Crinetics Pharmaceuticals, Inc. Price & Performance (CRNX)

Such forward looking statements are not a guarantee of performance. And the company's actual results can differ materially from those stated or implied such statements, due to risks and uncertainties associated with the company's business. These forward looking statements are qualified in their entirety by the cautionary statements contained in today's news release, the company's other news releases and Quinetics SEC filings including its annual report on Form 10 ks and quarterly reports on Form 10 Q. I would also like to specify that the content of this conference call contains time sensitive information that is accurate only as of the date of this live broadcast 02/27/2025. Kinetics takes no obligation to revise or update any forward looking statement to reflect events or circumstances after the date of this conference call. With that, I'll hand the call over to Scott. Thank you, Gayatri, and good afternoon to everyone joining today's call. 2024 was a remarkable year for Kinetics Crinetics, As you can see on Slide three, we successfully executed on all of the key objectives we set out to accomplish. This sets the stage for what we believe will be a transformative 2025. On today's call, we'll review some of these accomplishments.

And outline our plans for 2025 and beyond. Since our last earnings call, the FDA accepted the NDA for the treatment and long term maintenance therapy of acromegaly. The PDUFA date is September twenty five of this year. This is our first NDA filing and I'm extremely proud of the team for its hard work in getting us We're continuing to prepare our organization for the anticipated launch of Paltus Athene later this year. As part of this, we are completing the build out of our commercial and as well as the underlying administrative infrastructure. A very important part of this was hiring Isabel Colifonos, this past December as Chief Commercial Officer. She successfully launched many rare disease products at both large and small biopharmaceutical companies. Isabelle has all the skill sets and relevant experience to lead us through our I'm happy to introduce her to you here today. Given the strength of the clinical data for our lead programs, and the deep pipeline behind them, We continue forward with our stepwise regional growth strategy in Europe. We anticipate filing of the MAA for Acromegaly shortly.

We have incorporated a hub in Zug, Switzerland and brought a general manager and Leadership for EU regulatory market access and medical affairs and we're beginning to extend this organization to Germany.

As a leader in endocrine innovation, we plan on leveraging this infrastructure in the coming years as we evolve into a fully integrated global pharmaceutical company. Last year, we made significant progress on multiple clinical readouts, including for paltuzetine's second indication [indiscernible] In Phase two study, health system treatment demonstrated rapid sustained reductions in frequency and severity of flushing episodes and bowel movements. We have begun activating clinical trial sites for the Phase three trial in expect the first patient to enroll next quarter. We also shared extremely positive data for our second candidate, SMELNET, in both congenital adrenal hyperplasia or CAH and in Cushing's disease. In a Phase two study in adults with CHH, etumelan achieved rapid substantial and sustained reductions of both biomarkers, PAID4 and 17 OHP. Importantly, significant clinical improvements in symptoms were also observed which was impressive in a twelve week study. We believe that Asthma can provide healthier hormone levels on both dimensions, adrenal androgens and exogenous glucocorticoids, And this profile has the potential to differentiate baximelnet and provide meaningful improvements people living with CH. With this in mind, progressing towards initiation of late stage CH studies in both adults and in children. These studies are designed to take advantage of that's a very potent mechanism of action to provide benefits for a broad spectrum of patients with CH.

Aximona also demonstrated initial positive results in Cushing's disease, All participants in this Phase 1b2a trial rapidly achieved normalization of urinary precortisol and that is the primary endpoint required for registrational studies in Cushing's disease. Lastly, we're making notable progress on our earlier stage programs including 9,682, our first drug candidate from a novel nonpeptide drug conjugate or NDC platform. This year, we expect to submit four INDs in total including 9,682. Steve will discuss these in more detail towards the end of the call. With that, I'm pleased to introduce Isabel, who will tell you more about the progress in building our commercial capabilities. Thank you, Scott.

I'm pleased to have joined Kinetics to lead the commercial organization in this exciting new chapter for the company.

Today, I will share more about how we are advancing our commercial capabilities and working diligently to be launch ready ahead of our first potential FDA approval. We are building a best in class commercial and medical affairs organization. With strong leaders across all functions. [indiscernible] marketing, market access, medical affairs, and Sales.

Separately, our medical affairs team has talented endocrinologists leading the effort to liaise with healthcare professionals and KOS. Our MSL team has already reached out almost 100% of our core academic targets to solidify relationships and refine our understanding of the unmet needs in acromegaly treatment. We also have strong partnerships with the broader endocrinology community which we believe will be instrumental for a successful launch.

