BUSINESS
We are a specialty pharmaceutical company focused on the development and
commercialization of topically-delivered prescription pain management
therapeutics. We have six product candidates in clinical development; three in
late-stage clinical development that are ready to enter, or have entered,
pivotal Phase IIb or Phase III clinical trials, and three that have completed
initial Phase II clinical trials. All of our product candidates target
moderate-to-severe pain that is influenced, or mediated, by nerve receptors
located just beneath the skin's surface. Our product candidates utilize
proprietary formulations and several topical delivery technologies to administer
FDA-approved pain management therapeutics, or analgesics. We believe using
FDA-approved analgesics reduces the risks associated with new drug development,
lowers our development costs and speeds time-to-market. Our product candidates
are designed to provide effective pain relief with fewer adverse side effects
than systemically-delivered drugs, which are absorbed into the bloodstream. None
of our products has been approved by the FDA or its counterparts in other
countries.
Our lead late-stage product candidate, EpiCept NP-1, is a prescription
topical analgesic cream containing a patented formulation, the contents of which
include two FDA-approved drugs, amitriptyline and ketamine. Amitriptyline is a
widely-used antidepressant, and ketamine is an NMDA antagonist that is used as
an anesthetic. EpiCept NP-1 is designed to provide effective, long-term relief
from the pain of peripheral neuropathies. Peripheral neuropathies are medical
conditions caused by damage to the nerves in the nervous system. The initial
indication for this product candidate is post-herpetic neuralgia, a specific
type of peripheral neuropathy associated with shingles, a condition caused by
the herpes zoster virus. We have completed Phase II clinical trials in the
United States and Canada that included 343 subjects and plan to commence a
Phase III clinical trial in the United States by the second half of 2005 that
will include at least 800 subjects.
LidoPAIN SP, our second late-stage product candidate, is a sterile
prescription analgesic patch designed to provide sustained topical delivery of
lidocaine to a post-surgical or post-traumatic sutured wound while also
providing a sterile protective covering for the wound. If approved, we believe
that LidoPAIN SP would be the first sterile prescription analgesic patch on the
market. We have completed a Phase II clinical trial in Germany that included 221
hernia repair subjects and commenced a Phase III clinical trial in Europe during
the fourth quarter of 2004 that will include at least 400 hernia repair
subjects. In July 2003, we entered into an agreement with Adolor for the
development and commercialization of LidoPAIN SP in North America.
Our third late-stage product candidate is LidoPAIN BP, a prescription
analgesic non-sterile patch designed to provide sustained topical delivery of
lidocaine for the treatment of acute or recurrent lower back pain. We have
completed Phase IIa and Phase IIb clinical trials in the United States that
included 242 subjects and plan to commence a pivotal Phase IIb clinical trial in
the United States during the second half of 2005 that will include at least 400
subjects. In December 2003, we entered into an agreement with Endo for the
commercialization of LidoPAIN BP worldwide.
We have three earlier-stage product candidates in clinical development:
(1) EpiCept MP/DP, a topical spray gel matrix containing morphine and lidocaine
for the treatment of oral mucositis, an inflammation of the mucosa of the mouth
typically resulting from chemotherapy and radiation therapy, and dental pain;
(2) LidoPAIN TV, a topical lidocaine patch for the treatment of tinnitus, a
constant or intermittent buzzing or ringing noise in the ear; and
(3) LidoPAIN HM, a topical anesthetic patch for the treatment of headache pain.
We have completed initial Phase II clinical trials and expect to conduct
additional Phase II clinical trials for each of these product candidates.
Pain and Pain Management
Pain occurs as a result of surgery, trauma or disease. It is generally
provoked by a harmful stimulus to a pain receptor in the skin or muscle. Pain
can range in severity (mild, moderate or severe) and duration (acute or
chronic). Acute pain, such as pain resulting from an injury or surgery, is of
short duration, generally less than a month, but may last up to three months.
Chronic pain is more persistent, extending long after an injury has healed, and
typically results from a chronic illness or appears spontaneously and
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persists for undefined reasons. Examples of chronic pain include chronic lower
back pain and pain resulting from bone cancer or advanced arthritis. If treated
inadequately, unrelieved acute and chronic pain can slow recovery and healing
and adversely affect a person's quality of life.
IMS Health has estimated that the total U.S. market for prescription
analgesics has increased from $5.3 billion in 1998 to $14.7 billion in 2003,
representing an approximate 23% compounded annual growth rate. In 2003,
analgesics were the third most prescribed class of medications in the United
States with approximately 313 million prescriptions written. We believe that
growth in this market has been primarily attributable to:
increased physician recognition of the need for effective pain management;
patient demand for more effective pain treatments;
an aging population, with an increased prevalence of chronic pain
conditions, such as cancer, arthritis, neuropathies and lower back pain;
increased number of surgeries;
introduction of new and reformulated branded products; and
increased active and healthy lifestyles, resulting in additional sports and
fitness related injuries.
Analgesics typically fall into one of three categories:
opioid analgesics or narcotics, such as morphine, codeine, oxycodone
(OxyContin) and tramadol (Ultram);
non-narcotic analgesics, primarily non-steroidal anti-inflammatory drugs
(NSAIDs), including prostaglandin inhibitors (such as aspirin, acetaminophen
and ibuprofen) and inhibitors of the enzyme cycloxygenase-2 (COX-2),
so-called COX-2 inhibitors (such as Celebrex); and
adjuvant therapeutics, such as anesthetics (lidocaine), antidepressants
(amitriptyline), anti-convulsives and corticosteriods.
Limitations of Current Therapies
Until recently, analgesics primarily have been delivered systemically and
absorbed into the bloodstream where they can then alleviate the pain. Systemic
delivery is achieved either orally, via injection or through a transdermal
patch. Systemic delivery of analgesics can have significant adverse side effects
because the concentration of analgesics in the bloodstream can impact other
organs and systems throughout the body.
Adverse side effects of systemically-delivered analgesics are well
documented. Systemically-delivered opioid analgesics can cause respiratory
distress, nausea, vomiting, dizziness, sedation, constipation, urinary retention
and severe itching. In addition, chronic use of opioid analgesics can lead to
the need for increased dosing and potential addiction. Concerns about addiction
and abuse often influence physicians to prescribe less than adequate doses of
opioids or to prescribe opioids less frequently. Systemically-delivered NSAIDs
and adjuvant therapeutics can also have significant adverse side effects,
including kidney failure, liver dysfunction, gastric ulcers and nausea. In the
United States, there are approximately 16,500 NSAID-related deaths each year,
and over 103,000 patients are hospitalized annually due to NSAID complications.
These adverse side effects may lead doctors to prescribe analgesics less often
and at lower doses than may be necessary to alleviate pain. Further, patients
may take lower doses for shorter periods of time and opt to suffer with the pain
rather than risk the adverse side effects. Systemic delivery of these drugs may
also result in significant interactions with other drugs, which is of particular
concern when treating elderly patients who typically take multiple
pharmaceutical therapies.
Recent Scientific Developments
Almost every disease and every trauma is associated with pain. Injury or
inflammation stimulates the pain receptors, causing electrical pain signals to
be transmitted from the pain receptors through nerve fibers into the spinal cord
and eventually to the brain. Pain receptors include central pain receptors, such
as those found in the brain and spinal cord, and peripheral nerve receptors,
also called "nociceptors," such
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as those located directly beneath the skin and in joints, eyes and visceral
organs. Within the spinal cord, the electrical pain signals are received by a
second set of nerve fibers that continue the transmission of the signal up the
spinal cord and through the central nervous system into the brain. Within the
brain, additional nerve fibers transmit the electrical signals to the "pain
center" of the brain. The brain decodes the messages being sent to the central
nervous system from the peripheral nervous system, and the signals are perceived
as "pain" and pain is "felt." These messages can be disrupted with
pharmaceutical intervention either at the source of the pain, such as the pain
receptor, or at the point of receipt of the pain message, in the brain. Topical
delivery of analgesics blocks the transmission of pain at the source of the pain
message, whereas systemic delivery of analgesics primarily blocks the perception
of pain within the brain.
