 million, consisting of net sales of our two commercialized products, Auvelity and Sunosi. There were no net sales in the comparable prior period. Auvelity was launched in the fourth quarter on October 19th, and for the partial quarter generated net sales of $5.2 million. Sunosi generated total net sales to Axsome of $19.2 million in the fourth quarter, consisting of U.S. net sales of $18.3 million and international net sales of $900,000. Because the ex-U.S. acquisition of Sunosi closed on November 14th, the reported international net sales reflect the prior quarter. Total revenue for the full year of 2020 was $50 million.
Again, there were no reported sales for the prior year because the acquisition of Sunosi and the launch of Auvelity both occurred in 2022. For the full year of 2022, Auvelity net sales were $5.2 million. For the full year 2022, Sunosi generated total net sales to Axsome of $44.8 million, consisting of U.S. net sales of $43.9 million and international net sales of $900,000. As a reminder, the U.S. portion of the acquisition of Sunosi was completed on May 9th. Cost of product sales were $2.3 million and $5.2 million for the fourth quarter and full year of 2022 respectively, compared to none in the prior year.
Research and development expenses were $14.7 million and $57.9 million for the fourth quarter and full year of 2022 respectively, and $13.8 million and $58.1 million for the comparable periods in 2021. The increase for the fourth quarter was primarily related to higher costs associated with ongoing clinical trials, including post-marketing commitments for Sunosi and Auvelity. Selling, general and administrative expenses were $61.5 million and $159.3 million for the fourth quarter and full year of 2022 respectively, and $18.8 and $66.6 million for the comparable period in 2021. The increases for the fourth quarter and full year were primarily related to commercial activities for Sunosi and Auvelity, including sales force onboarding, marketing spend, as well as higher non-cash stock compensation expense.
Net loss for the fourth quarter of 2022 was $61.2 million or $1.41 per share, compared to a net loss of $34 million or $0.90 per share for the comparable period in 2021. The net loss for the fourth quarter included $10.8 million of non-cash stock compensation expense, compared to $5.9 million in the comparable period in 2021. Net loss was $187.1 million or $4.60 per share for the full year of 2022, compared to a net loss of $130.4 million or $3.47 per share for the comparable period in 2021.
The net loss for the full year of 2022 included $37.7 million of non-cash stock compensation expense, compared to $20.8 million for the full year of 2021. We ended the year with $201 million in cash and equivalents compared to $86.5 million as of December 31st, 2021. During the fourth quarter, we did not utilize our ATM facility. In January of 2023, we amended our loan agreement with Hercules Capital to increase the size of the facility to $350 million to reduce the interest rate and to extend the maturity and interest only periods while accessing a $55 million tranche. Additionally, in February of 2023, the company received approximately $66 million from the out-licensing of ex-U.S. Sunosi rights.
Inclusive of these events, our pro forma year-end cash balance now exceeds $300 million. We believe that our current cash balance, along with remaining committed capital from the $350 million term loan facility with Hercules Capital, is sufficient to fund anticipated operations into cash flow positivity based on our current operating plans. I will now turn the call over to Lori, who will provide a commercial update.
Lori Englebert (EVP of Commercial and Business Development)
Thank you, Nick. Q4 was certainly an exciting quarter for Axsome. With the launch of Auvelity and the continued relaunch of Sunosi. Both of our commercial products address serious, highly prevalent conditions and bring meaningful innovation to millions of potential patients. We are pleased with our commercial progress on Sunosi, and although it is still early days, we are encouraged by Auvelity's launch progress. I will share key metrics from our commercial efforts for both brands, starting with Sunosi, followed by Auvelity. As a reminder, Sunosi is the first and only DNRI for excessive daytime sleepiness in obstructive sleep apnea and narcolepsy, and the first and only wake-promoting agent proven to improve wakefulness through nine hours. In the fourth quarter, total prescriptions for Sunosi in the U.S. grew 11% year-over-year and 1% quarter-over-quarter.
For the full year 2022, U.S. total Sunosi prescriptions showed strong growth with an increase of 21% versus 2021. The total prescription split by the diagnosed patient population for Sunosi is 70% for EDS due to OSA and 30% for EDS due to narcolepsy. Payer coverage for Sunosi remains broad, with 96% of commercial lives and 83% of total lives covered. The growth potential for Sunosi in the currently approved indication remains substantial. Sunosi currently has only a 2% share of drug-treated OSA patients and a 7% share in drug-treated narcolepsy patients. Sunosi is the only branded therapy available for patients who suffer from EDS and OSA, and we expect increased and enhanced promotional and disease education efforts to drive market share growth for the product in 2023 in the U.S.