There is significant unmet need in the acromegaly market. Healthcare professionals and patients want therapies with it. Rapid onset of action sustained effect favorable adverse event profile and ease of use. We are building our commercial American organizations to drive educational efforts in a market that has not seen any meaningful innovation for a long time. Slide four outlines the four imperatives of our commercial strategy. [indiscernible] adopt Access and Adhere. First, we want to activate healthcare professionals and patients to demand more from their acromegaly therapy. For example, wanted to realize that they cannot ship better disease control and don't have to settle for frequent breakthrough symptoms. Across the Phase III program, patucatin demonstrated rapid reliable control biochemical markets decreased symptom severity and reduced frequency of breakthrough symptoms.

Second, after approval, we want to drive adoption of bantucitim by clearly articulating its differentiated efficacy, and safety profile to patients and healthcare professionals. Our reference will be focused on pediatric treatment centers as well as the community. Many patients see their doctors in the community setting where adoption of new therapies tend to lag behind academic centers. And since patients tend to visit their healthcare professional only one or two times per year, we expect a more gradual adoption at the outset.

We are actively developing strategies to motivate patients and healthcare professionals to accelerate this timeline. Over time, we are confident in the potential of paltuzetine to become the new standard of care. Third, we want to ensure access to participating. Our market access team has continued to engage with the top U. S. Payers and they have been very receptive to the value proposition of Fantisitin. As with any new drug, there will be a standard formula inclusion process. That will need to be followed. But we are working towards having comprehensive coverage as soon as feasible after launch. We're extremely confident that we'll be able to provide optimal access for all acromegaly patients that could benefit from paltustin. Lastly, we want patients to adhere to the patustin regimen, Patient support goes far beyond financial co pay assistance. And our comprehensive patient support center will include a full suite of services to provide unparalleled support for patients at every step starting an initiational therapy and throughout the course of their long term treatment regimen. In summary, the patuzatin profile we are sharing in market research is resonating with all key stakeholders. Healthcare professionals, payers and most of all patients. We look forward to sharing more detail on our launch strategy in the coming months.

Lastly, it is important to note that the work that we do today will serve as a solid foundation for anticipated future launches. We will leverage infrastructure we are building today in The U. S. And Europe across additional indications for patucatin as well as the other candidates in our pipeline. With that, I will hand the call to Dana to discuss our clinical development progress. Thank you, Isabelle. This is a very exciting time for Kinetics Crinetics. Turning now to Slide five, The NDA for paltuzatin was accepted last quarter. We have a productive relationship with the Endocrine Division at the FDA And our NDA review is proceeding normally. In addition, we expect to file our MAA for acromegaly to the EMA in the first half of this year. Separately, the Committee on Orphan Medicinal Products of the EMA has issued a positive opinion on our application for orphan designation for acromegaly. Based on the committee's [indiscernible] that it has a potential to provide significant benefit over the currently available therapies. We are continuing to activate for the Phase three study of paltuzetine in carcinoid syndrome. We are planning to run this study globally and expect to enroll our first patient in the second quarter.

For Adam Melman in CAH, are putting the finishing touches on our Phase three adult protocol after productive interactions on this design with the FDA and two European health authorities, I'll provide more detail on this in a moment, We've also had important and supportive discussions with FDA and EMA regarding our proposed Phase twothree pediatric study for CH. We are completing protocol development and will provide more details on the design and plan to begin this study before the end of the year. We are continuing to pursue development of anemelein in ACTH dependent Cushing syndrome or ADCS, We are finalizing a proposed seamless Phase twothree study design which we developed after review of our NIH study data and in close collaboration with external experts and regulatory advisors. In the near future, we will provide our proposal to the FDA and European agencies for discussion. Then finalize the protocol and would expect to enroll our first patient late this year or early next year.

Before I leave Adam Melnet, I realize there may still be some lingering discussion about the one case of elevated liver enzymes in the CAH Phase two study As we have previously described, one patient in the one hundred and twenty milligram dose cohort at liver enzyme elevations at the final study visit at twelve weeks, And those levels return to near normal within two weeks. The patient did not show any elevation in bilirubin nor any associated symptoms. It is also important to note that we have seen no concerning signals nor unexpected safety findings in the preclinical work or in the Phase one healthy volunteer studies. We have shared all preclinical and clinical data including the details on this patient with the FDA and global health authorities as part of the consultation process for our proposed Phase three design.

