Chairman of Cytokinetics Board of Directors. I welcome you to our 2022 annual meeting of stockholders. The meeting is now called to order. John Forescue, Vice President, Corporate Legal and Assistant Secretary, will record the minutes. Before proceeding to the formal business, let me introduce Robert Blum, the company's President and Chief Executive Officer, who will provide an overview of our plans for 2022 after our formal proceedings. Before proceeding, I'm pleased to introduce the members of the company's management joining us today. Ching Jaw, Senior Vice President, Chief Financial Officer. Diane Weiser, Senior Vice President, Corporate Communications and Investor Relations. Robert Wong, Vice President, Chief Accounting Officer. I would also like to introduce Marcus Linder of Ernst & Young LLP, the company's independent registered public accounting firm, who is available to respond to appropriate questions.
Before I hand over the meeting to John Forescue, I would like to take a few moments to recognize Dr. Pat Gage. Pat was chairman of the board from 2009 until he resigned last month from the board. During his tenure, he guided the board and the company with great skill, sensitivity, and humor, though through some significant ups and downs, I have to say. He should take great pride looking at Cytokinetics today. You will hear later from Robert Blum that our first NDA is under review. We have a robust pipeline, an organization that is growing significantly to meet the needs of the company, and this magnificent new building. We thank you, Pat, and wish you and Irina well.
Now, I'd like to turn the meeting over to John Forescue to conduct the formal business of today's meeting, as set forth in your Notice of Annual Meeting and Proxy Statement. After the formal part of our meeting, Robert I. Blum will review the company's recent business activities. John?
Thank you, John. I have at this meeting a complete list of the stockholders of record of the company's capital stock on March 21, 2022, the record date for this meeting. I have proof by affidavit that the company's proxy statement, proxy card, and annual report on Form 10-K, were deposited in the United States mail commencing on April 13, 2022, to all stockholders of record at the close of business on March 21, 2022. The affidavit, together with copies of the proxy statement, proxy card, and annual report, will be filed with the minutes of the meeting. In addition, Robert Wong, Vice President, Chief Accounting Officer, will serve as the Inspector of Election to carry out the duties set forth under the general corporation law of the state of Delaware. Mr. Wong has signed an oath of office as Inspector of Election.
The oath of Inspector of Election will be filed with minutes of this meeting. We have present in person and by proxy, holders of a sufficient number of shares to constitute a quorum, so the meeting is duly constituted. We will vote by proxy and written ballot today. If you're a stockholder attending the meeting today in person and have turned in a proxy and do not intend to change your vote, then it is not necessary that you vote, because we will count your votes as expressed in your proxy. Those attending stockholders present in the room today who did not turn in a proxy card or who wish to change your vote and have your proxy cards with you, please raise your hands. Are there any additional proxies to be submitted at this time?
Is there anyone present, whether or not you already submitted a proxy, who now wishes to vote in person? The polls are now open for voting this May 10, 2022, at 10:06 A.M. Pacific Time. The polls will be closed to voting after we go through the matters to be voted on. We will first present the four proposals submitted for approval. Please save all questions related to the proposals for after all the proposals have been presented, after which we will announce the preliminary results of the voting. The first item of business is the election of directors. The following four directors are nominated by the board of directors as Class Three directors of the company to serve until our 2025 annual meeting. Muna Bhanji, Santo J. Costa, John T. Henderson, and B. Lynne Parshall.
The board of directors recommends that the stockholders vote for these four Class Three nominees. The second item of business is the approval of the amendment and restatement of the company's Amended and Restated 2004 Equity Incentive Plan to increase the number of authorized shares reserved for issuance under the plan by 5,998,000 shares of common stock. The board of directors recommends that the stockholders vote for the approval of this proposal. The third item of business is the ratification of the selection by the audit committee of our independent auditors. The audit committee of the board of directors has selected Ernst & Young LLP to serve as our independent registered accounting firm for the fiscal year ending December 31, 2022.
The board of directors recommends that the stockholders vote for the ratification of this election. The fourth and final item of business is the advisory vote on the executive compensation of the company's named executive officers, as described in our proxy statement for this annual meeting. The stockholders have asked to vote on an advisory basis on the following resolution. Resolved, that the company stockholders approve on an advisory basis the compensation of the named executive officers as disclosed in the company's proxy statement for the 2022 annual meeting of stockholders pursuant to the compensation disclosure rules of the SEC, including the compensation discussion and analysis, the related compensation tables, and the narrative disclosures to those tables in the proxy statement. The board of directors recommends that the stockholders vote for the advisory proposal.