With recently announced licensing of ex-U.S. marketing rights for Sunosi to Pharmanovia, we are well-positioned to increase the availability of this important treatment to patients worldwide. Turning to Auvelity. We launched Auvelity on October 19th, and despite launching in Q4, a traditionally challenging quarter due to multiple holidays, we saw early signs of encouraging uptake with our initial HCP adopters. With only 10 full weeks of promotion in Q4, 2,200 unique HCPs wrote prescriptions for over 6,000 new patients. Those metrics have grown to 4,300 unique HCP writers and over 13,700 new patients since launch. Importantly, HCPs who have written Auvelity are gaining critical early clinical experience and are reporting promising patient response that is consistent with what we saw in clinical trials, with many reportedly seeing rapid onset of action and rapid achievement of remission.
With regard to payer coverage, the commercial channel is expected to be the primary channel for Auvelity, as it accounts for more than 60% of antidepressant prescription volume. Interactions with commercial payers as it relates to Auvelity have been active and productive. Effective January 2023, we have contracted with one of the largest group purchasing organizations, or GPOs, for potential coverage of Auvelity. Pharmacy benefit managers, or PBMs, and health plans under this GPO will now be able to make formulary coverage decisions for Auvelity based on the contracted terms. These interactions with commercial payers are proceeding as expected during the standard six to nine month period post-launch, when new drugs are blocked while coverage decisions are being made.
In the non-commercial channel, Medicaid coverage became effective in 49 states on January 1st, and Medicare plans have up to six months post-launch to determine coverage and add Auvelity to formulary. We expect additional formulary decisions over the next six months. I look forward to discussing more as the payer process progresses. We are extremely encouraged by the initial launch progress and remain committed to our launch focus of driving fast HCP adoption, empowering patients, and enabling quality access.
We are all aware that there is a mental health crisis happening in the U.S. Major depressive disorder, or MDD, is a major public health concern, with 21 million U.S. adults diagnosed in 2020 and a reported significant increase in prevalence as a result of the pandemic. Auvelity is an important new therapeutic option for patients living with this chronic and devastating condition, and we are proud of our efforts to make Auvelity available to patients living with MDD and their physicians. I will now turn the call back to Mark to lead the Q&A discussion.
Mark Jacobson (COO)
Great. Thank you, Lori. Operator, may we please have our first question?
Operator (participant)
Yes, thank you. Our first question is from Charles Duncan with Cantor Fitzgerald. Please proceed with your questions.
Charles Duncan (Managing Director)
Hey, good morning. Thanks, Herriot and team, for that great overview and congrats on the good quarter. I had a couple of questions on Auvelity. One is commercial, one is more development, and that is regarding the commercial question. I'm just kind of wondering. I think what Lori just said addresses this question, but I'm wondering if she could drill down on any feedback she's getting from the market in terms of response rates and even persistence. Now, I know it's too long or too early to know a real persistence, but what are prescribers seeing in their patients with regard to comparison in patients who are experienced with SSRI-based therapy? Thanks.
Lori Englebert (EVP of Commercial and Business Development)
Hi, Charles. Thanks for the question and good morning. You know, you're right. It is very early days for us. What we're receiving back from the field is purely anecdotal. I hope you take that for what it's worth. You know, what we are hearing anecdotally is that patients are responding very consistent to label. That rapid onset of action is happening. They are seeing very early achievement of remission. Again, it's a little bit too early to talk about durability across where we're just a few months into launch.
We have not seen anything that would suspect, you know, that we would suspect would be different than what we see in the label or what we saw in the clinical trials.
Herriot Tabuteau (CEO)
Yeah. Maybe to add to that is I think one of the things that we are seeing are repeat prescriptions. You know, patients are refilling their prescriptions. Presumably they would have been switched off if there was no persistence.
Lori Englebert (EVP of Commercial and Business Development)
Exactly. Just to give you some additional color there. You know, last week's reported data, about 50, you know, about 50% of the scripts were from refills.
Charles Duncan (Managing Director)
Okay. That's great to hear. Regarding TAM expansion efforts for 005 in Alzheimer's agitation. Herriot, you mentioned some feedback from agency. I wasn't completely clear on that in terms of timing. I think that you mentioned possibly completing the trial in 2024 versus prior 2025, if you could provide more color on that. Explicitly, you thought an NDA would happen after ADVANCE-2, but then also after an open label extension study. Could you give us a sense of timing on when an NDA could be filed?
