Q3 2025 REGENXBIO Inc Earnings Call
Speaker #2: Welcome everyone to the third quarter 2025 REGENXBIO Inc. Earnings Conference Call . At this time , all participants are in a listen only mode .
Speaker #2: After the speaker's presentation , there will be a question and answer session . To ask a question during the session , please press star one on your telephone and wait for your name to be announced .
Speaker #2: Please limit yourself to one question and one follow up . And if you have additional questions , please return to the Q and to withdraw your question , please press star one one again .
Speaker #2: Please be advised that today's conference is being recorded . At this time , I'd like to turn the conference over to Patrick Christmas chief Legal Officer of REGENXBIO Inc. .
Speaker #2: Please go ahead .
Speaker #3: Good morning , and thank you for joining us today Earlier this morning , REGENXBIO Inc. released financial and operating results for the third quarter ended September 30th , 2025 .
Speaker #3: The press release is available on our website at . HBO.com . Today's conference call will include forward looking statements regarding our financial outlook .
Speaker #3: In addition to regulatory and product development plans , these forward looking statements are subject to risks and uncertainties that may . results to differ from those forecasted and can be identified by words such as expect , plan , will , may , anticipate , believe , should , intend and other words of similar meaning .
Speaker #3: Any forward looking statements are not guarantees of future performance and involve certain risks and uncertainties . These risks are described in the risk Factors and the Management's Discussion and Analysis section of REGENXBIO Inc. Annual Report on Form 10-K for the full year ended December 31st , 2020 .
Speaker #3: For and comparable risk factors sections of REGENXBIO Inc. Quarterly Reports on Form 10-q , which are on file with the Securities and Exchange Commission and available on the SEC's website .
Speaker #3: Any information we provide on this conference call is provided only as of the date of this call , November 6th , 2025 , and we undertake no obligation to update any forward looking statements we may make on this call .
Speaker #3: On account of new information , future such events or otherwise . Please be advised that today's call is being recorded and webcast . In addition , any unaudited or pro forma financial information that may be provided is preliminary and does not purport to project financial positions or operating results of the company .
Speaker #3: Actual results may differ materially . I'll now turn the call to Curran Simpson president and CEO of REGENXBIO Inc. Curran .
Speaker #4: Thank you , Patrick , and thank you everyone for joining us today . I am pleased to share the strong momentum across our late stage pipeline of gene therapies , with the potential to deliver the best outcomes in devastating diseases .
Speaker #4: Our progress is anchored in our leading end to end capabilities , including in-house commercial ready manufacturing and innovative science , all driven by our commitment to bring new medicines to patients in need .
Speaker #4: Today , I am joined by Doctor Steve Pakula , our chief Medical officer , to discuss the exciting clinical development across our rare and retinal franchises .
Speaker #4: And Mitchell Chan , our chief Financial Officer , to provide financial updates . Let's dive in and start with our 202 . Our wholly owned program for Duchenne Muscular dystrophy .
Speaker #4: We are very encouraged by our progress in this program and are moving rapidly to deliver a much needed , differentiated treatment to Duchenne patients .
Speaker #4: Our comprehensive therapeutic approach behind RG 202 includes a novel construct , RTX 202 is the only micro-dystrophin that includes the CT domain , making it closest to naturally occurring dystrophin .
Speaker #4: A novel immune suppression regimen designed to enable high dose delivery and proactively counter issues seen in other AAV programs and commercial ready manufacturing .
Speaker #4: That is delivering the highest purity levels in Duchenne gene therapies . Boys with Duchenne have one chance at gene therapy . That's why we specifically designed RTX 202 with these elements to maximize opportunity for functional benefit .
Speaker #4: We are very pleased to see that this approach is resulting in the favorable safety and efficacy profile seen in phase one two . We are also very excited to announce that we completed enrollment in the Affinity Duchenne Pivotal trial , putting us on track to share top line pivotal data in early Q2 2026 and submit a Bla using the accelerated approval pathway in mid 2026 to meet demand from the patient community and support accelerated approval plans .
Speaker #4: The confirmatory trial is open and continues to enroll patients . As a reminder , we were able to complete enrollment ahead of our original year end guidance , underscoring the community's enthusiasm for RG 202 and strong need for new treatment options .
Speaker #4: We have more than enough supply of 202 ready and available for the entire confirmatory study . Delivering on the commercial readiness plans . We shared last quarter .
Speaker #4: We have produced the first batches of RG 202 intended for commercial supply at our Manufacturing Innovation Center here in Rockville , and expect to imminently complete our PBC or process performance qualification campaign .
Speaker #4: There is a significant commercial opportunity for RTX 22 due to our novel construct immune suppression regimen and our manufacturing capabilities , including our ability to produce 2500 doses per year , which make us uniquely prepared for clinical and commercial success .
