Apologies for the late start of our conference. Welcome to the DBV full year 2023 financial results and business update conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on your telephone keypad. To withdraw your question, please press star, then two. Please note, this event is being recorded. I would now like to turn the conference over to Katie Matthews, Investor Relations. Please go ahead.
Thank you, and again, our sincere apologies for the delay in starting today. This afternoon, DBV Technologies issued a press release that outlines our financial results for the 12 months ended December 31, 2023. This press release is available in the press releases section of the DBV Technologies website. Before we begin, please note that today's call may include a number of forward-looking statements, including, but not limited to, comments regarding our clinical and regulatory development plans, the design of our anticipated clinical trials, the timing and results of interactions with regulatory agencies, our forecast of our cash runway, and the ability of any of our product candidates, if approved, to improve the lives of patients with food allergies.
These forward-looking statements are based on assumptions that are subject to risks and uncertainties that could cause the company's actual results to differ significantly from those suggested by these statements. Given these risks and uncertainties, you should not place undue reliance on these forward-looking statements. Please refer to the company's filings with the SEC and the French AMF for information concerning risk factors that could cause the company's actual results to differ materially from expectations, including any forward-looking statements made on this call. Except as required by law, the company disclaims any obligation to publicly update or revise any forward-looking statements to account for or reflect events or circumstances that occur after this call. Joining me on the call today are Daniel Tassé, Chief Executive Officer of DBV, Dr. Pharis Mohideen, DBV's Chief Medical Officer, and Virginie Boucinha, our Chief Financial Officer.
Before handing the call over to Daniel, for those of you who may be new to DBV, we are developing Viaskin, an investigational proprietary technology platform with broad potential applications as an immunotherapy for the treatment of food allergies and other immunological disorders, with Viaskin Peanut as our lead candidate. I will now pass the call over to Daniel. Daniel?
Katie, thank you, and thank you, everyone. Again, I need to add my apologies. We were waiting for confirmation that the K had been uploaded. It usually takes a minute. It took much longer today. We will obviously dig into this and make sure it doesn't happen again. So my apologies for having you on hold for 30 minutes. Today, we'll obviously give you an update on our progress when it comes to, Viaskin Peanut programs and, and the regulatory pathway, and then Virginie will share with us a financial update. But before we do that, I'd like to share with you a few perspectives about Viaskin Peanuts and the peanut allergy market, things that we have not discussed in a while.
Starting with the fact that last week, DBV attended the American Academy of Allergy, Asthma & Immunology Annual Scientific Meeting, which was held in Washington, D.C. The meeting, which is known as Quad AI, is regarded as the premier event in the allergy immunology community. Every year, we have a lot of boots on the ground at Quad AI to listen, engage with all of our key stakeholders, allergists and patient advocacy groups, at the very top of that list. One of the highlights of Quad AI this year was the fact that the product theater. If you've been to Quad AI, the product theaters are a big deal and attract a lot of traffic. The one we hosted was called Importance of Early Intervention for Peanut Allergy, and I'm very proud of the fact that it had an unprecedented attendance.
In fact, we're told that we broke the record for Quad AI event, and the best attended product theater ever. The room held 125 people. 230 allergists or more showed up. The point here being that, intervening early in peanut allergy is important. Our technology is important, creating much interest, and obviously, that's the most validating feedback there is all the hard work that's been going in. Which I'd like to use to just again, reinforce, our commitment to the space and to the importance, and the benefit of generating plenty of data and plenty of long-term data. We understand and we understand the huge responsibility we have, of, establishing the long-term safety and clinical benefits of Viaskin Peanut, because treating children is an important, responsibility.
Our open-label extension commitment to patients, while it takes time and effort and financial resources, ensures a rich population of subjects on Viaskin Peanut to guide treatment, inform options, and optimize outcomes for patients. And we do have extensive follow-up of our subjects. You may recall, we recently reported back in November our interim year two data from our open-label extension study in toddlers. And obviously, we cannot wait to see what the year three data will look like when we share it later on this year. In 2024, we will continue to work towards creating a robust data package in toddlers and children. We have a lot of work cut for us, but we're enthusiastic about it.