Herriot Tabuteau (CEO)
Thanks for the follow-up question, Charles. With regards to Alzheimer's disease agitation for the [ADVANCE]-2 trials, you are correct. You know, based on the fact that, enrollment is going frankly, you know, faster than we had expected, you know, we now expect for that study to read out in the first half of 2024. The open label extension trial has been ongoing, and we would also expect that to read out in 2024. With regards to an NDA filing, we would be in a position to file an NDA within six months after the readout of those studies.
Charles Duncan (Managing Director)
Okay. That's helpful. Thanks for taking my questions. Congrats on a good quarter.
Mark Jacobson (COO)
Thanks, Charles.
Operator (participant)
Our next question comes from the line of Marc Goodman with SVB. Please proceed with your questions.
Marc Goodman (Senior Managing Director, Neuroscience and Senior Research Analyst)
Herriot, just to continue on this agitation study. Can you confirm, like, your discussions with FDA? Have they signed off on both studies from an efficacy standpoint, and all we're waiting for now is the safety data? Can you just confirm that? Second question is, if y'all can help us with how to think about gross to nets for both products for this year. Thank you.
Herriot Tabuteau (CEO)
Thanks for the question, Charles.
Lori Englebert (EVP of Commercial and Business Development)
Mark.
Herriot Tabuteau (CEO)
I'm sorry. Mark. Oh my God. You know, all these self-identities are starting to blur into one. No, of course not. All of you are very distinct. Mark, you know, with regards to the interactions with the FDA, we sought feedback on the trials. The feedback that we got from the agency is that in this elderly patient population, safety data is really important. Not just long-term safety data, but also a placebo-controlled safety data. The ACCORD trial, it was a randomized withdrawal study, so it does not provide the randomized safety data, which the FDA mentions is really important in this patient population.
The other aspect of the study, which the FDA did highlight, not necessarily a showstopper, is the fact that this was a truncated study. Importantly though, the feedback with regards to exact patient numbers for the safety database is that it must meet ICH E1 guidelines. What's good is, we're in a good position to provide actually all of those data points to the FDA. We do have the ADVANCE-1 trial, which is already ongoing and which is enrolling. I'm sorry, the ADVANCE-2 trial, which is already enrolling. So we're in a good position to provide all the safety data which would be required for the NDA filing.
Marc Goodman (Senior Managing Director, Neuroscience and Senior Research Analyst)
Herriot, if ADVANCE-2 fails from an efficacy standpoint, then what?
Herriot Tabuteau (CEO)
That would be speculation. We are encouraged that we currently have two positive trials in this indication.
Marc Goodman (Senior Managing Director, Neuroscience and Senior Research Analyst)
Right. That's my question. Did the FDA agree that you have two positive trials?
Herriot Tabuteau (CEO)
The FDA never agrees to anything until you file an NDA and they review it. It's very clear that we do have two positive trials. We're very encouraged by that, and we're on track to provide the safety information that would be needed for an NDA filing.
Marc Goodman (Senior Managing Director, Neuroscience and Senior Research Analyst)
Okay. Then the gross to nets for both products for this year, how do we think about that?
Nick Pizzie (CFO)
Yeah, sure. Hey, Marc, it's Nick. For gross to net, for the quarter, for Auvelity, I'll start with gross net for the quarter was in the 60s. As of right now, we're not currently in a position to give specific guidance around GTN. We would remind you that there's no reason to expect that it's actually going to improve from this quarter, and it obviously could potentially worsen based on Q1 being typical, you know, the seasonality that you would expect with typical headwinds of plan coverages resetting in year inclusive of both deductibles, coinsurance. PAs would need to be, in some plans, recreated again. Potentially utilization, higher utilization of the co-pay card. Obviously mix and channel distribution always impacts GTN.
We, you know, we would expect in Q1 and Q2 that we wouldn't expect anything better than where we're at today, and potentially it could worsen. Specifically around Sunosi. Sunosi, we were in the low 50s. For this quarter, we did have a favorable adjustment from prior quarters of $1.8 million of the GTN adjustment as we received updated claims, which is typical that we received them in this quarter. You know, for Sunosi, it's pretty much been stable in the low 50s.
Marc Goodman (Senior Managing Director, Neuroscience and Senior Research Analyst)
Thank you.
Herriot Tabuteau (CEO)
You're welcome.
Operator (participant)
Our next question is from the line of Vikram Purohit with Morgan Stanley. Please proceed with your questions.
