Intellia Therapeutics - Q4 2022
February 23, 2023
Transcript
Operator (participant)
Good morning, welcome to the Intellia Therapeutics fourth quarter and full year 2022 financial results conference call. My name is Drew and I will be your conference operator today. Following formal remarks, we will open the call up for a question-and-answer session. This conference is being recorded at the company's request and will be available on the company's website following the end of the call. As a reminder, all participants are currently in a listen-only mode. If you need operator assistance, press star than zero. I will now turn the conference over to Ian Karp, Senior Vice President of Investor Relations and Corporate Communications at Intellia. Please proceed.
Ian Karp (SVP of Investor Relations and Corporate Communications)
Thank you, Operator. Good morning, everyone. Welcome to Intellia Therapeutics fourth quarter and full year 2022 earnings call. Earlier this morning, Intellia issued a press release outlining the company's progress this quarter, as well as topics for discussion on today's call. This release can be found on the Investors and Media section of Intellia's website at intelliatx.com. This call is being broadcast live. A replay will be archived on the company's website. At this time, I would like to take a minute to remind listeners that during this call, Intellia management may make certain forward-looking statements and ask that you refer to our SEC filings available at sec.gov for discussion of potential risks and uncertainties. All information presented on this call is current as of today. Intellia undertakes no duty to update this information unless required by law. Joining me from Intellia are Dr.
John Leonard, Chief Executive Officer, Dr. David Lebwohl, Chief Medical Officer, Dr. Laura Sepp-Lorenzino, Chief Scientific Officer, and Glenn Goddard, Chief Financial Officer. John will begin with an overview of recent business highlights. David will provide an update on our clinical programs. Laura will recap the company's R&D progress across our pipeline. Glenn will review Intellia's financial results for the fourth quarter and full year 2022. John will then offer some concluding remarks before we open up the call for Q&A. With that, I'll now turn the call over to John.
John Leonard (CEO)
Thank you, Ian, and thank you all for joining us this morning. At Intellia, we're advancing our leadership position as the industry's most innovative genome editing company with the broadest and deepest toolbox of novel editing and delivery solutions. 2022 proved to be another outstanding year for Intellia, with several significant clinical milestones achieved across our pipeline. Having demonstrated human proof of concept for our first two in vivo clinical candidates, NTLA-2001 and NTLA-2002, we're now two for two. Notably, we've dosed more than 50 patients with our in vivo CRISPR-based therapies in ongoing clinical studies with durability and safety data now out two years in the earliest patients. These accomplishments reflect steady execution against our core strategy to harness the immense power of CRISPR-based technologies, both for in vivo and ex vivo applications. Building on last year's strong momentum, we've already hit the ground running this year.
We're pleased to share today that we initiated the phase II portion of the NTLA-2002 study outside of the U.S. Recently, we also submitted an IND application to the FDA to enable U.S. patient enrollment in this trial. We're highly encouraged by the rapid progress we have made in just the past few months and expect to hear back from the FDA in the coming weeks. Looking ahead, for NTLA-2001, we're poised to submit an IND application for a pivotal trial for the cardiomyopathy manifestation of ATTR amyloidosis mid-year, with a trial initiation anticipated by the end of the year, subject of course to regulatory feedback. Importantly, we look forward to presenting new interim clinical updates from both ongoing NTLA-2001 and NTLA-2002 first-in-human studies this year. Turning to our research pipeline, we are advancing new platform capabilities to the clinic.
This includes our CRISPR-based in vivo targeted gene insertion technology and a first of its kind allogeneic cell engineering solution designed to avoid both T-cell and NK cell mediated rejection. Additionally, we're leading the development of new gene editing and delivery modalities, which will drive further pipeline growth and allow us to reach a greater number of patients with our genetic medicines. With that introduction, I'll hand the call over to our Chief Medical Officer, David Lebwohl, who will review NTLA-2001 and NTLA-2002's progress in greater detail and outline updates across our clinical pipeline. David?
Ian Karp (SVP of Investor Relations and Corporate Communications)
Thanks, John, and welcome everyone. I'll begin with a review of 2001, a potential single-dose treatment that may halt and reverse the disease for people living with ATTR amyloidosis. In November, we shared additional positive interim results from the cardiomyopathy arm of the ongoing phase I clinical trial of 2001. These data, which were presented in a late-breaking oral presentation at the American Heart Association Scientific Sessions, demonstrated consistent greater than 90% serum TTR reduction following a single dose of 2001. The deep reductions were sustained with patient follow-up ranging from four to six months as of the data cut-off date. 2001 was generally well tolerated in all 12 patients. Two of the 12 patients reported transient infusion reactions which resolved quickly and which were the only observed treatment-related adverse events.
No clinically significant laboratory abnormalities were observed at either dose level.
David Lebwohl (Chief Medical Officer)
We continue to believe these deep, durable, and consistent levels of protein reduction support NTLA-2001's potential to be a best-in-class TTR lowering agent regardless of disease manifestation. In the last few months, we completed the planned enrollment for the dose expansion portion of the cardiomyopathy and polyneuropathy arms. Data from these cohorts will be used to inform our dose selection decision for subsequent pivotal studies. For ATTR-CM, we plan to submit an IND application mid-year and plan to initiate a global pivotal study by year-end, subject to regulatory feedback. We plan to present new and important interim clinical data later this year, including longer-term safety and durability data, as well as emerging clinical endpoints. For hereditary ATTR amyloidosis with polyneuropathy, we are continuing to prepare for a phase III study, including discussions with regulatory authorities, and look forward to presenting additional clinical data from the ongoing phase I study.
