Earnings Call: Q1 2021

May 10, 2021

Good morning, and welcome to the Axsome Therapeutics Conference Call. Currently, all participants are in a listen only mode. Later, there will be a question and answer session and instructions will follow at that time. As a reminder, today's conference call is being recorded. I would now like to turn the conference over to your host, Mark Jacobson, Chief Operating Officer at Axsome Therapeutics. Please go ahead. Thank you, operator. Good morning and thank you all for joining us on today's conference call. Our earnings press release providing a corporate update and details of the company's financial results for the Q1 of 2021 crossed the wire a short time ago and is available on our website at aximdot com. During today's call, we will be making certain forward looking statements. These statements may include statements regarding, among other things, the efficacy, safety and intended utilization of our investigational agents, our clinical and non clinical plans, our plans to present or report additional data, the anticipated conduct and source of future clinical trials, regulatory plans, future research and development plans, commercial plans and possible intended use of cash and investment. These forward looking statements are based on current information, assumptions and expectations that are subject to change and involve risks and uncertainties that may cause actual results to differ materially from those contained in the forward looking statements. These and other risks are described in our periodic filings made with the Securities and Exchange Commission, including our quarterly and annual report. You are cautioned not to place undue reliance on these forward looking statements, which are only made as of today's date when the company disclaims any obligation to update such statements. Joining me on the call today are Doctor. Herriot Tabuteau, Chief Executive Officer Mick Pizzi, Chief Financial Officer Lori Engelbert, Senior Vice President of Commercial and Business Development Doctor. Amanda Jones, Senior Vice President of Critical Development and Doctor. Cedric O'Gorman, Senior Vice President of Medical Affairs. Herriot will first provide an overview of the company and then review recent developments and upcoming milestones. Following Herriot, Lori will provide a commercial update and then Nick will review our financial results. We will then open the line for questions. Questions will be taken in the order they are received. And with that, I will turn the call over to Ariel. Thank you, Mark. Good morning, everyone, and thank you all for joining Axsome Therapeutics' 1st quarter 2021 financial results and business update conference call. The timing of this call coincides with Mental Health Month, and Axsome is proud to observe May is Mental Health Month by partnering with advocacy groups and helping to raise awareness and support for people living with depression and other mental health conditions. In the Q1, we continue to make significant strides towards becoming a premier CNS biopharmaceutical company focused on delivering potentially life changing medicines to people living with serious CNS conditions. The dedicated work of the Axsome team resulted in the submission of our NDA for AXS-five for the treatment of major depressive disorder or MDD. The NDA was granted priority review by the FDA and the FDA has set up a PDUFA target action date for the NDA of August 22, 2021. The NDA for our 2nd lead product candidate, AXS-seven, for the acute treatment of migraine is on track for submission to the FDA this quarter. And we expect to announce the FDA's decision regarding its acceptance of the filing in the Q3. With 2 NDA filings and a PDUFA target action date for AXS-five in late August, Axsome is quickly approaching commercialization stage. Lori will provide some details on our pre commercial activities to ensure launch readiness assuming a successful NDA review. The rest of our differentiated late stage pipeline continues to advance. AXS-five is also being developed for the treatment of Alzheimer's disease agitation and enrollment in the Phase III ACORE trial is progressing. Our AXS-twelve product candidate for narcolepsy is progressing towards initiation of the planned Phase 3 trial early in the Q3. For our AXS-fourteen product candidate for the treatment of fibromyalgia, we recently met with the FDA to discuss its further clinical development plan, and we are awaiting written feedback from the meeting. Our portfolio comprises 4 late stage product candidates under development for 6 distinct indications, representing unmet medical needs that affect a large percentage of Americans. We are energized by their potential to deliver significant benefit to patients and by our planned commercialization approach. I will now turn the call over to Lori, who will provide as we continue to prepare for a successful launch of AXS-five in major depressive disorder. Today, I will give you an update on our commercial activities as it relates to launch readiness. The prevalence of depression symptoms in U. S. Adults has been steadily on the rise for many years. However, recent studies have shown that in 2020, almost 1 third of U. S. Adults experienced depressive symptoms. That's a greater than 4 fold increase versus 2019. As a result of a rapid increase in mental health conditions and the associated personal and economic burden associated with them, there is an undeniable urgent