We will now review if there are any questions about the aforementioned proposals before we close the polls. If you have voted in today's meeting, would you please give your ballots to the Inspector of Elections? It is now 10:08 A.M. Pacific Time, and the polls for each matter to be voted on at this meeting are now closed. No additional ballots or votes and no changes or revocations to ballots or proxies will be accepted. At this time, I would like to report on the results of the voting. Regarding proposal one, the proposal to elect each of Muna Bhanji, Santo J. Costa, John T. Henderson, and B. Lynne Parshall. Muna Bhanji received 72,212,805 votes for her election.
1,809,550 votes were withheld, and there were 3,770,000 broker non-votes. Santo J. Costa received 71,304,951 votes for his election. 2,717,404 votes were withheld, and there were 3,770,000 broker non-votes. John T. Henderson received 69,492,156 votes for his election. 4,530,199 votes were withheld, and there were 3,770,000 broker non-votes. B. Lynne Parshall received 72,281,275 votes for her election.
1,741,080 votes were withheld, and there were 3,770,000 broker non-votes. Therefore, the proposal to elect each of Muna Bhanji, Santo J. Costa, John T. Henderson, and B. Lynne Parshall is carried. Regarding proposal two, the amendment and restatement of the company's Amended and Restated 2004 Equity Incentive Plan to increase the number of authorized shares reserved for issuance under such plan by 5,998,000 shares of common stock. Votes in favor of the proposal were 70,664,525 votes. Votes against the proposal were 2,928,000. 429,830 votes were abstained, and there were 3,770,000 broker non-votes. Therefore, the proposal is approved.
Regarding proposal three, the appointment of Ernst & Young LLP as the company's independent registered accounting firm for the fiscal year ending December 31, 2022. Votes in favor of the proposal were 77,521,359 votes. Votes against the proposal were 61,876. 209,120 votes were abstained, and there were zero broker non-votes. Therefore, the proposal has been ratified. Regarding proposal four, the resolution concerning the advisory vote on the company's vote on the compensation of the named executive officers, as disclosed in the company's proxy statement for the 2022 annual meeting of stockholders. Votes in favor of the proposal were 71,536,813. Votes against the proposal were 2,039,137.
446,405 votes were abstained, and there were 3,770,000 broker non-votes. Therefore, the proposal is approved. This concludes the formal business of the meeting, and we would now like to begin our report to stockholders. The meeting is now concluded. The following discussion and presentation contain forward-looking statements under the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. Our actual results may differ materially from those projected in these statements. Factors that could cause our actual results to differ materially are contained in our SEC filings, including our most recent annual report on Form 10-K, quarterly report on Form 10-Q, and current reports on Form 8-K. Copies of these documents may be obtained from the SEC or by visiting the investor relations section of our website.
These forward-looking statements speak only as of today. You should not rely on them as representing our views in the future, and we undertake no obligation to update these statements. I will now turn the meeting over to Robert I. Blum, our President and Chief Executive Officer.
Thank you, John. In my role as President and CEO, I'm pleased to be addressing you at Cytokinetics' eighteenth annual stockholder meeting.
Thank you to everyone who has joined us in person and to those listening by phone and also online. As I shared in my letter to shareholders in our 2021 annual report, last year was a year of great transformation for our company. We submitted our first new drug application, or NDA, to the U.S. Food and Drug Administration for omecamtiv mecarbil, our cardiac myosin activator, which was subsequently accepted for filing. This was an important milestone for our company, and it was made possible by employees of Cytokinetics who have worked very hard towards this goal for many, many years, as well as by thousands of patients who have participated in our clinical trials, and by the hundreds of investigators who have engaged in our clinical research. The FDA assigned a PDUFA target action date of November 30, 2022.
This year, as we approach this key inflection point, we're building our commercial infrastructure and readying for the potential approval and the potential launch of omecamtiv mecarbil for patients with heart failure with reduced ejection fraction, also known as HFrEF. Patients with HFrEF remain at high unmet need despite their being treated with guideline-directed medical therapy. This is particularly true for those with worsening heart failure who have a high symptom burden and are at high risk of cardiovascular events and hospitalization. Additional results presented throughout 2021 from GALACTIC-HF, our phase III clinical trial of omecamtiv mecarbil, underscore that the treatment effect of omecamtiv mecarbil when added to standard of care was more pronounced in patients with lower ejection fractions as well as more severe heart failure.