Not until recently has the contribution of peripheral nerve receptors to the
perception of pain been well understood. Recent studies have indicated that
peripheral nerve receptors can play an important role in both the sensory
perception of pain and the transmission of pain impulses. Specifically, certain
types of acute and chronic pain depend to some degree on the activation of
peripheral pain receptors located beneath the skin's surface. The topical
administration of well-known analgesics can localize drug concentrations at the
point where the pain signals originate, resulting in dramatically lower systemic
blood levels. We believe this results in a new treatment strategy that provides
significant pain relief, with fewer adverse side effects, fewer drug to drug
interactions and lower potential for abuse.
Our Solution
We are targeting peripheral nerve receptors using topical analgesics as a
novel mechanism to effectively treat both acute and chronic pain, without the
liabilities of traditional systemically-delivered analgesics. We are developing
innovative topically-delivered analgesics using a combination of our
internally-developed and in-licensed proprietary technologies and know-how to
address the unmet medical needs and adverse side effects associated with
systemically-delivered analgesics. Our topical delivery technologies and
formulations are designed to deliver FDA-approved analgesics safely, effectively
and conveniently to the appropriate peripheral nerves while preventing or
limiting the amount of drug that enters the bloodstream. We utilize patch, cream
and spray gel matrix delivery methods to topically deliver the active
ingredients to the pain site. In some instances, we combine existing
FDA-approved analgesics to create a new product having a therapeutic profile
superior to either one of the standalone analgesics.
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Our Products
We have six product candidates in clinical development; three in late-stage
clinical development that ready to enter, or have entered, pivotal Phase IIb or
Phase III clinical trials, and three that have completed initial Phase II
clinical trials. The following table summarizes the current status of our
principal development programs and product candidates:
Topical
Product Dosage Form Initial Indication Clinical Status Next Steps Marketing Rights
EpiCept NP-1 Cream Post-herpetic Phase II Initiate EpiCept
neuralgia completed Phase III
during
second half
of 2005
LidoPAIN SP Sterile patch Surgical incision Phase III Adolor has Adolor in North
pain initiated in announced America; EpiCept
Germany plans for outside of North
Phase IIb America EpiCept
and retains right to
Phase III negotiate future
clinical co-promotion
trials in agreement
United
States
LidoPAIN BP Patch Acute or recurrent Phase IIa Initiate Endo worldwide;
(non-sterile) lower back pain completed pivotal EpiCept
Phase IIb retains right to
clinical negotiate future
trial co-promotion
during agreement
second half
of 2005
EpiCept MP/DP Spray gel matrix Oral mucositis; Phase II Continue EpiCept
Dental pain Phase II
development
LidoPAIN TV Patch Tinnitus Phase II in Continue EpiCept
(non-sterile) Europe Phase II
development
LidoPAIN HM Patch Headache Phase II Continue EpiCept
(non-sterile) Phase II
development
We conduct our clinical trials in pain centers throughout North America and
in Europe. There are various ways in which to assess a subject's severity of
pain. Pain is a subjective phenomenon, and each person has a different pain
threshold. We utilize various types of validated pain assessment scales in our
clinical trials that are self-administered by each subject in the form of
questionnaires. The first is the numerical pain scale, or "11-point numerical
pain scale," which is generally a number line from 0 (no pain) to 10 (worst
possible pain). The subject is asked how much pain he or she feels at a given
moment or over a period of time and is asked to rank it based on the 11-point
numerical pain scale. A second pain assessment tool we often utilize is the
McGill Pain Questionnaire, which is a two part questionnaire that asks the
subject to rate both type and intensity of pain experienced. We analyze the data
from these studies in a number of ways, including a responder analysis. In this
type of analysis, subjects serve as their own control and are required to
demonstrate a clinically-significant level of response depending upon the
structure of the particular clinical trial.
We utilize various statistical analyses to evaluate the data from our
clinical trials. We commonly utilize the "area under the curve" analysis as a
measure of efficacy. The term "area under the curve" is a recognized statistical
analytical tool that refers to the measurement of the total sum of pain that a
patient experiences over a particular period of time. We also use statistical
analyses to estimate the probability that a positive effect is actually produced
by the product candidate. This probability is expressed as a "P-value," which
refers to the likelihood that the difference measured between the drug group and
the placebo group occurred just "by chance." For example, when a P-value is
reported as "P<0.05," the probability that the drug produced an effect just by
chance is less than 5%. A P-value of 0.05 or less is generally considered to be
statistically significant.
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Peripheral Neuropathy and Post-Herpetic Neuralgia
Peripheral neuropathy is a medical condition caused by damage to the nerves
in the peripheral nervous system. The peripheral nervous system includes nerves
that run from the brain and spinal cord to the rest of the body. According to
Datamonitor's study "Stakeholder Insight: Neuropathic Pain," published in
February 2004, peripheral neuropathy affects over 15 million people in the
United States and is associated with conditions that injure peripheral nerves,
including herpes zoster, or shingles, diabetes, HIV and AIDS and other diseases.
It can also be caused by trauma or may result from surgical procedures.
Peripheral neuropathy is usually first felt as tingling and numbness in the
hands and feet. Symptoms can be experienced in many ways, including burning,
shooting pain, throbbing or aching. Peripheral neuropathy can cause intense
chronic pain that, in many instances, is debilitating.
Post-herpetic neuralgia (PHN) is one type of peripheral neuropathic pain
associated with herpes zoster, or shingles, that exists after the rash has
healed. According to Datamonitor, PHN affects over 100,000 people in the United
States each year. PHN causes pain on and around the area of skin that was
affected by the shingles rash. Most people with PHN describe their pain as
"mild" or "moderate." However, the pain can be severe in some cases. PHN pain is
usually a constant, burning or gnawing pain but can be an intermittent sharp or
stabbing pain. Current treatments for PHN have limited effectiveness,
particularly in severe cases and can cause significant adverse side effects. The
initial indication for our EpiCept NP-1 product candidate is for the treatment
of peripheral neuropathy in PHN patients.
There are currently three FDA-approved treatments for post-herpetic
neuralgia: Neurontin (gabapentin), Lidoderm (lidocaine patch 5%) and Lyrica
(pregabalin). Market estimates indicate that Neurontin is expected to generate
sales of approximately $3 billion in the United States in 2004. According to the
Scott-Levin Physician Drug and Diagnosis Audit, approximately 55% of the
5.1 million prescriptions for Neurontin relate to some form of neuropathic pain.
Some patients also receive Tegretol (carbamazepine) to manage the symptoms of
peripheral neuropathy. However, these drugs only work in some patients, and
Neurontin may have significant side adverse effects, such as drowsiness. Often
the use of these medications is combined with topical analgesics such as the
Lidoderm patch and over-the-counter topical analgesic creams that provide
minimal relief with a short duration of action. Lidoderm is expected to generate
sales of approximately $300 million in the United States in 2004, much of which
we believe will be attributable to patients with PHN. Lyrica was approved for
the treatment of neuralgia in December 2004.
EpiCept NP-1. EpiCept NP-1 is a prescription topical analgesic cream
containing a patented formulation, the contents of which include two
FDA-approved drugs, amitriptyline (a widely-used antidepressant) and ketamine
(an NMDA antagonist that is used as an anesthetic). EpiCept NP-1 is designed to
provide effective, long-term relief from the pain caused by peripheral
neuropathies. We believe that EpiCept NP-1 can be used in conjunction with
systemically-delivered analgesics, such as Neurontin. The cream contains a 4%
concentration of amitriptyline and a 2% concentration of ketamine. Since each of
these ingredients has been shown to have significant analgesic effects and
because NMDA antagonists, such as ketamine, have demonstrated the ability to
enhance the analgesic effects of amitriptyline, we believe the combination is a
good candidate for the development of a new class of analgesics. We intend to
selectively seek a partner or strategic alliance to enable us to maintain
financial and operational flexibility while retaining significant economic and
commercial rights to this product candidate.
EpiCept NP-1 is a white vanishing cream that is applied twice daily and is
quickly absorbed into the applied area. We believe the topical delivery of our
patented combination represents a fundamentally new approach for the treatment
of pain associated with peripheral neuropathy. In addition, we believe that the
topical delivery of our product candidate will significantly reduce the risk of
adverse side effects and drug to drug interactions associated with the systemic
delivery of the active ingredients. The results of our clinical trials to date
have demonstrated the safety of the cream for use for up to one year and a
potent analgesic effect in subjects with both post-herpetic neuralgia and other
types of peripheral neuropathy, such as those with diabetic, traumatic and
surgical causes.