After reviewing all the data and the proposed Phase three protocol, the FDA has not recommended any changes to the safety monitoring in the ongoing open label extension study nor any additional testing on top of routine hepatic safety monitoring in our proposed Phase three protocol. We remain very enthusiastic about the strength of the overall Phase two efficacy and safety results And we believe this favorable benefit risk profile will be confirmed in our Phase three trial.

This enthusiasm is reflected in our Phase three protocol which we will share in detail when final, but our intention is to use a novel endpoint Based on the entirety of the clinical program, and at AMELNON's unique mechanism of action at the MC2R receptor anemelnet should be capable of reducing androgens into a normal range and allow for lowering glucocorticoid doses to physiologic replacement levels. Our proposed endpoint would capture this differentiating aspect of atamelnet and will allow for broader Phase three inclusion criteria than was used for the currently approved CAH therapy. In particular, patients with normal glucocorticoid doses but high A-four levels could potentially benefit from atamelnet and will be included in our Phase three study. 2025 is an exciting year for paltuzetine and enamelnet as we continue towards registrational studies for these candidates in multiple indications. We will soon have four late stage clinical programs underway which is a new high watermark Crinetics.

As we make progress on our preclinical pipeline, we look forward to potentially initiating additional early stage trials. With that, I will hand it to Steve to describe our upcoming INDs. Thank you, Dana. As you can see highlighted on Slide six, Kornix has an innovative pipeline of drug candidates with IP into the 2040s. [indiscernible] currently disclosed and more innovation happening within our discovery team. Our core expertise is in targeting G protein receptors or GPCRs with small molecules that have specifically tailored pharmacology and properties. To reflect the breadth of opportunities within the GPCR space, we have organized our discovery team into three main focus areas: endocrine disease, metabolism and what we call targeted therapeutics. Since our inception more than fifteen years ago, Trinetix Crinetics focused on developing innovative nonpeptide drug candidates that target specific endocrine pathways to modulate abnormal hormone secretion. Most of the candidates currently in our pipeline have come from our Endocrine Group, and we continue to explore additional GPCR targets within the endocrine system focused is always on key areas of unmet need. Relatedly, metabolic disorders in including diabetes and obesity, impact the lives of hundreds of millions of people around the world and their effects on patients are significant and varied.

We feel that many of these disorders can be addressed by appropriately activating or blocking the receptors of key metabolic hormones including insulin, glucagon, GLP-one and GIP. Kinetics' understanding of these hormonal pathways the GPCRs that control them is driving us to create new molecules with a chance to improve the lives of these patients. Lastly, I'd like to cover targeted therapeutics. Our efforts in this space began with the development of non pep for the imaging and treatment of a broad range of endocrine receptor driven cancers. Of using nonpeptide ligands to target endocrine GPCR is relevant to our with non radioactive payloads. This work has led to the development of a new modality that we call nonpeptide drug conjugates or NDC. NDCs are novel therapeutic approach that are conceptually similar to [indiscernible] but use a nonpeptide ligand instead of an antibody to selectively target and deliver payloads to tumor cells expressing GPCRs. We feel NDCs possess multiple advantages including straightforward production by standard synthetic methods, and tailored in vitro and in vivo properties that allow us to optimize half life, tumor penetration and payload. Four early stage programs from these discovery efforts are currently in IND enabling studies.

The farthest along of these is CRN09682, our NDC for SST2 expressing neuroendocrine and solid tumors. The SST two agonist ligand for 9,682 has been optimized to promote internalization so that its payload can be efficiently delivered intracellularly to induce tumor cell death. We are on track to submit an IND for this program early this year. The other candidates with IND planned for 2025 include a PTH antagonist for hyperparathyroidism, a TSH antagonist for Graves hyperthyroidism and thyroid eye disease, and an FFT3 agonist for autosomal dominant polycystic kidney disease or ADPKD. Similar to what we have seen in our development of both paltuzetine and Melinet, one advantage of several of these programs listed on the slide that we can get early mechanistic proof of concept in Phase one trials. The first in human studies of 09/1982 will be in oncology patients, so we can measure progression of disease. And hyperthyroidism and hyperthyroidism There are hormonal biomarkers that should demonstrate whether we are having our desired pharmacological These early insights ensure that we can optimize our potential for success across each of these programs while maintaining a capital and resource efficient development strategy. We look forward to sharing some of the early results from these programs with you they become available in the future.

