Q2 2021 Aurinia Pharmaceuticals Inc Earnings Call
[music].
Hello, and welcome to the Iridium Pharmaceuticals second quarter earnings call and webcast. At this time all participants are in a listen only mode.
And what should require operator assistance. Please press star zero on your telephone keypad, a question and answer session will follow the formal presentation. As a reminder, this conference is being recorded its now my pleasure to turn the call over to Glenn Schulman and head of Investor Relations. Please go ahead.
Thanks, Kevin and thanks, all for joining us today, as we discussed already and second quarter financial results John.
Joining me on the call. This afternoon are Peter Greenleaf, President and CEO, Joe Miller, Our Chief Financial Officer, Mexico allow our Chief commercial officer, and Neil Solomons, Our Chief Medical officer here to linear.
Our agenda for today, Peter will provide a review of and we've kind of its launch date, our outlook for the rest of the year, along with our ongoing clinical and regulatory activities.
From there Joe will discuss our financial performance in more detail and then after some closing remarks and Peter the whole channel be here and available for your questions.
Note that todays press release announcing our financial results and recent operational highlights are accessible from our website at www Dot Iranian pharma dotcom.
It's also been filed on a form 8-K with the S E T and SEDAR as well and it's afternoon.
We filed our financial statements and accompanying managements discussion and analysis and our quarterly report on form 10-Q.
Please note that during the course of this call. We may make forward looking statements based on our current expectations. These forward looking statements are subject to a number of significant risks and uncertainties and our actual results may differ materially.
For a discussion of factors that could affect our future financial results and business. Please refer to the disclosure and our press release and and our quarterly report and form 10-Q, and recently filed 10-K, which are publicly available on our website.
Along with all of our recent U S S SEC and Canadian Security Authority filings.
Also note that all the statements made today during the call are current as of today August 5th 2020, 1 and based upon information currently available to us at this time.
Except as required by law, we assume no obligation to update any such statements as of this date.
With all of that and let me turn the call now over to Peter our CEO and President Peter.
Hey, Thanks, Glen and I don't want to thank everybody for joining us. This afternoon. So through the first half of 'twenty 'twenty..1 we've made significant progress against all aspects of our company strategy.
And today, we're going to walk you through the 4 major areas of focus for India and provide you with details on our execution and results achieved to date.
The first and by far the most important at this stage is our progress with the U S launch of <unk> for the treatment of patients with active lupus nephritis.
We will briefly walk you through the work we are doing to expand access to loop guidance, which includes our global regulatory filings and our continued focus on generating new data for patients living with L and.
From there and we'll provide you with an update on our financial position and runway as a company and then lastly, we will touch on where we see Iranian strategically and operationally by the end of 2021.
After all of this we will open up the microphone to you all to see what questions you may have.
So here, we are well into the summer and just over 5 months into the loop kindness launch I guess needless to say and we generated a lot of data points up to this point to supplement our prelaunch research and continue to learn more now that we actually have entered the real world environment, including lupus nephritis patient characteristic.
<unk> and health care professional attitudes and behaviors.
With this ongoing understanding of the market and just under 2 quarters of commercial availability or our confidence with loop guidance remains undiminished.
Let's start with the primary key metric for the second quarter patient start forms, which as a reminder, equate to loop kindness prescriptions being written for patients there.
And there were 415, that's up approximately 60% from the first quarter, we see this as a clear signal of generating momentum and the adoption of loop kindness.
As you know lupus nephritis is a rare disease, we've said that from the outset. The majority if not all of the medications used by physicians to treat the disease are unapproved generic treatments that have been used for the last 20 to 50 years. So prior treatment regimens are all the health care.
<unk> and patients have known historically.
Education, and new products and adoption of new treatment approaches takes time, but.
But I'm happy to tell you that our data and promotional efforts to date are having real impact.
Next let me walk you through our revenue performance for the quarter and provide some context, because theres a positive message here as well and.
In Q2, we generated $6.6 million and net sales and this number exceeded consensus expectations for the quarter and shows the type of ramp we have expected with the new drug and an indication that did not historically have and FDA approved treatment. We believe this in combination with the prevailing wins of the Covid.
Environment is a significant result.
Okay, let's move on to some other positive trends as of today patient start forms are well north of 800 to date and our conversion rate to patients on therapy continues to increase from what we last reported at the end of Q1.