I'll turn now to our second in vivo program, NTLA-2002, our investigational therapy for the treatment of hereditary angioedema, or HAE. We shared additional positive results from the ongoing phase one/two clinical study at the American College of Allergy, Asthma and Immunology 2022 annual scientific meeting this past November. The data presented demonstrated that a single dose of NTLA-2002 led to robust reductions in plasma kallikrein and HAE attack rates. For the 25 milligram and 75 milligram cohorts, these deep reductions in plasma kallikrein were sustained in all patients through data cut-off, which ranged from week 16 to week 32. Importantly, all patients dosed in these two cohorts who completed the pre-specified 16-week observation period have maintained an attack-free status as of the data cut-off date.
Patients in the 50 milligram cohort have not yet completed the primary 16-week observation period before the presentation cut-off date, and so we look forward to presenting attack rate data on this cohort later this year. At all three dose levels, NTLA-2002 was generally well-tolerated, and the majority of adverse events were mild in severity. The most frequent adverse events were infusion-related reactions, which were mostly Grade one and resolved within one day. No dose-limiting toxicities, no serious adverse events, no adverse events of Grade three or higher, and no clinically significant laboratory abnormalities were observed. We believe these data speak to NTLA-2002's potential to address the significant disease burden faced by people living with HAE by permanently preventing the debilitating swelling attacks with a single dose.
We look forward to presenting additional data from the phase I portion of the study in 2023, including longer-term safety, durability, and attack rate data across all three cohorts. As John mentioned, it's been a very productive first two months of the year, especially for the NTLA-2002 program. In January, Intellia was awarded the Innovation Passport in the United Kingdom for NTLA-2002, which provides entry to U.K.'s Innovative Licensing and Access Pathway. We were pleased to receive the ILAP designation, which aims to accelerate time to market and facilitate patient access to innovative medicines. Today, we announced that Intellia has initiated patient screening in the phase II portion of the study in New Zealand. The phase II portion, a randomized placebo-controlled expansion study, is evaluating two doses, 25 milligrams and 50 milligrams. We anticipate expanding country and site participation in the coming months.
To support inclusion of patients in the United States, Intellia recently submitted an IND application to the FDA. We look forward to providing you with an update on the status of that application's review. As NTLA-2001 and NTLA-2002 continue to progress, we believe we are moving closer to setting a new standard of care for people living with these serious diseases. I'll now hand over the call to Laura, our CSO, who will provide updates on our R&D efforts and platform advancements.
Laura Sepp-Lorenzino (Chief Scientific Officer)
Thank you, David. We're entering the next stage of growth at Intellia as we advance new platform capabilities to the clinic, such as in vivo gene insertion, our allogeneic technology, and base editing. For targeted in vivo gene insertion, we're progressing both wholly owned and partner programs leveraging our modular insertion platform. This includes NTLA-3001, our wholly owned candidate for the treatment of AATD-associated lung disease, for which we plan to submit an IND or IND equivalent application in the second half of this year. In parallel, we're advancing IND-enabling activities for NTLA-2003, our third in vivo knockout candidate as a treatment for the liver manifestation of AATD. In collaboration with Regeneron, we're also making important progress advancing our Factor IX insertion program for people with hemophilia B.
Turning to our ex vivo pipeline, we're advancing multiple programs, ours and those shared with partners, utilizing our proprietary allogeneic platform. These platform capabilities demonstrate the already broad opportunity of our robust research engine. There is still more untapped potential, and so we're further pushing the boundaries of what therapeutic gene editing can do. We have made rapid and significant headway with the development of our proprietary DNA-writing technology. Since the acquisition of Rewrite Therapeutics, we have implemented and expanded the platform, leveraging Intellia's genome editing toolbox and expertise, and demonstrated robust performance and versatility. We're excited by the potential of our newest platform capability, offering us the potential to target diseases beyond those currently being explored in our pipeline. I now hand over the call to Glenn, our CFO, who will provide an overview of our fourth quarter and full year 2022 financial results.
Glenn Goddard (CFO)
Thank you, Laura. Good morning, everyone. Intellia continues to maintain a strong balance sheet that allows us to execute on our pipeline and platform. Our cash equivalents, and marketable securities were $1.3 billion as of December 31, 2022, compared to $1.1 billion as of December 31, 2021. The increase was driven by $337.9 million from our December follow-on offering, $227.9 million of net proceeds from the company's at-the-market program, and $17.2 million in proceeds from employee-based stock plans. The increase was offset in part by cash used to fund operations of approximately $372.8 million and the acquisition of Rewrite Therapeutics for $45 million.
Our collaboration revenue increased by $0.7 million-$13.6 million during the fourth quarter of 2022, compared to $12.9 million during the fourth quarter of 2021. Our R&D expenses increased by $28.9 million-$100 million during the fourth quarter of 2022, compared to $71.2 million during the fourth quarter of 2021. This increase was mainly driven by the advancement of our lead programs and personnel growth to support these programs. Our G&A expenses increased by $1.5 million-$23.6 million during the fourth quarter of 2022, compared to $22.1 million during the fourth quarter of 2021. This increase was primarily related to employee-related expenses. Finally, we expect our cash balance to fund our operating plans beyond the next 24 months.
With that, I will now turn the call back over to John for closing remarks.
John Leonard (CEO)
Thank you, Glenn. As you can see, we're making steady progress towards executing against our strategic priorities, which are focused on late-stage development of our CRISPR-based therapies while continuing to innovate and bring forth new platform capabilities. This year, we look forward to advancing the phase II portion of the NTLA-2002 study and expect to add U.S. clinical sites. We're also focused on preparing for the initiation of a global pivotal trial of NTLA-2001 for patients with a cardiomyopathy manifestation of ATTR amyloidosis. For both programs, we plan to provide further updates in the coming months. As we continue to deliver on the promise of gene editing, we maintain our broader vision for Intellia by rapidly expanding the reach of our platform to accelerate the impact on patients. With that, we'd be happy to answer any questions. Operator, you may now open the call for Q&A.