We believe omecamtiv mecarbil, if it were to be approved, may represent a new mechanism add-on therapy for patients with worsening heart failure that could be complementary to current standard of care. Another key achievement of 2021 was our sharing of positive results from REDWOOD-HCM, the phase II clinical trial of aficamten, our cardiac myosin inhibitor in patients with obstructive hypertrophic cardiomyopathy, also known as HCM. The results show that treatment with aficamten demonstrated statistically significant reductions in left ventricular outflow tract gradients, with the majority of patients achieving the target goal of treatment. Treatment was also well-tolerated, with importantly no treatment interruptions or discontinuations. We subsequently began preparations for our phase III clinical trial of aficamten, called SEQUOIA-HCM, which has opened to enrollment earlier this year. Last year, we also began a phase III clinical trial of reldesemtiv, our fast skeletal muscle troponin activator.
That trial is called COURAGE-ALS. At Cytokinetics, we've been committed to making a difference in the lives of patients with ALS for many years. We remain steadfastly dedicated to researching our investigational medicines diligently and with integrity, and with patients always as our North Star. In the second half of this year, we expect the data monitoring committee to conduct the first interim analysis in that trial, which will assess for the potential of futility and is triggered 12 weeks after approximately one-third of the planned number of patients are randomized. We look forward to sharing more at that time later this year.
In addition to supporting progress across our pipeline and enabling our cardiovascular franchise strategy, last year we executed corporate and business development deals, including raising approximately $297 million through an equity offering, as well as expanding our collaboration with Ji Xing Pharmaceuticals Limited, granting an exclusive license to develop and commercialize omecamtiv mecarbil in Greater China in exchange for $70 million in committed capital and up to $330 million in additional milestone payments, plus royalties on the net sales of omecamtiv mecarbil in Greater China.
We also continued our deal-making into the beginning portion of 2022 by executing a royalty monetization transaction, our second deal with Royalty Pharma, that provided long-term capital and debt financing of up to $300 million to support the potential commercialization of omecamtiv mecarbil, as well as the expanded development program for aficamten, as well as an additional $150 million in exchange for the sale of a revenue participation right on potential future sales of aficamten. We ended 2021 with over two years of cash runway, multiple late-stage development programs, and a growing pipeline of muscle-directed drug candidates. In the corporate presentation that will now follow, I plan to share highlights of the progress we achieved in 2021, as well as some of our more recent activities this year related to these development programs.
For those of you joining us by webcast, you can find a PDF of the presentation slides under the Downloads tab in the webcast window. I'll now begin my update on the company. This first slide tells it as it is. This is what inspires us. These are patients who we know, who participate in our advisory councils and have inspired us to do the work that we do every day because it matters. Cytokinetics is by pursuing its research in the biology and pharmacology of muscle, seeking to empower muscle and thereby empower lives. A little bit of technical difficulty, but we're back on track. I will be making forward-looking statements, and much like John has already advised, we refer you to our SEC filings with regard to any potential updates to those statements.
We don't obligate to update those statements and otherwise, we will point to those risk factors in connection with these statements. Our mission at Cytokinetics has been clear, and from the beginning, we are dedicated to bringing forward new medicines rooted in our research that may improve the health span of people who are suffering from devastating cardiovascular and neuromuscular diseases associated with impaired muscle function. We've pioneered, and we continue to lead in the area of muscle biology-directed research. Every few years, we update our vision so as to be demonstrating to all stakeholders, patients and shareholders included, how we continue to address and execute on our business objectives. Our Vision 2025 is clear. We want to be achieving regulatory approvals and bringing forward new medicines for patients by 2025, at least two, if not three, medicines arising from our research.
Importantly at the same time, and in contrast to many such peer group companies, still also doubling down on our research, expanding our pipeline, now five compounds in development to 10. Also at the same time, expanding our research platform currently rooted in the mechanics of muscle contractility to include also energetics, growth, and metabolism of muscle. Always at the time that we're advancing our R&D and commercial activities, remaining committed to patients who may benefit from our medicines and understanding how patient centricity can guide our work, and always being that science-driven company that people want to join and partner with.