With that, I will hand it over to Mark to review the 2024 financial results. Thank you, Steve. Turning to Slide seven. 2024 was an outstanding year that demonstrated the strength of our strategy and our team's execution capabilities. Kinetics entered 2025 with strong momentum of across all programs and the company remains focused on discovering and developing novel therapies patients as well as generating value for its co owners. The tremendous progress made over the course of last year has enabled the company to continue investing in the pipeline as we prepare to launch the first drug candidate emerging from our own R and D efforts. Now I will walk through the financial results for the fourth quarter and year. Revenues were $1,000,000 for the full year ended 12/31/2024, compared to $4,000,000 for the same period in 2023. There were no revenues in the three months ended 12/31/2024 the three months ended 12/31/2023.

Revenues in both years consisted of the amortization of payment we received in connection with our Paltusatin licensing arrangement with our Japanese partner SKK Revenue in 2023 also included approximately $2,000,000 associated with a development candidate that we licensed to Loyall to explore extension of life span in large and giant breed dogs. Research and development expenses were $66,600,000 and $240,200,000 for the three months and full year ended 12/31/2024, compared to $45,600,000 $168,500,000 for the same periods in 2023. The increases were primarily attributable to higher personnel costs and increased development activities associated with the G and A expenses were $28,200,000 and $99,700,000 for the three months and full year ended 12/31/2024, compared to $17,100,000 and $58,100,000 for the same period in 2023. These increases were primarily driven by increased personnel Our net loss for the three months ended December 3120 was $80,600,000 compared to a net loss of $60,100,000 for the same period in 2023. For the year ended 12/31/2024, the company company's net loss was 298,400,000.0 compared to a net loss of $214,500,000 for the prior year. For 2025, we anticipate our cash burn to be between $340,000,000 and $380,000,000 This increase reflects our plans to initiate four late stage trials in 2025, So we expect our R and D spend to grow in 2025 as those trials start ramp up SG and A will also increase this year as we and prepare for the potential launch of paltuzetine in the fourth quarter.

We ended 2024 on strong financial footing approximately $1,400,000,000 in cash and investments. Which is expected to fund our operating plan into 2029.

Before I turn it back to Scott, I'd like to take a moment to thank my fellow Cornedisians for their support during my tenure particularly since I announced my plan to transition out of the CFO role a number of months ago.

I would also like to thank those of you in the investment community who have been out outstanding colleagues over the years. I truly believe in the work that is being done at Crinetics is a genuinely unique company and I'm honored to have been a small part of what the organization has accomplished. I am optimistic about the future I'm confident that Toby will be an exceptional steward of the company's resources through its next phases of growth. I'll now turn it over to Scott for closing remarks.

Scott?

Thank you, Mark, and thank you for your leadership over the past seven years.

You've been instrumental through these years of incredible growth. To the public company we are today with operations around the world and on the verge of our first PDUFA Day. I speak for everyone here when I say that we are deeply grateful for your dedication and contributions.

We're also very excited to welcome Toby Schilke, who will succeed Mark as Kinetic's CFO Crinetics.

Toby brings over twenty five years of global pharmaceutical experience and has led several biotech companies through the transition to fully integrated commercial enterprise. He brings a wealth of experience and a unique as we prepare for our first commercial launch. Turning to Slide eight, I'm very bullish on the bright future before Kinetics Crinetics.

The array of opportunities for us to help patients with endocrine related diseases with pipeline we've created from scratch is breathtaking. With the progress I have described today, we've made great strides on our path to becoming the wholly integrated global pharmaceutical company. The combination of our best in class in house discovery capabilities, proven clinical development, and our ongoing build of commercial capabilities strongly positions us to execute on a number of key milestones in 2025.

We plan to leverage our growing infrastructure across multiple programs and therapeutic areas while recognizing economies of scale along the way. I believe this strategy will help us to maximize patient reach and drive long term value growth for all our stakeholders. With that, I'll hand the call back to the operator to begin Q and A. Please limit yourself to one question each in the interest of time. Operator?

Thank you, Doctor. Stuller. Ladies and gentlemen, at this time, if you do have any questions or comments, please Great. Thanks, guys. It's great to be back in coverage of Kinetics here again and congratulations on all of your achievements Mark. I wish you the best. I want to ask about Paltu. The data with PAL2 and acromegaly are clearly strong and the likelihood of approval in September is very high.