need to bring awareness and support to those affected. If approved, AXS-five would be an important new treatment option for the many Americans living with depression. We are committed to bringing this meaningful innovation to patients by commercializing the product in a timely manner. With an expected PDUFA date of August 22, we anticipate launch in the Q4 of this year. Consistent with Acxiom's culture, our commercial launch strategy is innovative and purposeful. I spoken previously about the plan for our digital centric commercialization or DCC platform to be used as means to optimize engagements across all customer types. Our commitment to and belief in a digital focus has only amplified over the past year as research continues to indicate a strong preference for and trend in this direction with our core customers. Our foundational technology infrastructure is now fully implemented and we continue to build out our digital capabilities. Using sophisticated data and analytics, streamlined systems and digital enablement tools, our DTC platform will allow for a more effective, efficient and meaningful engagement with physicians and consumers. Along with building out our DCC platform, over the past year, we've constructed a commercial team that combines breadth and depth of commercial experience with a desire to innovate. I am extremely proud of our commercial team and I am impressed with their thought leadership and passion for helping those affected by CNS condition. Functional senior leadership across marketing, market access, commercial operations and sales are all in place. Launch activities are focused on a potential Q4 launch of AXS-five if approved, but preparations also include launch readiness for a potential AXS-seven launch. Our marketing team is focused on disease education and post PDUFA launch promotional planning. The market access team continues to engage in ongoing permitted discussions with payers, ensuring awareness of Axsome and of AXS-five product profile, along with actively setting up comprehensive patient support services. The commercial operations team is expertly working to implement and execute our DCC vision. And lastly, our sales team has determined the optimal size, structure and design of our sales force and are now concentrating on field force preparedness as hiring at both the field leadership and rep level has commenced. And finally, outside of commercial, the Medical Affairs Group is focused on data presentations at upcoming congresses and continuing MSO engagement with KLL. I will now turn it over to Nick, who will review our financials. Thank you, Laurie, and good morning, everyone. Today, we'll discuss our Q1 of 2021 results and provide some financial guidance. We ended the Q1 with approximately $165,000,000 in cash compared to roughly $184,000,000 in cash at the end of the 4th quarter, a net decrease of approximately $19,000,000 R and D expenses were $16,600,000 for the quarter ending March 31, 2021 versus $27,500,000 for the comparable period in 2020. The decrease in R and D expense was driven by a one time charge in the prior period of $10,200,000 related to the Pfizer license agreement along with several of our clinical trials that were ongoing in comparable period that have subsequently been completed. The current quarter includes a $2,900,000 charge related to the PDUFA application fee for the NDA submission for AXS-five. Subsequent to the end of the quarter, we have received confirmation from the FDA that our small business waiver request has been accepted and we will be refunded this PDUFA application fee. G and A expenses were $11,200,000 for the quarter ending March 31, 2021, and $5,000,000 for the comparable period in 2020. The change was primarily due to the increase in pre commercial activities and stock compensation expense. Net loss was $29,300,000 or $0.78 loss per share for the quarter ended March 31, 2021 compared to a net loss of 32,500,000 dollars loss per share for the comparable period in 2020. As a reminder, we currently have a $225,000,000 term loan facility, of which $175,000,000 in funding remains available. This committed non dilutive capital gives us additional financial flexibility through both anticipated potential commercial launches on AXS-five and for AXS-seven. We believe our current cash position of $165,000,000 along with the remaining committed capital from our $225,000,000 term loan facility is sufficient to fund our anticipated operations based on our current operating plan into at least 2024. That concludes our Q1 2021 financial review. I will now turn the call back to Mark to lead the Q and A discussion. Thank you, Nick. Operator, may we please have our first question? Thank you. Thank you. Your first question comes from the line of Charles Duncan from Cantor Fitzgerald. Please go ahead. Your line is now open. Yes, fabulous. Good morning, Herriot and team congrats on really good progress in the quarter. Had a quick question regarding the PDUFA, the upcoming PDUFA date for 2005 for MBD, would you anticipate an AdCom in advance of that? Has the FDA communicated anything or even if they haven't, are you prepared to conduct an ad comp? Thanks, Charles, for the question. We have not gotten any communication from the FDA indicating that there will be an ADCOM. Now that can change. And if that were to change, we'd be in a position to let the street know as soon as possible. And with regards to preparations for an adcom, as you