Vikram Purohit (Equity Analyst)
Hey, good morning. Thanks for taking our questions. We had two on Auvelity. The first, just wondering if you could provide some color on kind of the typical profile of patients that are currently receiving Auvelity in terms of their prior treatment history and the lines of therapy they've been on prior to being prescribed Auvelity. Secondly, I just wanted to see if you could provide an update on ex-U.S. commercialization and partnership discussions, if those have been happening, and if so, what you'd be looking for in a potential partner for AXS-05 ex-U.S. Thanks.
Lori Englebert (EVP of Commercial and Business Development)
Hey, Vikram, I'll take that. Sorry. You know, currently as we've mentioned multiple times and as with standard, most of the commercial plans have Auvelity sitting in an NDC block, which requires, you know, quite an effort to get patients online, which is why we're really excited about the demand that we're driving despite these challenges. However, due to that, you know, line of therapy use has been relatively later line right now, with, you know, about 28% sitting in second line and 61% sitting in third line plus. The response has been again to the question I answered with Charles, the response has been very, very consistent with label, and to see that in later line patients is extremely encouraging.
Herriot Tabuteau (CEO)
Just with regards to the second part of your question, which relates to what we would be looking for with regards to a potential partner for Auvelity in ex-U.S. I think one of the things that we would look for is a partner with proven commercial capabilities, but also a partner that has experience with regards to navigating the pretty complex reimbursement landscape in certain geographies such as Europe.
Vikram Purohit (Equity Analyst)
Okay. Got it. Thank you.
Operator (participant)
The next question is from the line of Jason Gerberry with Bank of America. Please proceed with your questions.
Jason Gerberry (Managing Director and Equity Research Analyst for Pharma and Biotech)
Hey, good morning. Thanks for taking my questions. Are you guys planning to increase enrollment of ADVANCE-2 to get to the 300 patients by six months? I was just, you know, doing the math on, you know, I think, what, 50 patients from ACCORD went into randomized withdrawal, and then you have, like, 175 under the current enrollment plan for ADVANCE-2. Just curious how you get to the 300. If you can comment on how we should be thinking about SG&A and OpEx ramp is 4Q 2022 on an annualized basis, sort of a good place to think about some growth off of that number, or is there gonna be any step up from there?
Just, you know, last question, any comments on any inventory launch stocking here on the fourth quarter number? Thanks.
Herriot Tabuteau (CEO)
Yeah, I'll take first question and then Nick will take the others. The answer is no. We do not anticipate having to increase enrollment in ADVANCE-2 to meet
The required patient safety database. Just as a reminder, you know, we do have patients from ADVANCE-1 in terms of general safety experience. We also have 170 patients as a reminder, who were enrolled in period one of the ACCORD trial. A lot of those patients, or most of those patients went into the open label safety extension trial. If you take the patients rolling over from ACCORD as well as the expected patients rolling over from ADVANCE-2, that should put us in pretty good shape. Nick?
Nick Pizzie (CFO)
Sure. Hey, Jason. Related to OpEx guidance, like I think you mentioned using Q4 essentially as a proxy. I think that's a fair estimate. We stated in the press release that we expect expenses to increase year-over-year. Obviously, with the launch of Auvelity and Sunosi being acquired in the second quarter of this year, we'll have a full year of SG&A expenses. And Q4 being almost a full quarter, I think you can expect use that as a proxy and potentially a modest growth from the on the SG&A piece as it relates to thinking about 2023 on a quarterly basis.
I think your other question, it broke up a little bit, but I think your question was related to inventory and channel and where we were as of the end of the year. For Auvelity, we have roughly two and a half weeks of future demand in the channel. I think obviously it's a growth brand. We just launched it and, you know, we do expect inventory levels to fluctuate at our distributors as Auvelity builds additional momentum in the market. It's not unexpected and we believe we're in patterns we really reflect the strong patient demand that we've seen. For Sunosi, we did have increased wholesale buying during due to the seasonality at the end of Q4. The inventory levels were somewhat elevated.
However, we do see in Q1 that these inventory levels are coming down to approximately two to two and a half weeks. One note is that we are actually in Q1, we operationally for distribution, we changed our model from a title model to the traditional 3PL model. Title model was as it relates to as we launch and ensuring that we get licenses in every state. We changed to a traditional 3PL model now and reduced the essentially the trick that the middleman distributor. We will see an inventory reduction in the channel, which will impact Q1 sales for Sunosi by roughly two weeks.
Jason Gerberry (Managing Director and Equity Research Analyst for Pharma and Biotech)
Yeah. Thank you.
