Bristol-Myers Squibb Company (NYSE:BMY) 44th Annual TD Cowen Healthcare Conference March 4, 2024 9:50 AM ET
Company Participants
Roland Chen – SVP and Head, Cardiovascular and Neuroscience Development, Global Drug Development
Conference Call Participants
Steve Scala – TD Cowen
Steve Scala
Well, good morning once again. We’re delighted to have Bristol-Myers Squibb here at the Cowen 44th Annual Healthcare Conference, representing the company is Roland Chen, who’s Senior Vice President and Head of Immunology, Cardiology, or Cardiovascular and Neuroscience Development. So thank you so much for making the effort to be with us.
Roland Chen
Thanks, Steve.
Steve Scala
You’re in charge of three critical areas to the outlook for Bristol-Myers Squibb. Just tell us in very brief fashion, what is the central objective in each of these three areas, say for the next three to five years?
Roland Chen
Yes. So thanks for that question, Steve. It’s a pleasure to be here. I think if I just think about the three areas, I mean, let me start with cardiovascular. I think where we are focused is in cardiomyopathies and heart failure and thrombosis. And so if you think about the next three to five years, we are highly focused on CAMZYOS, our first in class cardiac myosin inhibitor now approved for obstructive HCM, as well as milvexian, which is deep into Phase 3 as a next generation oral factor XIa inhibitor in the antithrombotic space. And so those are two pillars that we continue to be focused on in the cardiovascular area. Now, with respect to neuroscience, this is an exciting area. Bristol was in neuroscience, this was in the past decade, we exited, but we are reemerging in the neuroscience space. And we are looking to build a diverse portfolio of agents with a focus conditions of high unmet need that is in conditions which are neurodegenerative in nature, neuroinflammatory and neuromuscular, areas of high unmet need where the technology and the science are really starting and really just at the cusp, I think, of seeing really great innovation and products there. Of course, we’re excited about our pending acquisition of Karuna and what KarXT does in terms of accelerating our entry into neuropsychiatry. And then finally, in immunology, of course, we’ve been long in immunology with ORENCIA. We continue to have a focus in development in the rheumatologic space, of course, with the ongoing development of Sotyktu. We also continue on with programs in the GI space. We’re very excited about pulmonary. And so with our LPA-1 antagonist, which is now in Phase 3, for IPF and PPF. And so those are some of the areas of focus, Steve.
Question-and-Answer Session
Q – Steve Scala
Okay, great. I should have mentioned at the outset, should you have questions anywhere along the line, please ask and we’ll get your questions answered. So lots to dig into here. So much going on. Let’s start out with Milvexian. So the last time I think we got a full update was perhaps at your analyst meeting back in September. Give us an update on the three major studies, stroke, ACS and Afib, where do they stand, how is enrollment going and when should we look for data?
Roland Chen
Yes. So thanks for that question. As I mentioned already, we’re very excited about Milvexian. Milvexian is a new approach in the antithrombotic space. And it really is trying to address an unmet need that continues to persist in spite of the advances represented by Factor Xa inhibition. There still remains unmet need, particularly with respect to bleeding, the inability to use Factor Xas in certain clinical conditions and to combine with certain agents. That is what we are trying to achieve with Milvexian, that is to bring forward a molecule with efficacy, that is at least as good and hopefully better than Eliquis, but with a better bleeding profile. We continue to be very confident based on, again, the number of lines of evidence that support Factor Xa s a target genetic epidemiologic preclinical but I think most importantly, our Phase 2 clinical data, which was a comprehensive program into very different treatment constructs that gave us the confidence as we move forward into Phase 3. I think, Steve, you asked about Phase 3 and where we are. We are well underway in Phase 3. We’re very pleased by the way in which our programs have been received by the investigator community, of course, our academic leadership, we are progressing well. We have received fast track designation in all three of these indications that we’re pursuing. And we’re looking forward to bringing data in house around the ‘26 timeframe for ACS and SSP and in 27 for AF. Of course, we’re looking to do everything we can to accelerate that with our partners at Johnson & Johnson.
Steve Scala
Maybe you can talk about this unmet need. Eliquis is a very good drug, huge success. So where are all these patients that will be used — helped by Milvexian that aren’t by Eliquis, what do those patients look like?