But expectations for the launch seem conservative or even modest. From some of your investors. So can you elaborate on the ongoing launch preparations for PEL2? What might surprise people in your global strategy in particular? Thanks, Tyler. I totally agree with you.

How strong the data has been for Ocomegaly. And as we talk to the KOL community, I think there's an emerging consensus that really is the next level of care And we are super pleased with the announcement from the EMA that we've been granted or which in part recognizes that because they felt that paltustetine constitutes a clinically relevant advantage over currently approved therapies. And that's part of their process in making orphan designation.

So I think we've built something that is going to give Isabelle and the rest of the team something very strong to work with. And let me let her talk to you about the ongoing preparations.

Yes. Thank you, Scott. Yes, we are in a really good place in preparing the organization, the market and the product. In terms of the organization, we hired a very talented team and we're very pleased to welcome our VP of Sales, as we continue to build our customer engagement model, including not only the sales team, but field reimbursement managers. To facilitate the onboarding of the patients. In addition to that, we are preparing the market and that involves very successful engagement right now with the payers that are responding very well to the value proposition of the drug As Koda stated, we have a treatment that has fast onset of action sustainable effect less breakthrough symptoms has a very good tolerability profile and of course is a once daily, which really resonates not only with the payers, but also with the physicians and the healthcare professionals. We continue to drive educational activities to engage with the doctors, in disease awareness as well as with the patients. In terms of the product, we are in a very good place when it comes to our supply chains and distribution And we continue to develop our training modules and launch materials consistent with the expected label.

So we are in a very good place and the product really offers the opportunity to really change the standard of care.

In terms of the international organization, We think it's very important that this product is not only for The U. S. Patients, but it starts really making a difference international as well. So we're starting in Europe, where we had hired a very talented team that as in The U. S. Has significant experience on pro launches and rare diseases. We have a General Manager Market Access, Medical Affairs and Regulatory in place. And it's our goal to now focus on building Germany. Similar to The U. S, the model is very fit for purpose really with the significant value concentrated in centers of excellence and we're preparing and advancing that [indiscernible] So really exciting times in the commercial organization. It's in full engagement and making sure that we advance towards a successful launch.

You. We'll go next now to Yasmeen Rahimi at Piper Sandler. Hi. This is Dominic on for Yasmeen. Thank you for taking questions and congrats on continued strong execution. Our question is just how do you envision your disclosures as you continue your dialogue with the FDA between now and September 25?

Are there certain topics of interest that could come up at your mid cycle review And also have you had your mid cycle review yet? And what was the outcome?

If you had. Thank you. Let me let Dana answer that. But just in general, I pleased with the overall cadence of our communications. And from a Communications point of view, I think that will be simply as an as needed basis. But let Dana just say a little bit more. Yes. Well, we haven't had the mid cycle yet. But we are scheduled to do that.

And we're awaiting further interactions with the FDA as we go along, but as I mentioned, in my initial remarks, everything is proceeding normally and there's very productive relationship with the agency. Thank you. We'll go next now to Joe Schwartz of Leerink Partners.

I was wondering if you could talk about the strategies you're working on to motivate acromegaly patients to see their healthcare providers such as those in the community we heard you say often lag in the up uptake of new treatments? And in a related sense, how long do you think Phase three enrollment for etumelnet and CAH may take recognizing that there's a new treatment and could be a bit competitive, but also I think you've Already had a lot of experience with clinical development now. For peltucetine. So I'm just wondering relative to that Phase three enrollment timeline, how should we think about how long it might take for otovelin in Phase three?

Nice working in a compound question, Joe. So let me answer the latter and then I'll hand it off to Isabel. But look, we've we've got quite a bit of experience now in that community. In many cases, it's the same institutions as we did with Acromegaly the fact that now there's an approved drug on the market in Krinesiti is fabulous for these patients. But I don't think it's going to significantly impact our enrollment especially since we're in a a global clinical trial. And in fact, has been our past experience. And I think the past experience most other companies. Recruitment tends to be higher outside The U. S. Than inside The U. S. And so I see no effect. And then compared to prior trials, of CAH that were underway. During the pandemic, where people were late to the international markets, I expect us to do significantly better than Previous experience.

But Isabelle, maybe talk a little bit about activating patients. I think they're highly motivated already, but we want to make sure they're empowered, not just motivated.