Operator (participant)
Our next question is from the line of David Amsellem with Piper Sandler. Please proceed with your questions.
David Amsellem (Senior Research Analyst)
Thanks. Just had a couple. First on Sunosi. Just broadly, what do you think you can do, differently from the predecessor company that controlled the asset, in terms of driving an inflection, in volumes? Is the focus gonna be more on OSA versus narcolepsy? Just give us a sense of what you're prioritizing and how you believe, the commercial landscape, for Sunosi might prove to be, different, over time, to the extent, it is at all. That's number one. Then number two on Auvelity. How should we think about, eventual expansion of the sales organization to the extent you need to? Just talk about, you know, how that's going to, evolve, over time as the product gets more into its commercial life. Thank you.
Lori Englebert (EVP of Commercial and Business Development)
Hi, David. I'll take both of those. First of all, I'll start with Sunosi. You know, how do we think we'll have an inflection point with this relaunch that we've talked about with Sunosi. You know, Jazz laid a really strong foundation for the launch for their, you know, the initial launch. The important thing to remember about the initial launch with Jazz was that they launched about three months prior to the COVID shutdowns. The initial launch was heavily impacted for the majority of the first, you know, 18 months of the launch for that product. What we believe we are doing right now that will help provide an inflection point is that we've gotten really hyper-focused on the highest potential prescribers.
Our plan is to make sure that with our differentiating clinical profile, that those high prescribers, that we penetrate those high prescribers and then start to expand out in terms of targets. Doing that will help us gain market share very quickly as we really get sophisticated on the approach. In terms of OSA versus narcolepsy, OSA has a prevalence of about 22 million patients and narcolepsy is 200,000. That stark difference right there tells you that a much larger opportunity is in OSA. We will right now continue to focus on OSA, but we're not letting our foot off the gas on narcolepsy because there's still a lot of room for growth there as well.
In terms of Auvelity and the expanded sales organization, you know, right now we have about 165 reps calling on 25,000 HCPs. We are very confident in our using our DCC approach to make sure that our reps are able to have the tools that they need to make effective calls.
Be very efficient about doing it. Because of that, we are very focused on making sure that penetration in those original target list, which are the highest potential prescribers in the MDD space, is really high, before we comment any further on any additional plans.
David Amsellem (Senior Research Analyst)
Okay. Helpful. Thank you.
Operator (participant)
Our next question is from the line of Joon Lee with Truist Securities. Please proceed with your questions.
Joon Lee (Managing Director and Senior Biotech Analyst)
Hey, thanks for taking our questions and for the updates. In the press release, you mentioned potential for up to four NDAs over the next 12-18 months. I'm assuming that it also includes narcolepsy, and if so, is SYMPHONY and the phase II sufficient to file? I have a follow-up.
Herriot Tabuteau (CEO)
Thanks for the question. Yes, we do believe that SYMPHONY and phase II trial will be sufficient to file, assuming that SYMPHONY is a positive study.
Joon Lee (Managing Director and Senior Biotech Analyst)
Great. Regarding the Sunosi deal, you know, at a high level, it looks like you were able to monetize the European rights at a very attractive valuation, possibly more than what you guys got for giving away for the worldwide rights. What do you think changed that allowed you to extract such value?
Herriot Tabuteau (CEO)
I think that [we always] felt strongly about the potential for Sunosi and the overall value of the product. This transaction, the ex-U.S. licensing, it reflects the value of the product. It's consistent with our perspective, what our perspective has always been and what we've communicated with regards to the potential of the product.
Operator (participant)
Our next question is from the line of Joseph Thome with Cowen and Company. Please proceed with your question.
Joseph Thome (Managing Director and Senior Biotechnology Equity Research)
Hi there. Good morning, and thank you for taking our questions. Maybe the first one, just a clarification on the availability number that you gave earlier, that 13,700 new patients. Was that as of last Friday, or when was the cutoff date for that? Then second was the ANDA for Teva on Auvelity. If you can just give us overall thoughts, on your strength of the 2034 and 2040 patents. I know they're only challenging the 2040, but what are next steps here, and how does the company think about that? Then I'll have one more very quick follow-up. Thanks.
Lori Englebert (EVP of Commercial and Business Development)
Yes. Hi, Joseph. Thank you for the question on the cutoff date. That would be as of the last reporting week, which was February 17th.
Herriot Tabuteau (CEO)
You cut out there for the second part of the question.
Joseph Thome (Managing Director and Senior Biotechnology Equity Research)
Yeah.
Herriot Tabuteau (CEO)
You repeated it.