Speaker #4: We continue to invest in preparations for a commercial launch in 2027 , when the vast majority of the prevalent population will remain available .
Speaker #4: Now to RTX . 121 also known as chlamydia gene Lampard , Vivek the potential first gene therapy in one time treatment for MPs two .
Speaker #4: Our recent FDA interactions regarding the ongoing Bla have been highly productive , and we remain confident in our 121 approval by early next year .
Speaker #4: We delivered positive 12 month data to FDA , which Steve will discuss in more detail , and the FDA completed inspections of our clinical sites and in-house manufacturing facility with no observations .
Speaker #4: A rare and significant achievement . These developments have further strengthened our confidence in the ongoing Bla review with our commercial MPs partner , Nippon Shinyaku .
Speaker #4: We look forward to the February 8th date and delivering the first commercial doses of RG 121 by early next year . Let's turn our focus to our retinal disease franchise and our ongoing partnership with AbbVie to .
Speaker #4: Develop gene or avec for wet AMD and diabetic retinopathy . These programs have the strength of AbbVie's leading clinical and commercial global eye care infrastructure behind them .
Speaker #4: In Subretinal wet AMD . We recently announced that the last patient was enrolled in our two global phase three studies . This is a tremendous accomplishment .
Speaker #4: Together , atmosphere and assent represent the largest global gene therapy program ever conducted , with over 1200 patients enrolled across 200 sites . If approved , Subretinal Cerovec would not only be the first gene therapy for wet AMD , a disease that impacts millions worldwide , but also the first gene therapy for a non rare indication .
Speaker #4: We look forward to sharing top line data in the fourth quarter of 2026 , as a reminder , we manufacture all clinical and future commercial zurovec at our facility here in Rockville .
Speaker #4: Like wet AMD , our diabetic retinopathy program is designed to deliver service to patients that rely on frequent , lifelong injections to halt degeneration and vision loss .
Speaker #4: And we look forward to initiating the phase 2B/3 pivotal program across our pipeline . These achievements reflect the strength of focused execution and a differentiated approach to developing and delivering best in class therapeutics .
Speaker #4: With that , I would like to now turn the call over to Steve for more in-depth updates on our clinical programs . Steve .
Speaker #5: Thank you . Karen . I'll start with the RCS 202 program for the treatment of Duchenne . As Karen mentioned , we are incredibly excited that enrollment has completed in the Affinity Duchenne pivotal trial .
Speaker #5: As a reminder , this study is designed to enroll ambulatory patients aged one and older and is the most advanced clinical stage gene therapy program for Duchenne .
Speaker #5: RG 202 has demonstrated a highly differentiated safety and efficacy profile , with consistent , robust Microdystrophin expression in the phase one two study .
Speaker #5: Last month , at the International Congress of the World Muscle Society . We presented individual nsaa data on the first four patients who received the pivotal dose .
Speaker #5: All four patients one year after dosing exceeded expected disease trajectory across multiple methods of assessment . Specifically , each patient exceeded their expected functional outcomes when compared to matched external controls and the well-established Ctap disease progression model .
Speaker #5: These data , combined with the June 2025 data showing all patients demonstrated improvement on time function tests , reinforce our belief that 202 is driving meaningful , functional benefits for patients .
Speaker #5: With this degenerative disease . It's important to note the majority of these patients were eight years and older at dosing , an age when functional decline is expected , making these results particularly impressive .
Speaker #5: The Duchenne patient and physician communities continue to recognize the excellent safety profile . 202 as demonstrated to date as reported in the phase one two study , we have seen no SAEs or adverse events of special interest , including no thrombocytopenia or liver injury .
Speaker #5: We attribute this to our proactive immune suppression regimen , our novel construct , using the nav aav8 vector and our field leading product purity with more than 80% full capsids .
Speaker #5: We are very pleased with how these differentiated elements enable us to deliver 202 at the two E14 vector genome per kilogram dose . We believe this dose gives patients and families the best shot at efficacy without compromising safety .
Speaker #5: In the phase one two study . This approach has translated into a favorable safety and efficacy profile for patients with this momentum in our pivotal study and results to date in phase one two .
Speaker #5: We intend to expand the RG 202 program outside of the US and are actively exploring opportunities to do so , starting in Europe .
Speaker #5: Shifting focus to RCS 121 . The positive 12 month pivotal data delivered to the FDA and presented at ICM in September were consistent with the previous findings and demonstrated the long term potential of RG 121 to change the course of MPs two further , we saw a continued favorable safety profile and a strong correlation between biomarker level and neurodevelopmental improvement .
Speaker #5: If approved , RG 121 would become the first and only gene therapy for MPs two and potentially the only one time treatment option to address the neurodevelopmental decline for this devastating disease .