Over the next year, we expect to have approximately 1,400 children, age one to seven, enrolled globally in our phase III trials. All our phase III studies have an open label extension, which, as I mentioned just now, is key to understanding long-term treatment and the benefits of our therapy. It goes without saying, we will have the largest cumulative exposure to investigational product ever in pediatric food allergies. It's going to be a massive safety database.
For our one- to seven-year-olds, we will have, in fact, close to 1,700 subjects on active treatment, and if we combine that with the data from our prior phase III trials, we—to break this down, we'll have approximately 600 toddler patients, 600 toddlers aged one to three, and about 1,100 patients aged four to seven, will have been on immunotherapy for up to three years. And let's not forget all the work we've done in four to 11 before that, where some of those children were treated with Viaskin Peanut for up to five years. In fact, some of that data was shared at Quad AI last weekend. To sum it all up and put this in perspective, over 1 million Viaskin patches have been applied to children aged one through 11 in our clinical development program.
That's obviously more than 1 million days of therapy that makes up the safety database of this product, safety and efficacy database of this product. It is, as I said, the most comprehensive research in children with peanut allergy. We have a well-studied product with demonstrated efficacy and consistently favorable safety profile. We're proud of that, and we keep on building that database. The second point I wish to touch on today is the disease-modifying potential of Viaskin Peanut. I'd like to share with you data that's been discussed in the past, but put together, I think, as an important perspective here. Let's start with our recent and striking observation in toddlers from year two of our ongoing open label study, extension study.
Data showed that approximately three out of five toddlers could consume almost 3.5 grams of peanut protein without triggering stopping symptoms during the food challenge. That is the equivalent of 12-14 peanuts, way beyond what we anticipated during accidental exposure, and a massive jump from what was, a median, insane dose at baseline of 100 milligrams. These data suggest VIASKIN Peanut is potentially rewiring immune systems, and we suspect that is due to a plasticity immune system in this age group. We also have two other data sets from prior studies showing that VIASKIN Peanut can induce what is known as sustained unresponsiveness to the allergen in older children, who, after two-three years of treatment, 80% of participants maintained desensitization of a thousand milligrams or more, two months after stopping treatment.
Thirdly, we know from our studies in animal models, that the data suggests that Viaskin Peanut induces sustained unresponsiveness to the allergen by modulating the epigenetic signature of specific T-cell compartments. Remember, Viaskin Peanut has a unique mode of action that leverages its skin thinning properties, induces tolerance, and there's no other product, out there that shares that mode of action. With all this in mind, while this is not the indication we'll be pursuing at approval, we fully intend post-approval, and as part of our long-term commitment to these children, to explore if Viaskin Peanut is fundamentally disease-modifying after a few years of treatment. With that as background on our commitment to science and to our patients, I'll turn the call over to Pharis, our Chief Medical Officer, for a detailed update on our two Viaskin Peanut programs.
Thank you, Daniel. As a reminder, we intend to submit two separate BLAs for the treatment of peanut allergy. In the one-three-year-olds, we are using the original square patch. The 12-month efficacy study, EPITOPE, is completed, and the results were published in the New England Journal of Medicine. In the pre-BLA meeting held in April 2023, the FDA did not request any additional efficacy data, but did request a supplemental safety study to increase exposure on active product to close to 600 subjects per ICH guidelines. To be clear, the FDA was not looking for a specific safety signal or a specific safety concern. We call this six-month safety study COMFORT Toddlers. In parallel, we are running the four-seven-year-old indication with the modified circular patch. We started this program last year with a 12-month VITESSE study. Recruitment is ongoing at this time....