That vision guides how we think about executing on our business, and throughout this presentation today, you'll understand how we're investigating new medicines, leading with science, building franchises around the biology that we know so well, but also putting ourselves in the position of patients, thinking like patients, elevating their voice, and ensuring that they always remain our North Star. Our research at Cytokinetics has been rooted from the beginning in the biology of the cytoskeleton, and over time, we've focused and refined that focus, and the cornerstone of our research has evolved to be within the cytoskeleton, that structure that gives rise to muscle, power and force and endurance. Importantly, it's called the sarcomere. It's the fundamental unit of muscle contractility, and it has from the very beginnings informed how we do what we do.
As you can see on this slide number six, that our drug candidates that populate our pipeline are either activators or inhibitors of proteins involved in the contractile machinery of muscle. Omecamtiv mecarbil, as well as aficamten and CK-271 directed to cardiac myosin, which is the enzyme that gives rise to muscle contractility. Also reldesemtiv and CK-136 and CK-601 that are directed as activators of troponin, which is a protein that regulates the contractility of muscle, and in particular to the interactions between myosin and actin. Fast-forward to today, and you see where that focus and that discipline has given rise to a pipeline of drug candidates that have advanced through early and mid-stage studies to now late-stage development.
We divide our pipeline into two verticals, those drug candidates that modulate cardiac muscle or those that modulate skeletal muscle. Most advanced amongst this is omecamtiv mecarbil, our cardiac myosin activator, which entered clinical trials in 2005, the subject of 32 completed clinical trials now sitting in front of the FDA under NDA review for a filing that we hope to lead to an approval later this year. Not alone, we look at this area as could afford a franchise around cardiac myosin, and aficamten is a cardiac myosin inhibitor, next-in-class opportunity directed to hypertrophic cardiomyopathy now in phase III. Joining reldesemtiv, our fast-twitch skeletal troponin activator, also in phase III for the potential treatment of ALS.
Underscoring the importance to Cytokinetics and shareholders and patients, we continue to innovate, we continue to advance in research, as you can see here, populating an early pipeline. Today's presentation won't delve so much into those drug candidates as much as in the future we look forward to updating you on their progress. Instead, today, I'm gonna focus to our later-stage pipeline, starting with cardiac muscle and omecamtiv mecarbil. Omecamtiv mecarbil is designed specifically to address cardiac dysfunction in patients with heart failure and reduced ejection fraction. Heart failure is itself a public health epidemic, and much like the pandemic that we all know so well, in this case, heart failure has contributed to even more mortality risk and morbidity issues, but over a long period of time.
You can see with the aging demographics on page, rather slide 10, that we can do much better to address what are the needs, the unmet needs in heart failure. Heart failure accounts for approximately one million hospitalizations in the United States each year. It's the number one reason why patients in the United States over the age of 65 are hospitalized. With current standard of care, we're doing a relatively poor job. In fact, 24% of those patients are readmitted at great economic burden to hospitals within 30 days, roughly half of them to hospitals within five years. This is contributing to a major clinical and economic challenge.
We conducted a study many years ago called GALACTIC, a pivotal phase III study that was designed to build on the prior knowledge of omecamtiv mecarbil and assess its potential when added to standard of care to improve clinical outcomes. This study enrolled over 8,000 patients in 35 countries in nearly 1,000 centers, and it assessed the potential to reduce a composite endpoint of heart failure-related events and death. It was a positive study. As you can see on the left-hand side of slide 12, there was a treatment benefit of omecamtiv mecarbil when compared to standard of care, that achieved highly statistically significant effect and an overall effect that admittedly was modest in the total population. Importantly, when considered where heart failure risk is greater as ejection fraction falls, the effect of omecamtiv mecarbil when added to standard of care is even more pronounced.
This is the biologically plausible mechanistic hypothesis that we knew going into the trial design, that as ejection fraction, a measure of cardiac function, declines, we should be seeing an amplified effect of omecamtiv mecarbil, and we did. This is especially important because current standard of care can be demonstrating waning effect in this population as risk increases. If you look at patients who have worsening heart failure or at risk of worsening heart failure, whether you look at ejection fraction, recent hospitalizations, high BNP, low blood pressure, compromised renal function, or any other measure of increased risk in heart failure, we saw an approximate doubling or more of the effect, maintaining high statistically significant impact. This is demonstrating a potential positioning or placement of omecamtiv mecarbil where guideline-directed therapy may potentially underscore its added utility to standard of care.