Speaker #5: The Hunter and MPs communities have been fierce . Advocates for the need to deliver new treatment options to their children as quickly as possible .
Speaker #5: We look forward to continuing to advance our Bla and potentially bringing this much needed therapy to boys . Living with Hunter syndrome in the coming months .
Speaker #5: Turning to our retina servic franchise for wet AMD and diabetic retinopathy or doctor completing enrollment in our pivotal wet AMD studies is a major milestone in our and AbbVie's continued effort to serve the millions of patients worldwide suffering retinal diseases .
Speaker #5: The data from our Subretinal wet AMD program have been excellent with durable outcomes reported through four years . Additionally , in the fellow Eye study , Cervavac has demonstrated comparable safety and efficacy when dosed in the second eye .
Speaker #5: These results , along with patient enthusiasm to return and receive treatment in their second eye , underscore the robust interest we're seeing among patients and physicians .
Speaker #5: Finally , I'll speak to Cervavac for doctors using in-office suprachoroidal delivery . We continue to make progress towards initiating a global pivotal program .
Speaker #5: Site selection is in progress for the phase two . B three double masked sham injection controlled trial for patients with Nonproliferative doctor or NPDR .
Speaker #5: In the phase two altitude trial , a single in-office injection of CureVac was well tolerated in patients with NPDR terrific demonstrated durable long term efficacy , including meaningful drss improvement and an over 70% reduction in the risk of vision threatening events .
Speaker #5: Finally , I'd like to express my sincere gratitude to all the patients families , clinicians , site staff , and patient advocacy representatives who have supported all these trials .
Speaker #5: With that, I'll turn the call over to Mitch to review our financial guidance. Mitch.
Speaker #6: Thank you , Steve , and good morning , everyone . REGENXBIO Inc. ended the quarter on September 30th , 2025 with cash . Cash equivalents and marketable securities of $302 million , compared to $245 million as of December 31st , 2024 .
Speaker #6: The increase was primarily driven by the $110 million upfront payment from Nippon Shinyaku in the first quarter of 2025, and $145 million in net proceeds received from the royalty monetization with healthcare royalty partners in the second quarter of 2025, and was partially offset by the cash used to fund operating activities in the first three quarters of 2025.
Speaker #6: Revenues were $30 million for the quarter ended September 30th , 2025 , compared to $24 million for the quarter ended September 30th of 2024 .
Speaker #6: The increase was primarily due to the development service revenue under the Nippon Shinyaku partnership . In the third quarter of 2025 , we expect the September 30th cash balance reported today to fund our operations into early 2027 .
Speaker #6: Note this cash runway guidance does not include multiple Non-dilutive financing opportunities that could further extend our cash runway . These include the sale of our anticipated priority review voucher for RCS 121 development or sales milestone for our MPs programs .
Speaker #6: Development milestone associated with our diabetic Retinopathy program . Per the AbbVie Collaboration and potential additional funds from the May 2025 Healthcare Royalty Agreement .
Speaker #6: Together , these Non-dilutive opportunities could further extend our cash runway well beyond 2027 . In all , we find ourselves in a strong financial position as we advance towards multiple product launches .
Speaker #6: With that , I turn the call back to Corinne to provide final thoughts .
Speaker #4: Thank you Mitch . As you've heard today , our strong execution throughout 2025 has positioned us for an exciting and transformational year ahead , including the anticipated approval of RCS .
Speaker #4: 121 by February and top line readouts in Duchenne and wet AMD , both large indications and large commercial opportunities . Each of these potential best in class gene therapies address a significant unmet need for patients and are built upon our 15 year history of pioneering AAV gene therapy with a commitment to scientific excellence and disciplined execution .
Speaker #4: I want to thank our REGENXBIO team, partners, and the patients and families who participate in our trials. Your partnership is key to advancing our mission to improve lives through gene therapy.
Speaker #4: With that , I'll turn the call over for questions . Operator .
Speaker #2: Thank you . As a reminder to ask a question , please press Star one on your telephone and wait for your name to be announced .
Speaker #2: And to withdraw your question , please press star one one again . As a reminder , please limit yourself to one question and one follow up .
Speaker #2: And if you have additional questions , please return to the queue . And our first question is going to come from Judah Frommer with Morgan Stanley .
Speaker #2: Your line is open .
Speaker #7: Hi . Good morning guys . Thanks for taking the questions and congrats on the progress here . Maybe first just on on 202 .
Speaker #7: Can you help us with when next interactions with FDA will be . And can we get your thoughts on clearly news coming out of FDA that impacts the DMD community with arguably higher unmet need in DMD , but also just on external controls and other gene therapy programs .
Speaker #7: How are you thinking about the potential for the accelerated pathway for 202 at this point ? Thanks .