This indication will also have a six-month supplemental safety study, which we call COMFORT Children. The two studies combined will have 600 subjects on active treatment to meet the ICH guideline. So our attention this year will be focused on completing recruitment for VITESSE and starting our two supplemental safety studies. As Daniel mentioned, DBV has always been committed to generating the most robust data sets possible in our clinical trials. The VITESSE is no exception. We recently submitted an amendment to extend the open label phase so that every subject enrolled in the trial has the opportunity to receive Viaskin Peanut for up to three years. And remember, we also have our expanded access program for subjects that have completed a treatment in a DBV clinical trial and want to continue to receive Viaskin Peanut.
VITESSE is set up to provide another large, robust data set, unmatched by any other peanut allergy study in this age group. Recall that the population in the test is considered to be more sensitive than subjects in our previous studies, with the inclusion eliciting dose set at 100 milligrams. This is aligned with a younger, four- to seven-year-old age group, where we believe VIASKIN Peanut can provide great clinical benefit. In VITESSE, we have 86 clinical centers spread across the U.S., Canada, Australia, and Europe. Sites in every country are open and actively recruiting subjects. Like other sponsors, we were set back by the new European Clinical Trials Directive, which significantly delayed our opening of our European sites. However, that's behind us now, and we expect to build momentum and complete screening by Q3 this year.
That brings me to the COMFORT Children supplemental safety study in four- to seven-year-olds. This will have a six-month core period, followed by an open label extension that will provide an additional six months of treatment for subjects randomized to active product and 12 months of treatment for subjects randomized to placebo. Every subject will have the opportunity to receive Viaskin Peanut for a full year. This will be a 270-subject study, randomized three to one, active to placebo. The main inclusion criteria will be based on skin prick test and peanut-specific IgE levels. These criteria are sufficient to ensure a similar patient population relative to VITESSE, thus there is no need for a food challenge as part of the inclusion criteria. One of the differences in COMFORT Children relative to VITESSE is the use of a simplified instructions for use.
The safety study IFU states, "Each DBV712 250 microgram epicutaneous system is intended to be worn for a full day, 24 hours." This is a shift away from the 24 ± four hours per day and the minimum wear time used in previous studies. This new IFU more accurately reflects allergen immunotherapy and how we expect our product to be labeled if approved. Based on a past similar safety study we conducted in four- to 11-year-olds, we believe COMFORT-Children would be an attractive study with potential subjects and at research centers. Be assured that study startup activities with our CRO have already begun, so that we will be in a good position to initiate the study at an optimal time. Okay, let's move to the toddler program.
The results from the first 12 months of the EPITOPE study were published last year in the New England Journal of Medicine. The open label extension to EPITOPE is ongoing. Recall that all subjects have the option to receive Viaskin Peanut for up to three years. For subjects originally randomized to active treatment, we have data for two years on treatment, and for those randomized to placebo, we have the one-year crossover data from placebo to active. These data were presented as the very first ever late breaker at the American College of Allergy, Asthma, and Immunology annual meeting last November. In the interim data from the open label extension to EPITOPE, we observed continued improvement in treatment response following the second year of treatment, which is consistent with our previous open label extension data in four-11-year-olds.
Using the responder criteria in EPITOPE, the response rate increased from 67% to almost 84%, and four out of five subjects, 81%, consumed an eliciting dose of greater than or equal to 1,000 milligrams. To put this into perspective, the median eliciting dose at baseline was 100 milligrams. That's a tenfold increase. Finally, participants consumed—sorry, 56% of participants consumed the entire food challenge of nearly 3.5 grams, or about 14 peanut kernels, without meeting the food challenge stopping criteria. We believe these are really impressive results that continue to build upon our extensive and robust VIASKIN Peanut clinical data set. During the second year of treatment, the safety results in toddlers were entirely consistent with trials in older children, which demonstrated a well-tolerated, predictable safety profile.