know, when you file the NDA, there's a lot of preparation that goes into that very significant filing. And so based upon that work, we think that we would be prepared for whatever happens during the review cycle. Adcoms are a potential expected part of any review cycle. But for the time being, we have not gotten any indication that there would be an outcome. Okay. That's helpful. Let me ask a quick question for Laurie and then I'll hop back in the queue and that is regarding the commercial readiness. When you think about 'five versus 'seven, can you perhaps highlight some of the synergies in the preparations that you're doing? But then also perhaps how would you address any differences in the prescriber base? And how does that impact optimal sizing of the field force? I imagine also you haven't talked about those numbers, but can you provide any color on that? Hey, Charles. Thank you for the question. Can you hear me okay? Yes. I'm a bit under the weather, so I just want to make sure everyone can hear clearly. Sounds great. It's a great question. Rest assured, as we've been planning for commercialization, we've always planned for AXS-seven to potentially follow very closely behind AXS-five. And that includes everything from how we set up our DTC platform in terms of being able to enable quick execution from an 5 and an 7 standpoint as well as how we're structuring our sales force. So whereas our sales force will obviously be originally constructed to call on our depression prescribing physicians. There is quite a bit of overlap with physicians in terms of migraine and depression. And so we do anticipate being able to quickly pivot when AXS-seven is ready to launch. Okay. Last question for Nick, just kind of housekeeping. Nick, congrats on getting that money back from the agency. But I know we're dealing with the U. S. Government here. When would you actually Q2? Yes. Hi, Charles. Yes, that's a good question. So they have accepted the waiver as I did in the opening remarks. So now we are just waiting for reimbursement. So the process has been started to receive the $2,900,000 back and we should be receiving it back shortly. I can't give a specific time on when we would be receiving that back then. Okay, sounds good. Thanks for taking my questions. Congrats on the progress. Your next question comes from the line of Jin Lee from Choo Securities. Please go ahead. Your line is now open. Hi. Thanks for taking our questions and congrats on the progress. So the first question is, the prevalence of depression is more than fourfold pre pandemic levels as you say, and that's corroborated by many other sources. But does that necessarily imply that there are that many diagnosable MDD patients? And I'm just curious if those people who claim to be depressed are actually represent pool of patients who could be medically diagnosed and be prescribed AXS-five? And I have a follow-up. Thank you. Thanks, Jim, for the question. If you look at the CDC data, which we referenced, if you look at the percentage of patients or the percentage of U. S. Adults with depression symptoms that they've measured, which was about 6.9% or roughly 7 percent in 2019. That actually corresponds to the prevalence of MDD of major depressive disorder. So it's the same CDC numbers and those have gone up to roughly 30% or so and then that of patients or U. S. Adults with the symptoms of depression. So we don't know the answer to the question of whether or not all these individuals would be diagnosed with MDD, but the original starting point did correlate pretty well with the it did correlate pretty well with the prevalence of MDD. Now so I'd like to turn it over to Lori to see if she's got anything more to add to that. Hi, Dew. Thanks for the question. It is something that we are obviously actively watching to watch either diagnosed and drug treated. But what we do know through data is that in 2020, the overall prescription market grew about 6% to 7%. So that would indicate that more patients are coming into the Okay, great. Looking forward to the numbers and progress there. And then the second question is that it's great that you got the priority review, but that does shorten the time for inspections of the clinical sites and more importantly, the manufacturing sites. So can you tell us a little bit about your CMO? Can you disclose who they are? And if you can't, maybe their capabilities, experience level and whether they've been inspected recently or not? Thank you. So our CMO is a blue chip CMO. And so they get regularly inspected. So they didn't expect they expected at least once a year. Your next question comes from the line of Mark Goodman from SVB Leerink. Please go ahead. Your line is now open. Hi. This is Roana on the line for Mark. Thanks for taking the question. I was curious a little bit more detail about the launch plan for AXS-five. Could you let us know how what the cadence is of your payer engagement activities and maybe the scope of educational programs that you're doing ahead of the 5 launch? Hi, Joanna. Thank you for the question. So from a payer engagement standpoint, we have been and continue to engage with payers in a permitted fashion, both producing Axsome overall as well as really educating them on the AXS-five clinical profile. Payers are extremely interested. As we mentioned earlier, there is a mental health crisis happening in America and that causes tremendous personal and economic burden to the system. Payers obviously