Speaker #4: Thanks , Judah . Yeah . I mean , if you think about the . Progress next year , we'll have top line data that we pointed to in early Q2 , and then we've also guided to a mid 2026 Bla submission .
Speaker #4: So absolutely we'll have potentially several FDA interactions . Of course the key one is the pre Bla meeting . And based on that timing we haven't got a specific date set for it .
Speaker #4: But it would happen somewhere around the vicinity of top line data . And preparing to file the Bla . I think in general you know , we are watching carefully other programs going through FDA and you know , the debate around external controls .
Speaker #4: We've continued to update our access to some of the same databases . For example , that were used in the approval . And I think that when when we look at it , one of the things that's striking to me is especially in our older patients , we're not looking at a marginal stabilization of patient functional outcomes .
Speaker #4: We're looking at a really significant difference from natural history in which we're matching that patient to say , 12 up to 20 patients .
Speaker #4: And so I don't think we're going to be going into FDA with sort of a modest benefit approach . I think what we're seeing in our data is a significant benefit .
Speaker #4: And even improvement in patients that you would expect . Maybe the best case at their age would be stabilization . So I think that's the strength at which we think we're eligible for accelerated approval .
Speaker #4: And I won't leave out , you know , to date , the safety profile of the program . So you think about benefit to risk ratio .
Speaker #4: And I think we can provide a significant advantage over the product on the market to date .
Speaker #7: Great . Thanks . And then maybe just a quick one for for Mitch on on cash runway . I guess kind of you know , when you internally probability weight you know potential for for these non-dilutive financings that that you listed .
Speaker #7: Can you give us a sense of where those could potentially get you through without kind of bringing in external capital or how you're thinking about the potential for cash runway ?
Speaker #7: If we do layer in some of those non-dilutive options . Thank you .
Speaker #4: Yeah , absolutely .
Speaker #6: So if you factor in the Non-dilutive financing options , inclusive of the PRV , as an example , and for modeling purposes , if you use the market price as you probably well aware of what the prices are for these prvs , it could significantly get us into a well into 2027 , if not even early parts of 2028 .
Speaker #6: But again , this is all contingent on what the market price of some of these items can go for . Other Non-dilutive financings , for example , the milestone associated with the first patient dose that we already disclosed is $100 million .
Speaker #6: So that in itself you can factor into the cash runway .
Speaker #7: Great . Thanks .
Speaker #2: And the next question will come from Manny Frewer with Leerink . Your line is open .
Speaker #8: Hi . Good morning . This is Lilly on for money . Thanks for taking our question . Just a quick question regarding the confirmatory trial for DMD .
Speaker #8: Maybe could you provide an update in terms of the tempo of enrollment ? And where do you see enrollment be at the time of filing ?
Speaker #4: Good question . So we've begun enrolling the confirmatory study , actually right at the end of October when we completed the pivotal enrollment and it's it's hard to predict at this point where we'll be , let's say mid 2026 at the point of filing .
Speaker #4: But I would expect us to be substantially through enrollment of the confirmatory study , given that that's pre-specified in our protocol . As an additional 30 patients .
Speaker #4: So we'll have to monitor that as we go . And we'll definitely give updates throughout the first half of next year . Regarding progress , Steve , maybe you just want to comment quickly on high level design for confirmatory .
Speaker #5: Sure . So the basic concept is very similar to what we've already done . So we're looking for a broad patient population of ambulatory patients .
Speaker #5: One year old and above . So very broad . And this is really based on the data that we've seen to date . Whereas current mentioned we're seeing very good differentiation , not just on safety but also in terms of functional benefit for these boys .
Speaker #5: And that's particularly striking in the older boys . And we're seeing results that have never been seen by any program . When you look at function in those eight and older boys and no placebo control .
Speaker #5: So that's a state consistent . And we're looking to enroll an additional 30 patients . And it's key . What what Curran mentioned we're just continuing to roll along with all the sites that we've got up and going that we're enrolling in the pivotal .
Speaker #5: They're energized . And one of the things we're seeing is with each new update that we give , that's showing more and more differentiation , we're getting more and more enthusiasm from the investigators and the patient families that they see .
Speaker #5: So we're very excited about the pace of enrollment .
Speaker #8: Thank you .
Speaker #2: And the next question will come from Gena Wang with Barclays . Your line is open .
Speaker #9: Thank you for taking my questions . So I would just ask one regarding the regulatory part . I know you have two programs like DMD and and MMPs .
Speaker #9: Two you know , you need to talk to the FDA . Just wondering . So for DMD . When will you have a Bla meeting with FDA .
Speaker #9: And then also regarding the MPs two , you know , I know Paducah is a February 8th . Any additional meetings set up before approval , maybe any update color you can have in terms of interacting with FDA , especially after Nicole departure and any concern regarding prior agreed upon .
Speaker #9: The accelerated approval path .