Roland Chen
Yes. So thanks for that question. It’s an important question, because again, it goes right to the heart of where the unmet need is. It’s been estimated that upwards of 40% of patients don’t receive a Factor Xa or are under dosed with a Factor Xa when indicated for that. The types of patients that one might associate with this could be those who are elderly, those who have certain comorbidities, such as say renal disease and other factors, as well as intangible factors that lead to this situation where patients are unable to receive a Factor Xa inhibitor. I would add one other thing, Steve, to your question, is that it is a challenge to combine Factor Xa inhibitors with certain regimens that are already in place for very important indications. So the challenge of combining Factor Xa inhibitors with say dual anti-platelet therapy has been a challenge. It’s not a challenge on the efficacy side we think based on data that came out in the ACS space, but really a challenge with respect to safety. And that’s really — and really impeded the ability to use Factor Xa inhibitors in conditions such as acute coronary syndrome or secondary stroke prevention. So those are the kinds of populations and the kinds of patients that we’re really trying to study with Milvexian to see if we can make a difference for those patient populations.
Steve Scala
Questions from the audience? So one of your competitors in an Afib trial had an issue. Our independent KOLs believe that Bristol’s trial design was just more thoughtful and better plans. So maybe that could be one reason why the competitor had an issue and Bristol has not. But does Bristol believe it’s out of the woods with respect to the Afib trial and having a similar issue, are we far enough along, have we seen enough patients to be reasonably confident we’re not going to have a similar issue?
Roland Chen
Yes. So thanks for the question. I might touch first on the first part of your question and what you mentioned. It’s part of why BMS continues to have confidence in Librexia AF and it is founded on the data that we accrued in Phase 2, specifically and most particularly in our TKR study where Milvexian was studied as monotherapy in patients undergoing total knee replacement. We had the chance, and this was also across our other study, to evaluate Milvexian across a very broad dose range. This was a 16 fold dose range across both studies. And in both studies, we saw proof of concept in efficacy and safety. In TKR — and this was the model, the Phase 2 model that was used actually to help develop Eliquis moving forward into the ARISTOTLE program, is that in that study, we were able to show a dose response for efficacy as well as no major bleeding. And so that allowed us to really select the dose that we thought would be able to compete with Eliquis in Librexia AF specifically with a 100 milligrams VID in our Phase 2 study, we were able to show superiority versus Enoxaparin, which is the standard of care.
And we showed superiority to an extent, of course, with the caveats in cross-trial comparisons that we think will give us the opportunity to compete on an efficacy front and/or perhaps even be better than Eliquis, we’ll have to wait for that data. But also I think with that we are able in our Phase 2 program by studying in two populations to tailor the dose in our Phase 3 program. And so if you think about the dosing strategy that we took for Librexia AF, it’s a dose four times that we’re using in ACS and SSP. And that is important, because I think we know that we’re going to have to take a higher dose in the AF program because we had an active comparator and a really good product in Eliquis to go up against. In terms of your question about how we think about readout, we’re not going to get into to specifics on interim analyses. We do have a DSMB that is monitoring all three studies and all programs. There are regular intervals at which we — the DSMB, I would say, actually evaluates these data. Of course, as more time passes, we continue to gain reassurance with the program. But we continue to read forward. We are well underway with the programs and things are going well with recruitment.
Steve Scala
Great. Can I ask if the competitor’s trial hit futility relatively early, presumably that would give one pause about the idea that a higher dose with [indiscernible] issues on the efficacy funds? Do you consider that a fair statement? And with your interim analyses, are you beyond where they were at their futility analyses?
Roland Chen
So actually, there isn’t a lot of detail as to exactly why the study, OCEANIC-AF was terminated. We have word from the press release actually that it was terminated based on the DSMB recommendation. We don’t know the details. We don’t have a sense of the details. I think, though, when you think about our program, if, again, go back to our Phase 2 study, we’ve selected doses based on efficacy against standard comparators as well as our knowledge of Eliquis and our modeling data that we think can give efficacy that is on a par with Eliquis in Librexia AF. So it’s hard to comment exactly the reasons or how far along they are. We would just be speculating at this point in time but we continue to gain confidence as we move forward in Milvexian program.
Steve Scala
So let’s move on to other assets within the Bristol portfolio, maybe we’ll move to CAMZYOS. So we’re awaiting the HFpEF data Phase 2a readout later this year. What’s your level of confidence or what should investor confidence be in this readout being positive?