are very interested in understanding and learning more about products that may help alleviate efforts. And then with regards to the educational programs, depending on the medical conferences that are upcoming, there's an opportunity for sponsored educational programs that raise awareness to disease states. And we recently had a significant presence with the American Psychiatric Association where we have a sponsored product theater based around the unmet need within MDD, the limitations of current treatments and future directions in terms of clinical development. And by all accounts, based on metrics that we received from the American Psychiatric Association, Axsome Product Theater was amongst the best attended at that conference. So there's many more conferences where we can have those kind of educational programs promoted. Got it. Thanks. And one more if I can. I wasn't sure if you've disclosed this yet, but curious how many target accounts do you plan to detail at the initial launch of 5? Yes, it's a great question. I'm going to disclose that right now. What I can tell you is that the size and structure of our sales force has long been set. It was actually part of the impetus for our VCC platform. The VCC platform was really developed to help maximize our sales force's efficiency. But rest assured, we will not sacrifice either quality and or reach with our target position. Got it. Thanks. Your next question comes from the line of Vamil Divan from Mizuho Securities. Please go ahead. Your line is now open. Hi, great. Thanks for taking the questions. Maybe 2, if I could. Just one on the AXS-five filing, obviously great that you got exception accepted in prior year review. I'm just curious if you had further discussion at all with the FDA around the ASCEND trial. I think just given some of the surprises we've seen from the regulators recently, there's been some concerns around is that trial sort of big enough robust enough to be considered pivotal. I assume it is, but if you can get any sort of updates on your conversation that would be helpful. And then just on 7, maybe you can just update it. I know you're saying you're going to file this in the second quarter here. I think it's supposed to be earlier this year, got pushed back a little bit. Can you maybe remind us of what the gating factors are in terms of getting that submission to the FDA? Thanks. Thanks for the questions. With regards to AXS-five and the NDA, so what we can tell you is that the obvious the filing was accepted. It was granted prior to review. So therefore, the FDA clearly has everything that it needs in order to conduct a substantive review. Of course, we can't comment on specifics on the specifics of our communications with the FDA one way or another. And with regards to the ASCEND trial, I do remind you that this is a breakthrough therapy designated product and we did previously disclose that the ASCEND trial after the breakthrough meeting was declared a pivotal trial. With regards to AXS-seven, we're very much on track to file the NDA this quarter as we've previously stated. And there really isn't any update there. So the team is working diligently to make sure that we have a timely but also a quality filing. Your next question comes from the line of Yatin Sengja from Guggenheim Partners. Please go ahead. Your line is now open. Hey, guys. Thank you for taking my question. Can you maybe help us understand the time the enrollment timeframe for the narcolepsy Phase 3 program. It seems like it got pushed a little bit, any gating factor to initiating that study. So that's number 1. The second is, if you can comment a little bit on the pricing work that you might have done for 5. Are there certain price points where you are seeing sensitivity in the market research? And would you keep the price below specialty tiers and what you might do or what you could do with regards to the co pay and the help you could provide? Thanks. So thanks, Jan, for the question. So I'll turn it over to Laurie to answer the pricing question. With regards to the narcolepsy study, so we are on track to start that trial early in Q3. So initially, the guidance that we had given was the 2nd quarter to start the Phase III trial. And then frankly, that will slip into roughly the 1st month of the Q3. So that's well within the normal variability, which you would expect with planning for a complex study at the Phase 3 trial. And Laurie, would you like to address the pricing? Hi, Yatin. Thanks for the question. It's a bit premature for us to disclose any details around pricing, but you can we plan to do that closer to launch. But what I can tell you is that we are working really hard to make sure that we ensure fair and timely access payers with the clinical profile of AXS-five. But as Cedric mentioned earlier, we are continuing to present additional data at congresses that are upcoming that we will use as supportive information for the patients. One more question, I'd like to ask. No, I was just going to answer your patient support and co pay questions. Just wanted to assure you that we as I mentioned in the prepared remarks, we are preparing patient support services to make sure that patients receive that product in an easy fashion. Got it. The question I have is on the Veeva, your partnership with Veeva system. If you can just maybe talk a little bit how are you going to leverage it? What does this system exactly do? Are there other companies that have