As you can see here on slide 14, these results were recently presented, whether patients were in-hospital or outpatient and recently hospitalized, the effects seem to be similar. This is further underscoring the robustness of the clinical trial results, which is important when you consider how guidelines and ultimately physicians may want to know consistency of effect across any measure of risk in heart failure. What's important also to note is these effects were observed without added safety or tolerability concerns relative to standard of care. Whether you're looking at AEs or SAEs or other measures of increased risk, the addition of omecamtiv mecarbil to standard of care did not introduce any new concerns.
In fact, where there might be lower blood pressure, lower renal function, and other things as mentioned, and increased stroke risk, there appeared to be favorable benefits to adding omecamtiv mecarbil to standard of care. Where does this leave us then in terms of how it may ultimately be positioned commercially if this drug is approved by FDA later this year? We've segmented the large and growing heart failure population, as you can see on slide 16. There are roughly six million patients today growing to eight million by 2032 with the aging demographics. If you look at those roughly half that have HFrEF, you have about two-thirds of those who are suffering risk of worsening heart failure or who have low ejection fractions, which is indicative of more significant dysfunction and higher risk.
We think that two to three million patients represents a large and growing opportunity for omecamtiv mecarbil as could be meaningfully impactful, not just to treatment, but also to shareholders in Cytokinetics. This is the group of patients that we think have limitations given comorbidities and other issues of tolerability with existing standard of care. How might we think about this in terms of what is important and increasingly significant to payers? These are the same patients that are frequent flyers in U.S. hospitals. As recently presented in a subgroup analysis of patients in GALACTIC, we're seeing a meaningfully impactful reduction in costs associated with the add of omecamtiv mecarbil to standard of care.
A roughly 19% reduction in patients in this subgroup, which is significant to those payers and those hospital administrators who are currently being penalized by Medicare for admissions and readmissions within 30 to 60 days of an index hospitalization. We believe there's a meaningful clinical benefit in terms of efficacy and safety, but also importantly pharmacoeconomic value that may accrue to the increased use of omecamtiv mecarbil. How are we approaching the potential deployment of a commercial infrastructure? Slide number 18 speaks to hotspots of activity where we anticipate omecamtiv mecarbil may be especially a meaningful addition to a standard of care, and our focus will be on those subspecialty cardiologists who focus on heart failure and heart failure patients at increasing risk. We believe this is a concentrated customer segment tractable to a lean commercial infrastructure. It's especially meaningful, we need to understand the payer landscape.
Our Cytokinetics managed access team, our GMAD team, has already been engaging with payers. This is a predominantly Medicare Part D enrollment, category, and we know quite well where those customer segments are concentrated and already beginning to establish relationships around which we hope to be ultimately contracting for the use of omecamtiv mecarbil. We're especially mindful of the fact that many biopharma companies, especially in cardiology, get in front of their skis too soon. We're gating the build of our commercial infrastructure, focusing to those things that we need to attend to today. The majority of the costs associated with what would be a commercial sales and marketing activity will be gated on a commercial launch that would only follow, the NDA approval.
Underscoring a majority of the salespeople we might ultimately be hiring would only be hired were we to receive FDA approval, and otherwise we'll be focusing on positioning, supply chain, research, pricing, and other things like market access that may be enabling of competitive advantage upon approval. That's where we are with omecamtiv mecarbil. Our hope is that we'll be receiving an FDA approval later this year, and we'll be able to update shareholders on our commercial strategies as they are further refined and potentially following a launch later this year. Now turning to aficamten, our cardiac myosin inhibitor. It's a next-in-class compound following behind the recent mavacamten approval. Mavacamten discovered by Cytokinetics scientists in collaboration with MyoKardia acquired by BMS. Now BMS is launching mavacamten, and we congratulate BMS and everybody involved in that program on that important milestone.
We think mavacamten is a great drug. We have some pride in its discovery and development, and we continue to innovate in this space now with the advancement of aficamten, a potential next-in-class myosin inhibitor meant to address the increasing market for hypertrophic cardiomyopathy, both obstructive and non-obstructive. Currently diagnosed around 280,000 patients, as you can see on slide 22, and growing as would likely be expected with the advent of new medicines in this category. We believe that aficamten has a potential target profile that renders it next in class based on things we've learned along the way in connection with our role with mavacamten and in observing its development.
