Participants

Timothy Papp; Chief Financial Officer, Company Secretary; DURECT Corp

James Brown; President, Chief Executive Officer, Director; DURECT Corp

WeiQi Lin; Executive Vice President of Research and Development, Principal Scientist; DURECT Corp

Carl Byrnes; Analyst; Northland Capital Markets

Presentation

Operator

Greetings, and welcome to the DURECT Corporation third quarter 2024 earnings conference call. (Operator Instructions) As a reminder, this conference is being recorded.
It is now my pleasure to introduce your host, Tim Papp. Thank you. You may begin.

Timothy Papp

Good afternoon, and welcome to DURECT Corporation's third quarter 2024 earnings conference call. This is Tim Papp, Chief Financial Officer of DURECT.
Before we begin, I would like to remind you of our safe harbor statement. During the course of this call, we may make forward-looking statements regarding DURECT's products and development, expected product benefits, our development plans, future clinical trials or projected financial results. These forward-looking statements involve risks and uncertainties that can cause actual results to differ materially from those in such forward-looking statements. Further information regarding these and other risks can be found in our SEC filings, including our 10-K and 10-Qs under the heading Risk Factors.
To begin, I would like to review our third quarter 2024 financial results. Total revenues in the third quarter were $1.9 million compared to $1.7 million in 2023. 2024 revenues were higher primarily due to an increase in product sales, partially offset by a decrease in revenue from collaborations. R&D expense was $2.2 million in the third quarter of 2024 compared to $7.2 million for the prior year. The decrease was primarily due to lower clinical trial-related expenses and lower employee-related costs.
SG&A expenses were $3.2 million in the third quarter of '24 compared to $3.8 million for the prior year. The decrease was primarily due to lower employee, professional services and legal expenses. As of September 30, 2024, we had cash and investments of $10.5 million, and our cash utilization in the third quarter was $5.3 million.
We believe our cash on hand is sufficient to fund operations through the first quarter of 2025. Lastly, Innocoll has notified us that they are terminating the licensing agreement related to POSIMIR. We are in the process of evaluating our options for POSIMIR, but given that we have not been receiving royalties in recent quarters, we do not expect that this will have a material financial impact for DURECT.
Now I would like to turn the call over to Jim for a business update.

James Brown

Thank you, Tim. Hello, everyone, and thank you for joining us today. DURECT's priority continues to be initiation of the confirmatory Phase 3 clinical trial of larsucosterol in alcohol-associated hepatitis, or AH. And I'm excited to share an update on our progress. As we finalize preparations for the trial, we continue to have positive dialogue with the FDA, utilizing the advantages offered under our breakthrough therapy designation.
During the quarter, we held a Type B meeting with the FDA and reached an agreement on key aspects of our planned Phase 3 trial design. The Phase 3 trial is designed as a randomized, double-blind, placebo-controlled, multicenter study that will be conducted in patients with severe AH in the US. We plan to enroll approximately 200 patients who will be randomized 1:1 to either 30 milligrams of larsucosterol or placebo. The primary outcome measure will be a 90-day survival endpoint.
We are conducting this trial at US sites to avoid the variability we observed in health care provision at ex US sites in the prior AHFIRM study. For example, we observed a difference across regions of the world in the time to treat patients in the AHFIRM trial. These data will be presented in an oral presentation at the AASLD meeting this weekend.
The dosing regimen in Phase 3 is consistent with AHFIRM, with patients receiving the first dose on day one and is still hospitalized a second dose on day four. This trial design leverages the data from our Phase 2b AHFIRM trial and the feedback we received from the FDA through our Type B meeting held under the breakthrough designation.
As a reminder, in AHFIRM both doses of larsucosterol reduced mortality by nearly 60% in the US patients who represented 76% of the total number of patients in the trial. The FDA has confirmed that a single pivotal trial would be sufficient to support an NDA filing in AH. And with breakthrough therapy, we have the opportunity to submit the NDA on a rolling basis. We are preparing to initiate the trial as soon as we can, subject to obtaining sufficient capital, and our goal is to have top line data within two years of initiation.
We remain committed to obtaining approval for larsucosterol and AH as expeditiously as possible and ultimately bringing this potentially life-saving therapeutic to patients with no effective treatment options today.
We have already undertaken important steps to prepare for initiating the trial, including starting the process of onboarding clinical sites and selecting a CRO to help manage the trial. We expect to report top line data within two years of initiating the trial.
We've continued to analyze the AHFIRM data and we'll have additional data presented at the AASLD meeting during the next week. We have an oral presentation of the time to treatment data that I mentioned previously. We also have two poster presentations, one on liver transplant and the other on drinking behavior of patients who participated in the AHFIRM trial.
We remain encouraged by the strong interest from hepatology thought leaders and key opinion leaders for the AHFIRM results and their continued support for larsucosterol's potential to provide a clinically meaningful survival benefit in AH patients. As a brief reminder, our Phase 2b AHFIRM trial was a placebo-controlled double-blind multinational study with two active arms of 30 milligrams and 90 milligrams of larsucosterol and a placebo arm of approximately 100 patients each.
In total, we randomized 307 patients with severe AH from a global network of clinical sites. Our sites included renowned liver centers in the United States, Australia, the EU and the UK and we had the honor of working with some of the world's preeminent thought leaders in AH.
The top line results in the key secondary endpoint of mortality at 90 days showed a 41% reduction with the 30-milligram dose of larsucosterol and a 35% reduction with the 90-milligram dose of larsucosterol as compared with placebo.
Even more impressive results were observed in the US population, which comprised three quarter of the total enrollment in AHFIRM, that was 232 out of 307 patients. In the US, we saw reductions in 90-day mortality up 57% and 58% for the 30 and 90-milligram arms, respectively, compared with placebo. Although not part of the original trial statistical analysis plan, the p-values for these results were both approximately 0.01.
Very importantly, larsucosterol exhibited an excellent safety profile, with no serious adverse events in either arm and greater than 20% reductions in the total number of treatment-emergent adverse events for both active arms when compared with the placebo group in these severely ill patients.
Ultimately, these clinically meaningful reductions in mortality, coupled with the reduction in adverse events in these severely ill patients, reinforce the compelling risk/reward proposition of larsucosterol.
We continue to believe that the AHFIRM data provide compelling evidence that larsucosterol could represent a safe and effective therapy with life-saving potential for AH patients. There are no approved therapies for AH today. So if larsucosterol meets our expectation in the Phase 3 and we gain approval, it would likely be the first FDA-approved treatment for this disease and establish a new standard of care.
AH is the cause of more than 160,000 hospitalizations each year in the US and with a 90-day mortality rate of approximately 30% is responsible for tens of thousands of deaths each year. In addition to its high mortality rate, AH represents a significant cost to the US health care system. Hospitalizations attributed to AH incurred charges between $67,000 to $180,000 per patient, a total charge to hospital of approximately $10 billion annually. As a result, larsucosterol could potentially save thousands of lives each year while representing a potential blockbuster opportunity in the US alone that could simultaneously provide overall cost savings to the health care system.
We would now like to take any questions you may have.