Joseph Thome (Managing Director and Senior Biotechnology Equity Research)
Yeah. Just in terms of, we saw the ANDA submission from Teva, challenging those 2040 patents. What are sort of the next steps in terms of litigation or in terms of potential settlement? Maybe if you could just comment on your confidence in the strength of the 2040 and the 2034 patents for Auvelity?
Herriot Tabuteau (CEO)
Sure. Yeah. Hunter, our GC, will take that.
Hunter Murdock (General Counsel)
Hi, nice to see you. I'm Hunter Murdock, the company's general counsel. As we previously announced earlier this month, we did receive a paragraph four notice from Teva relating to Auvelity. The receipt of the letter was normal. It was an expected part of the Hatch-Waxman process. To get to your question, it's no way indicative of the quality of our IP portfolio, which we're extremely proud of. Under the Hatch-Waxman Act, we have 45 days to file a lawsuit against Teva if we wish to invoke the 30-month regulatory stay. We're carefully analyzing Teva's Paragraph IV notice right now, and we're carefully evaluating our next steps. I'm not able to provide much additional commentary regarding the notice or the steps we may take in light of the potential for future legal proceedings.
Joseph Thome (Managing Director and Senior Biotechnology Equity Research)
Great. Thank you. Just really quickly, I know you mentioned that the, for narcolepsy, the phase II and the phase III would be sufficient on an efficacy standpoint. Would you need an additional open label safety experience and, or will you have that necessary exposure once this trial reads out? Thank you.
Herriot Tabuteau (CEO)
We do have an open label safety extension trial ongoing. That safety experience will be part of the filing. As a reminder, in conjunction with our licensing deal with Pfizer, we did get the safety data, which is or the safety experience, which is extensive with the molecule. That will also be part of our filing should we have success.
Joseph Thome (Managing Director and Senior Biotechnology Equity Research)
Great. Thank you very much.
Operator (participant)
Thank you. Our next question is from the line of David Hoang with SMBC. Please proceed with your questions.
David Hoang (Director and Senior Analyst)
Hey, good morning. Thanks for the update and fitting me into the Q&A. I just had a quick question on gross to net for Auvelity in coming quarters. Can you give us any sense of how quickly we should expect the GTN to improve over time? Would improvement correlate with the, you know, the rate at which you can establish favorable coverage at major health insurance plans? I know you mentioned six to nine months window for that to generally take place. Is that fair to assume GTN should also improve over that time?
Nick Pizzie (CFO)
Yeah. David, thanks. It's Nick. I think that's the guidance that we previously gave, and we're really staying to that. It's hard to give any further quantitative guidance on GTN until we start seeing broad payer coverage. We'll be able to give a good sense of, you know, of what the GTN and where the GTN will lie. You know, several quarters from now, I think we'll be able to give a better, give you a better sense of where GTNs will be.
David Hoang (Director and Senior Analyst)
Great. Thanks.
Yatin Suneja (Managing Director, Biotechnology Analyst)
The next question is from the line of Yatin Suneja with Guggenheim Securities. Please proceed with your questions.
Eddie Hickman (Equity Research Analyst)
Hey, good morning. Thanks for taking our questions. This is Eddie on for Yatin. Just a few from us. On AXS-12, can you just provide a little bit more detail on the timing of the data this year and what you would need to see to give you confidence moving forward, especially with comparison to Sunosi? Just a quick follow-up on the Auvelity inventory. How much of that $5.2 in reported revenue for the quarter was due to channel stocking? Thanks.
Herriot Tabuteau (CEO)
Yeah, you wanna take the last question?
Nick Pizzie (CFO)
Yeah. Yeah. I haven't quantified the actual, the actual amount related to specifically the inventory. But as I mentioned, earlier on the question, it was roughly two and a half weeks of a future demand. You can kinda ballpark what that is. That two and a half weeks, we do take GTN deductions on that. Even though it hasn't been sold, it's been sold to our distributor, it hasn't been sold in channel, so we are accruing based on the proceeds or what we expect January's GTN would fall out at.
Herriot Tabuteau (CEO)
With regards to the timing for AXS-12, we expect to have results from that trial in the first half of this year. That's the guidance.
I think you can figure out what the first half is. That would mean through the end of June. Then, in terms of, you know, what we would want to see, we wanna see a positive trial. This is a placebo-controlled study, so obviously we wanna see a positive trial that would give us two studies that demonstrate the efficacy of a product. With regards to the comparison to Sunosi, the indications are different. Sunosi is approved to treat excessive daytime somnolence in patients with narcolepsy. AXS-12, you know, we're studying it for the treatment of cataplexy in patients with narcolepsy.