Aficamten is designed to improve what may be compromised exercise capacity and symptoms associated with NYHA class and quality of life, and also demonstrating what might be the potential for minimal drug-drug interactions while maintaining ejection fractions north of 50% and demonstrating the clinical benefits associated with a rapid reversibility and a dose titration absent requiring the monitoring of PK-guided plasma concentrations. Those are the aspirational next-in-class target profile elements as were already assessed in REDWOOD-HCM, cohorts 1 and 2 presented in 2021. You see here on slide 24 the trial design. It assessed aficamten added to standard of care in patients with OHCM, and we were very pleased with the results reported last year. Meaningful response rates demonstrating reductions, clinically meaningful reductions in left ventricular outflow tract gradients rapidly within two weeks and importantly, absent treatment interruptions, no treatment related SAEs.
We demonstrated a reversibility of the drug effect associated with a half-life that we think renders it more, dose titration friendly. We observed statistically significant reductions in NT-proBNP, a measure of cardiac wall stress associated also with effects we observed an improvement in NYHA class. Here on slide 26, you see how those reductions in gradients, both resting and Valsalva, were observed rapidly within two weeks and maintained throughout the treatment period and reversible within two weeks following washout. This is important, and we believe these results were embraced by the academic community, lending support for the work we're now doing in phase III. It doesn't stop there. We also observed effects that were important, meaningful, and dose-dependent in reducing NT-proBNP at week 10 and improvements in symptoms as measured by improvements in NYHA class, heart failure symptoms.
Those increased, as you can see, with increasing dose between cohorts 1 and 2. We also conducted a cohort 3 and a cohort 4, and those results have recently been communicated and presented. Altogether we are proceeding with the conduct of now cohort 4, looking at patients with non-obstructive HCM, importantly guiding our thinking in that adjacent indication. SEQUOIA-HCM, as you can see on slide 29, is now underway. This is a clinical trial intended to be a pivotal study to support potential registration. This trial will be enrolling patients around the world looking at doses already assessed in the phase II program, now looking out to week 24 and seeking to demonstrate effects on exercise capacity and measured by CPET, changes in peak VO2 being the primary efficacy endpoint measured at week 24.
Also looking at improvement in NYHA class as a secondary endpoint. We'll be enrolling 270 patients, making this the largest clinical trial ever conducted in obstructive HCM. This trial is enrolling well. We expect that we could have completed enrollment within approximately a year and looking forward to the potential results in 2023. Here we're looking at slide 30, the ongoing open-label extension from Redwood. We're very excited to report that these data cutoff of these data will be presented on May 22 at the upcoming heart failure meetings in Madrid. Here we point shareholders to what may be demonstrated durability of effect, hopefully still ensuring safety without dose interruptions. Aficamten is now the subject of an expanded clinical development program as partly funded by the deals we announced in recent months.
As you can see here on slide 31, not only are we pursuing an indication in obstructive HCM, but also, we are now conducting a cohort 4 of REDWOOD-HCM that may tee up a phase III pivotal study in NHCM, potentially as soon as next year. We also recently announced that we will be conducting a second phase III study, not requested by FDA, but rather as we ourselves believe would be potentially beneficial to advance standard of care. That study should be underway later this year, and we look forward to providing more clarity on the study design over the next few months. Aficamten, together with omecamtiv mecarbil, form what we believe can be a somewhat uncommon franchise strategy, especially important in biopharma when competing with pharma.
We believe that we have a relatively unusual situation to potentially go to market with both a cardiac myosin activator and inhibitor in the next couple of years, enabling of us to become a reliable, highly credible expert partner to the physician and payer community around this biology. Here you can see on slide 33, we think it affords us economies and synergies in terms of sales, commercial support, medical affairs, as well as what we do in the way of corporate affairs, altogether as may be enabling of enhanced present value, rewarding shareholders for the fact that we will be establishing this franchise.