We believe EpiCept NP-1, if approved, would offer the following favorable
attributes:
analgesic effect comparable to levels provided when using
systemically-delivered analgesics;
additive therapy to systemically-delivered analgesics, such as Neurontin;
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minimal adverse side effects, including reduced drowsiness;
ease of application and suitability for self-administration;
low potential for abuse;
good patient compliance;
no drug to drug interactions; and
potential to treat a broad range of peripheral neuropathic conditions.
Clinical Development. We have completed two Phase II clinical trials, one
initiated in Canada in October 2001 and one initiated in the United States in
February 2002.
Placebo-controlled Factorial Trial. This four center Canadian Phase II
clinical trial in Ontario and Nova Scotia (Dalhousie University) was a
placebo-controlled factorial trial designed to demonstrate that the use of the
combination of amitriptyline and ketamine was more effective than either drug
alone. A factorial trial is a clinical trial in which the active ingredients in
combination are compared with each drug used on its own accompanied by a placebo
control. The trial included 92 subjects with a history of diabetic, post
surgical or traumatic neuropathy or PHN. The trial tested a low-dose formulation
of EpiCept NP-1, consisting of a 2% concentration of amitriptyline and a 1%
concentration of ketamine, applied three times daily for three weeks. Subjects
were allowed to continue their current pain medications (other than Lidoderm) as
long as they did not alter their dosage level or frequency. Subjects who entered
the trial had to have a score of at least 4 on the 11-point numerical pain
scale. We completed the analysis of data from this clinical trial in February
2004.
We assessed several end points in this clinical trial, including mean daily
pain severity as measured on the 11-point numerical pain scale, pain relief, a
responder analysis and changes in the McGill Pain Questionnaire. While none of
the results was statistically significant, the results of the responder analysis
were the most compelling. In the responder analysis, subjects were required to
show at least a 30% reduction in their pain as compared to placebo for the
duration of the study. The results indicated a desirable rank order of the
combination being more effective than either amitriptyline or ketamine alone or
placebo. The cream was well-tolerated by a majority of the subjects, and no
significant adverse reactions were observed. Based on a review of our Phase II
clinical trial results, the FDA concurred in our End of Phase II meeting that we
design our Phase III clinical trial as a responder analysis.
The following chart shows the number of subjects that completed the clinical
trial with a reduction in pain of two points or more on the 11-point numerical
pain scale. The number of subjects in each group were as follows: placebo: 25;
ketamine only: 22; amitriptyline only: 22; and combination of amitriptyline and
ketamine: 23:
NP-1 Factorial Trial Results
Percentage of Subjects with Reduction in Neuropathic Pain>2
[[Image Removed: BAR GRAPH]]
Note: p=0.10; (ami + ket vs. placebo)
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Dose-Response Clinical Trial. In the United States, we conducted a Phase II
placebo-controlled dose-response clinical trial in subjects recruited from
21 pain centers to determine an effective clinical dose of EpiCept NP-1. The
trial included 251 subjects with post-herpetic neuralgia who had been suffering
significant pain for at least three months. We tested two dosage formulations,
one containing a 4% concentration of amitriptyline and a 2% concentration of
ketamine, which we refer to as "high-dose" and one containing a 2% concentration
of amitriptyline and a 1% concentration of ketamine, which we refer to as
"low-dose," as compared to placebo. Subjects were allowed to continue on their
current pain medications as long as they did not alter their dosage level or
frequency. Subjects who entered the trial had to have a score of at least 4 on
the 11-point numerical pain scale. All subjects initially received the high-dose
formulation twice daily for seven days. Responders, which were defined in the
initial phase of this clinical trial as those experiencing a one point or
greater drop on the 11-point numerical pain scale for three or more days, were
then randomized into one of three study arms (high-dose, low-dose or placebo).
Each study arm applied the applicable formulation of EpiCept NP-1 or placebo
twice daily for an additional 14 days. We completed the analysis of the data
from this clinical trial in August 2003.
The primary endpoint was the baseline average daily pain score compared to
the average daily pain score at day 21, measured on the 11-point numerical pain
scale. We measured the score for a 14 day period beginning on the day the
subjects were randomized. The clinical trial's primary objective was to
determine if the subjects in either the high-dose or low-dose groups experienced
better analgesia as reflected by lower pain intensity scores over the length of
the trial. Secondary endpoints included pain relief, sleep quality and patient
global satisfaction, all measured on the 11-point numerical scale.
The following chart shows the outcome following randomization of the
responding subjects in either the high-dose, low-dose or placebo group:
NP-1 Dose-Response Clinical Trial Results
[[Image Removed: BAR GRAPH]]
Note: *p=0.026 (NP-1 high-dose group versus placebo group - baseline to day 21)
The clinical trial results indicated that the high-dose formulation of
EpiCept NP-1 met the primary endpoint for the trial and resulted in a
statistically significant reduction in pain intensity and increase in pain
relief as compared to placebo. We also observed a dose-related effect, i.e. the
subjects receiving the high-dose formulation had more favorable results than the
subjects receiving the low-dose formulation. In addition, the subjects receiving
the high-dose formulation reported better sleep quality and greater overall
satisfaction than subjects receiving placebo. In addition, we observed a greater
number of "responders," which for purposes of the responder analysis conducted
during the 14-day period were defined as subjects with a two or more point drop
in average daily pain scores on the 11-point numerical pain scale. No
significant adverse reactions were observed other than skin irritation and rash,
which were equivalent to placebo.
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After the completion of the two Phase II trials, we conducted open label
trials in which participants in the clinical trials could continue to use the
low-dose formulation for a period of up to one year. The low-dose formulation
was well-tolerated and detectable blood concentration levels of the active
ingredients were insignificant, which is indicative of the safety and potential
long term efficacy of the product.
The results of our Phase II clinical trials helped us decide to use the
high-dose formulation of EpiCept NP-1 in our Phase III clinical trials.
Current Clinical Initiatives. We held an End of Phase II meeting with the
FDA in April 2004 to discuss the Phase II clinical trial results and the
protocols for our planned Phase III clinical trials. In that meeting, the FDA
accepted our stability data and manufacturing plans for the combination product,
as well as toxicology data on ketamine from studies conducted by others and
published literature. The FDA also confirmed that the proposed New Drug
Application, or NDA would qualify for a Section 505(b)(2) submission (for
details on this submission process, see "Business - Government Regulation -
Section 505(b)(2) Drug Applications" below). In addition, the FDA approved our
Phase III clinical trial protocol and indicated that a second factorial
Phase III clinical trial would be required. The FDA also requested that we
conduct an additional pharmacokinetic trial to assess dermal absorption of
ketamine and outlined the parameters for long-term safety studies for the
high-dose formulation. The pharmacokinetic clinical trial will involve applying
the cream twice daily and measuring blood concentration levels of amitriptyline
and ketamine over 48 hours.
We will work with the FDA to develop an appropriate toxicology program for
amitriptyline and ketamine where existing data is not available. We initiated a
supplemental toxicology study in the third quarter of 2004 related to the
application of EpiCept NP-1 on the skin. The duration of the study and the
number and types of animals to be tested will be determined during further
discussions with the FDA.
In addition, we plan to commence our Phase III clinical trial in the United
States during the second half of 2005 with at least 800 subjects with PHN. The
enrollment of these subjects could take up to one year to complete. This
Phase III clinical trial will test the high-dose formulation against each
component used on its own accompanied by a placebo control. We expect to utilize
primarily the same endpoints that we used in our Phase II clinical trial
conducted in the United States. A responder analysis based on pain intensity and
pain relief, as well as sleep and patient global satisfaction, will be assessed
over the eight-week duration of the clinical trial.
Surgical Pain
According to Datamonitor's study "Postoperative Pain," published in April
2004, there are over 53 million surgical procedures conducted annually in the
United States. Traditional post-surgical pain treatment usually begins with the
application of a local anesthetic at the surgical incision site during the
surgery. The pain relief provided by the anesthetic applied during surgery
typically wears off within the first two hours. Pain relief is then provided by
a combination of oral or injectible narcotic analgesics and NSAIDs, with
accompanying adverse side effects and drug to drug interactions.