successfully used the Veeva platform in launching the product? Just trying to understand the edge it gives you and what the what other successful launches that have been done using this platform? Thank you. Yes. Thanks for that question. So it's important to keep in mind that whereas Veeva is a critical foundational component of our DCC platform, it's not the only component. Companies all over the world are leveraging Veeva right now, and we have been extremely pleased with the partnership that we have with them in setting the foundation for DCC. We are also working to add systems and to complement the Veeva systems with a digital capability that does enable real time data to be fed and sophisticated analytics to be fed back out to sales reps so to make efficient and effective promotional calls. Your next question comes from the line of Ram Selvaraju from H. C. Wainwright. Please go ahead. Your line is now open. Ram Okay. So why don't we move on to the next question and then we'll get back to Ron. Certainly. Your next question here comes from Joe Fung from Cowen and Company. Please go ahead. Your line is now open. Hi there. Good morning and thank you for taking my questions. The first one, I know we touched a little bit on the difference between the increase in depressive symptoms that have been seen over the past year versus the formal MDD or TRD diagnosis. You expect that this impacted the enrollment of the MERIT trial or how are you thinking about that? And then my second one is on AXS-fourteen. Can you just remind us what the base case expectations are here and do patients or the FDA a certain symptom that they are looking at kind of most carefully? Thank you. Sure. So with regards to MARE enrollment, as a reminder, that study and just to remind folks, the MARE trial is the Phase II trial in treatment resistant depression. So that study uses a randomized withdrawal design. And so that study has been really enrolled. Currently, what we are waiting for are relapses to occur in that trial, and that determines the timing of data rehab. And then you asked the question about the FS14. So this is our product candidate for fibromyalgia. Could you just be more specific in terms of what you'd like to know about excess 14? Yes. I guess in terms of next steps, what are your base case expectations as sort of another things 3 expected? Can you file on the current package? And then I guess in your conversations with the FDA, was there a certain symptom that appeared that they were most concerned about whether it's pain or fatigue? Kind of what do you think will drive benefit in the update here? We met with the FDA the Q2 as we had planned around 16. And currently, we are anticipating and waiting for the final meeting minutes. And we'll have more to say once we get those final meeting minutes. But we'd like to get the written feedback prior to providing any details. And with regards to symptoms in general for fibromyalgia, as you accurately pointed out, fibromyalgia, it does incorporate pain, but not just pain, but other symptoms such as fatigue or concentrating symptoms. Current regulatory endpoints for fibromyalgia studies, they do incorporate those other symptoms. So there is pain, obviously, and that is one regulatory endpoint. But another regulatory endpoint, for example, is a functional endpoint, which incorporates many other symptoms of fibromyalgia. Your next question comes from the line of Chris Howerton from Jefferies. Please go ahead. Your line is now open. Wonderful. Thanks so much for taking the questions. I think a lot of them have been asked at this point, but I guess, as we move towards commercialization, is the plan does the team have a plan to give us more color and solid information around kind of how it is that they've devised the commercial infrastructure and team and kind of what will be the key metrics moving forward. So just trying to get an understanding of when might we learn more about the commercial efforts and the structure and all that. The second question that I would have is with respect to the MERIT trial and the readout. Obviously, we're expecting the PDUFA for 5 soon in August. So how might that information alter your activities in the commercial setting if it is approved at that time? Thanks. Hi, Chris. Thanks for the question. So in terms of when we will disclose size and structure, you can expect that at or around launch. That's typically when we would be prepared to reveal that information. I think what I can tell you is that we recently, within the past 3 weeks, have started our hiring efforts for the sales force at the field leadership level as well as the rep level. The response has been overwhelming in terms of the amount of applicants as well as the quality of the applicants. So we're quite pleased at the response that we've received as well as give this great assurance that we'll be able to meet our time line as we set out to meet and then also make sure that we have the right type of people in the position given our unique approach and vision. In terms of metrics around how we're going to measure Zagresta launch, we will you can expect us to start thinking about drilling that closer to launch. Okay. Thank you. And in regards to your question on the MERIT study. So the MERIT trial, this is a Phase II trial, which is which we launched at the same time that we had launched our other studies, the CONET studies, for example, the CONET sub studies with the goal of generating