This has been demonstrated, uncommonly, but has occurred in precedent by other biopharma companies that we admire, and we believe a franchise strategy is both important for offensive and defensive purposes as we hopefully will be building a more sustainable and durable business. That's because we believe that the customer segments have a high degree of overlap for aficamten and omecamtiv mecarbil. The incremental add for the commercial infrastructure is modest, but the returns on investment are quite substantial. We think that would be demonstrating a return that shareholders will find valuable and that physicians and patients will find meaningful because of our expertise in this one area of biology as it extends to now multiple potential new medicines. I'll now briefly turn to our skeletal muscle program, reldesemtiv.
Reldesemtiv, as you may know, is the subject of COURAGE-ALS, an ongoing phase III clinical trial in patients with ALS. Significant is that we recently announced we've enrolled over 150 patients, on our way to 555, thereby approximating nearly one-third of the patients, one-third of patients required to conduct the first interim analysis which we expect will be occurring later this year. This is a very large ALS clinical trial when compared to other recent studies, but that's not new for us because we at Cytokinetics, we believe we've enrolled more patients with ALS into clinical trials than any other company in recent years, to be sure. We understand what matters to these physicians, sites, coordinators, and patients, and we've designed into COURAGE-ALS a number of the features that render this study timely and recognizing of patient voice.
In particular, patient advocacy groups have given this study their highest ranking for meaningful patient engagement. We look forward to being a continued partner to the ALS community, hopefully bringing a new medicine forward for patients and caregivers who so desperately need new innovation in that space. In wrapping up on slide 39, I'll just point to some of the key metrics that we look to to know that we're advancing our business in the interest of all shareholders. You can see on this slide, not only are we demonstrating progress in terms of one potential drug to be hopefully approved later this year, but that's occurring with a continued advancement of our pipeline. Two programs in advanced phase III studies, potentially three approvals by 2025, accompanied today by five clinical programs that may double to 10.
We believe that we're thereby learning lessons from those great biopharma companies that preceded us in terms of building a business that doesn't only pivot on its commercial stage activities, but also its continued ability to demonstrate innovation in R&D. We do that, however, with a keen eye on those financials that get us there. We have now, with over 300 employees, still $686 million on our balance sheet as reported recently with our Q1 earnings call. That represents, as is a high water mark amongst many peer group companies, over two years of forward cash, even as we recognize that our burn rate is increasing.
That is an important measure of discipline for us financially and for our financial engineering to ensure we always have good runway to be able to satisfy not only our science and R&D activities, but protect shareholders from the kinds of biopharma financing winters like we're experiencing today. Here you see on slide 40 our balance sheet, and this is consistent with what you see on the right-hand side of this slide, which is our financial guidance. We guided to the net spending of between $365 million-$385 million this year. Also to culminate this presentation, here you see on slide 41 our key expected milestones. We expect shareholders to keep us accountable to these milestones, and we're demonstrating our discipline by continuing to lay out these as key metrics of our progress enhancing shareholder value.
You can see not only are we looking forward to the potential launch of omecamtiv this year, but the advancement of SEQUOIA-HCM, the reading out of the open label extension data from REDWOOD-HCM, the beginning of a next clinical trial, a phase III study of aficamten later this year, as well as the first interim analysis from COURAGE-ALS later this year. With that, I appreciate your interest. Thank you for your attention and can open up for any questions if there are any here in South San Francisco. There being no questions here in South San Francisco, we appreciate very much the steadfast support of our shareholders. We hope that this report on our progress was satisfactory. We welcome your interactions and questions. With that, I'll turn over the meeting back to John and thank you for your interest.
We're optimistic, we're excited, we're motivated as we enter 2022. Last year, our company began a transformation that will continue through this year as well. We remain committed to our goal of transforming patient lives. I'll turn it now to you, John. Thank you.
Thank you very much indeed, Robert, for the update and the progress that Cytokinetics is making across our pipeline of muscle-directed therapies. 2022 is going to be a very important year for Cytokinetics, as I think you will have seen from Robert's presentation. It will be one marked by tremendous but prudent growth and expansion to support the potential approval of omecamtiv mecarbil. Building these capabilities will carry forward synergies and cost efficiencies to the future potential launch of aficamten, supportive of the cardiovascular franchise model that Robert described to you. We have a bright future ahead of us, and we remain committed to the patients, caregivers, and shareholders who count on us to deliver continued progress against our goal of improving the lives of people living with diseases of impaired muscle function.
I want to thank all of you who participated today in this stockholder meeting, and I now declare the meeting adjourned. Thank you very much indeed, everyone.