LidoPAIN SP. LidoPAIN SP is a sterile prescription analgesic patch designed
to provide sustained topical delivery of lidocaine to a post-surgical or
post-traumatic sutured wound while also providing a sterile protective covering
for the wound. The LidoPAIN SP patch contains a 10% concentration of lidocaine
and is intended to be applied once daily for as many days as needed, typically
two to three days. LidoPAIN SP can be targeted for use following both inpatient
and ambulatory surgical procedures, including among others: hernia repair,
plastic surgery, puncture wounds, biopsy, cardiac catheterization and tumor
removal.
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Currently, there is no marketed product similar to LidoPAIN SP, and we
believe that it would be the first sterile prescription analgesic patch on the
market. If approved, we believe LidoPAIN SP would offer the following favorable
attributes:
safety and ease of use;
sterility on a sutured wound;
reduced need for systemically-delivered narcotic analgesics and NSAIDs;
once daily administration;
minimal adverse side effects, including no observed nausea or vomiting;
additive therapy to systemically-delivered analgesics;
no drug to drug interactions; and
no wound healing interference.
Clinical Development. In December 2001, we initiated a randomized,
double-blind, placebo-controlled Phase II clinical trial in 221 subjects who
underwent hernia repair. We conducted the clinical trial in nine surgical
centers in Germany. Subjects were randomized to receive two different doses of
lidocaine, 9.5% and 3.5%, or placebo, in a patch applied once each day for two
days. Subjects were not allowed to take any supplemental analgesics. We
completed the analysis of this clinical trial in January 2003.
The primary endpoint was subject pain self-assessment at various intervals
during the 48-hour period following the subject's surgery and the secondary
endpoint was the number of "rescues," i.e. subjects receiving
systemically-delivered analgesics to alleviate pain. The results of this trial
indicate that the 9.5% formulation of LidoPAIN SP provided a statistically
significant analgesic effect in the subjects. A dose-related response was also
observed, with subjects receiving the higher dose reporting a greater reduction
in pain and fewer rescues. No significant adverse reactions were observed.
The following chart shows the pain scores over time for LidoPAIN SP relative
to placebo in a two-day trial following hernia repair surgery:
LidoPAIN SP Placebo-Controlled Clinical Trial Results
[[Image Removed: Placebo Graph]]
Current Clinical Initiatives. Our clinical protocol for a Phase III clinical
trial in Europe was approved by Germany's Federal Institute for Drugs and
Medical Devices, commonly known as the BfArM. We initiated dosing for this trial
during the fourth quarter of 2004. The clinical trial is a randomized,
double-blind, placebo-controlled trial in which at least 400 subjects who
underwent hernia repair will receive a LidoPAIN SP patch or a placebo patch, for
48 hours. The primary endpoint is
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self-assessed pain intensity at various times from 4 to 24 hours. The secondary
endpoints include pain intensity over the 48-hour duration of the study, global
satisfaction and the use of rescue medications. We believe that this clinical
trial will be adequate for European registration, but we anticipate that we will
need to conduct additional clinical trials in Europe in order to broaden the
product labeling. We remain responsible for continuing and completing our
ongoing dermal sensitivity study for LidoPAIN SP, but Adolor is responsible for
further clinical trials and managing the approval process in North America under
our strategic alliance with them. Adolor has announced that it plans to conduct
Phase IIb and Phase III clinical trials in the United States.
Back Pain
In the United States, 80% of the U.S. population will experience significant
back pain at some point. Back pain ranks second only to headaches as the most
frequent pain people experience. It is the leading reason for visits to
neurologists and orthopedists and the second most frequent reason for physician
visits overall. Both acute and chronic back pain are typically treated with
NSAIDs, muscle relaxants or opioid analgesics. All of these drugs can subject
the patient to systemic toxicity, significant adverse side effects and drug to
drug interactions.
LidoPAIN BP. LidoPAIN BP is a prescription analgesic non-sterile patch
designed to provide sustained topical delivery of lidocaine for the treatment of
acute or recurrent lower back pain of moderate severity of less than three
months duration. The LidoPAIN BP patch contains 140 mg of lidocaine in a 19.5%
concentration, is intended to be applied once daily and can be worn for a
continuous 24-hour period. The patch's adhesive is strong enough to permit a
patient to move and conduct normal daily activities but can be removed easily.
If approved, we believe LidoPAIN BP would offer the following favorable
attributes:
safety and ease of use;
reduced need for treatment with NSAIDs, muscle relaxants and narcotic analgesics;
once daily administration;
minimal adverse side effects; and
no drug to drug interactions.
LidoPAIN BP is designed to treat acute or recurrent lower back pain. As part
of our strategic alliance with Endo, we licensed to Endo certain of our patents
to enable Endo to develop a patch for the treatment of chronic lower back pain.
The significant differences between LidoPAIN BP and Endo's product, Lidoderm,
are as follows:
LidoPAIN BP is designed for 24-hour use whereas Lidoderm is approved for
12-hour use;
LidoPAIN BP is made with a stronger adhesive;
LidoPAIN BP contains a higher concentration of lidocaine; and
LidoPAIN BP is designed to provide earlier onset of action.
Clinical Development. In May 2001, we initiated a placebo-controlled
dose-response trial Phase IIa clinical trial in the United States. In this
clinical trial, we tested two dosage formulations of LidoPAIN BP - one patch
measuring 150 sq. cm. with a 19.5% concentration of lidocaine and one patch
measuring 75 sq. cm. with a 19.5% concentration of lidocaine - compared to
placebo. Each patch was applied once daily for three days to 43 subjects with
acute lower back pain of at least moderate intensity. Subjects abstained from
other analgesics and other therapeutic regimens.
We completed the analysis of this clinical trial in August 2003. The primary
endpoint was pain intensity measured by a 5-point numerical pain scale where 0
indicated no pain and 5 indicated severe pain. Pain measurements were made at
various times over the three-day duration of the trial. We assessed
51
a number of secondary endpoints, including pain relief, muscle stiffness and
global satisfaction. The trial demonstrated a dose-related statistically
significant reduction in back pain intensity and muscle stiffness as well as
increase in pain relief from the initiation of the trial.
The following chart demonstrates the significant improvement in pain
intensity relative to the baseline over the three-day duration of the study:
LidoPAIN BP Placebo-Controlled Dose-Response Clinical Trial Results
[[Image Removed: Pain Graph]]
In January 2002, we initiated a double-blind, placebo-controlled Phase IIb
clinical trial in three centers in the United States. In this clinical trial, we
tested a LidoPAIN BP patch measuring 150 sq. cm. with a 19.5% concentration of
lidocaine. Each patch was applied once daily for three days to 198 subjects with
acute lower back pain of at least moderate intensity. Subjects abstained from
other analgesics and other therapeutic regimens.
Although the results at two of the three centers in this study did indicate
that LidoPAIN BP had a greater analgesic effect as compared to the placebo
control, the results at a third center were contradictory. At that center, the
trial subjects who received placebo reported an analgesic effect that exceeded
the analgesic effect reported by the subjects receiving LidoPAIN BP. After the
trial, our consultant concluded that the unusually large placebo effect reported
at this center most likely resulted because many of the subjects may have been
concerned that a failure to report an analgesic effect would result in a loss of
the stipend offered as compensation for participation in the trial. Due to the
results reported at this center, this clinical trial did not demonstrate a
statistically significant analgesic effect.
Current Clinical Initiatives. Based on the results from our Phase I and
Phase II clinical trials, we are designing a new pivotal Phase IIb clinical
trial, which we expect to commence by the second half of 2005. Our new trial
will be designed to address the issues raised in our previous Phase IIb clinical
trial. The trial will be longer and will have more stringent enrollment
criteria. Under our strategic alliance with Endo, we remain responsible for the
development of LidoPAIN BP, including all clinical trials and regulatory
submissions. We intend to request an End of Phase II meeting with the FDA during
the first half of 2005.
Other Product Candidates
EpiCept MP/DP
EpiCept MP/DP is a spray gel matrix of morphine and lidocaine for the
treatment of oral mucositis and dental pain. A spray gel matrix is a liquid
spray that solidifies upon contact with a warm surface. Oral mucositis is an
inflammation of the mucosa of the mouth that ranges from redness to severe
ulceration and typically results from chemotherapy and radiation therapy. It is
anticipated that other clinical uses will be
52
considered to expand upon the initial indications being studied. The FDA cleared
our IND for EpiCept MP/DP in July 2001, and we completed a Phase IIa clinical
trial on dental pain subjects in Europe in April 2002. Preliminary results have
indicated that the product is well tolerated and provided a longer duration of
pain relief compared to lidocaine by itself. We intend to continue dose ranging
and dose optimization trials.