On the payer coverage front.
<unk> is currently covered for over 110 million lives and the United States and we are continuing to pursue further coverage.
To provide somatic granularity behind that number there are as of today at least 50 published loop kind of clinical coverage policies importantly.
Importantly, the prior authorization requirements across these policies are very much in line with the package insert and in fact, the restrictions are less onerous and what we had originally expected all are reasons to be optimistic.
We believe this trend will continue to grow for the remainder of 2021 and drive down our time to starting therapy and drive up our overall conversion rates.
In addition, I can also reported at the rate of prescription abandonment to date, so far has been low.
And so far, albeit it is early on and the launch our rate of compliance is also exceeding our initial launch expectation.
And the face of these results. We have also experienced some challenges enacted on many key end market learnings.
And most prominent of these of course is the pandemic.
I think you've all heard the impact of Covid on patients, either postponing or canceling care and treatments for all types of conditions, but.
But I'm here to tell you that the impact on lupus nephritis patients has been particularly particularly problematic.
Treatment used by patients is down no matter, which metric you look at almost 10% of LNG patients completely exited the health care system in 2020, while diagnostic kidney biopsies, which is how lupus and lupus patients are diagnosed with lupus nephritis are down 22 per.
St compared to before the pandemic. So the addressable pop population of lupus nephritis patients was reduced by and material extent just as we were approved for use.
And of course this impacts the initial rates by which things can initially ramp up but regardless to pandemic related factors that have been speeded access to health care today will recede and hopefully refer back to pre pandemic levels over time.
And we are also being proactive and have implemented definitive steps to help identify more patients more rapidly and drive loop kind of its adoption.
Our sales marketing and medical affairs effort together made an important impact for patients.
Team has conducted more than 30000 calls on target clients to date.
This is due in part by US taking and early stand on vaccination and I'm glad to report that nearly all of our field force has been vaccinated.
The <unk> team is also gaining greater access to health care professionals as COVID-19 restrictions begin to ease, which is especially noticeable and the northeast and out and the west regions. The.
And the percentage of live calls also increased from the first quarter to 80% of interactions versus where we were the last quarter.
And internal and external market research has reported that loop kind of efficacy messages resonating favorably with health care professionals with a high level of recall.
The implication of that is that more clinicians we can visit and communicate this powerful message to the more prescribing will resolve.
Through all of these efforts we have seen the physician intent to treat continue to increase we are seeing both the community and the large lupus centers.
And increased responses from both Rheumatologists and Nephrologists.
While we always aspire for more I can tell you that our efforts to date have been on target.
Knowing there is more to do we will continue to execute with tremendous urgency and our entire Iranian team remains committed to realizing the true potential of <unk> for patients living with lupus nephritis.
So with all this in mind I want to provide some guidance on where we feel the full year will shake out.
I am often assets and while we still think it's very early and the gain we would like to provide some steer on how we see the first year revenue landing.
Based upon a number of factors, including the current growth rates expected conversion rate improvements payer reimbursement attrition rates and our compliance estimates we believe that our 2021 net revenue will land and the range of consensus and currently forecast net.
Avenue between 40 and $50 million for loop kindness. After the first 11 months of marketing.
Now I'd like to shift our focus beyond the U S and onto our efforts to make Boquist born global therapy.
We're pleased to announce that in June that our ex U S partner Otsuka submitted the MAA for <unk>, 4 and seeking regulatory approval for the treatment of adults with active lupus nephritis and Europe with the application filed we still expect a standard 12 month review cycle, meaning that the.
CH ANP opinion.
Should be made around mid 2020.
Followed by an MAA decision anticipated and the third quarter of 2022.
Just as a reminder, approval in the EMA will result, and the achievement of additional milestone payments of up to $30 million to Iranian.
As well as the ability to earn low double digit tiered royalties on sales.
Along with further revenue for supplying the product to us silica.
This all has potential to significantly strengthen our future financial position as a company.
With regards to Regulus support regulatory support and work going on for the J NDA filing in Japan, we alongside of US Suk are currently engaged in discussions with the MDA.
And these early conversations have been encouraging and we look forward to providing updates as definitive filing timeline is determined.