Local application site reactions were the most commonly reported adverse events, though notably, the frequency of such reactions decreased in the second year of treatment with VIASKIN Peanut. No subjects had treatment-related serious treatment emergent adverse events during the second year of treatment with VIASKIN Peanut, and no treatment-related permanent study discontinuations occurred. Furthermore, there were no treatment-related anaphylactic events during the second year of treatment with VIASKIN Peanut. And remember, our studies use a very broad definition of anaphylaxis, purposefully designed to set a very low bar in reporting anaphylactic events. Overall, we were extremely pleased with the results of the second year of treatment from an efficacy point as well as from a safety point.
We didn't present the placebo crossover data in the slides today, but it was discussed at the college meeting in November, and the placebo crossover efficacy and safety appeared to be virtually identical to the first 12-month data set in EPITOPE that was published in the New England Journal. This confirms what was observed previously and also provides reassurance that slightly older subjects, the three-year-olds in EPITOPE, that crossed over as four-year-olds in an open label extension, still had a robust treatment effect. It bodes well for the VITESSE study. Let me wrap up with the toddler, COMFORT Toddlers study. This is a six-month study that will include 400 subjects, randomized three-to-one, active to placebo. Like the COMFORT Children study, subjects will have the opportunity to receive active treatment for up to one year.
COMFORT Toddlers will use the same IFU as COMFORT Children, so there will be consistency between the two studies. This study will use the same square patch as the EPITOPE study. One of the differences between COMFORT Toddlers and COMFORT Children, other than the obvious difference in age range and patch, is that the toddler study will use a double-blind, placebo-controlled food challenge as part of the inclusion criteria. We chose to include a food challenge to ensure that the study population in the safety study would be as closely matched to that as EPITOPE as possible. We believe a food challenge was the best way to ensure that outcome. Peanut-specific IgE is more reliable as a biomarker of peanut allergy in older children, but is less reliable in toddlers.
Our EPITOPE data shows that half of our subjects had peanut-specific IgE levels at or below 14, but still tested positive for peanut allergy by a food challenge. That is, they had low IgE levels but were still allergic, whereas the older subjects in the middle and far right figures on the slide, had much fewer subjects with low IgE that were peanut allergic. We appreciate that this adds a bit of complexity to the study and may have a small impact on recruitment, but we believe this will allow us to best replicate the EPITOPE study population for a BLA submission in the future. As we have stated previously, we will initiate COMFORT Toddlers after we receive FDA feedback on the protocol, which was submitted in November last year. The DBV clinical team has been gearing up with our CRO for study initiation.
We believe we are in position to initiate the study in a short period of time, pending FDA feedback on the protocol. With that, back to you, Daniel.
Thank you, Pharis. Before turning the call over to Virginie to review the financials, I'd like to cover a corporate update. During the fourth quarter, we further strengthened our leadership team in advance of our two BLA submissions and anticipated commercialization so that we are best positioned for long-term success. On top of our new CFO, Virginie, who joined us in November, we appointed Dr. Kevin Malobisky, PhD, as our new Chief Operations Officer. Kevin has an extensive track record of more than 35 years in biopharmaceutical, strategic, and operational leadership roles, including roles that span both research as well as drug development and drug approval. Kevin will be instrumental to a successful BLA submission, and I couldn't be more thrilled that he has joined our leadership team.
I would like to take the opportunity to formally welcome Kevin to our team, and he's already making a very positive impact. So really delighted to have both Virginie and Kevin joining us. Without further ado, I will invite Virginie to cover briefly our financial highlights.
Thank you very much, Daniel, and I will now provide a brief overview of our financials for the year 2023, which I invite you to further review in our press release and filings.
... There are three highlights I would like to point out for year of 2023. Number one, we closed the year with $141 million in cash. Number two, we dedicated over 90% of the cash we used in operations to progressing VIASKIN Peanut clinical development and preparing for BLA filing. Number three, our 2023 P&L includes the favorable impact of the termination of our collaboration with Nestlé. As you may be aware, in Q4 of last year, 2023, we terminated a collaboration agreement with Nestlé, which was meant to develop and commercialize a diagnostic marker for cow's milk allergy. This contract was draining resources and attention away from our priority, VIASKIN Peanut, with neither tangible nor medium-term income. Terminating the contract was a financially sound decision with material positive impact on our 2023 financial expenses and net loss.