LidoPAIN TV
LidoPAIN TV is a topical lidocaine patch applied to the periauricular skin
region (behind the ear) for the treatment of tinnitus. This product releases
doses of lidocaine into nerve endings located behind the ear. Tinnitus is
characterized by a constant or intermittent hissing, buzzing or ringing noise in
the ear that affects over 50 million Americans. There are many causes of
tinnitus, including defects in nerve conduction, however, there are no currently
approved treatments. We completed a European Phase II clinical trial in subjects
with tinnitus in May 2002. Subjects utilizing the LidoPAIN TV patch perceived a
beneficial effect as compared to subjects given the placebo patch.
LidoPAIN HM
LidoPAIN HM is a topical lidocaine patch applied to the forehead for the
treatment of headaches. LidoPAIN HM releases analgesic doses of lidocaine
directly into the trigeminal nerve, a nerve located in the face and forehead,
stimulating the coverings (meninges) of the brain, which is believed to be a
cause of migraine pain. The FDA cleared our IND for LidoPAIN HM in January 2001,
and we completed a Phase II clinical trial for LidoPAIN HM in headache subjects.
Our initial pilot study indicated that the patch was well tolerated and
demonstrated statistically significant efficacy of the lidocaine patch over the
placebo patch. A second larger study was unable to replicate those results. We
intend to continue our clinical trials to establish efficacy of this product
candidate in various types of headache pain.
Our Strategy
Our objective is to address unmet medical needs in pain management by
developing a broad portfolio of topically-delivered prescription analgesics for
the treatment of moderate-to-severe pain where existing treatments are
ineffective or cause significant adverse side effects. To achieve our objective,
the key elements of our strategy are to:
Focus our development efforts on topically-delivered analgesics targeting
peripheral nerve receptors. We intend to leverage our pain management
expertise by developing proprietary products that target peripheral nerve
receptors as a novel mechanism to effectively treat both acute and chronic
pain, with fewer adverse side effects than conventional oral, injectable or
transdermal pain therapeutics. We are developing new patent-protected
products for conditions that can be treated by blocking the ability of
peripheral nerve receptors to transmit pain messages to the brain.
Focus our development efforts on FDA-approved drugs. All of our product
candidates utilize several proprietary formulations and topical delivery
technologies to administer FDA-approved analgesics. We believe using
FDA-approved analgesics reduces the risks associated with new drug
development, lowers our development costs and speeds time-to-market.
Opportunistically enter into development and commercialization alliances for
our products. We plan to market products for which we obtain regulatory
approval through co-marketing, co-promotion, licensing and distribution
arrangements with third-party collaborators. We may also consider
contracting with a third party professional pharmaceutical sales
organization to perform the marketing function for our products. Where
appropriate, we plan to retain certain rights to the development and
commercialization of our product candidates and build our own internal sales
and marketing capabilities in order to retain a greater share of any
potential revenues. We believe that our current approach allows us maximum
flexibility of selecting the marketing method that will optimize market
penetration and commercial acceptance of our products and enable us to avoid
developing a large internal sales and marketing organization.
53
Our Strategic Alliances
We have established strategic alliances with Adolor with respect to our
LidoPAIN SP product candidate for the treatment of pain associated with surgical
incisions and with Endo with respect to our LidoPAIN BP product candidate for
the treatment of lower back pain. These strategic alliances are designed to
provide us with operating capital and supplement our development and marketing
capabilities. We intend to selectively pursue additional strategic alliances as
appropriate.
Adolor
In July 2003, we entered into a license agreement with Adolor under which we
granted Adolor the exclusive right to commercialize a sterile topical patch
containing an analgesic alone or in combination, including without limitation,
LidoPAIN SP, throughout North America. Upon the execution of the Adolor
agreement, we received a non-refundable payment of $2.5 million, and we may
receive additional non-refundable payments of up to $15.0 million that become
due upon the achievement of various milestones relating to product development
and regulatory approval. Under the agreement, we will also receive royalties
from Adolor based on the net sales of licensed products in North America. These
royalties are payable on a country-by-country basis until our last patent
covering the licensed product expires or the tenth anniversary of the first
commercial sale of licensed product, whichever is later. Under the agreement,
Adolor is obligated to pay us a one time bonus payment of up to $5.0 million
upon the achievement of specified net sales milestones of licensed product. The
total amount of upfront and milestone payments we are eligible to receive from
Adolor is $22.5 million.
Under the terms of the agreement, Adolor is responsible for conducting
further clinical trials and completing the approval process in North America. At
Adolor's option, we may be required to supply or to obtain supply of the
clinical products necessary to complete clinical trials. Alternatively, Adolor
can choose to subcontract these responsibilities to a third party. In North
America, Adolor is responsible for the supply and manufacture of LidoPAIN SP for
commercial use or, at its option, may subcontract these responsibilities to
third parties. In October 2004, we and Adolor entered into an amendment to the
license agreement to facilitate our respective clinical development activities.
The amendment provided that the we and Adolor would coordinate our independent
pre-clinical and clinical activities with respect to the LidoPAIN SP product. In
addition, we agreed to provide Adolor with clinical trial data generated from
our recent clinical trial conducted in Europe and to permit Adolor to use such
data for development, regulatory and commercialization of licensed products.
Adolor, in turn, agreed to provide us with certain data generated by Adolor
relating to the lidocaine patches manufactured by Corium International, Inc. and
to permit us to use such data for the development, regulatory and
commercialization of sterile lidocaine patches. Lastly, the amendment permits us
to enter into an agreement with Corium pursuant to which Corium will manufacture
and supply our clinical and commercial supplies of sterile lidocaine patches for
use outside North America. We have not yet entered into any manufacturing or
supply agreement with Corium.
At our option, within 30 days after Adolor's first filing of an NDA (or
foreign equivalent) for LidoPAIN SP or similar product, we have the right to
negotiate with Adolor regarding a co-promotion arrangement in any country in
North America in which such filing has been made. However, neither we nor Adolor
is under any obligation to enter into any such arrangement.
The Adolor license terminates on a country-by-country and licensed
product-by-licensed product basis upon the expiration of the royalty obligations
in the particular country. Adolor may also terminate the agreement upon 120 days
advance written notice to us, and either Adolor or EpiCept may terminate the
agreement upon an uncured material breach by the other or, subject to the
relevant bankruptcy laws, upon a bankruptcy event of the other.
Endo
In December 2003, we entered into a license agreement with Endo under which
we granted Endo (and its affiliates) the exclusive (including as to us and our
affiliates) worldwide right to commercialize LidoPAIN BP. We also granted Endo
worldwide rights to use certain of our patents for the development
54
of certain other non-sterile, topical lidocaine patches, including Lidoderm,
Endo's non-sterile topical lidocaine-containing patch for the treatment of
chronic lower back pain. Upon the execution of the Endo agreement, we received a
non-refundable payment of $7.5 million, and we may receive payments of up to
$52.5 million upon the achievement of various milestones relating to product
development, regulatory approval and commercial success for both our LidoPAIN BP
product and Endo's own back pain product, so long as, in the case of Endo's
product candidate, our patents provide protection thereof. We will also receive
royalties from Endo based on the net sales of LidoPAIN BP. These royalties are
payable until generic equivalents to the LidoPAIN BP product are available or
until expiration of the patents covering LidoPAIN BP, whichever is sooner. We
are also eligible to receive milestone payments from Endo of up to approximately
$30.0 million upon the achievement of specified regulatory and net sales
milestones of Lidoderm, Endo's chronic lower back pain product candidate, so
long as our patents provide protection thereof. The total amount of upfront and
milestone payments we are eligible to receive under this agreement is
$90.0 million.
We remain responsible for continuing and completing the development of
LidoPAIN BP, including conducting all clinical trials (and supplying the
clinical products necessary for those trials) and the preparation and submission
of the NDA in order to obtain regulatory approval for LidoPAIN BP. We may
subcontract with third parties for the manufacture and supply of LidoPAIN BP.
Endo is conducting Phase II clinical trials for its Lidoderm patch and remains
responsible for continuing and completing the development, including conducting
all clinical trials (and supplying the clinical products necessary for those
trials) in connection with that product candidate.