Roland Chen
Yes. So we’re very excited about the cardiac myosin inhibition broadly with respect to heart failure with preserved ejection fraction and with CAMZYOS in particular. And I’ll also touch on MYK-224, our next generation CMI in HFpEF. With CAMZYOS, our confidence is born really, if you think about our Phase 2 study, the MAVERICK study in nHCM, where we saw realsy strong decreases in NT-proBNP and troponin, as well as other markers and indices in a condition that shares a lot of similarity with heart failure, with preserved ejection fraction. So that was the genesis of the EMBARK study. We are looking forward to data coming out this year in house that we’ll have to evaluate with the EMBARK study. And so we’re very excited about that. We’re also excited about the fact that we’ve initiated a Phase 2 study in heart failure with preserved ejection fraction with our follow on cardiac myosin inhibitor, MYK-224. This is a molecule that we’re very excited about. We’ve been studying it in patients with obstructive HCM, a condition that we know a lot about, and helps us to accelerate our own understanding of MYK- 224 as we move forward. We’re excited that that study has kicked off. We are looking forward to data coming out of our Phase 2 program in MYK-224 in 2025. I think this highlights as well the flexibility, Steve, that we have in having more than one cardiac myosin inhibitor by having a portfolio, if you will, of CMIs, we can tailor how we develop our programs accordingly. So we’re excited about data readouts in both.
Steve Scala
So, if EMBARK hits its Phase 2a endpoint later this year, do you move to Phase 3 and what does Phase 3 look like?
Roland Chen
So I think we’re going to have to wait and look to see what the data are in EMBARK. I’ll say that we are really though focused in HFpEF with MYK-224, our follow on compound. And so I think we’ll also be able to take a look at the data from EMBARK when it’s available and also use that to apply learnings as we think about our cardiac myosin inhibitor portfolio overall.
Steve Scala
Okay. Another assay you have in development is danicamtiv, and we’re awaiting data here too, also Phase 2 data. What’s your level of confidence in that, maybe you could also say a word about primary dilated cardiomyopathy and what the level of unmet need is and so forth?
Roland Chen
Yes. So I think with danicamtiv, that’s our cardiac myosin activator. It is currently in study in patients with the genetic dilated cardiomyopathies, condition of high unmet need. Look, at this stage, we’re looking at various options on how we could develop danicamtiv and how we’ll actually move forward with that asset, especially when we have data in house and the complete data picture. But I think we’ve been focused, I will say, on our cardiac myosin inhibitor portfolio right now. That said, we’ll continue to look forward as to how we might move forward with various options with danicamtiv.
Steve Scala
Questions from the audience? Sticking with cardiology. Bristol had a relaxin program for years and years and years, and we don’t see it in the pipeline any longer. Other companies are starting to work in the area. What’s going on at Bristol with relaxin or is that a target that you’re not focused on at this point?
Roland Chen
Yes. So we did discontinue our relaxin program a few years back, it was because it didn’t meet the high bar that we set for development products in general as we think about how we prioritize in our development space. That said, relaxin is an interesting target and it’s along with all other targets in cardiovascular, one that we monitor, we’ll continue to look at as we move forward. But we discontinued our program a few years back.
Steve Scala
Okay. Let’s move to KarXT. So what should investor expectations be for the Phase 3 readout in adjunctive schizophrenia that we’ll get next year?
Roland Chen
Yes. So with adjunctive — the adjunctive readout, first of all, I think if you step back with KarXT, there’s a high degree of excitement founded on the EMERGENT data that is EMERGENT 1, 2, 3 and then the data that’s forthcoming in the long term. I mean this is an innovative approach to schizophrenia an area where there really hasn’t been innovation in decades literally. And I think with that and that data with an efficacy and safety profile that differentiate from standard of care, there’s a lot of excitement here. I think when you think about adjunctive schizophrenia, the realization is that a number of patients who received atypical antipsychotics, as much of an advance as that was patients don’t necessarily respond. There is a fraction of patients that don’t respond and certainly a fraction that responding completely. I think that is compounded by the fact that there are tolerability challenges with atypical antipsychotics. With KarXT having a complementary mechanism of action that is M1, M4 agonism that is, we believe, complementary to the atypical mechanisms, that there’s an opportunity to show benefit in an injunctive indication. I think the target is data around ’25 in-house for the RISE program. Again, an exciting program if you think about the data that have come forward thus far.
Steve Scala
You touched on this a moment ago, but compliance is an issue with schizophrenia drugs. Is there a reason I think KarXT will be better or worse than [indiscernible]?
Roland Chen
The compliance, we are — we’d be very excited about the potential for KarXT to be different based on its profile. If you step back with the atypical antipsychotics with compliance, there are challenges with, if you think about metabolic impact and adverse effects, weight gain and other issues with the atypicals as well as factors that relate to, say, movement disorders and other side effects. Because KarXT works through a different path, a different mechanism, again, through M1 M4 agonism, the data that have come forth have shown a good tolerability profile that is different than from the atypical antipsychotics. I think that’s part of the hope that, that tolerability profile how will drive a different compliance picture than we’ve seen with the atypical antipsychotics historically.