Speaker #4: Sure , I'll I'll take the second question first and then circle back to Duchenne for the Hunter program . We're far along with the the Bla review .
Speaker #4: As you know , the date was moved to February 8th from the initial date , we expect between now and that decision point to have a late cycle meeting with FDA and that , you know , we're getting messages from the project leader to schedule that .
Speaker #4: So that's moving along as what I would call business usual . I think it's important to point out on the Hunter program , we're already past our inspection .
Speaker #4: No observations . Our clinical sites have been inspected as well , with no observations as facility so some of the things that have held up other programs were de-risked , if you will , in that process , and the other , I think , area that we interact as we undergo this review is in the information request that we get from FDA .
Speaker #4: And I think I would characterize those as well as typical requests , some of which in an encouraging way , are questions related to commercial aspects of a program , specifications , pharmacovigilance .
Speaker #4: So the color of the interactions we're having is positive , and we feel positive about the data we provided for that program . And therefore our confidence is high that this program .
Speaker #4: And we think patient support that has a really , really important place in therapies for Duchenne . The . Bla meeting will happen between our top line data , which we pointed to early Q2 of 2026 and the filing of the Bla , we haven't got a specific date for it yet , but that somewhere in that time frame is when we would expect to have it .
Speaker #2: And our next question will come from Luca Eisai with RBC Capital Markets . Your line is open .
Speaker #10: Good morning team . Thanks for taking our question . This is Luca . Congrats on the progress this quarter . Maybe a question on your manufacturing capacity .
Speaker #10: If you can talk about your in-house capacity , the Rockville site is obviously up and running and already produced first commercial batch . So I'm wondering what is the scale of production volume that the site is designed to deliver today ?
Speaker #10: And what percentage of the domestic patients are you planning on capturing with that site ? Maybe for both the PS2 and DMD , if you could speak to that .
Speaker #10: Thanks so much .
Speaker #4: Sure . Yeah , the manufacturing facility is contains a 2000 liter bioreactor . It's the largest bioreactor that we know of utilized in gene therapy .
Speaker #4: And we've already scaled a program up to that level . We've been public about being able to produce up to 2500 doses of our 202 per year , and I think keeping in mind that just is what we can do on an ongoing basis , we can certainly inventory , which we're doing presently more quantities than that to have a significant number of doses available at launch .
Speaker #4: The Hunter program being an ultra rare program , I would characterize it uses less than 5% of our overall capacity . So it's not we have good yields , good expression , and we have our own internal fill finish capability .
Speaker #4: So we can run very efficiently . But it doesn't take up a significant amount of our overall capacity .
Speaker #10: Thanks so much .
Speaker #2: And our next question will come from Annabel Samimy with Stifel . Your line is open .
Speaker #11: Hi . Thanks for taking my question . Great progress on all the programs . Just on the issue of using FDA natural history as a control in DMD , I guess it's clear that you have both propensity matched comparisons and now this Ctap disease progression model is that something designed into affinity prospectively ?
Speaker #11: And could that lend further support ? And is it a measurement that's accepted not only in the DMD community , but also consider it as a valid metric from FDA ?
Speaker #11: So that's the first question .
Speaker #4: Okay , great . Hi , Annabel , I think that's a great one for Steve to address .
Speaker #5: Sure . Hi , Annabel . Great question . I think right off the bat . It's it's important to recognize each program and indication is is different .
Speaker #5: So you know , starting with DMD external natural history matching can be done in different ways . And you mentioned a couple of them .
Speaker #5: That's why we're excited about our data . We're we're seeing clear response across the dose range . That's very consistent . When we look at a traditional external natural history matching by baseline characteristics .
Speaker #5: And also the Ctap model , there is also the propensity score matching approach that's been accepted by the FDA . And that's actually prospectively specified in our our protocol as an accepted approach for 202 on the 121 program .
Speaker #5: Importantly , we've had numerous interactions with the FDA . Of course , and there hasn't been an issue of how we've prospectively looked at our individual data .
Speaker #5: And the only thing that's been asked for from an efficacy standpoint was what we provided in terms of the encouraging one year data .
Speaker #5: And since then , we we discussed with the FDA , was there any other data that would be needed ? And the answer was no , that this would allow them to complete their review .
Speaker #5: So I think this reality of what type of feedback we've gotten from the current regime puts us in a good place for both these indications .
Speaker #11: Okay , great . And I'm going to be different and ask a what AMD question I guess . Can you opine on the recent M&A and licensing activity for gene therapy and what AMD obviously we had Lily , Fred and a 4D licensing .
Speaker #11: And of course your licensing . So does the street have it wrong on the level of interest from retina specialists and where's your program rank as far as level of engagement with these retinal specialists ?
Speaker #5: Sure .