In the event that we have obtained regulatory approval of LidoPAIN BP in a
particular country and Endo fails to commercialize LidoPAIN BP in that country
within three years from the date on which we receive final regulatory approval
in the United States, then the license granted to Endo relating to the
commercialization of LidoPAIN BP in that country terminates, and we will have
the right to commercialize or license the product in that country. In that
event, we will be required to pay Endo a royalty on the net sales of LidoPAIN BP
in any such country.
At our option, within 30 days after our first filing of an NDA (or foreign
equivalent) for LidoPAIN BP, we have the right to negotiate a co-promotion
arrangement with Endo in any country in which such filing has been made.
However, neither we nor Endo is under any obligation to enter into any such
arrangement.
The license terminates upon the later of the conclusion of the royalty term,
on a country-by-country basis, and the expiration of the last applicable EpiCept
patent covering licensed Endo product candidates on a country-by-country basis.
Either Endo or EpiCept may terminate the agreement upon an uncured material
breach by the other or, subject to the relevant bankruptcy laws, upon a
bankruptcy event of the other.
Manufacturing
We have no in-house manufacturing capabilities. We intend to outsource all
of our manufacturing activities for the foreseeable future. We believe that this
strategy will enable us to direct operational and financial resources to the
development of our product candidates rather than diverting resources to
establishing a manufacturing infrastructure.
We have entered into arrangements with qualified third parties for the
formulation and manufacture of our clinical supplies. We intend to enter into
additional written supply agreements in the future and are currently in
negotiations with several potential suppliers. We generally purchase our
supplies from our current suppliers pursuant to purchase orders. We plan to use
a single, separate third party manufacturer for each of our product candidates
that we are responsible for manufacturing. In some cases, the responsibility to
manufacture product, or to identify suitable third party manufacturers, may be
assumed by our licensees. For example, under the Adolor agreement, Adolor is
responsible for the manufacture of the commercial supply of LidoPAIN SP in North
America. We may source LidoPAIN SP for marketing outside of North America from
Adolor or Adolor's third party supplier. Alternatively, we can separately
arrange for other third party suppliers to manufacture the commercial supply of
LidoPAIN SP outside
55
North America. Pursuant to the October 2004 amendment to the Adolor agreement,
Adolor has agreed to permit us to enter into an agreement with Corium pursuant
to which Corium would manufacture and supply our clinical and commercial
supplies of sterile lidocaine patches for our use outside North America. We have
not yet entered into any manufacturing or supply agreement with Corium.
We cannot assure you that our current manufacturers can successfully
increase their production to meet full commercial demand. We believe that there
are several manufacturing sources available to us, including our current
manufacturers, which can meet our commercial supply requirements on commercially
reasonable terms. We will continue to look for and secure the appropriate
manufacturing capabilities and capacity to ensure commercial supply at the
appropriate time.
Sales and Marketing
We do not currently have internal sales or marketing capabilities. In order
to commercially market our product candidates if we obtain regulatory approval,
we must either develop an internal sales and marketing infrastructure or
collaborate with third parties with sales and marketing expertise. We have
retained full rights to commercialize EpiCept NP-1 worldwide. We have granted
Adolor exclusive commercialization rights for LidoPAIN SP in North America but
have also retained the right to negotiate with Adolor a co-promotion agreement
for LidoPAIN SP in North America. In addition, we have granted Endo exclusive
worldwide marketing and commercialization rights for LidoPAIN BP but have also
retained the right to negotiate with Endo co-promotion rights for LidoPAIN BP
worldwide. We will likely market our products in international markets outside
of North America through collaborations with third parties. We intend to make
decisions regarding internal sales and marketing of our product candidates on a
product-by-product and country-by-country basis.
Intellectual Property
Our commercial success will depend in part on obtaining and maintaining
patent protection and trade secret protection of our technologies and drug
candidates as well as successfully defending these patents against third-party
challenges. We have various composition of matter and use patents, which have
claims directed to our product candidates or methods of their use. Our patent
policy is to retain and secure patents for the technology, inventions and
improvements related to our core portfolio of product candidates. We currently
own 17 issued U.S. patents, five issued foreign patents, one allowed U.S. patent
application and seven pending U.S. and foreign patent applications. We also rely
on trade secrets, technical know-how and continuing innovation to develop and
maintain our competitive position.
The following is a summary of the patent position relating to our three
late-stage product candidates:
EpiCept NP-1 - We own a U.S. patent with claims directed to a formulation
containing a combination of amitriptyline and ketamine, which can be used as
a treatment for the topical relief of pain, including neuropathic pain, that
expires in August 2021. We also have a license to additional patents, which
expire in September 2015 and May 2018, and which have claims directed to
topical uses of tricyclic antidepressants, such as amitriptyline, and NMDA
antagonists, such as ketamine, as treatments for relieving pain, including
neuropathic pain. Additional foreign patent applications are pending related
to EpiCept NP-1 in many major pharmaceutical markets outside the United
States.
LidoPAIN SP - We own two U.S. patents that have claims directed to the
topical use of a local anesthetic or salt thereof, such as lidocaine, for the
prevention or relief of pain from surgically closed wounds, in a hydrogel
patch, which expire in October 2019. Additionally, we own a pending U.S.
patent application that is directed to a breathable, sterile patch that can
be used to treat pain caused by various types of wounds, including surgically
closed wounds. We have foreign patent applications pending relating to
LidoPAIN SP in many major pharmaceutical markets outside the United States.
LidoPAIN BP - We own a U.S. patent that has claims directed to the use
and composition of a patch containing a local anesthetic, such as lidocaine,
to topically treat back pain, myofascial pain and
56
muscular tensions, which expires in July 2016. Equivalent foreign patents
have been granted in many major European pharmaceutical markets.
We also seek to protect our proprietary information by requiring our
employees, consultants, contractors, outside partners and other advisers to
execute, as appropriate, nondisclosure and assignment of invention agreements
upon commencement of their employment or engagement. We also require
confidentiality or material transfer agreements from third parties that receive
our confidential data or materials.
We also rely on trade secrets to protect our technology, especially where we
do not believe patent protection is appropriate or obtainable. However, trade
secrets are difficult to protect. While we use reasonable efforts to protect our
trade secrets, our employees, consultants, contractors, partners and other
advisors may unintentionally or willfully disclose our information to
competitors. Enforcing a claim that a third party illegally obtained and is
using our trade secrets is expensive and time consuming, and the outcome is
unpredictable. In addition, courts outside the United States are sometimes less
willing to protect trade secrets. Moreover, our competitors may independently
develop equivalent knowledge, methods and know-how.
The pharmaceutical, biotechnology and other life sciences industries are
characterized by the existence of a large number of patents and frequent
litigation based upon allegations of patent infringement. While our drug
candidates are in clinical trials, and prior to commercialization, we believe
our current activities fall within the scope of the exemptions provided by
35 U.S.C. Section 271(e) in the United States and Section 55.2(1) of the
Canadian Patent Act, each of which covers activities related to developing
information for submission to the FDA and its counterpart agency in Canada. As
our drug candidates progress toward commercialization, the possibility of an
infringement claim against us increases. While we attempt to ensure that our
drug candidates and the methods we employ to manufacture them do not infringe
other parties' patents and other proprietary rights, competitors or other
parties may assert that we infringe on their proprietary rights.
For a discussion of the risks associated with our intellectual property, see
"Risk Factors - Risks Relating to Intellectual Property."
License Agreements
We have in the past licensed and will continue to license patents from
collaborating research groups and individual inventors.
Hyson
In March 2001, we entered into a license agreement with Dr. Morton Hyson
under which Dr. Hyson licensed to us various patents relating to LidoPAIN HM. We
are required to pay Dr. Hyson a royalty based on both the composition and the
net sales of the product ultimately developed. Commencing with the first
commercial sale of a product incorporating the licensed patents, the royalties
to Dr. Hyson will not be less than $50,000 per year. The term of the license
extends until the last to expire of the licensed patents, at which time the
royalties also terminate. Dr. Hyson may also terminate the agreement if we fail
to pay royalties when due or, subject to the relevant bankruptcy laws, if we
become subject to a bankruptcy event. We may terminate the agreement if we
determine that commercialization of the products incorporating the licensed
patents is not in our best commercial interests.