Question and Answer Session

Operator

(Operator Instructions)
François Brisebois, Oppenheimer.

Hi, this is Dan on for Frank. At this time, are you sharing your -- anything about your strategy for the onboarding of sites? Would you be targeting the same sites in the US as in the AHFIRM trial? Were there any sites that were faster enrolling sites. Any color there?

James Brown

Yeah, we definitely are going to be using a number of the same sites, and we've been spending this time actually putting in place confidentiality agreements and putting in place the agreements because when starting any clinical trial, it's the paperwork, the legal component of it all that takes the longest from starting it. But WeiQi is on the line. I'll let her also speak to that. WeiQi, any thoughts on the specific the approach you're taking with these US sites?

WeiQi Lin

Yes. We actually will include at least 60%, 70% of the AHFIRM trial sites in the US for our Phase 3 trial.

Thanks for that. And with respect to -- you highlighted that there were some time to treatment differences around the world. I'm wondering if there were any geographical differences within the US? Or was this mostly a US versus ex US phenomenon?

James Brown

All right. Once again, I'll let WeiQi speak to that first. Go ahead, WeiQi.

WeiQi Lin

Yeah, there were huge differences of time to treat of the regional differences for the time to treat, which we are going to present at AASLD meeting on the November 18. Within US, of course, there might be site-to-site variation, which we did observe that. But however, because the -- and numbers from US region is much bigger.
So it's more or less overcome that variation because of smaller sample size from ex US regions, so that's exaggerating -- further exaggerating that the time to treat variations. That's why this Phase 3 trial will be focusing on US at least for now for the Phase 3. That's why this phase three trial will be focusing on us at least for now for the Phase 3.

That makes sense. Thanks for taking my questions.

Operator

Ed Arce of H.C. Wainwright.

Hello, everyone. Good afternoon. This is Thomas asking a couple of questions for Ed. So first, besides funding, what are some other preparations that are needed for larsucosterol to enter Phase 3?

James Brown

Well, the funding, obviously, is the most important piece. And once that's in place, we feel like we can complete the trial from about two years from when we established a start of the trial. The things we're doing now are things that do have a long lead time and can be done with very little money, and those are putting in place the legal relationships and contracts between ourselves and the various clinical sites as well. We have selected our CRO, which is always -- it takes a bit of time. So that's been done. And so we're just doing everything we can in preparation to start the trial as quickly as possible once we have the funding in place.

I see. So it sounds like pretty much everything is ready to go, but just waiting for the funding.

Timothy Papp

Yeah. Exactly.

And then so I suppose to the issue of funding, can you give a ballpark figure of how much the Phase 3 study is estimated to cause especially given the relatively short initiation to readout time lines that they point out in about two years?

James Brown

Yeah. I don't know, Tim, do you want to maybe speak to that?

Timothy Papp

Sure. Yes. As Jim mentioned, we've been working with CROs, and we've had a competitive bid process to get their estimates for what the Phase 3 trial would cause from an external cost perspective, and that's in the kind of $20 million to $25 million range. And then obviously, on top of that comes the G&A associated with running the business here at DURECT. So we think our burn is probably in the $3 million to $4 million a quarter range once we are scaled to start the trial.

Got it. Thank you again for taking our questions and looking forward to additional progress.

James Brown

Thank you, Thomas. Good talking to you.

Operator

Carl Byrnes, Northland Capital Markets.

Carl Byrnes

Thanks for the question. Actually, most of my questions related to the trial been answered. So kind of moving over just a bit. Were there any royalty revenue recognized from Innocoll in the third quarter? And if so, can you quantify that? Thanks.

James Brown

Let Tim speak to.

Timothy Papp

Yes. There were no.

Carl Byrnes

Okay, great. Thank you.

James Brown

Sure.

Operator

At this time, we have no further questions. And I would like to hand the floor back over to Jim Brown for any closing remarks.

James Brown

Well, I want to thank you for your time today. We all do. And as always, if you have any further questions, please reach out to us. We look forward to catching up. Thank you so much and take care.

Operator

Ladies and gentlemen, that concludes today's conference. Thank you for joining us. You may now disconnect your lines.