Operator (participant)
We will now begin the question-and-answer session. To ask a question, you may press star then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. Please limit yourself to one question. At this time, we will pause momentarily to assemble our roster. The first question comes from Maury Raycroft with Jefferies. Please go ahead.
Maury Raycroft (Research Analyst)
Hi. Good morning. Congrats on the progress, and thanks for taking my question. I was going to ask about the HAE IND. Wondering if you're commenting any more on what exactly FDA requested to be in the IND and what you included in the IND for the phase II. Do you expect a typical IND acceptance timeline for that program?
John Leonard (CEO)
Maury, good morning. Thanks for your question. It's pretty standard application and aligns with some of the comments we've made in, you know, prior communications about what FDA is looking for. I think where this IND may differ from other INDs is that, you know, we're pretty far along from a clinical point of view, and we were able to supply clinical information from the ongoing study done outside the United States. We were, of course, careful to provide a very careful and complete update of that information. Otherwise, I'd say it's pretty standard stuff.
Maury Raycroft (Research Analyst)
Okay. Maybe one follow-up, just if you could talk a little bit more about the phase II design, and types of patients and how you can leverage the data for a potential streamlined pivotal study in HAE.
John Leonard (CEO)
David, you wanna address that?
Glenn Goddard (CFO)
Yeah. The phase II, we've shown it publicly, it's in our slides, but basically it's three arms. There'll be an arm at 25 milligrams, an arm at 50 milligrams, and a placebo arm.
John Leonard (CEO)
The size, it's 10, and five patients. The idea here is to select the dose for the pivotal study. We have, obviously, some very good information already from the phase I, seeing really excellent results at all three doses. 50 and 75 looked very much the same in terms of pharmacokinetics, so we did choose the lower dose possibly being a safer dose. The 25 milligram dose as well was quite good but did look a little different in terms of pharmacokinetics. That's really the trial. It will be informing our phase III, which we are already thinking about the design and getting ready for. It will contribute to the eventual BLA, by, you know, for additional information about patients. But that's the main use of the trial.
Maury Raycroft (Research Analyst)
Okay, thanks for taking my questions. I'll hop back in the queue.
Operator (participant)
The next question comes from Greg Harrison with Bank of America. Please go ahead.
Greg Harrison (Vice President and Senior Research Analyst)
Hey, good morning, and thanks for taking the question. Wanted to ask how you're thinking about the future of the curative sickle cell landscape now that some competitors have discontinued investment in the space. What do you think will be the next step beyond the CRISPR-Vertex approach, and how do you win there?
John Leonard (CEO)
Yeah, thanks for the question. It's an important one and one that we certainly thought about even from the earliest days of the company. I think what we've seen is that sickle cell is curable. I mean, and that question, in our judgment, has been answered, and I think that's great news for patients. The challenge for those patients, however, is the nature of that cure. The editing, I think, is enhanced. It's the application of that editing that where we believe we can make significant progress. We've been focused really since the outset as we thought about that disease, doing it in an in vivo setting where one can avoid a bone marrow transplant and the morbidity and occasional mortality that comes with that. That's a more general solution for patients.
And in fact, I think it's a very, very broad-based solution, even for patients outside the standard Western markets where most patients with sickle cell reside. That's where we've focused our efforts. You know, from our perspective, based on what we've seen, that space is wide open and, you know, we intend to get there first.
Greg Harrison (Vice President and Senior Research Analyst)
That's helpful.
John Leonard (CEO)
Okay.
Greg Harrison (Vice President and Senior Research Analyst)
Thanks again for taking the question.
Operator (participant)
The next question comes from Joon Lee with Truist Securities. Please go ahead.
Mehdi Goudarzi (Biotech Equity Research Analyst)
Hi. Good morning. This is Mahdi on for Joon Lee. I will follow up on the previous question and asking, like, what is your strategy now? Is that you're following the same type of edits for sickle cell? What would be your delivery mechanism? I have a quick follow-up question afterwards.
John Leonard (CEO)
Well, thanks again. Our strategy hasn't changed for some years now. We've always been focused on the in vivo setting. Just to be clear with respect to the Novartis news, that was an ex vivo only application and one that has been, you know, followed by them and others in the space. For us, we've always focused on the in vivo setting. From an editing point of view, we think there's any number of potential edits that can be successful. Our particular approach is not one that we've disclosed, but what I think we've learned is that the disease is curable. It's really a matter of delivery and making sure that that's done in a way that is robust and works well for patients.
Mehdi Goudarzi (Biotech Equity Research Analyst)
Awesome. Could you please provide some color on your in writing system? Any idea, is it similar to existing techniques out there like PEs and twinPE, or is it more similar to homologous recombination? Any color in that domain would be appreciated. Thank you.
John Leonard (CEO)
Yeah. We're not disclosing the specifics. We think about it in terms of capabilities, which is the resulting gene edit. In our case, we're most interested in, you know, what the resulting change in the DNA is and the specifics of how you get there. The particular enzyme system is proprietary and one that we've worked to develop. We're excited about our ability to introduce the intended changes and do that with great fidelity and great specificity and great activity, frankly. As we go on and the results mirror it, we will be in a position to share more about the progress we're making. Needless to say, as Laura made clear in her remarks, we're very, very excited about where we are and where we're headed.
Mehdi Goudarzi (Biotech Equity Research Analyst)
Thanks for taking our questions.
Operator (participant)
The next question comes from Swapnil Medhekar with Piper Sandler. Please go ahead.