Memorial Sloan Kettering
In January 2001, we entered into a license agreement with Memorial Sloan
Kettering Institute for Cancer Research, or MSK, under which MSK granted us an
exclusive license to certain patent applications related to topical anesthetics
involving opioids for the treatment of pain associated with the skin and mucosal
surfaces. We are required to pay MSK royalties based on the net sales generated
from products utilizing the licensed patents. The agreement provides for minimum
royalties of $25,000 per year starting from the first sale of product and
increases by $25,000 per year, up to a maximum of $125,000 per
57
year. The royalty obligations terminate upon the last to expire of the licensed
patents. MSK may terminate the agreement if we become insolvent or if we fail to
make royalty payments when due after a specified period. We may terminate the
agreement if we determine that the commercialization of products incorporating
the licensed patent is not in our best interests. Either of us may terminate the
agreement upon a material uncured breach of the other.
Cassel
In October 1999, we acquired from Dr. R. Douglas Cassel certain patent
applications relating to technology for the treatment of surgical incision pain.
On July 16, 2003, this royalty agreement was amended. Pursuant to this
agreement, we have agreed to pay Dr. Cassel a fee of $4,000 per month until July
2006. We will also pay Dr. Cassel royalties based on the net sales of any of our
products for the treatment of pain associated with surgically closed wounds. The
$4,000 per month fee will be credited towards these royalty payments. The
royalty obligations will terminate upon the expiration of the last to expire
acquired patent. As part of the royalty arrangement, we have engaged Dr. Cassel
as a consultant, for which he is paid on a per diem basis. Dr. Cassel provides
us with general scientific consulting services, particularly with respect to the
development and commercialization of LidoPAIN SP. Dr. Cassel has also granted us
an option to obtain, on mutually agreeable terms, an exclusive, worldwide
license to any technology discovered by Dr. Cassel outside of his performance of
services for us.
Epitome
In August 1999, we entered into a sublicense agreement with Epitome
Pharmaceuticals Limited under which we have an exclusive license to certain
patents for the topical use of tricyclic anti-depressants and NMDA antagonists
as topical analgesics for neuralgia. This technology has been incorporated into
EpiCept NP-1. We have been granted worldwide rights to make, use, develop, sell
and market products utilizing the licensed technology in connection with passive
dermal applications. We are obligated to make payments to Epitome upon
achievement of specified milestones and to pay royalties based on annual net
sales derived from the products incorporating the licensed technology. At the
end of each year in which there has been no commercially sold products, we will
be obligated to pay to Epitome a maintenance fee that is equal to twice the fee
paid in the previous year, or Epitome will have the option to terminate the
contract. The sublicense terminates upon the expiration of the last to expire
licensed patents. The sublicense may be terminated earlier under specified
circumstances, such as breaches, lack of commercial feasibility and regulatory
issues.
Government Regulation
United States
The U.S. Food and Drug Administration and comparable state and local
regulatory agencies impose substantial requirements upon the clinical
development, manufacture, marketing and distribution of drugs. These agencies
and other federal, state and local entities regulate research and development
activities and the testing, manufacture, quality control, safety, effectiveness,
labeling, storage, record keeping, approval, advertising and promotion of our
product candidates. In the United States, the FDA regulates drugs under the
Federal Food, Drug, and Cosmetic Act, or FFDCA, and implementing regulations.
The process required by the FDA before our product candidates may be marketed in
the United States generally involves the following:
completion of extensive pre-clinical laboratory tests, pre-clinical animal
studies and formulation studies all performed in accordance with the FDA's
good laboratory practice, or GLP, regulations;
submission to the FDA of an IND application that must become effective
before clinical trials may begin;
performance of adequate and well-controlled clinical trials to establish the
safety and efficacy of the product candidate for each proposed indication;
58
submission of an NDA to the FDA;
satisfactory completion of an FDA pre-approval inspection of the
manufacturing facilities at which the product is produced to assess
compliance with current GMP, or cGMP, regulations; and
FDA review and approval of the NDA prior to any commercial marketing, sale
or shipment of the drug.
The testing and approval process requires substantial time, effort and financial
resources, and we cannot be certain that any approvals for our product
candidates will be granted on a timely basis, if at all.
Pre-clinical Activities. Pre-clinical activities include laboratory
evaluation of product chemistry, formulation and stability, as well as studies
to evaluate toxicity in animals. The results of pre-clinical tests, together
with manufacturing information and analytical data, are submitted as part of an
IND application to the FDA. The IND automatically becomes effective 30 days
after receipt by the FDA, unless the FDA, within the 30-day time period, raises
concerns or questions about the conduct of the clinical trial, including
concerns that human research subjects will be exposed to unreasonable health
risks. In such a case, the IND sponsor and the FDA must resolve any outstanding
concerns before the clinical trial can begin. Our submission of an IND, or those
of our collaborators, may not result in FDA authorization to commence a clinical
trial. A separate submission to an existing IND must also be made for each
successive clinical trial conducted during product development, and the FDA must
grant permission before each clinical trial can begin. Further, an independent
institutional review board, or IRB, for each medical center proposing to conduct
the clinical trial must review and approve the plan for any clinical trial
before it commences at that center, and it must monitor the study until
completed. The FDA, the IRB or the sponsor may suspend a clinical trial at any
time on various grounds, including a finding that the subjects or patients are
being exposed to an unacceptable health risk. Clinical testing also must satisfy
extensive Good Clinical Practice, or GCP, regulations and regulations for
informed consent of subjects.
Clinical Trials. For purposes of NDA submission and approval, clinical
trials are typically conducted in the following three sequential phases, which
may overlap:
Phase I: Studies are initially conducted in a limited population to test the
drug candidate for safety, dose tolerance, absorption, metabolism,
distribution and excretion in healthy humans or, on occasion, in subjects.
In some cases, a sponsor may decide to run what is referred to as a
"Phase Ib" evaluation, which is a second safety-focused Phase I clinical
trial typically designed to evaluate the impact of the drug candidate in
combination with currently approved drugs.
Phase II: Studies are generally conducted in a limited patient population to
identify possible adverse effects and safety risks, to determine the
efficacy of the drug candidate for specific targeted indications and to
determine dose tolerance and optimal dosage. Multiple Phase II clinical
trials may be conducted by the sponsor to obtain information prior to
beginning larger and more expensive Phase III clinical trials. In some
instances, a sponsor may decide to run what is referred to as a "Phase IIa"
clinical trial, which is designed to provide dose-ranging and additional
safety and pharmaceutical data. In other cases, a sponsor may decide to run
what is referred to as a "Phase IIb" evaluation, which is a second,
confirmatory Phase II clinical trial that could, if positive and accepted by
the FDA, serve as a pivotal clinical trial in the approval of a drug
candidate.
Phase III: These are commonly referred to as pivotal studies. When Phase II
clinical trials demonstrate that a dose range of the drug candidate is
effective and has an acceptable safety profile, Phase III clinical trials
are undertaken in large patient populations to further evaluate dosage, to
provide substantial evidence of clinical efficacy and to further test for
safety in an expanded and diverse patient population at multiple,
geographically dispersed clinical trial sites.
In some cases, the FDA may condition approval of an NDA for a drug candidate
on the sponsor's agreement to conduct additional clinical trials to further
assess the drug's safety and effectiveness after NDA approval. Such
post-approval trials are typically referred to as Phase IV clinical trials.
59
New Drug Application. The results of drug candidate development,
pre-clinical testing, chemistry and manufacturing controls and clinical trials
are submitted to the FDA as part of an NDA. The NDA also must contain extensive
manufacturing information. Once the submission has been accepted for filing, by
law the FDA has 180 days to review the application and respond to the applicant.
The review process is often significantly extended by FDA requests for
additional information or clarification. The FDA may refer the NDA to an
advisory committee for review, evaluation and recommendation as to whether the
application should be approved. The FDA is not bound by the recommendation of an
advisory committee, but it generally follows such recommendations. The FDA may
deny approval of an NDA if the applicable regulatory criteria are not satisfied,
or it may require additional clinical data or an additional pivotal Phase III
clinical trial. Even if such data is submitted, the FDA may ultimately decide
that the NDA does not satisfy the criteria for approval. Data from clinical
trials are not always conclusive and the FDA may interpret data differently than
we interpret data. Once issued, the FDA may withdraw drug approval if ongoing
regulatory requirements are not met or if safety problems occur after the drug
reaches the market. In addition, the FDA may require testing, including Phase IV
clinical trials, and surveillance programs to monitor the effect of approved
products that have been commercialized, and the FDA has the power to prevent or
limit further marketing of a drug based on the results of these post-marketing
programs. Drugs may be marketed only for the approved indications and in
accordance with the provisions of the approved label. Further, if there are any
modifications to the drug, including changes in indications, labeling or
manufacturing processes or facilities, we may be required to submit and obtain
FDA approval of a new NDA or NDA supplement, which may require us to develop
additional data or conduct additional pre-clinical studies and clinical trials.