Steve Scala
Another indication you’re pursuing for KarXT is Alzheimer’s disease psychosis about a year behind, but also in Phase 3. What’s your level of confidence here or maybe you could talk about that opportunity?
Roland Chen
Yes, another exciting opportunity. As I mentioned, BMS’s interest in neuropsychiatry and again, broadly, as we reenter into the neuroscience space. With KarXT, there’s enthusiasm about its potential in AD psychosis, because of the data that have come forward and because of the mechanism. So again, when you think about M1, M4 agonism, these are places where we think that, of course, Karuna has thought that we could drive benefit. And this is borne out in part from data, proof-of-concept data that were generated from xanomeline. And so this is xanomeline alone prior to the construct that is KarXT with trospium, but xanomeline alone have been shown in patients with probable Alzheimer’s disease to actually have benefits in Alzheimer’s disease psychosis as well as agitation. And so when you look at a number of measures in that proof-of-concept study that has driven some of the promise and the belief in this approach for that particular indication. And so I think, again, with data, we hope in ‘26 with the ADEPT program, again, a very exciting program with KarXT in Alzheimer’s disease psychosis.
Steve Scala
Across these indications, you may have competition from M4 selective compounds in the future. How important is the M1 pathway for all the various symptoms?
Roland Chen
Yes. Thanks for the question. We think that the M1 pathway is important as well as the ability to have direct agonism at M1, M4. I think if you think about the M1 pathway, that we think could be potentially important as you think about some of the cognitive benefits that might be associated with, say, M1, M4 agonism, something that you would miss with say in M4 alone or an M4 PAM, for example. I think of course, the data will bear out. But if you also think about the positive allosteric modulators, they rely on a sort of native level of acetylcholine for effect. Again, it defer from the way KarXT works with direct agonism at the level of receptors. But when you think about it, that’s part of the reason why we have belief in the KarXT approach. Of course, again, these will be studies that will run out over the coming years.
Steve Scala
Questions from the audience? You mentioned Alzheimer’s disease, Bristol has a long held focus in this area. Now you’re working on an anti-tau antibody. What should we know about that?
Roland Chen
Yes. We’re really excited about our anti-MTBR tau antibody. I don’t need to spend time talking about the unmet need associated with Alzheimer’s. I think that there is — there is, as I mentioned or alluded to some hope with recent approvals in that area. With our tau program, we believe that we have a differentiated approach to how we’re approaching tau. I think a few things I would point out, Steve, is I think, first, with tau in general, tau is a protein which seems to correlate better than say amyloid beta with respect to cognitive empowerment. And I think that’s important as you think about attacking the sequelae of Alzheimer’s disease specifically. But I think secondly, with our approach that is an antibody that attacks the MTBR region of tau, there’s a lot of data and data that continues to emerge that shows that the MTBR tau is actually very well correlated, perhaps best correlated with tau accumulation through, say, tau PET scanning as well as cognitive empowerment. So the approach of trying to attack tau is one that defers from some of the other tau approaches that have come before. And so we’re very excited about this tau program. I think the preclinical as well as our clinical data thus far with our MTBR tau also give us belief in this target. So we’re looking forward to in the near future enrolling patients in our Phase 2 study here.
Steve Scala
Great. We’re down to about a minute left. You did mention at the outset immunology, well, that’s immunology is one of your areas of responsibility, but the pulmonary aspect of it. So maybe you could just update us on your program now.
Roland Chen
Yes. We’re very excited about our LPA1 antagonist, we are well underway in both Phase 3 studies in IPF and in PPF. Again, our belief borne out of our Phase 2 data, where we showed proof-of-concept and efficacy with over a 60% reduction in the progression of pulmonary decline by FPC with a good tolerability profile without GI tolerability issues and without hepatic issues. And so we’re excited about this target. We have been excited about LP1 antagonism, because this is actually a second generation engineered molecule with the first generation molecule had also shown efficacy. That gives us confidence moving forward into Phase 3. And so we’re looking forward for data in-house in ’26 and ’28 in IPF and PPF respectively.
Steve Scala
Great. With that, we are actually out of time. Is there one last question from the audience? Okay. If not, Roland, thank you so much for a great rundown.
Roland Chen
Thank you.
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