Swapnil Medhekar (Analyst)
Hey, good morning. Thank you for taking my question. You had previously mentioned the likelihood of having an interim readout for the pivotal trial in ATTR cardiomyopathy. Just wondering, like, how the new emerging data and the new emerging clinical endpoints that you mentioned in the press release are informing this decision of an interim analysis?
John Leonard (CEO)
David, do you wanna address that? Just to be clear, we're not talking about sharing interim results of a pivotal trial. I think maybe, David, you could just clarify what.
Swapnil Medhekar (Analyst)
Sure.
John Leonard (CEO)
what our plans are with data disclosures for the ongoing study and.
Swapnil Medhekar (Analyst)
No. Yeah. Sorry. I meant just in terms of clinical trial design, if there will be an interim analysis. Yeah.
David Lebwohl (Chief Medical Officer)
Okay. Yeah. For the phase III, as you know, we're designing that now. We're not talking about the exact details, but we have said that we think the important endpoints are cardiovascular events and mortality. You've seen some of the other trials out there. It does have to be a large trial to study these questions. We, you know, we'll have a big advantage as we start to do our trial, and that will may see early results from the other trials, which will help inform how we design this trial. We are considering whether an interim analysis would be valuable here. Because we have the best reduction in TTR, we also expect to have the best efficacy in that trial.
Because of that, the trial could be positive in interim analysis, and we're looking carefully at that possibility.
Swapnil Medhekar (Analyst)
Got it. One follow-up I had is, you mentioned that there have been like, more than 50 patients dosed across two programs, with some of the patients reaching two-year mark. I was just wondering if there were any relapses in TTR or kallikrein in any of the patients that required redosing. Thanks for taking my questions.
David Lebwohl (Chief Medical Officer)
Yeah. I think what you've seen in our studies is this effect seems to be permanent. We see the same reduction across time with these drugs. Based on the mechanism and based on what we're seeing clinically now, we do expect the effects to be permanent.
Operator (participant)
The next question comes from Gena Wang with Barclays. Please go ahead.
Huidong Wang (Managing Director, Biotech Equity Research)
Hi, good morning. This is Hashida on for Gina. Thank you for taking our questions. Can you hear me okay?
John Leonard (CEO)
We can.
Huidong Wang (Managing Director, Biotech Equity Research)
Awesome. Thank you. For NTLA-2002, are you able to disclose how recently you submitted the IND? How will you communicate to the investor community the outcome? Can we expect a press release?
John Leonard (CEO)
We're not sharing when we submitted the IND. you know, we're giving a broad update today, and so that's part of that process. We will, of course, share the results of the FDA review when we have that information, just as we promised, you know, from the outset here. Stay tuned and, you know, hopefully we'll have some favorable results to report.
Huidong Wang (Managing Director, Biotech Equity Research)
Okay, great. Thank you. I had a very quick follow-up. On NTLA-2001, in the prepared remarks, I think David Lebwohl mentioned to expect new emerging data on other endpoints, like later in 2023. Can you elaborate, you know, what other endpoints that we can expect data on? That would be great. Thank you so much.
John Leonard (CEO)
David, what lies in store?
David Lebwohl (Chief Medical Officer)
Yeah. What we're looking at, you know, the patients who've been longest on the trial, where we would possibly have the most information are the patients with polyneuropathy. Some things we've looked at in those patients include the NIS score, the NIS, which is slightly different from the mNIS+7, but gives similar information on the neuropathy symptoms. Another thing we're looking at is cardiac amyloid. This is present both in polyneuropathy patients and in the CM patients. Those are the type of things that we may have enough information on later this year.
Operator (participant)
The next question comes from Terence Flynn with Morgan Stanley. Please go ahead.
Terence Flynn (Managing Director and Senior U.S. Pharma and Biotech Analyst)
Great. Thanks so much for taking the questions. I was just wondering, as you think broadly about the pipeline, I know you did the Rewrite Therapeutics deal, but just thinking more broadly, do you think there's a need for any additional business development, or do you think you have all the tools you need at this point, John? Then one kind of second question, which again, not sure if it's applicable or not, but yesterday, a CRO announced some supply chain issues with non-human primates. I was just wondering if that might impact any of your preclinical work or timelines. Thank you.
John Leonard (CEO)
Yeah. Thanks for the question. Yeah, we read the same news and have inquired. We're not aware today that there's any impact on the work that we're doing. We hope that that doesn't change, but that's the current situation. With respect to BD, you know, we think about it two ways, I guess. You asked about it in terms of tools. You know, an important part of our strategy is to have a toolbox that is complete, and we think about that in terms of the capabilities, in terms of those different changes that we wanna be able to introduce into DNA. We think we've got a great toolbox. You know, we watch what's happening on the outside.
We have our own scientific efforts internally and, you know, look for new capabilities that we think would augment the toolbox. At this point, we're pretty satisfied with the things that we wanna do. Of course, we'll keep our eyes open. I think the broader approach to BD for us is just thinking about deploying that toolbox, not bringing things into it. What we're seeing is all kinds of wonderful opportunities, some of which we're advancing ourselves, some of which we're advancing with collaborators. You know, in the last 18 months, we've had four different collaborators that, four different collaborations that we've struck to augment the work that we do in our own pipeline.
Whether it's ophthalmology with SparingVision, autoimmune disease with Kyverna, our spin out with AvenCell, or work in NK cells with ONK, these are really exciting applications of the capabilities already in hand, and we expect to do more. I think if you step back and look at our pipeline, and bear in mind the clinical rights that we have, commercial rights that we have from each of those different collaborations. You see that this is, especially for a company like ours of this size, a wonderful pipeline that's replete with opportunities. BD, yes, toolbox good, with a lot of internal work going to make sure that it remains unsurpassed.
Operator (participant)
The next question comes from Luca Issi with RBC. Please go ahead.