Lori Englebert (EVP of Commercial and Business Development)
Eddie, if I could just add here, if you don't mind, just to help provide context there. For narcolepsy patients, 100% of all narcolepsy patients suffer from excessive daytime sleepiness. It's only estimated that about 70% suffer from cataplexy. Just wanna give you context in terms of patient difference, the difference in patients.
Eddie Hickman (Equity Research Analyst)
Got it. Thank you so much.
Operator (participant)
Our next question comes from the line of Graig Suvannavejh with Mizuho Securities. Please proceed with your questions.
Graig Suvannavejh (Managing Director)
Great. Thanks so much for taking my question. Congrats on the quarter and the year. Maybe my question is a bit bigger picture and perspective, as it relates to your marketed products and Auvelity and Sunosi. I know you've just launched Auvelity, and you've just gotten your hands on Sunosi, but do you have a sense of at what point you, as a company, might be in a position to provide financial guidance around what you see for sales for each of those products? And maybe even from a bigger picture perspective, could you remind us as you think about the total revenue opportunity for Auvelity or AXS-05, either in depression or and also in AD agitation, and how you think about Sunosi in EDS, both in OSA and narcolepsy? Thanks so much.
Nick Pizzie (CFO)
I'm sorry, Graig, can you repeat the first part of your question one more time for me?
Graig Suvannavejh (Managing Director)
It was really more a questions around the timing of when, as a company, you might feel that you're comfortable enough to provide financial guidance on forward-looking sales in any particular year for this. Is this a situation where perhaps, you know, maybe three years down the line or two years, just how you're thinking about when you might be comfortable?
Nick Pizzie (CFO)
Yeah, I would say, obviously, the way you prefaced your question originally is, you know, it's we're in the very early stages for Auvelity as well as Sunosi. You know, we haven't discussed when we would potentially give sales guidance as it relates to both products. One would surmise, though, with Sunosi being a somewhat more mature product, that we would be able to give some guidance on that product first. Auvelity, we're looking at, you know, various models here and would fluctuate, you know, drastically. We're... You know, it would be further along. I can't give you any specific timing when we would give sales guidance. All right.
Herriot Tabuteau (CEO)
You know, to answer the second part of your question, you know, we have talked about the sales potentials, the peak sales potentials for both Auvelity as well as Sunosi. Starting with the Sunosi. Just in the current indication, we believe that the product could achieve peak sales of $300 million-$500 million. We've also said that we believe the product has a lot less of potential, meaning, sales potential of at least $1 billion if you take into account potential new indications. As we discussed, you know, we are about to launch a pivotal trial in ADHD. With regards to Auvelity, we think that Auvelity has billion-dollar potential in both MDD individually as well as in Alzheimer's disease agitation individually.
MDD based upon the size of that market in terms of the number of patients who have AD and who are diagnosed and treated Alzheimer's disease agitation, based upon not just the prevalence of Alzheimer's disease and the percentage of patients who have agitation, which is about 70%. It also based upon the fact that there's nothing approved currently to treat those patients.
Graig Suvannavejh (Managing Director)
Maybe one more follow-up from me. Just on Sunosi, where the split in its current use is, I believe, 70% in OSA and 30% currently in narcolepsy. I'm wondering if, as you look out in the future with your current plans, whether that is a number that will evolve from there or if it'll stay there, and if it does evolve, any sense on which direction it might evolve in terms of that split? Thanks.
Lori Englebert (EVP of Commercial and Business Development)
Yeah, thanks, Graig. I don't think or I don't foresee, especially in this current indication, that that's going to evolve much. As I mentioned before, our focus is heavily on OSA, just given the sheer size of the prevalence of that condition. We're not taking our foot off the gas on narcolepsy, because it is a very efficacious product, and, you know, for narcolepsy.
Graig Suvannavejh (Managing Director)
Thank you. Thank you.
Operator (participant)
Thank you. The next question comes from the line of Bert Hazlett with BTIG. Please proceed with your questions.
Bert Hazlett (Managing Director and Partner and Equity Research Analyst)
Yeah, thank you for taking the question, all the clarifying comments here. My question's on the smoking cessation program. Could you just frame some of the parameters and timing surrounding the phase II, III there? Size of trial, again, timing, endpoints, things like that. Then with regard to the administration dosing of AXS-05, would you expect it to be dosed in similar fashion titration to a top dose as it is in MDD and AD agitation? Thank you.