So alongside of our globalization efforts, we continue to drive new data for loop kindness and 2021 and beyond.
And we see this as key to our objective of evolving the treatment paradigm.
So let me recap this past may we announced a supportive interim analysis of the Aurora 2 continuation study showing that individuals that were treated with loop China's sustained meaningful reductions in proteinuria with no change and <unk> mean, egfr and 104 weeks of treatment.
The Iranian team remains on track to achieve database lock to the Aurora 2 blinded to year continuation study by the end of 2021.
We are therefore updating our guidance and we will report topline data from Aurora 2 by the end of this calendar year.
We believe Aurora 2 will be critically important to support the longer term treatment of L and with loop guidance.
In addition to Aurora 2 the team is finalizing the protocol and working to initiate vehicle, which is the adolescent trial, a volume was born and lupus nephritis.
As well as the protocol for a lack patient study with thoughtful of scoring which.
Which is all and alignment with our FDA post marketing commitments.
Additional phase 4 work includes a lupus nephritis registry that we are initiating to explore additional real world usage of loop kindness.
And the research team is also evaluating novel novel dosage formulations of <unk> foreign including both oral and topical applications.
Now moving on to the financials and obviously 1 important question is how much cash do we have on hand and.
And is it enough to actually get us what we need to accomplish.
With a cash position and excess of 320 million, we remain sufficiently capitalized to fund our current operations and execute on our longer term strategy.
While we don't run a static business year things can always change of course, we have no immediate needs to raise money.
Something I'm proud to say that not every company and our position Kim report at.
And at this early stage of a launch.
Our earlier cash runway guidance into 2023 remains consistent.
Outside of performance I'd like to take a moment to highlight some recent board changes 1 of our long term directors Dr. Michael Hayden retire during the second quarter, which provided us with an opportunity to appoint Dr. Brenda balakrishnan to fill the seats Dr.
Dr. Balakrishnan as group, Vice President of corporate and business development at Biomarin.
Where she leads initiatives on corporate strategy, and mergers and acquisitions and partnering and licensing.
We look forward to her contributions to the board and leveraging her experience and guidance as we continue to build there anyway.
Finally on the long term strategy front. The company continues to evaluate strategic opportunities through external business development. We remain focused on identifying the right auto immune disease assets for the right indication and an effort to provide our stakeholders with long term value.
We remain committed to building out and diversifying our pipeline and we expect to make progress on this key objective by the end of 2021.
So to sum it all up we are seeing positive trends across almost every aspect of our business we.
We remain confident that we have a significant commercial opportunity with loop guidance and.
And we know that we have the right team the right product and approach and place to get there.
Well I'll circle back at the end of the close to call thank to close things out.
I'd like to now pass the baton over to Joe Miller, our CFO to provide more color on the financials Joe.
Thank you Peter and good afternoon, everyone as of June 32021 Arena had cash cash equivalents and investments of $323.7 million compared to $423 million at December 31, 2020.
We are devoting a majority of our operational efforts and financial resources towards the commercialization and post approval commitments of our approved drugs look guidance.
Taking into consideration the cash and cash equivalents and investments as of June 32021, we believe that our cash position is sufficient to fund our current plans, which includes funding commercial activities, including our FTE and related post approval commitments manufacturing commercial drug supply conducting our planned R&D programs funding are supporting corporate.
Infrastructure and investing and our pipeline into at least 2023.
Total revenue was $6.6 million and $29 and for the 3 months ended June 32021, and June 32020, respectively and.
Total revenue was $7.5 million and $59 and for the 6 months ended June 32021, and comparison to the prior year period. Our revenues primarily consisted of product revenue net of adjustments Portland guidance. Following FDA approval in January of 2021.
Cost of sales were 308000 and $0 for the 3 months ended June 32021, and June 32020, respectively.
Cost of sales were 356000 and $0 from the 6 months ended June 32021, and comparison to prior year period. This increase was primarily the result of our commercial sales guidance.
Gross margin for the 3 and 6 months period, ending June 32021 was approximately 95%.
SG&A expenses increased to $43.8 million from the 3 months ended June 32021, compared to $15.4 million for the 3 months ended June 32020.
For the 6 months ended June 32021, and June 32020, SG&A expenses were $83 million and $26.5 million respectively.