Lisa Su (Analyst)
Oh, great. Thanks for taking our questions, congrats on all the progress. This is Lisa on for Luca. Just one on the cardiomyopathy pivotal trial. Just wondering if we should expect two trials here, maybe one with the six-minute walk test as the primary endpoint and another with, cardiovascular-based outcome study. Maybe on sickle cell disease, can you expand further on why Novartis decided to discontinue the program? If there's any clinical data available, will you be in a position to share it? Thank you.
John Leonard (CEO)
Yeah. I can't speak to Novartis's decision other than they've been going through what appears to be a broad review of their pipeline and their different approaches to it. I would just remind you that for us, that has been a Novartis-only program, one that we've not directly participated in. We provided reagents to them some years ago. We've always believed that the future lies with the in vivo approaches, and that's been focus of the work that we do. I'm sure they looked at the ex vivo space and may have had some of the same realizations that, you know, we had some years ago. I think it's apparent where that space will ultimately go. David, maybe you can ask or answer the question about pivotal trials. How many do you actually wanna do?
David Lebwohl (Chief Medical Officer)
Right. you know, we're not telling the exact program, but we don't think that dividing those things into two trials is a great idea going forward. The six-minute walk test, there's been more questions about how valuable it is to understanding how patients are doing, and you've seen that in some of the recent trials of in amyloidosis. Again, we think the important endpoints are cardiovascular events and mortality. That's what the patients are interested in, the doctors are interested in, the payers are interested in. It's really what we're most interested. The regulators, of course, are very interested in those factors.
Lisa Su (Analyst)
Great. Thanks for taking our question.
Operator (participant)
The next question comes from Yanan Zhu with Wells Fargo. Please go ahead.
Yanan Zhu (Senior Analyst, Biotechnology Equity Research)
Hi. Thanks for taking my question. On the HAE program, I was wondering, what's the reason or rationale for having this placebo arm in this phase two study? Also in terms of the goal of the treatment, for this kind of one-time treatment approach, do you think, a complete cure is kind of the expected outcome for this kind of type of approach or there could be a different kind of outcome and still appropriate for this approach? Thanks.
John Leonard (CEO)
David, what role does placebo play, and what's the aspiration?
David Lebwohl (Chief Medical Officer)
Sure. Having placebo-controlled trials are the gold standard in randomized trials. Of course, you don't expect them to benefit in the placebo arm, but of course, you've also seen there can be a strong placebo effect in many trials. That's the risk of not having that arm not to compare, it's not a comparative trial, it's a phase II, but it's a reference arm to see that what we expect is to have a very strong effect in both of the doses, 25 and 50, and to have little or no effect on the attack rate in the placebo arm. That will help, again, inform and help us design the pivotal trial and choose the dose.
I should mention that the patients with placebo arm will be offered to cross over and get the active drug once their evaluation is completed. Of course, we do this because of the contribution they're making to our study and their desire to get this type of therapy as part of their potential cure, going to the second part of this. This idea of a functional cure is what the idea that you could get to zero attacks in patients with this single treatment. Whether we can achieve that is, you know, it's too early to say. We're very encouraged by the early results. We are getting deeper reductions in kallikrein than to achieve with the best agents that are out there. So it is possible that this will also lead to better efficacy.
This aspiration to have a functional cure or to patients to have no attacks after receiving our drug.
Yanan Zhu (Senior Analyst, Biotechnology Equity Research)
Great. Thanks. If I could have a quick follow-up on the cardiac amyloid you mentioned, that might be a readout for the 2001 program. Just wondering, is the expectation that the cardiac amyloid will be resolving or the expectation that it is just stabilizing and no more additional amyloid addition? Thanks.
David Lebwohl (Chief Medical Officer)
This hasn't been well established. There are, you know, of course, there aren't therapies that get to the very low levels of TTR that we're able to achieve. The idea we have and we hear from the key investigators in this area is that if you do get to low enough TTR levels, you will the rate of amyloid deposition into organs will be so reduced that the equilibrium will be the other way. In other words, the removal of amyloid from the heart greater than the addition of amyloid due to, you know, the small amount of TTR that would be in the blood at that point. That's what we're hoping to. The idea then is a possible reversal of the heart disease by getting rid of that amyloid, and that is our aspiration for that trial.
Yanan Zhu (Senior Analyst, Biotechnology Equity Research)
Great. Thank you for taking the questions.
Operator (participant)
The next question comes from Salveen Richter with Goldman Sachs. Please go ahead.
Salveen Jaswal Richter (Equity Research)
Hi, this is Srinathra on for Salveen. Thank you so much for the update. Could you provide some color on the nature of discussions that you're having with regulators regarding the global pivotal study for NTLA-2001, in both ATTR-CM and ATTR-PN? Also regarding NTLA-2002, how confident are you regarding the IND acceptance, and do you have any timelines in mind about when we'll get this information?
John Leonard (CEO)
Maybe, David, you can address, you know, how we think about the pivotal and when we'll be in a position to share information. I just, with respect to the IND, I would say it this way. We've had a variety of interactions with various regulators, including the FDA, in the run-up to this. We believe that we're addressing the questions that they wanted us to address. It's not just the list of those questions, but it's the extent of the data that we've tried to provide that actually goes to, you know, making sure that we're not just checking boxes, but we're really answering questions and helping them to evaluate the product.
Additionally, as I said at the outset, we've supplied clinical information, which I think is unique with respect to some of the other INDs that have played out over the last, you know, few years in this space. We think that that's a helpful bit of information for the FDA to consider as, as they do their evaluation. We look forward to the outcome. You know, obviously it's subject to their review, but we think we've done a good job of robustly supplying information. As we've said with respect to timelines, when we have the information, in terms of the outcome of that review, we will share it and, everybody will know at the same time. David, you just wanna say a few words about how we approach the pivotal and when we'll be in a position to share that information?