Speaker #4: I can . It might be good , Steve , to reflect on what we just heard out of AAO regarding gene therapy in general .
Speaker #4: And specifically our program .
Speaker #5: Sure . So I think there's tremendous excitement about one time treatment and the way to do that is gene therapy . And one strong piece of evidence is what we're hearing actually from retina specialists .
Speaker #5: And this is coming from the Pat as survey of close to 1000 retina specialists , where every year , a number of questions are asked of these experts in in the field , the actual treating clinicians and important one is exactly what you're asking .
Speaker #5: How what pipeline approaches are you most interested in as to retina specialists across all the different approaches and half the respondents say gene therapy because of the the one time potential here , that isn't the case for any of the other treatment approaches like Tkis or or any other durability approaches .
Speaker #5: Because no matter how long you extend that durability , you're still going to need injections indefinitely for any of the indications that we're looking at .
Speaker #5: You know , I think we're seeing that in terms of interest in the in the field and some of the licensing deals or M&A deals that that you mentioned , Annabel .
Speaker #5: And of course , we have a major global partnership with AbbVie who has quite a lot of experience globally , including quite a reputation when it comes to ophthalmology and experience there .
Speaker #5: So there continued advancement with our program , including paying two of every $3 for the advancements , both in diabetic retinopathy and other areas .
Speaker #5: I think really speaks to the validation of not just gene therapy , but specifically our program with the muscle of AbbVie behind it .
Speaker #5: Globally .
Speaker #11: Okay . That's great color . Thank you .
Speaker #2: And the next question will come from Alex Stranahan with Bank of America. Your line is open.
Speaker #12: Hey guys . This is Matthew . On for Alex . I appreciate you taking our questions . You know , given a recent expectation for a boxed warning for a competitor product and the removal of the Non-ambulatory indication , just curious whether your expectation is for something similar on your label or other AAV gene therapy labels and how you're thinking about long term development in the non-ambulatory population in general .
Speaker #12: Thanks .
Speaker #4: Thanks for the question . I think in terms of expectations , I mean , I think our track record in phase one two on safety has been exemplary , and I wouldn't expect Black Box warning of of that nature , given that we've shown clearly the incidence rate of , of any sort of liver injury for us is is virtually nonexistent in terms of the data , whereas we're seeing on the label for Elevidys or in their filing that they have upwards of 40% liver injury in the approved product .
Speaker #4: So I think we don't expect that . In fact , we expect to leverage safety as part of the accelerated approval pathway that we're pursuing .
Speaker #4: And I think accompanying that is strong conviction that the differentiation of the product with the immune suppression regimen , we utilize and the construct in manufacturing purity , put those all together .
Speaker #4: I think we have something very different and very exciting to the patient community . To date .
Speaker #2: And our next question will come from Brian Skorney with Baird . Your line is open .
Speaker #13: Hey , good morning everyone . I'd actually like to talk to regulatory questions on the EMA side of things . I know EMA's granted 1 to 1 the Atmp designation , but was just wondering the status of any plans for it at the EMA .
Speaker #13: And also any thoughts on the potential sufficiency of the affinity Duchenne study for EMA review or what else you think you need to do .
Speaker #13: There ? Is your FDA confirmatory sufficient for EMA filing ? Thanks .
Speaker #4: Yeah , we've had some interactions with EMA regarding RCS 121 , and I think that what we're typically seeing there is the requirement for a control arm , placebo control arm still seems to be the predominant feedback that we get .
Speaker #4: Having said that, there's a significant opportunity in named patient sales that would potentially exist off an accelerated approval. So, I think that's something that we are carefully evaluating and could be part of our commercialization approach.
Speaker #4: Steve , do you want to address the Duchenne question ?
Speaker #5: Sure . Hi , Brian . So based on all the discussions we've had stateside , so to speak , you know , we're very confident on our approach here , not having had the the discussions outside the US .
Speaker #5: You know , we don't want to project what will be the case . Certainly historically there has been a need for a placebo control .
Speaker #5: There . We recognize the problems of that as well as with the patient advocacy community . There is increased data that that keeps growing with different ways of assessing function that are becoming accepted in , in different regulatory regions , like the SV 95 , just to give one example .
Speaker #5: So it's something that's an evolving field , but it's really going to take actual discussion . And you know , we keep coming back to differentiation because it matters .
Speaker #5: So the functional data , if we continue to see what we're seeing , including in the older boys , not just stabilization but improvement , we think we're in a stronger position for being able to come up with an approach that would be acceptable .
Speaker #5: ex-US .
Speaker #13: All right. Thank you.
Speaker #2: And the next question will come from Sean McCutcheon with Raymond James . Your line is open .
Speaker #14: Hi guys . Thanks for the question . Just one for me on diabetic retinopathy . A competitor was able to get an agreement with FDA for an ordinal two step dress change .