The primary drivers for the increase from the 3 and 6 months ended June 32021, as compared to the prior year period, where an increase in salary and incentive pay and employee related benefits and share based compensation expense related to the expansion of the commercial and administrative functions to support the launch of loop guidance. Following FDA approval. In addition.
There was an increase and professional fees for activities, such as patient assistance programs and consulting recruiting cost legal market research and other marketing related activities.
R&D expenses were $10.1 million and $11.1 million from the 3 months ended June 32021, and June 32020, respectively.
For the 6 months ended June 32021, and June 32020, R&D expenses were $19.9 million and $24.9 million respectively.
The primary drivers of the decrease from lower <unk> expenses and other third party clinical trial costs together with a decrease and clinical supply and distribution costs following the approval and the guidance.
The decrease was partially offset by an increase and employee related expenses.
For the quarter ended June 32021 Arena and reported a net loss of 47 million or <unk> 37 per common share as compared to a net loss of $26.5 million or <unk> 24 per common share for the quarter ended June 32020 for the 6 months ended June 32021 Arena and recorded a net loss of $97.4.
From <unk> 76 to 76 per common share as compared to a net loss of $52.5 million or <unk> 47 cents per common share with that I would like to hand, the call back over to Peter for some closing remarks, Peter So thanks, Joe and again. Thank you all for taking the time to join US This afternoon and closing we <unk>.
Do you have a clear picture of the early launch trajectory and our beliefs and Luc kindness and the success of this company with our metrics across the board continuing to show positive results. We are making a difference for people with serious autoimmune diseases, we look forward to providing additional updates and the months and quarters to come and I would now like to.
Turn to microphone over to the operator for questions with that operator, please feel free to open it up to Q&A.
Thank you and other conducting a question answer session and people.
If you place from the question queue. Please press star 1 on your telephone keypad.
A confirmation tone will indicate your line is and the question queue.
You May press star 2 if you'd like to remove your question from the queue for participants using speaker equipment and may be necessary to pick up your handset before pressing the star keys.
And that's far 1 and to replace and the question queue.
Our first question today is coming from OUP Young from Cantor Fitzgerald. Your line is now live.
Hi, This is Emily on for Alethia, Thanks for taking our questions and congrats on the solid quarter I'm curious what are the factors that you are seeing to be most helpful and driving rheumatologists and nephrologists to prescribe the drug based on your education efforts and maybe as a follow up do you have any feedback on how physicians are thinking about duration of treatment.
And if you think the Aurora 2 data later this year could potentially help that makes those decision. Thank you.
Walter and I said, well, thank you very much and water and I start and if I Miss on anything I'll jump to Max Colao and see if he has anything to add I think it's a multitude of different factors that are helping us.
And to get initial prescriptions 1.
You have to 0.1st at the data and the compound without that I think you always have a challenge to market any drug.
It is a data driven itself, we have to not only work the physician through.
And the data that we've been able to devote develop and deliver through phase II and phase III, but I think it's also important that we have to deliver that with a specific patient and minds so patient.
Filing patient identification, helping a physician come up with a patient and mind as being critical.
Can't emphasize enough I guess, if this is a very strong clinical cell and.
Our reps are trained to do so and that's probably the single biggest driver too.
Getting a patient on the drug that and identifying the right patient to your question on the and the.
Aurora, 2 extension trial, and its importance and expectations around physician dosing I think this is something we're learning about right and it is our expectation net debt because when we position the product that physicians are looking to reduce.
There are overall levels of proteinuria, but to do that over time, because the data that's out there shows that.
And Harry has not kept and control over time that these patients have worse outcomes and can move on to more severe disease and even depth if theyre not treated and that is generally that's not just with our drug but if they're not treated aggressively.
So I think physicians go in with a mindset that therapy.
They're putting patients on this drug and not just for induction, but to maintain the patient's overtime. The Aurora 2 data is going to be important because remember.
And our initial approval was based upon 1 year data and throughout the year we were.
Done cuts of the data at major medical meetings, and we've been able to produce data to show continued control of proteinuria as well as.
No negative at least through this data set no negative impact on kidney function as measured by by GFR Egfr. So it's important and we think this data is going to be very helpful. As we move into our second year of launch and patients looking to get on another year of treatment for those early ones that we've got on early and.