David Lebwohl (Chief Medical Officer)
Just what John said about all aspects of our, the IND submission. Another piece of that are clinical discussions that have gone on both in the pre-IND setting with regulators around the world, in Europe. With that, we have, we're coming forward with a trial design. We have the leading investigators in this area, supporting us in designing this trial. The point at which we'll have an agreed trial will have to do around the time of the IND. We've said that's the middle of the year for the IND for NTLA-2001. As well in Europe, you know, with the CTA applications that go on for that phase III as well. That will be.
The other thing we've said is that the trial will start by the end of the year. That's sort of the time frames you have. As we have more details, we will share those with you.
John Leonard (CEO)
I might add one important distinction for the listeners to keep in mind. With respect to NTLA-2001, which differs from the NTLA-2002 IND application, we're talking about an IND that would pursue a pivotal trial. In some respects, it's not just an IND with all the preclinical work, it's also supplying the information that would typify an end of phase II meeting with the FDA. We expect the NTLA-2001 application to be a very, very substantial filing, when we in fact do it. Which is different from NTLA-2002, and it's certainly different from most of the other INDs in the space that have been for first in human applications. As the year goes on, I'm sure we'll be talking more about this.
Salveen Jaswal Richter (Equity Research)
Thank you.
Operator (participant)
The next question. Go ahead. Okay. The next question comes from Rick Bienkowski with Cantor Fitzgerald. Please go ahead.
Rick Bienkowski (Director and Equity Research Analyst)
Hi, everyone. Good morning. Congrats on all the progress, and thanks for taking the questions. For the NTLA-2002 program, the worldwide phase II trial initiation looks to be a bit staggered with sites outside the U.S. opening first while the IND application is submitted to the FDA. My question is, if the FDA does have any feedback on either trial design or endpoints in the study as you know, after the IND review, are there any mechanisms to amend the trial protocol for sites outside the U.S. after the trial has already started?
John Leonard (CEO)
David, do you wanna speak to that? I mean, I'd remind everybody this is a phase II study. It's not a pivotal trial. Some of the details are less consequential. David, do you wanna speak to that?
David Lebwohl (Chief Medical Officer)
Yeah, I should say that, you know, when you're submitting a trial around the world, different regulators will often have different ideas about details of a trial, usually not the big picture. It is very possible that there can be amendments to the trial that occur related to feedback either in the U.S. or from outside the U.S. Sometimes it's very helpful. We think they're good ideas. Sometimes we just have to follow their direction for various reasons. Yeah, that certainly could happen. There is a good mechanism for doing that, which is the amendment process for the trial.
Rick Bienkowski (Director and Equity Research Analyst)
All right. Got it. Thank you. A quick follow-up. There's a few novel technologies in the early pipeline now, gene writing, base editing, and proprietary LNPs. I guess it's difficult to get a sense of how far away all these technologies are from getting into the clinic or what sort of indications, you know, these technologies might be able to address. Are there any timelines for when we may get some more substantial updates for the progress of these earlier stage technologies?
John Leonard (CEO)
We haven't guided to any particular products or pipelines. We've spoken generally in prior presentations about useful applications of base editing, where we think it makes the most sense. That tends to fall primarily in the ex vivo setting, where one is hoping to introduce many simultaneous knockouts. We have very advanced work in that space, and we've talked a little bit about our allogeneic platform that we're very excited about. I would encourage you to stay tuned with respect to future updates and that and where base editing may fit into that space. We'll see. With the gene writing approach, it's earlier days, but we're making really excellent progress in terms of getting very high levels of specificity, and we're able to introduce the intended changes that we're looking to do.
As that moves along, we'll find what we think are the appropriate applications and talk more about that. In the meanwhile, we're focused on, you know, progressing NTLA-2001 and NTLA-2002 and making sure that we continue to demonstrate that any of these technologies really matter for patients in a meaningful way. That's where we think we are with, you know, the current progress. More to come and we'll share those updates as appropriate.
Rick Bienkowski (Director and Equity Research Analyst)
Got it.
Operator (participant)
A reminder to kindly keep yourself to one question. The next question comes from Raju Prasad with William Blair. Please go ahead.
Raju Prasad (Analyst)
Thanks for taking the question. Just kind of wondering the cadence of the IND submissions, why NTLA-2002, well, did come in ahead of NTLA-2001. Was it because, as you referred to earlier, the NTLA-2001 application's larger, or I'm just wondering because the durability and amount of data for the NTLA-2001 program on the clinical side is much higher?
John Leonard (CEO)
It's really unrelated to what you're saying. 2002 is at the proper point to begin phase II. 2001 will be at the point to begin phase III work and to have the information necessary to support that 2001 IND, which again, I liken to an end of phase II meeting, you know, a far more substantial filing than a typical first in human IND. Getting the full complement of clinical information, which is not just the acute exposure and the short-term editing results, but actually following these patients for some period of time is an important part of that application. It's just the way the timelines work out. David, if you have anything to add to that, I mean, that's the essence of it.
David Lebwohl (Chief Medical Officer)
Yeah. No, Those are the important features of the timing.
Raju Prasad (Analyst)
Great. Maybe just a quick follow-up. Just wondering the rationale behind the ATM in Q4 on top of the follow-on. Just wondering why. Thanks.
John Leonard (CEO)
Glenn, you wanna speak to our fundraising?
Glenn Goddard (CFO)
Sure, yeah. We thought at the end of Q3 of last year and early Q4 was an opportune time to use the program just based on how the stock was trading and volume. An opportunity opened up in late November, December to do the follow-on. We took advantage of that. Wasn't pre-planned to do it that way. It's just how things worked out.