One more word on our financials and resources allocation. If you consider our financial statements without the impact of the Nestlé collaboration agreement, our operating expenses increased by 25% in 2023 to support VIASKIN Peanut clinical studies, CMC preparation, regulatory activities, and getting ready on the manufacturing site in view of all of this for the approval and launch of VI. Back over to you, Danny.
Thanks, Virginie. Now, before communicating DBV's upcoming milestones, I would be remiss if I did not take a moment here to appreciate how much the food allergy landscape has changed in the past few years, and how we believe VIASKIN Peanut will serve that community. There's nothing we hear more clearly from the food allergy community that this therapeutic area desperately needs treatment alternatives. The recent FDA approval of omalizumab, which goes by the brand name Xolair, for the treatment of food allergy in children and adults, is a welcome addition. We see treatment for food allergy requiring a range of options, just like other immunological conditions such as asthma, atopic dermatitis, or inhalant allergies.
I'm asking you here to imagine the position of a parent with a young child just diagnosed with peanut allergy at a pediatrician's office or the allergist's office, until very recently stopped there. The only option available to concerned parents and caregivers was avoidance and diligent readiness with epinephrine auto-injector. Today is a different story, and over time will keep on getting different, better. Children are now channeled to the allergist's office, where they and their families can have real conversations, as illustrated here, about all the conditions that, and all the circumstances that surround the life of that child and that family. That was another topic that we picked up in talking with KOLs and experts at Quad AI. Having a range of treatment options available only fuels that conversation.
And for the 670,000 children in the U.S., ages one through seven, currently living with the daily burden of a peanut allergy, every patient's story and situation is unique, requires a bespoke solution, and that's what's needed here. Simply put, one size will not fit all. In an ever-evolving market, and we want to be very much part of that evolution, VIASKIN Peanut will always be a very important product. In fact, it will be, that's the opinion of most, a foundational product, as was evidenced after speaking with hundreds of allergists attending the Quad AI conference. Before I open up the call for questions, I would like to take a moment to share our anticipated milestones for 2024, and this is a critical year for DBV.
We anticipate initiating the first subject of our COMFORT Toddlers trial, a six-month supplemental safety trial in support of a BLA. We also anticipate completing enrollment of our ongoing VITESSE phase III efficacy trial in children aged four-seven years of age. And once VITESSE enrollment is close to completion, we'll initiate recruitment for our six-month COMFORT Children trial in support of that BLA. Recruitment, as Pharis touched on, will be carefully timed so as not to compete for the same study subjects across two different clinical trials. During the second quarter, also plan to host an Investor Day, and we will share those details as soon as possible. We hope many of you will be able to join us. We also plan to announce the three-year results from our ongoing phase III open label extension of the EPITOPE trial later on this year.
And finally, the publication in science and medical affairs mission at DBV continues to be operating very actively. We anticipate publication of additional manuscripts, which includes publications of the results of the year two open label extension of EPITOPE, which Pharis shared a few minutes ago, an additional invited review with a peer-reviewed scientific journal, as well as submitting abstracts of new results for presentation in upcoming conferences. So we'll keep on publishing a lot of data on our technology and its benefits. With that, we'll now ask Pharis and Virginie to join me for the Q&A. And operator, if you could open up the line for questions, that'd be great.
We will now begin the question-and-answer session. To ask a question, you may press star, then one on your telephone keypad. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star, then two. Our first question comes from John Walden with Citizens JMP. Please go ahead.
Hey, good afternoon, and thanks for taking the question. Questions, sorry. The first, I was hoping you could give a little bit more color on this EU directive, and then also, can you comment how many of the 600 expected patients in VITESSE you've already enrolled to date?
I'll have Pharis answer the question on the directive and then...