Herriot Tabuteau (CEO)
Thanks, Bert, for the question. With regards to the timing, we do expect to initiate the phase II, III trial in the fourth quarter of this year. The team is working very hard to get that done. In terms of the design of the trial, this will be a standard parallel group trial design. We will have more to say once we launch the trial. As we always do, we'll provide details in terms of the endpoints that we're looking at. You know, rest assured that the endpoints will be registration endpoints. You know, we have gotten feedback from the FDA on exactly what that will look like, and we'll provide those details once we launch the trial.
In terms of the dosing regimen, we'll also provide that information once we launch the study.
Bert Hazlett (Managing Director and Partner and Equity Research Analyst)
Great. Looking forward to that. Thank you.
Operator (participant)
Thank you. At this time, we have time to take two more additional questions. The next question comes from Myles Minter with William Blair. Please proceed with your questions.
Myles Minter (Research Analyst in Healthcare)
Hey, thanks for taking the questions. Just wondering how many or what percentage of covered lives are actually represented through the plans that will use that GPO you bought online last month, and when you anticipate those plans making those decisions?
Lori Englebert (EVP of Commercial and Business Development)
Yeah. Hi, Myles. I'll take that one. You know, as updated, you know, in the prepared remarks, it was one of the three GPOs that are currently operating right now. Each of the three have, you know, fairly substantial amount of covered lives. The PBMs and plans that are underneath them now have the ability to access those contracted rates once they work through their standard and expected six-to-nine month NDC block. You know, discussions are active with the other GPOs and payers, both from clinical reviews as well as discussions on formulary decisions. We do expect those to be made over the next six months.
Myles Minter (Research Analyst in Healthcare)
Okay. Just as a follow-up, last year when you met with the FDA and you decided to run ADVANCE-2, I think, you know, did they guide that they wanted to see an additional placebo-controlled study for AD agitation because they wanted to see additional placebo-controlled efficacy as well as safety data at that time? Has that tone or commentary changed at the current meeting that you just had? Thanks.
Herriot Tabuteau (CEO)
Sure. Thanks, Myles, for the question. When we made the decision to initiate the ADVANCE-2 trial, that was a decision that we made just from a business perspective. That was not based upon, you know, final feedback from the FDA. However, once we did meet with safety data, in particular placebo-controlled safety data as well as a safety database, based on ICH guidelines, you know, that was information that was provided to us and that will be a requirement for the [audio distortion] filing.
Myles Minter (Research Analyst in Healthcare)
Okay. Thank you.
Operator (participant)
Our final question is from the line of Matthew Kaplan with Ladenburg Thalmann. Please proceed with your questions.
Raymond Wu (Equity Research Associate)
Hi, this is Raymond in for Matt. Congrats on the quarter, thanks for taking our questions. Just a quick one. I wanted to ask about Auvelity as a DCC platform. You've had early success with Sunosi and DCC. I was wondering how DCC, in your initial experience with Auvelity, has kind of driven sales and any initial learnings that you'd hope to incorporate as the launch progresses? Thanks.
Lori Englebert (EVP of Commercial and Business Development)
Yeah. Hi, thanks. Thanks for the question. It's a good one. You know, as you mentioned, we have talked about what we're seeing on Sunosi, so I won't rehash that. On Auvelity, we're still very early. What we've done is we've, you know, established a platform, the same platform that Sunosi's operating off of. We are very confident in our sales force size as well as the tools that we've given them to reach the number of HCPs that we believe will drive rapid growth. You know, it's a bit too early to really comment on that. We are very pleased with how the team is using the platform, and how they are, you know, helping drive growth that way.
Raymond Wu (Equity Research Associate)
Appreciate that, [color]. Thanks.
Operator (participant)
Thank you. I will now turn the call back to Axsome's CEO for any concluding remarks.
Herriot Tabuteau (CEO)
Well, thank you again for joining us on the call today. We are proud of the hard work of the Axsome team, which is now resulting in meaningful differences in patients' lives. This is only the start of more great things to come. 2022 was a pivotal year for Axsome. We are not the same company we were a year ago. We won't be the same company next year with all the strategic growth we anticipate. We are in line to report value-driving updates with multiple [IND late trial] candidates and multiple late-stage clinical trials in some of the most challenging to treat CNS disorders in the next 12-18 months. Long close of time, Axsome has the potential to have five commercial products in the market by 2025. We're hard at work to meet those goals. Thank you.
Have a great rest of your day.
Operator (participant)
This will conclude today's conference. Thank you for your participation. You may now disconnect your lines at this time.