Raju Prasad (Analyst)
Great. Thanks.
Operator (participant)
The next question comes from Dae Gon Ha with Stifel. Please go ahead.
Dae Gon Ha (Director, Biotechnology Equity Research)
Great. Thanks for taking our questions and congrats on all the progress. I'll just stick with the IND question again. With regards to the 2002, I guess to what extent do you think you've fully addressed some of the FDA concerns? We're obviously very limited to what's publicly disclosed from one of your competitor programs or peer companies. To what extent is the depth and the extensive nature of your submission, so in the case of how many pages you submit, will that be a limitation factor as it pertains to the review within that 30-day period? Thanks so much.
John Leonard (CEO)
I can't speak to the number of pages and how fast the various reviewers at the FDA read them. That's not the metric. That we use, although, you know, these applications tend to be very, very large, as you know, because there's a lot of information shared. We try to, you know, address the questions as posed by the regulators. You know, I think an important thing to emphasize is it's not just data, but it's really testing the robustness of the system. You know, these are principles that apply not just to our space, but to drug development in general, whether you're doing small molecules, antibodies, whatever. We've tried to apply that kind of thinking, knowing from prior experience how the FDA thinks about this stuff.
With respect to other people, I can't address that. I don't know the work, the nature of it, et cetera. We'll see. You know, the FDA, as they review it, I'm sure will pose questions to us. We'll do our best to answer them. We don't expect to have major deficiencies in the IND. If there's smaller questions that they want clarification on, we will answer them as quickly and as robustly as we possibly can. You know, we think we have a full complement of information available.
Dae Gon Ha (Director, Biotechnology Equity Research)
John, just a naive question. With regards to the IND review, is there something analogous to a PDUFA extension where they just need more time to review, or does it have to be a binary yes or a clinical hold?
John Leonard (CEO)
My understanding is that it's 30 days, and you get a clearance or a hold, then if there is a hold, there's additional information provided by the FDA in terms of what they're looking for in a very formal way. Then, you know, that's when you're in a position to best answer their follow-up. You know, if it takes a little longer for them to go through this stuff, we'll see. Again, we believe that full complement of information has been provided to them.
Dae Gon Ha (Director, Biotechnology Equity Research)
Great. Thanks so much.
John Leonard (CEO)
Sure.
Operator (participant)
The next question comes from Debjit Chattopadhyay with Guggenheim. Please go ahead.
Debjit Chattopadhyay (Managing Director and Senior Biotech Analyst)
Hey, good morning, all. Thanks for taking our question. Can you provide an update of how many patients have been treated across each clinical stage program, including the dose expansion cohorts? Thanks.
John Leonard (CEO)
I think we'll keep it at the high level. You know, collectively over 50 patients have been treated. A lot of the information is already out there in terms of different groups and different studies, et cetera. Most of that information is fairly current. Obviously, we continue to dose patients in the, you know, second phase of the study, and later on this year, we'll give you the full complement of that information.
Debjit Chattopadhyay (Managing Director and Senior Biotech Analyst)
Great. Thank you.
Operator (participant)
The next question comes from David Lebowitz with Citi. Please go ahead.
Debanjana Chatterjee (Senior Research Associate)
Hi. This is Debanjana, on for David. We wanted to ask if you can provide us any further color with respect to the timing of data in 2023. Are you collecting kallikrein activity data in addition to the reduction in protein levels?
John Leonard (CEO)
David, do you wanna speak to what we're actually collecting with NTLA-2002 with respect to kallikrein and what is the anticipated flow of clinical data across the programs this year?
David Lebwohl (Chief Medical Officer)
Yeah. We are collecting both kallikrein protein and activity. We said we'll be presenting more data towards the end of the year. The important piece of that data is a dose that we haven't reported on in terms of attacks, and that's a 50-milligram dose. If you recall, we went 25 to 75 and then stepped back to 50 to sort of fill in our dose response. We found 50, as I said, is good as 70. We expect, of course, to get a similar activity to 25 and 70 because they both were able to reduce attacks to 0. We will be reporting that later this year.
Debanjana Chatterjee (Senior Research Associate)
Thank you for taking our question.
Operator (participant)
The next question comes from Richard Law with Credit Suisse. Please go ahead.
Richard Law (Analyst)
Thank you. Are HAE's phase II studies such that the timeline is not dependent on U.S. sites? For example, if you receive a clinical hold on the IND, you can run the trial to completion in the ex-U.S.
John Leonard (CEO)
We can.
David Lebwohl (Chief Medical Officer)
Mr. Law, could you please repeat your question?
Richard Law (Analyst)
Yeah, sorry. The question is that, would you design HAE phase II study such that the timeline is not dependent on the US site? If you get a clinical hold from the for the IND, you can run the entire phase II study outside the US, and it wouldn't affect the overall development trial completion.
John Leonard (CEO)
Yeah. I mean, the simplest answer to that question is yes, we can. Of course, the, you know, priority is to have U.S. sites participating, and that's the expectation, and that's something we're gonna work very, very hard to do.
Richard Law (Analyst)
Also, have you thought about what's the for ATTR-PN, would you use an external control group or an active control group for the pivotal?
John Leonard (CEO)
David, are you in a position to talk about your polyneuropathy study designs?
David Lebwohl (Chief Medical Officer)
Yeah. Again, we're not giving the exact designs. We have been very interested in all the submissions, or all the pivotal trials so far have not used a, an active, comparative arm, and that has to do with the rarity of this disease and the reliability of some of the historical data about what's happening in these patients. And that's been used, as you've seen in, for example, the vutrisiran submission.
John Leonard (CEO)
We're looking at all that, and we'll be coming forward with a design, that we'll talk about, when we have the details.