Yeah. Hey, John, it's Pharis. So this new EU directive is a little bit different from how things were done in the past. So you have to submit your dossier, your protocol, and the countries that you've selected in Europe all are banded together essentially as one country. So in the past, you could go one off to Germany, Italy, Spain, whichever countries you wanted. In this case, they're all bundled into one. So if any country has any objection, it has to go all the way to be resolved, and that process can continue almost indefinitely. And the big difference here is if one country protests and has an issue, all of the countries are stuck. They can't participate, and you can't pull out and one-off go separately to all the different countries.
So it is a bit different, and I think the challenge here was we were one of the first phase II protocols that went through, and so the system wasn't quite worked out. And I think there was a just a glitch here and there, and as these new things come through, they're not always well-oiled. So that's the nature of the difference in the directive now versus how it was in the past.
I've got it.
And then-
Can you comment on how many of the expected 600 patients have been enrolled so far?
Yeah, we don't provide that clarity of guidance for competitive reasons here. The study is progressing well against the forecast we had in place, assuming that the sites were up and running. They've been up and running later than expected. What I can share is we expected 60-90 days would be sufficient to get through the new directive process. It took us closer to... Actually, it took exactly nine months to go through it. And that explains why we are out of abundance of prudence, pushing the expectation of last patient screen from first half of 2024 Q2 of 2024 to Q3 of 2024.
Got it. Okay. And, any timing guidance on when COMFORT Toddlers will be starting? And then how do you think about the parallel programs? Do you want them to be exactly parallel with BLA submissions in the same time period? Does that make it easier for you or potentially the review division, or could there be staggering and one coming before the other?
Yeah. So, I'll have Pharis answer the first question on COMFORT Toddlers, and I'll talk about the benefits of having the two programs being parallel here.
Yeah, John, as we've always said, we will start our phase III programs when we have FDA feedback. So we're waiting for the FDA feedback. We've done all the preparations we can in terms of the team and the CRO being ready to go once we get that feedback. So we believe it will be a short period turnaround from a clin ops standpoint. So again, I think it's the right thing to do for phase III trials, get FDA feedback and alignment before we start to run.
We're in communication with them, and they reinforce to us, and we believe from the pace of no response, emails, everything else, that they are—they say it's their top priority. We very much see that, but we're just waiting for that final sign-off before starting the study out of, again, common sense prudence.
To-
And then-
May I add a question?
And then-
Yeah, to come back to the benefits of the two doses in parallel. Sorry, you had other question?
Yes. Yes, please.
Yeah. Look, both markets are huge, so if it was essentially coming down to a race to commercial potential, rate them even, quite simply. Obviously, the program in toddlers is more straightforward. There's only one study to run, while we have two to run with in four-seven-year-olds. But that was why we were very happy when the agency agreed that these would be two separate BLAs, making not one to be junior to the other by being the BLA and the supplemental BLA. And thus, whichever one we can file first, we will file first, and making us, as a commercial matter, indifferent to which one is ready first.
Okay.
Does that make sense?
And then just... Yeah, last one for me, Daniel. You, you touched on this, the Xolair approval.
Yes.
Can you discuss how allergists you speak to are thinking about Viaskin Peanut use versus Xolair use? Do you think there's an overlap between the patients that may like both, or do you think these are gonna be separate addressable markets based on product profiles? I'll jump back in the queue. Thanks.
Yeah, I'll have Pharis give you more detail because he's ta-- we've all talked to a bunch of allergists at ACAAI, but no, there's very little overlap between the two markets, which is why Xolair's approval is important here by offering options. The populations are pretty significantly different, so Pharis want to share the, what you've learned from.
Sure. So we spent quite a bit of time at Quad AI talking to our different sites. And the take-home message we're getting from them is that Xolair had been approved a long time, and it had been used off-label with OIT in certain situations. And there hasn't been huge, huge off-label use for peanut allergy as a standalone indication or even multiple food allergies. And the reason, you know, for our one to seven-year-olds, the way we've been told is, especially in the toddlers, one to three, none of the investigators we spoke to would use it as sort of monotherapy for multiple food allergies or single food allergies because it's a toddler population. It's unknown what it would do for a immune system that is still evolving, very immature, and of course, it's an injectable.