Just thought Indeed, we are engaging with the patients through different venues, including our disease awareness campaign. Really to highlight the significant unmet need that is happening in the marketplace. Today, the data which shows that only thirty five percent of of the patients The thirty five percent of the patients are uncontrolled. So many of the patients have significant unmet needs. And the majority of the patients had breakthrough symptoms. Even though the IGF-one level might look like normal, they continued to experience significant effects from fatigue, [indiscernible] other symptoms as well. That impairing the [indiscernible] So we are making them aware of that and that different educational events and a deceased awareness as well as our media outreach that is starting right now throughout the country. In addition to that, we have patients have that we believe is going to really help patients reach out and we will support them not only to co payments and additional activities, but also helping with the with the mental health and other things that will provide support to them. So overall, Sorry, we are in the process of activating only the patients, but the community.

Very helpful. Thanks for the insights.

Thank you. We go next now to Jessica Fye of JPMorgan.

Hey guys, good afternoon. Thanks for taking my question. I was curious if there's any update on where things stand with the open label extension for the CAA Phase two trial just trying to think about if that's something we could see data from prior to getting those Phase three results Thanks, Jess.

Yes, the sites are activating and patients are switching into the open label extension and eager to see how they do. It's a little bit of a second bite at the apples.

We had a bit of a delay in starting the OLE to finish up the long term talks. So all the patients had come off of drug and now they're coming back on under physician care. And yes, I look forward to seeing how that plays out and I think it will be a valuable source of information. Thank you. We'll go next now to Cory Jubinville of Lifesize Capital.

Hi there. This is Kate on for Cory. Thanks for taking your questions and congratulations on the amazing progress this year. Just one from us related to the CEH program. It's of course still early days, but it seems like the Kinesiti launch in CEH has gotten some early momentum. And we're just curious what are the learnings you've taken from the launch thus far? And how you might be considering that for Aetumelnet in the future? And is there anything thus far that surprised you? Thanks, Kate.

I think it's really a little early for us to draw any conclusions, but Our friends and neighbors down the street have proven themselves as very good commercial pharmaceutical companies. So I expect they'll do a good job. And we're watching closely to learn from them and wish them well. Thank you. We'll go next now to Gavin Clark Gartner at Evercore ISI. Hey, guys. Congrats on the progress For ashumelimab, can you share any additional details on cohort four in the TUKAN study and when we may be able to possibly see that data? [indiscernible] We haven't really started talking about Cohort four, remember, as just one cohort in a large overall program.

I think one thing we will be telling you about in the not too distant future is is the overall study design details for the Phase three program and maybe at that time it's relevant to talk about Cohort four.

But I'll try and get that out as soon as we have the final pieces in. I just don't want to tell you something that might have slight revisions. So we're very close to finalizing that and starting to activate sites and things like that. So think we'll be able to provide clarity by our next earnings call at the latest.

Thank you. The next to John Wabel at Citizens. Hi. This is Catherine on for John. I think kind of follow-up question on CIH as well. I know that you just mentioned that you're going to be discussing the design details of the Phase three program going forward. But just a general general kind of question on the end [indiscernible] From the one that was kind of previously previously used. So what is the kind of rationale for regulatory standpoint as well as the commercial standpoint on changing up the endpoint? Can you give a little bit more color on that?

Yes. Thanks. I think the thing to recognize is that sorry, we're getting some feedback?

I think the thing to recognize is that this is a completely different mechanism of action with a different pharmacologic profile. [indiscernible] we've shown in both the Phase II and CAH patients deep suppression of A4 We've shown in healthy volunteers that even under conditions of very low glucocorticoids and extremely high levels of ACTH, that we can maintain suppression of the adrenal gland and keep those patients even to the point where they still need glucocorticoid add back. And so our vision for the drug is not one which is just helping glucocorticoids manage the adrenal, we think that Atsumelanat should be the treatment for CAH and then glucocorticoids are not used for treatment, they're simply used for And so maybe Dana can elaborate a little bit more trying to be not completely specific because there's still a few things to work out. But let me let her talk about principles.

Well, yes, I think, as Scott mentioned, And as I mentioned earlier on the call, we feel that the drug is capable of doing more than just helping manage the disease with glucocorticoids, right? We feel, as Scott says, that this should be able to do both.

Right?

And so when we put together an endpoint, it has to have both dimensions in it. Now we haven't finalized exactly how that's going to work from a but we think that the basis for that belief in terms of the mechanism of action could lead to a different potential indication for the drug.