David Lebwohl (Chief Medical Officer)
Great. Thank you.
Operator (participant)
The next question comes from Jay Olson with Oppenheimer. Please go ahead.
Jay Olson (Managing Director and Senior Analyst)
Oh, hey, thank you for the update and congrats on the progress. For 2002, can you talk about the rationale for using the 25 and 15 milligram doses in the phase II study and any particular reason not to pursue the highest 75 milligram dose? Are there any lessons learned or read-across from the 2002 IND that you plan to apply to the 2001 IND? Thank you.
John Leonard (CEO)
David will speak to the doses and how we think about that. I think with respect to the read-through, we'll see. Obviously, NTLA-2002 is going in before NTLA-2001, and if there is information or feedback that we can apply, we would certainly do that. The same basic philosophy has been applied to both of those programs with respect to prior engagement with regulatory agencies, the sorts of things that they're looking for, which doesn't differ across the programs.
Just again, to draw the distinction, NTLA-2001 is a far more advanced clinical program, and the nature of the progression of the program in that IND would be moving to pivotal programs where a dose selection, CMC material, a pivotal trial, et cetera, will all be part of that review, which we think will be more substantial in nature. In terms of the basic preclinical information, we expect them to be quite similar. David, do you wanna speak to the dose selection in the NTLA-2002 phase II?
David Lebwohl (Chief Medical Officer)
Yeah. The phase II was always planned to study two doses in addition to the placebo. This is a preferred method from regulatory agencies to really understand the best dose rather than picking it coming right out of phase I. In this case, the three dose levels were all safe. They all led to 0 attacks, it made it a little more challenging. What we did see is that the pharmacokinetics was very similar. We think we're saturating by the time you reach about 50 milligrams. 75 milligrams looked very similar in terms of pharmacodynamics, the reduction in kallikrein, reduction... Based on that, we chose the two, 50 as one of the doses, which is sort of, we think, as high as you need to go to get, you know, optimal activity.
We chose the 25 as a second dose. A little bit less in terms of pharmacodynamics, as you saw. Instead of reaching towards 90%, it was more like a 60% reduction in kallikrein. We thought, again, for regulatory agencies to demonstrate that the higher dose might be better than lower dose is important because you are going to a higher dose for the potential additional risks of going to a higher dose. All in all, the safety is so good, we're not really too concerned about that aspect of it, but that's why you do those things.
Jay Olson (Managing Director and Senior Analyst)
Great. Thank you very much.
Operator (participant)
The next question comes from Brian Cheng with JP Morgan. Please go ahead.
Brian Cheng (Vice President and Equity Research Analyst)
Good morning, John and Dave. Thanks for taking my questions. We're curious if you have any thoughts around the regulatory bar for IND clearance, specifically in the U.S., for in vivo gene editing for some of the non-orphan larger disease indications, compared to smaller orphan in markets. Any feedback that you can provide on how the regulators are handling the risk-benefit, especially in the indications with larger TAM? Thank you.
John Leonard (CEO)
I can't speak to how the FDA is assessing benefit risk in terms of the actual application of an editing approach. We've tried to be very, very careful about choosing disease states in which it's pretty clear that an editing approach should benefit every single patient that is exposed to the agent. Treating risk factors, for example, has its own challenges. I think a good case can be made to do that. When we think about, at this point in the evolution of these therapies, a benefit risk backdrop where you're dealing with mortal illnesses or illnesses that pose great risk to patients is the right setting to apply and to apply the particular modalities. The FDA has shared some sense of that, I think, in guidances that they've released.
You know, I think the regulators, in my experience, try to take a considered view of what one can do for patients with different approaches. As they assess some of these other indications, those are, you know, conversations that I'm sure will play out as they're brought up one by one by the various sponsors who do that. That would be our experience thus far.
Brian Cheng (Vice President and Equity Research Analyst)
Great. Thanks. That was helpful.
John Leonard (CEO)
Sure.
Operator (participant)
The last question today will come from Joseph Thome with Cowen and Company. Please go ahead.
Joseph Thome (Managing Director and Senior Research Analyst)
Hi there. Good morning. Thank you for taking my question. Maybe just the first, give me one. Did you have a pre-IND meeting formally, before the HAE IND or maybe why wasn't one appropriate at this time? Just a follow-up on the CM trial. In terms of timing of that initiation, is the main gating factor just clearance of the U.S. IND, or is there a certain amount of follow-up that you wanna see from those expansion cohorts? Thank you.
John Leonard (CEO)
Maybe David can speak to, you know, the nature of our conversations with FDA in 2002. I just with respect to that 21 pivotal trial, we intend for it to be a global program, which means U.S. sites. We wouldn't begin a pivotal trial, at least the way we think about it now, without those U.S. sites. As we've said previously, you know, what we're looking for is a very robust filing that includes extensive clinical information tantamount to an end of phase II filing. That work is underway. That data collection will certainly be a part of what the application is. You know, when you do a pivotal program, you wanna have your final commercial material available to be used in that clinical trial. That's certainly part of this as well.
The program is quite advanced and moving as we had hoped. Stay tuned. As we have more information, we'll share it. David, you want to say anything about 2002?
David Lebwohl (Chief Medical Officer)
Yeah. We did have a formal pre-IND meeting, for this. We've, because we've said before, we have feel we've addressed the questions that they've raised in that process.
Operator (participant)
Great. Thank you very much. This concludes our question and answer session. I would like to turn the conference back over to Ian Karp for any closing remarks.
David Lebwohl (Chief Medical Officer)
Great. Thanks so much, everyone, for joining us today and for your continued interest. We certainly look forward to providing additional updates as we progress throughout the year. Thanks, and have a great day.
Operator (participant)
The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.