data to provide to clinicians across a wide spectrum of patients with MDD. So that was the reason for launching that trial. And so once it reads out in terms of its potential impact on the launch, that impact will be that it will be it will allow us to publish and provide additional data to clinicians on how AXS-five performs in a variety of different types of patients with MDD. Your next question comes from the line of Matt Kaplan from Ladenburg Thalmann. Please go ahead. Your line is now open. Hi, good morning guys. Just wanted to follow-up a little bit more on the your interaction with payers. Specifically, Laurie, maybe can you give us a sense in terms of how we should think about the rollout of coverage over time, maybe initially and then the 1st 6 to 12 months with respect to commercial and other coverage for AXS-five? And then also, I guess, with AXS-seven kind of close on the heels potentially filing approval, what are your thoughts and interaction with payers on 7 as well? Hey, Matt. Thanks. So in terms of coverage, I know I've said it's a lot on this call, but it is really too premature for us to really disclose that, but it's also premature because our discussions are ongoing. And so we're thinking through that in terms of a patient support services offering so that we make sure that patients are covered. But we do anticipate that the product will be covered. We have high confidence that the product will be covered. And we do believe that payers are extremely interested in the product profile. In terms of AXS-seven, that those discussions have we perform market research, but we have not discussed AXS-seven with payers specifically outside of just an overall Axsome portfolio introduction. Okay, very good. And then maybe Herriot, in terms of next indications for 5, can you talk a little bit about where you are and how the AD agitation Phase 3 program is progressing? And then kind of next steps for smoking cessation as well? Sure. Thanks, Matt, for those questions. And I going to turn it over to Amanda Jones to provide color on those 2 programs. Great. Thank you. Hi. So in regards to the AD agitation program, it is progressing nicely. It's still a little bit early for us to give any formal guidance on the overall status just based on the nature of the study design, which involves patients responding and then being randomized and going on to relapse. And then the second question was around smoking cessation? Yes. Yes. So we are planning to meet with the FDA in the Q3. And then based on our interactions with them, we'll provide an update on that program. And then if I just may add tremendous comments regarding Alzheimer's disease agitation. So the in addition to the progress that's being made in the trial, while it is still early, the metrics that we're seeing internally corroborate our initial guidance of data readout in the second half of twenty twenty two. Okay. Thanks for the detail. Your next question comes from the line of Myles Mentor from William Blair. Please go ahead. Your line is now open. Thanks for taking the questions. Just one on the payer landscape and for V. It seems reasonable that a payer is probably going to force sector of a few therapies. And by the time a clinician is going to prescribe this product, it's technically a TRD population. So I'm wondering, have you got any pushback from clinicians that STRIDE-1 missed the endpoint, So we haven't necessarily seen controlled positive data there. And I guess if that's the case, what's your current educating to those clinicians to get them over the line to prescribe this upon potential launch? Hey, Myles. So I'll certainly answer some of your questions, but I'd like to turn it over to Cedric in terms of what the MSLs are hearing on those lines. Yes. And I'm happy to share Miles that the nature of clinical trials, people who are actually enrolling in clinical trials for MDD tend to have difficulty in responding to existing treatment. So in essence, patients who are coming into MDD are already patients who are somewhat resistant. There hasn't been a great degree of pushback because people realize that new treatments coming out, pre branded treatments tend to market. And I think that the data that we've generated to be in MDD with versus bupropion and the ASCEND study versus placebo shows a differentiated clinical profile, both in terms of rapidity, onset of action, but also in the early improvements in quality of life and functioning. So I think overall, the clinical profile and differentiation of AXS-five is in from what we're hearing in the field is a compelling argument as to why they use this drug as they see a difference from what's already out there. Right. And if I may add to one of the things that we're hearing from KOLs and from the MSLs in the field based upon our recent data presentation on the COMET studies. For example, the our COMET stuff studies in TRD is that there's a very compelling profile that is emerging with a lot of evidence showing that the drug works actually just as well in those patients who have TRD and will fail multiple lines of treatment as in the patients who are treated frontline. And then the other thing too that we are hearing from experts in the field who are familiar with PRD and just depression in general is that it is actually rather impressive that we have had now essentially more Phase III trials, all of which have been positive. So even if you look at the STRIDE-one trial in TRD, the drug