Right? Because we feel that this is the treatment for the disease and glucocorticoids aren't just a safety mechanism to prevent adrenal insufficiency.

Thank you. We go next now to Dennis Ding of Jefferies.

Hi, thanks for taking our question. We just had one on on Atumanant. Can you from a timing perspective, can you commit to sharing additional data this year whether from CHF, like the four zero four or longer term extension data or Cushing's? For a long term extension, how do you think efficacy would evolve with longer TRUDEON? Well, I try never to commit to any timelines around things until we're absolutely certain about it. So just have to stay tuned. Sorry to keep you in suspense, but In terms of the second part of the question, was Just around the long term extension and how do you think efficacy could evolve [indiscernible] Yes. So I think that most relevant data there is what we saw with the adrenal sizes in very short twelve week study.

So ACTH is trophic for the gland. In CAH, when these patients are experiencing high ACTH levels from birth, they end up getting larger adrenal glands as my friend Doctor. Krasner says, they become angry. Certainly, they're very active. And we're showing shrinkage of those glands in only twelve weeks.

So I would expect that to continue with time And if anything, then the ability to suppress the adrenal should increase or remain with time. There's no mechanistic release reason to believe any sort of tachyphylaxis should develop Thank you. Thank you. We go next now to Catherine Novak of Hi, good afternoon. My question is around how are you prioritizing the three non oncology assets that you're moving forward into IND filing this year? If you had to pick which indication is most exciting to you at this time? Thanks.

Hi, Catherine.

I'll answer that the same way I I often do, which is I now up to four grandkids and they each have their wonderful traits and I love them all. But The prioritization, we're in a fortunate position where because of our strong balance sheet and our build of company that we're not at a position where we have to prioritize them. We are able to move all of those forward at their natural pace And at the moment, well, clearly, 9,682 is in the lead. We'll be filing that IND very shortly. There's a bit of a race between the PTH antagonist and the TSH antagonist and it looks like TSH is catching up a bit. And then ADPKD is working in the background.

I just saw you wrote a note about ADPKD and hit my inbox as this was starting. So I'm looking forward to reading it. Thank you. Absolutely. Thanks, Scott.

You. We go next now to David Lebowitz at Citi.

Hey guys, John on for David. Thanks for taking our question. The I don't know if Phase two data, just curious what is the current thinking behind the lack of observed dose response in the 17 OHP decrease across all the doses Understand that E4 was the primary endpoint, but just given the fact that 17 OHP plays an important role as an intermediate hormone, just interested to hear what the latest thinking is on Thanks. Thanks very much for the question. 17 hydroxyprogesterone is a very variable biomarker even in the clinical care of these patients and particularly when you use it to try and assess adequacy of care in clinical practice, I feel like both biomarker responses including the more variable 17 hydroxyproj are pretty pretty impressive and I take a lot of learnings from the fact that we actually in this very short study see clinical outcome benefits And in that kind of situation, we no longer need to rely on the exact amount of biops biomarker reduction. We know it's an unprecedented magnitude compared to other TRIP therapies in the past and it's very difficult to achieve those kinds of reductions with glucocorticoids which is why we'd like to think of Etimelnet as the ultimately hopefully the treatment for CH whereas glucocorticoid just used at low doses for replacement.

But I will say, I was looking earlier this week with the group at some of the exposure response modeling and I don't think I agree with you. I think there is a nice exposure we with both 17 OHP and A-four. So although as Alan says 17 ohhp is a bit more variable.

Thank you. We go next now to Rohan Mather at Oppenheimer.

Hey, this is Rohan on for Leasing Driscoll.

Just one for me on paltuzetine. Just given the use of somatostatin receptor agonist, In acromegalyan patients with neuroendocrine tumors How do you think about carcinoid from a commercial standpoint there may be some overlap in call points and complementary dynamics once it's potentially made available in both indications. [indiscernible] Yes. Thank you. I think there's a couple areas of synergy there. One from a geographic point of view, the on oncology centers of excellence and the pituitary centers of excellence are geographically overlapping. So there is some efficiencies there. I also think that our growing experience in acromegaly provides additional safety confidence for the patients with neuroendocrine tumors which I'll remind folks are things that are really becoming a chronic disease in many ways So long term safety is of course important. There's an interesting dynamic to note outside The U. S. Which is in many of the countries in Europe, unlike The U. S. That prescribers who manage the acromegaly patients overlap more frequently with manage those that are managing their under consumers. So for example, investigators of ours in The U. K. And some in Germany and some of the other countries.