Speaker #14: Primary endpoint for the pivotal studies in NPDR . Can you speak to how that's informing your discussions with AbbVie on your pivotal NPDR program and ability to adjust that study plan to potentially improve probability of success relative to a two step dress improvement at one year ?
Speaker #14: Thanks .
Speaker #5: Sure , I can . Thank .
Speaker #4: That's a great , great question , Steve . Go ahead .
Speaker #5: Sure . Yeah . Thanks for the question . Yeah , I think one item off the the bat is that the ordinal approach is something people have thought about over time .
Speaker #5: The prior lead or director of the ophthalmic division had always required a meaningful change in dress with meaningful defined as either a two step improvement change or in either direction of worse or improvement .
Speaker #5: So the advance of being able to get more information out of each patient's dress change by looking in an ordinal way . Now , with the new regime has come on the table .
Speaker #5: So it is definitely something we've been looking at both US and AbbVie . And in close collaboration . So I think it gives us more options .
Speaker #5: Fortunately , what we've seen is we look good in in both respects , two step improvement , greater proportion of patients achieving that .
Speaker #5: And also two step worsening a greater proportion of patients showing that in a placebo control setting , as well as what you expect without treatment in the real world and other controlled negative control arms .
Speaker #5: So we think we're we're really well positioned to really take advantage of what looks best in our discussions with the FDA .
Speaker #14: Thank you .
Speaker #2: And the next question will come from Daniel Gatlin with Chardon . Your line is open .
Speaker #15: Yes . Hey , good morning guys . Thank you for taking my question . Quick , quick one on suprachoroidal wet AMD first , can you remind us how many patients you're looking to enroll at dose level for ?
Speaker #15: For that study ? And now with the Subretinal program fully enrolled , do you expect the the speed of enrollment for Suprachoroidal program to pick up a little bit ?
Speaker #15: Now , with the shifted focus to that program ? Thank you .
Speaker #4: Steve , go ahead .
Speaker #5: Thanks for the question . So asks wet AMD is advancing . We're looking to enroll 20 patients in that arm . As you mentioned we reached the quite significant milestone of completing enrollment in the SR wet AMD pivotal studies .
Speaker #5: The largest gene therapy program ever conducted across any indication . It's a great point that now with that trial completed , enrollment , a lot of the overlapping sites can now focus on the Suprachoroidal delivery route .
Speaker #5: So yes , indeed , we're seeing a pickup in enrollment in that study .
Speaker #15: Got it . And a quick follow up for for Subretinal program . Do you expect to file in the US and EU roughly at about the same time ?
Speaker #4: Yeah , I think that's the safe assumption . We haven't got a specific timeline for the filing mapped out . We're primarily focused on top line data next year , but we would expect a global filing and we'll be more specific as we get closer about the interval between us and ex-US filings .
Speaker #4: But the they're recruiting not on the basis of the ascent study being recruited in Europe , was to enable that to be a smooth process .
Speaker #15: Okay . Got it . Thank you very much . And congrats on all the progress .
Speaker #2: And the next question will come from Bill mine with Clear Street . Your line is open .
Speaker #16: Hey good morning and thanks . So I just wanted to look again at the functional endpoints on 202 and just ask about the powering around those and whether or not you believe there's a certain threshold or I guess , outcome that you need to see as a , as a bar for , for success to really kind of put together a definitive answer in front of the FDA , that kind of can't be can't be denied .
Speaker #4: Steve , do you want to cover that ?
Speaker #5: Sure . Thanks . Thanks for the question . So we are seeing a nice response , both in terms of change from baseline with improvement even in the older boys , where you might expect just stabilization or worsening .
Speaker #5: And with improvement just stabilization . So I think we're in a good position where if we continue to see what we're seeing and what we report on in early Q2 next year , with not only the primary endpoint for accelerated approval , but also the Micro-dystrophin .
Speaker #5: I think we're going to be very well set up . And that's based on to your question . Looking at . The traditional endpoints .
Speaker #5: So certainly Nsaa , where marginal effects , if any , depending on the age of of the patients , has been seen previously , and also the time function tests .
Speaker #5: So the traditional time to stand ten meter walk , run time to climb as the traditional ones where there's a lot of data out there and we have the opportunity to look with propensity matching .
Speaker #5: So how good of a data do we have to see again if we continue to see what we're seeing , we're going to pass that that bar because of the differentiation that that we're seeing .
Speaker #5: And some bars you can look at are not only against natural history , but also there's data and published interpretations of the data on minimally important clinical difference that we're surpassing .
Speaker #5: And we can also look by age and by baseline status . What's been seen with approved therapy and that allows us to feel that we're in a good position to to have power based on the data that that we're seeing .