In the older patients, maybe six or seven, what we've heard was there could be extreme, extreme cases of patients that are ultra, ultra sensitive. So the anecdote that was told to me was, a practitioner has a patient who could go to Chuck E. Cheese, and this patient is so allergic to milk that any of the residual, pizza cheese grease that's on there, and if they had, you know, touched their mouth or their eyes, they would go into an anaphylactic reaction. And this is just almost straight verbatim what this investigator told me. And for a case like that, where it's well documented that their sensitivity is just extreme and they've tried to avoid and done everything they can, that patient might be a candidate for omalizumab.
But again, it's a pretty extreme case, and they don't tend to overlap with our patients very much at all. I don't know if that helps, Jonathan, but that's just what we've gathered as anecdotes, talking to as many of the investigators as we can to get an understanding of how the product may be used.
No, that's consistent with what we're hearing as well, so good to hear, and, thanks for the feedback and color, guys.
Sure.
Yeah, the formal market research also, besides dialogue with KOL, shows, yeah, to be used in older kids and adolescents or young adults who are multi-allergic at times in their lives where you want to make sure that their behavior or whatever they're experiencing is covered. It's not the population that we wish to help with our product.
Again, if you-
Questions are clear.
Again, if you have a question, please press Star, then One. Our next question comes from Sushila Hernandez with Van Lanschot Kempen. Please go ahead.
Yes, thank you for taking my question. Could you just walk us through the steps ahead to get to the BLA filing for the toddlers? And the second question, does your cash runway until the end of 2024 include the start of both phase III studies? Thank you.
Good question. So the answer to the second part of your question is yes. Our forecasts have always been, as you know, rather smart and conservative. So this assumes not only the initiation of those two studies, the continuation of the test, but a lot of work we're doing also when it comes to regulatory dossiers, CSA, CMC, and building up inventory also. So there's a lot of our expenses this year are going to that. As far as next steps for the toddler dossier, sign-off from the FDA on the protocol and then initiation of the trial. As Pharis said, we've been in dialogue with many of the investigator sites. We can turn that around pretty quickly. What we don't know is how quickly the study will enroll. We know there's a lot of enthusiasm for that study.
We know that food challenges, especially only one at entry in toddlers, is easier to do, much easier to do than food challenges in older children. So we're confident this study will enroll at a good pace. But we have no analogues here, and for that reason, we're going to leave that as an open question until we have more data to guide more precisely to study completion and BLA filing. We expect also that once we have the clinical data to move to filing a BLA, we move rather quickly. The CMC work will be done by then, and it's not a complex dossier, by the way, right, so, so it's pretty straightforward when it comes to the clinical data that we have to pull and analyze.
Thank you.
Answering your questions, Sushila? Yeah.
Yes, thank you.
This concludes our question and answer session. I would like to turn the conference back over to Daniel Tassé for any closing remarks.
Covered a lot today, and thanks for those questions. So to recap, we're continuing to advance VITESSE, our phase III study, in peanut allergy children four-seven. In parallel, the successful completion of the supplemental comfort safety studies are important. And as I just shared with our colleagues asking questions here, we have two BLAs that are distinct and in parallel, and thus one is not really linked to the other one. And the moment we have sign off on the protocol in toddlers, we will initiate that study. It's well lined up. We are very confident or remain very confident this work will support BLAs in both age groups.
And as we've picked up from dialogues with allergists at Quad AI, what we pick up when it comes to talking investigators, what we pick up in our market research, families want treatment options. The more treatment options are available, the more dynamic the market will be, and we all benefit from that. This concludes the call for today. Again, we hope that we will keep on conveying success of our programs to 2023 and to 2024 with laser focus on execution. Lastly, I want to apologize again profusely for a call that started later than expected. I thank you all. Wish you a good evening.
The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.