And the launch so we think it's going to be important Max did I Miss on anything there.
No I think you've hit it perfectly thank you.
Thank you. Our next question today is coming from Justin Kim from Oppenheimer and company. Your line is now live.
Alright, and good afternoon, and thanks for taking the questions and congratulations on the progress.
Just wanted to know if you could talk a little bit more about the 50% conversion rate do you have any insight as to what proportion of those unconverted start forms continue to be executed compared with those having run their course.
And additionally, sort of which forms may or what proportion could be challenged somewhat of a coverage payer level.
So all of them.
Here are 2 let me let me start.
I think.
Any initial rare disease launch.
And I wouldn't even call it a challenge I think the.
And the initial.
Process for getting a patient on drug involved and paperwork and involves a prior off and most cases and and that alone is an initial hurdle you need to get over but.
On this rate Max or any color you want to give.
Below the 50, 50% plus conversion rate that we reported that.
I think it's important I think.
Sure.
Go ahead match, yes, no as Peter highlights.
There is some paperwork involved.
To to get access and and that takes a little bit of time, so really it at any point in time, we may have 20% to 25% of the start forms that are work in process.
And where the payoffs are being completed there may be some appeals and need to be done so and.
And then there is some of the start forms that are canceled and but as Peter highlighted and the call. The cancellation rate that we've been seeing is relatively low, especially when we compare ourselves with benchmarks. So our cancellation rate is less.
Less than 20%.
And we see with benchmark, 25% to 35%. So so I think that's the way to think about it always some portion that's work in process and then.
And the rescue to patients on treatment.
Okay got it and it's great to see that number tick up from from the prior quarter.
Just on the start forms.
The sort of.
Right at which I think the third quarter is shaping up looks to be somewhat flat and I'm. Just wondering is there a sort of a seasonal effect do you anticipate with the summer.
In terms of start forms and.
Any thoughts there.
I didn't catch and comment on what where you see the rate of start forms, but what I would say is.
And we're interested and looking at the impact of how this summer months affect both patients coming into the office is patient.
And consistency consistency of patients staying on drug and of course, the activity of physicians prescribing the drug and what.
What I can tell you and the early start of the month data from July that's a little bit of color under underneath those numbers. We reported is that I would say there is consistency.
And.
And our but our back half of the year numbers, obviously can continue to show.
Progressive growth and those numbers in order to achieve what we projected as our revenue range for the year.
Okay got it.
And maybe a final question.
With the data that youre seeing it seems encouraging how patients getting on therapy and staying on therapy. Just wondering if 65000 net price per patient and something that we should still expect and how we should think about cogs as a percentage of that number.
Yes ill give you cogs to Joe but.
What I would tell you is I think our band it made number is low and we're happy about that and our EBIT and this early stage I think that's something we can track and and feel good about I think on the persistency side and that would be patient starting on.
Prescriptions, and then continuing on and those numbers are even better but it's so early in the game that we have to watch that over time.
And Ah patients that we have to see patients on drug for 6 months, a year year and a half 2 years before we really know what our ongoing persistent fee rate is going to be.
I can tell you early and the launch it's less than 10% and that are going off of drug and Thats a good number even at this early stage on the average net all I can tell you is that we are we are consistent or above where our average net we projected which was 65000.
And again, there I think we need time to continue to see how that shapes, but we are not below and and <unk>.
As I said, we're either on or above which is which I think is a good positive trend going forward, Joe you want to take cost.
Probably non registration work, we don't have intent to go into other broad base kidney diseases and and the reason for that is not necessarily mechanistic, it's probably more based upon our ability and our inability to continue to drive further intellectual property. If we can find ways to extend.
And that longevity, then we might change our view there we are doing some formulation work, which is centered around bolt.
Maybe some some other ways to administer the product and have some elements of intellectual property around them more to report their when we have something meaningful and up to do so.
And the other elements of business development Center.
<unk> center totally around diversifying our portfolio and what I would say is.
And we said and the call. Our goal is to make start making inroads on that front and 2021, so expect to hear more from us soon there.
Alright.
1 more question is has the kindness and prescribed and newly diagnosed and and patience.
As we said even on the first call and I'll repeat for the year repeated here the products and prescribed to cross I would say that continuum.
And and clinician to clinician interaction. Thanks, so much.