Have many more neuroendocrine tumor patients than they do acromegaly patients, but they see both. So they're beginning to experience in one population to help them understand how they might use it in another later So I think overall that people are used to using somatostatinib analogs for both and paltuzetine is a next generation somatostatin analog or ligand, excuse me.

Thank you.

Thank you. We'll go next now to Andy Chin of Wolfe Research.

Hey, thank you for taking the question. Think it was Isabelle during the prepared remarks that mentioned that payers are very supportive of the value proposition of tauquizatin.

Can you discuss which features of the product they are the most excited about?

So especially now that we know that Cipla will be back to The U. S. Market IBSON in this quarter. And then I hear that generics will launch in Europe in the second quarter. Wouldn't payers be more excited about those generics a lot more or do you think those are just basically non factors in the in the grand scheme of things? Thank you.

Yes. I do think that in general, the generics or five zero one the equivalent are really just the next generation and the long term small changes to the injectables and I don't think that that provides the next generation of care that paltusitine So let me let Isabelle answer a little more detail though.

Yes, it's good. That's right. Currently with injectables, you see a significant discontinuation rate and lack of adherence to treatment, which many of the payers consider almost wastage, because in theory, you are reimbursing for those treatments, but you are not getting the efficacy you are expecting to get. Also the coverage where it's a generic or where it's a branded [indiscernible] and many of the patients continue to have breakthrough symptoms. We have done some economic analysis that shows that many of those patients end up having to have surveys and continue to have [indiscernible] So overall, the payers see this as an improvement on the standard of care. They are very positive about sustainability of effects, the rapid action because you also see in injectables that sometimes it takes a long time to find the right dosage, which is not a case with aducitine and this is really transforming the standard of care.

So we are very pleased with how they are appreciating the value proposition of the drugs.

Thank you.

Thank you. We go next now to Brian Skorney of Baird.

Hey, this is Charlie on for Brian. Thanks for taking the question. Just touching on the PTH antagonist. It would be great if you could tell us more about the landscape there in terms of how patients are usually treated as well as, what you believe the antagonist could offer over that as well as when you think about the two hundred thousand incident cases How many of those would you expect to be addressable with this compound? Thank you.

Thanks very much.

Yes, a PTH antagonist for clinical use would be a very novel opportunity for patients with primary hyperparathyroidism right now the major treatment option is surgical removal of the overgrown parathyroid adenoma, which usually causes this disease. That is curative much of the time. However, unfortunately, there are a lot of patients with this disease as he mentioned and many of them do not get surgery.

There is really not a true medical option for the treatment of hyperparathyroidism. There is Senecalcet, which is approved Synocalcet, however, has only been shown to resolve or improve one aspect of this condition that's the hypercalcemia or elevated calcium levels. Factorparathyroidism is a multi organ disease that affects the bones and the kidneys adversely Phenacalcid although approved has never been shown to help the kidneys or the bones.

We really need a treatment medical option for the treatments. I want to spend some time talking to the community in more detail about these programs. So that people can begin to appreciate it. I know most of our conversations with the various investors and analysts has to typically stop at [indiscernible] But we are planning on putting together an R and D day this spring or early summer to try and provide more clarity. And I think the other thing about PTH is one of the ones together with neuroendocrine tumors that has started to become more personal. So as we address more and more of these diseases, I'm meeting employees or family members that are suffering from these. And we're starting to hear some of the firsthand experiences and challenges that they're facing, which always brings this home. And so as we think about PTH, I think it's a great example where you got to think of us as trying to really transform the treatment paradigm for the disease And maybe there's a better way to manage patients while they're either waiting for surgery or maybe they're not the best surgical candidate. Or maybe there's just not a good surgeon nearby.

So I think we can do I think we can do something special with PTH. Thank you. Ladies and gentlemen, that's all the questions we have today. Doctor. Struthers, I'd like to turn things back to you, sir, for any closing comments. Well, thank you everybody for your questions and your hard work. We appreciate all of you and look forward to talking to folks in the coming hours and days. Take care. Will conclude Kinetics Pharmaceuticals' Crinetics quarter and full year 2024 financial results call. Again, thanks so much for joining us, everyone, and we wish you all a great remainder of your day.