clearly separated from an active control than using a higher dose. And the effect that we're seeing with regards to depressive symptoms was evident at week 1 and at week 2. So just to remember that in the TRAD trial, statistical significance was achieved at week 1 and at week 2 in a TRAD patient population. And not only that, improvements in quality of life and also in disability were much higher than have been seen with other agents. So overall, it's been very positive. And accurately, the MSLs have been getting a lot of questions around STRIDE because of its positivity of what happens variability, which is expected in this patient's population. And Myles, I'll just pile on here as your third comment question to comment on your question. What was just stated by both Frederick and Herriot is very consistent to what we're hearing with payers as well. They are taking the entire patient population in the studies that we conducted in those populations into account. Yes. I think all of that's aligned with what I've been hearing as well. Maybe just another quick one. I know you're not commenting on the minutes because you're waiting for them. But in the cash guidance that you've provided today, does that actually include provisions for potential additional clinical trial for access for same in fibromyalgia? Thanks. So our cash guidance certainly includes spend for AXS-fourteen. So as you know, as we previously stated, we are synthesizing API. This is a new chemical entity. And we do want to make sure that we have our global supply ready since that would be necessary for registration for exits. So that spend is necessary for any potential next step. With regards to the specifics of a clinical development plan, we will wait getting written feedback from the agency before making any pronouncements. Fair enough. Thanks for the questions. Your next question comes from the line of David Hoang from SMBC. Please go ahead. Your line is now open. Hi. Thanks for the update and taking my questions. A lot of great questions asked already, so I just have a couple of quick ones. So first on AXS-five in MDD, how much of the target prescriber population would you say is primary care physician versus psychiatrist? And do you expect that there would be a lot of prescribing from the primary care side of the subscriber base? Yes. Hi, David. Thanks for the question. It's a really good one. So we tend to not look at it as psych versus PTP. We tend to look at it as high prescribers and or the highest propensity to prescribe on either category, sites or PCPs. There are many PCPs out there who are mental health focused and are actually prescribed at the same level as some of the sites. So our targeting will encompass high prescribers along with the ones that we consider to be the most the best potential for prescribing. Got it. That's really helpful. And then just in terms of both 5 and 7, are there any plans to eventually commercialize those products outside the U. S, in ex U. S. Geographies, either on your own or through a partner? So I can answer that question as well. Yes, there is. We publicly disclosed that we are looking for partners outside of the U. S, and those discussions are ongoing. Okay. Thanks. That's all for me. Your next question comes from the line of Robert Hazlett from BTIG. Please go ahead. Your line is now open. Hi. This is Perry on the line for Bert. Thanks for taking the question. Just a brief question on the AXS-five Alzheimer's disease agitation trial. Should we expect an interim analysis at some point? And if so, what can we expect in terms of efficacy data at that point? And any color on in terms of timing for a potential interim analysis? Thanks. There currently is there is not currently a plan for an interim analysis of this trial. However, the study is designed so that based upon what we see in terms of event rates that one could be incorporated. So randomized overall studies are driven by the number of events and that is typically how they are powered. So right now, as we mentioned in the earlier remarks, it's too early to know what the cadence will be of relapses. No one has done a study like this before in Alzheimer's disease agitation. So we're very much looking forward to seeing how the study plays out. And but right now, we are not we have not planned the interim analysis. Okay. Thanks. Thanks for that. And then just one more on AXS-twelve. Could you just talk a bit about potential thoughts on endpoints in the trial, including timing? Any color would be helpful. So for AXS-twelve, the primary endpoint of the study will be the change in the frequency of cataplexy attacks. So that is the same as that is the primary endpoint that is completed Phase 2 trial, which And your last question here comes from the line of Ram Selvaraju from H. C. Wainwright. Please go ahead. Your line is now open. Once again, Ram Selvaraju from H. C. Wainwright. Please go ahead with your question. Okay. And there are no further questions in the queue. I will turn the call back over to management for closing comments. Well, thank you all again for joining our call this morning. We are excited as we move potentially towards commercialization and as we advance the rest of our pipeline for the benefit of the many people living with serious CNS conditions. We look forward to keeping you updated on our progress in the months ahead. And this concludes today's conference call. Thank you for participating. You may now disconnect.