Okay, Thanks, again and good questions.
So I think we'll stay consistent here came with what we've said on the patient population from the start but I'll provide a little bit more of a drill down in terms of the over arching sort of diagnosed patient population. We think there's probably somewhere and of course. These are estimates 80 to 120000.
And patients and the U S and that we've said and the past we think that number outside the U S can probably be replicated through Europe and are and what little Japan work that we have so it's a sizable patient population now there's a caveat to that as you go further down and.
And sort of disease severity, and where patients are and the continuum of their disease, whether they have active lupus nephritis, whether what drug therapy. There on what stage of disease. They have that number whittles down so back to the previous question on are you getting.
Newly diagnosed patients eventually to grow with this thing to the point that we're going to want to grow it too we're going to have to continue to press down earlier and the treatment paradigm, which I think is everybody knows our data supports because then we studied a wide range of patients, but today it feels even.
And more like a rare disease because of the patients were hunting for are probably more of those patients who have seen at least a course of MMF and steroids and still have active disease, which is a much smaller and and today I would hesitate to put an exact number on that as we learn more.
And will most likely provide more more detail on what we're learning, which I think leads a little bit into your second question, which was you know.
Is there a tendency and what we're seeing for physicians too.
Not be aggressive and adoption of new therapies and sort of be wedded to what they've done.
It was pretty purposeful the commentary that we put into the the earnings call around.
New therapies, where where there have not been FDA approved medicines and the past and these areas like Lucas nephritis, where physicians have been used and the same therapies for for decades that it's a little it takes longer to educate to gain comfort and.
And to get physicians to be more aggressive in terms of how they treat and trying to lower proteinuria I would say rheumatologists are probably a little more aggressive on that curve than our nephrologist and I think that has a lot to do with the onslaught of new innovation, that's been driven into.
Rheumatology and maybe as it pertains to certain bear kidney diseases, where there hasn't been as much new innovation. So what we're doing about that is we are driving it and are clinical messaging. We're trying to go as early as possible or overly educating and how we train our <unk> our rep.
Presented is we are trying to do peer to peer programs, we're trying to drive thought leader driven speaker programs.
We're working hard with our medical science liaisons.
Both in the fields and that the major medical conferences, and we're trying to continually produced data and continue to move forward and not just with the data we have but new data. So this is fresh and the minds with those treating physician. So I'd say, it's the continuum of tactics you would expect on the medical education from.
Yeah, Peter and what I would add to that is and Ah.
Market Research post surveys, we consistently see that when we ask nephrologist or rheumatologists, we can see that more than half of them their intent to prescribe what kindness is is more than 50% of them have and tense prescribed within the next month or the next 3 months and just to add a little bit of color to the extent of our effort.
Around education over the since launch we've we've we've run more than 500 peer to peer programs uninvolved healthcare practitioners as well as S. K O L.
Thank you Max.
They can and what else.
Our next question is coming from David Martin from Blue Burn Your line is that a lot.
Good afternoon, and and congratulations.
A couple of questions are you seeing any off label use with cyclophosphamide.
I don't know I don't have specifics on net but I would say it has not come up and our conversations and combo with cyclophosphamide, but I know, we have such a wide range of patients.
And.
Probably and that mix, but if it is it's minimal and.
Okay, and you mentioned low abandonment, we're still relatively early in the adoption of the drug and discussions with physicians and you get a sense psalm any of them will treat to remission and withdrawal the patience from treatment or is this gonna be chronic.
Alright, and it's really too early and tell from data, but I can tell you David that are messaging and our positioning is centered around the data and we don't speak about or or talk about the drug with finish positions and a and junction and maintenance sort of mode. We talk about the import.
And is that controlling protein area over time, but it will play out and the data will know more when we start to see patients <unk>.
6 months, a year 2 years and I think.
It's kind of early to tell from just a straight data early data is good.
Okay, and then what about with bad list.
And show you around the same time issue or are you getting a sense now of what kind of patient doctors are putting on bad list versus Lou kindness.
Or do some doctors just treat all their patients would look kinda <unk>, how is that split and.
Yeah, and you know what I'm gonna phenomenon of pictures from 1 to 2 Max cloud because we were just talking about it yesterday and it's something that we do look at Max you want to you want to take this 1 on.