Speaker #5: Again , if we continue to to see what we're seeing , the overall package is important as well . So the benefit risk relative to that functional improvement , then we go to the safety , where again , we're seeing very good differentiation .
Speaker #16: And on your Suprachoroidal program , where are you on your understanding of how closely that can recapitulate the amount of effective delivery of your subretinal delivery ?
Speaker #5: So on .
Speaker #4: Are you asking if the protein levels match in terms of transgene expression between the two ?
Speaker #16: Yeah .
Speaker #4: Yeah , I think because Steve can comment further , but because they're delivered to different compartments of the eye , it's very difficult to do direct comparison .
Speaker #4: So ultimately what we look at is sustained vision and safety . But Steve , maybe you want to comment further on the differences we see .
Speaker #5: Sure . So geographically they're different spaces . They're both close to the target tissue . And they're both in compartmentalized spaces . So that's why we selected them so that they greatly limit off target tissue potential side effects .
Speaker #5: In terms of immunogenicity , that also changes as as Karen mentioned , the reality that you really can't compare . It'd be apples and oranges , but fortunately , what really matters is what do you see clinically , which shows that you have the transgene product at the target tissue where you need it .
Speaker #5: And that's where the diabetic retinopathy data is so compelling for us in AbbVie that you're seeing what you want to see . And that's why we're advancing with Suprachoroidal already .
Speaker #5: And actually accelerated development so that we can we and AbbVie can actually start . Phase 2B3 next year .
Speaker #16: Got it . Thank you .
Speaker #2: And our next question will come from you Chen with H.C. Wainwright . Your line is open .
Speaker #17: Good morning . Thank you for taking my questions . Could you comment on your current thinking regarding the pricing strategy for RTX one , two , one versus 202 ?
Speaker #17: And also, how large do you think your sales team needs to be for 1 to 1? 202, thank you.
Speaker #4: Okay , so if you recall earlier in the year , we signed an agreement with NS Pharma for commercialization in the US . And so the pricing decisions will be made by NS Pharma as we move through the approval process .
Speaker #4: And Mitch can comment . We certainly will enjoy a nice royalty from sales . But the actual price determination will be made by them .
Speaker #4: We would eventually make the . Price decisions since we wholly own the Duchenne asset . And I'd say at this point it's very preliminary for us to to state any sort of thinking on pricing until we get closer to commercialization .
Speaker #4: Yeah . Okay .
Speaker #6: Yeah . So as you recall from the pharma partnership , we are eligible to receive meaningful double digits in sales royalty . So as current kind of mentioned , pricing decisions will be made by NS Pharma at a later time .
Speaker #17: Thank you .
Speaker #2: And the next question will come from Paul Choi with gold . Goldman Sachs , your line is open .
Speaker #18: Hi . Thank you . Good morning , everyone , and thanks for taking the questions . With regard to 202 , could you please comment on where you think you might see the potentially greatest demand initially , as you start to commercialize in 2027 ?
Speaker #18: Do you think about it in particular , Exxon skipper experience patients or just thinking primarily about newly diagnosed patients ? Any color there would be helpful and then second , on with regard to your collaboration with AbbVie and 314 , how are you thinking about sort of rough timelines for potential Medicare coverage of 314 ?
Speaker #18: You know , Post-approval and just sort of what are the block steps they're involved with for gene therapy coverage in this particular Medicare population ?
Speaker #18: Thank you very much .
Speaker #4: Okay . Yeah , I'll take the first one . I think obviously if you look at the inclusion criteria for the study , we're dosing patients one and older .
Speaker #4: So we'll have data at the time of review for potentially a broad label . One thing that we see based upon the public announcements on sales is that the prevalent market really isn't changing in terms of Duchenne .
Speaker #4: So by 2027 , the prevalent market will be something like 14,000 patients . And if you think about eligible for gene therapy , it's probably closer to 3000 patients .
Speaker #4: When you subtract out non-ambulatory . So at the time of launch , our aim is to have a broad label and really be able to address patients of all ages .
Speaker #4: But to your point , we do expect that over time , as the prevalent market diminishes , which could be past 2030 , is that at that point we would be in a great position to address the incident market .
Speaker #4: Most Kols think early treatment is ultimately the answer for gene therapy , and we'll have the data in hand to support that age group based on the fact that we're already dosing kids right after diagnosis in some cases , I think on the Medicare coverage for 314 , that's a question that I'll defer out a bit .
Speaker #4: We haven't had those discussions with AbbVie . AbbVie will obviously be leading the significant element of the commercialization , but we do believe broad access for gene therapy is fairly easily achieved .
Speaker #4: It's just too early in terms of our conversations with Avi to be specific . There .
Speaker #18: Okay . Thank you .
Speaker #2: This does conclude today's question and answer session . And conference call . Thank you for participating . And you may now disconnect . Have a good day .