Yeah sure. So you know the data we have on that is anecdotal and then also a again through our market research poll surveys, but what we hear is that with the fries with some rheumatologist. Both is that they do position been list and kind of us really for different types of patience Anne.
And they look kind of patient that comes to the forefront is that patient.
Peter mentioned with high a level of proteinuria, where there's a sense of urgency in terms of bringing and the person area down quickly and and that and that patient maybe on M. M F and steroids currently the and.
And our approach surveys when we look at the intent to prescribe between <unk> and Luke kindness, it's actually it's it's around the same type of intensive prescribed but again, we believe that that's due to the physicians are thinking about different patient types and a portioning that out.
Okay.
Next question that you had a question about the trajectory of the patient start forms the math I've done and it looks like you.
Added.
Think about 165 and second quarter and now you've already added 135, you know just a little beyond the first quarter and Q3 that looks to be accelerating is my maths right or at my missing something here.
I think what you're doing is and you and knows number you're putting quarter over quarter additional patient, so remember and a quarter to we had $415 for a total of up to date north debate haunting right. So the weight and thinking about.
Growth quarter over quarter, we really had some guidance to that David because and not because we're trying to be tricky.
Because based upon the numbers, we've projected out a lot of different scenarios can happen. We tried to drive patient star forms every day. That's that's the number 1 objective and then once we get those star forms to get those patients honest on commercial medication as quickly as possible, but different things can happen like our average.
Net price can be different it can be more it can be less whereas to get to our forecast.
Is it the variability and all the metrics that feed into that can can can be there.
I don't think that's a bad assumption to think about is growth on top of the growth rate that we've put forward and and quarter to to think about that and additive way going to the back end of the year because I think if you average net on those patients and you assume a certain conversion racism and you can probably get you a <unk>.
Good idea of how we got to the numbers, we had and.
And so I mean, we wanted to get it and see arising here because we get asked so often but there still are a lot of parameters. We're dealing with that are non COVID-19 parameters based upon.
Assisted C average net et cetera that can all move around by the end of the year.
Okay, Great and I do have 1 other question if I can.
You you mentioned the target patience is kind of defined by at least right now having sales M. M S and steroids from your own trial and from other trials. We C. M. M. S and steroids you only get about 20, 25% of patients remitting on those so is is that remaining.
And 75% to 80% your target population right now or does it cut down smaller than that.
And <unk> me out a little bit here, but the.
I think the essence of your question is when we see a pulse survey of intent to prescribe how rapidly or we'd seen net materialize and to actual prescribing behavior and I think it's generally variable we have seen it pick up and I will tell you.
Now that we're seeing more improvement and the Covid environment I E patients getting back into physician offices, and our reps being able to get into offices that it's improving but I'm not sure that we have an exact quantification of how quickly. It takes a survey to materialize and to actual action Max do we have.
And anything on that no and and I think the perspective on this and as Peter highlighted this is a rare disease right and most of the patients from the community setting and and that setting an average of a physician may have 4 or 5 Ellen patients and total lists of their whole practice. So it's not that they're seeing these patients.
On a daily basis, and not even on a weekly basis right. So the intent to prescribe is how their digest and my mind is other digest and the data and how they are thinking about positioning and then it's the when the opportunity comes and clearly as you highlighted the opera urgency clearly drives prescribing and when that if that patient as presents at the net.
Next visit with a very high level of proteinuria and by and large most patients are with M. F and steroids right. So if they present MMF and steroids high level and area with kindness is going to be top of mind from a prescribing standpoint and from there. There's a discussion with the patient gaining agreement going through the the the the <unk>.
Assess the access process. So that that's that's all you know kind of how it works. So he can't really tie you know he 50 per cent next month is gonna realize this it's a matter of the flow of the patient and so that they work through the practice.
Okay operators and we have any more questions.
413 place and good question Q.
1 moment, please while he pull and further questions.
I like from the floor back over pretty further closing comments at this time.
Okay, well and with that I will again Wanna. Thank everybody for joining us today were encouraged by the results. We've seen today, but we obviously have more work ahead of us and we look forward to update and you again and the near future have a good night everyone.
Thank you. It does conclude today's teleconference and webcast you may disconnect July and at this time and have a wonderful day. We thank you for your participation today.