Satisfaction of FDA regulations and requirements or similar requirements of
state, local and foreign regulatory agencies typically takes several years, and
the actual time required may vary substantially based upon the type, complexity
and novelty of the product or disease. Government regulation may delay or
prevent marketing of drug candidates for a considerable period of time and
impose costly procedures upon our activities. The FDA or any other regulatory
agency may not grant approvals for new indications for our drug candidates on a
timely basis, if at all. Even if a drug candidate receives regulatory approval,
the approval may be significantly limited to specific usages, patient
populations and dosages. Further, even after regulatory approval is obtained,
later discovery of previously unknown problems with a drug may result in
restrictions on the drug or even complete withdrawal of the drug from the
market. Delays in obtaining, or failures to obtain, regulatory approvals for any
of our drug candidates would harm our business. In addition, we cannot predict
what additional governmental regulations may arise from future U.S. governmental
action.
Any drugs manufactured or distributed by us or our collaborators pursuant to
FDA approvals are subject to continuing regulation by the FDA, including record
keeping requirements and reporting of adverse experiences associated with the
drug. Drug manufacturers and their subcontractors are required to register their
establishments with the FDA and certain state agencies and are subject to
periodic unannounced inspections by the FDA and certain state agencies for
compliance with ongoing regulatory requirements, including cGMPs, which impose
certain procedural and documentation requirements upon us and our third-party
manufacturers. Failure to comply with the statutory and regulatory requirements
can subject a manufacturer to potential legal or regulatory action, such as
warning letters, suspension of manufacturing, seizure of product, injunctive
action or civil penalties. We cannot be certain that we or our present or future
third-party manufacturers or suppliers, will be able to comply with the cGMP
regulations and other ongoing FDA regulatory requirements. If our present or
future third-party manufacturers or suppliers are not able to comply with these
requirements, the FDA may halt our clinical trials, require us to recall a drug
from distribution, or withdraw approval of the NDA for that drug.
The FDA closely regulates the post-approval marketing and promotion of
drugs, including standards and regulations for direct-to-consumer advertising,
off-label promotion, industry-sponsored scientific and educational activities
and promotional activities involving the Internet. A company can make only those
claims relating to safety and efficacy that are approved by the FDA. Failure to
comply with these requirements can result in adverse publicity, warning letters,
corrective advertising and potential civil and
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criminal penalties. Physicians may prescribe legally available drugs for uses
that are not described in the drug's labeling and that differ from those tested
by us and approved by the FDA. Such off-label uses are common across medical
specialties. Physicians may believe that such off-label uses are the best
treatment for many patients in varied circumstances. The FDA does not regulate
the behavior of physicians in their choice of treatments. The FDA does, however,
impose stringent restrictions on manufacturers' communications regarding
off-label use.
Section 505(b)(2) Drug Applications. As an alternate path to FDA approval
for new or improved formulations of previously approved products, a company may
file a Section 505(b)(2) NDA. Section 505(b)(2) permits the filing of an NDA
where at least some of the information required for approval comes from studies
not conducted by or for the applicant and for which the applicant has not
obtained a right of reference. The rule permits the applicant to rely upon
certain pre-clinical or clinical studies conducted for an approved product. The
FDA may also require companies to perform additional studies or measurements to
support the change from the approved product. The FDA may then approve the new
product candidate for all or some of the label indications for which the
referenced product has been approved, as well as for any new indication sought
by the Section 505(b)(2) applicant.
To the extent that the Section 505(b)(2) applicant is relying on studies
conducted for an already approved product, the applicant is required to certify
to the FDA concerning any patents listed for the approved product in the FDA's
Orange Book publication. Specifically, the applicant must certify that: (i) the
required patent information has not been filed; (ii) the listed patent has
expired; (iii) the listed patent has not expired, but will expire on a
particular date and approval is sought after patent expiration; or (iv) the
listed patent is invalid or will not be infringed by the new product. If the
applicant does not challenge the listed patents, the Section 505(b)(2)
application will not be approved until all the listed patents claiming the
referenced product have expired. The Section 505(b)(2) application also will not
be approved until any non-patent exclusivity, such as exclusivity for obtaining
approval of a new chemical entity, listed in the Orange Book for the referenced
product has expired.
Foreign Regulation
Whether or not we obtain FDA approval for a product, we must obtain approval
of a product by the comparable regulatory authorities of foreign countries
before we can commence clinical trials or marketing of the product in those
countries. The approval process varies from country to country, and the time may
be longer or shorter than that required for FDA approval. The requirements
governing the conduct of clinical trials, product licensing, pricing and
reimbursement also vary greatly from country to country. Although governed by
the applicable country, clinical trials conducted outside of the United States
typically are administered with the three-phase sequential process that is
discussed above under "Government Regulation - United States." However, the
foreign equivalent of an IND is not a prerequisite to performing pilot studies
or Phase I clinical trials.
Under European Union regulatory systems, we may submit marketing
authorization applications either under a centralized or decentralized
procedure. The centralized procedure, which is available for medicines produced
by biotechnology or which are highly innovative, provides for the grant of a
single marketing authorization that is valid for all EU member states. This
authorization is a marketing authorization approval, or MAA. The decentralized
procedure provides for mutual recognition of national approval decisions. Under
this procedure, the holder of a national marketing authorization may submit an
application to the remaining member states. Within 90 days of receiving the
applications and assessment report, each member state must decide whether to
recognize approval. This procedure is referred to as the mutual recognition
procedure, or MRP.
In addition, regulatory approval of prices is required in most countries
other than the United States. We face the risk that the resulting prices would
be insufficient to generate an acceptable return to us or our collaborators.
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Competition
The pharmaceutical industry, and the pain management sector specifically, is
highly competitive and includes a number of established, large and mid-sized
pharmaceutical and specialty pharmaceutical companies, as well as smaller
emerging companies, whose activities are directly focused on our target markets
and areas of expertise. These organizations also compete with us to attract
qualified personnel and potential parties for acquisitions, joint ventures or
other strategic alliances. Many of our competitors have significantly greater
financial, manufacturing, marketing and drug development resources than we do.
Large pharmaceutical companies in particular have extensive experience in
clinical testing, obtaining regulatory approvals and drug commercialization. If
approved, our product candidates will compete with a large number of products
that include over-the-counter treatments, prescription drugs specifically
indicated for pain management and prescription drugs that are prescribed
off-label. In addition, new developments occur in the pharmaceutical industry at
a rapid pace.
If approved, each of our product candidates will compete for a share of the
existing market with products that have become standard treatments recommended
or prescribed by physicians.
We believe that the primary competition for our lead product candidates are
as follows:
EpiCept NP-1. The primary competition for EpiCept NP-1 in the area of
post-herpetic neuralgia is Neurontin (gabapentin), which is currently
marketed by Pfizer. Gabapentin, the generic equivalent of Neurontin, is now
available at a cost substantially below the price of Neurontin. Pfizer has
developed a successor product candidate to Neurontin called Lyrica or
pregabalin, which has been shown in Phase III clinical trials to effectively
treat subjects with neuropathic pain. We also face competition from Endo's
Lidoderm patch, which is currently indicated for post-herpetic neuralgia.
LidoPAIN SP. The primary competition in the market for acute
post-operative pain are narcotic analgesics. Several competitors are seeking
product candidates that would be used in combination with opioids to mitigate
one or more of the adverse side effects associated with their use. For
example, Endo recently announced that the FDA has approved Skyepharma's NDA
for DepoDur for the treatment of pain following major surgery, to which
product Endo has licensed the commercial rights. Previously referred to as
DepoMorphine, DepoDur is a single dose sustained-release injectable
formulation of morphine. Other competitors include Purdue Pharmaceuticals and
Ortho-McNeil Pharmaceutical, Inc.
LidoPAIN BP. There are a number of competitive products that are used to
treat acute lower back pain. We compete with fully-integrated pharmaceutical
companies, smaller companies that are collaborating with larger
pharmaceutical companies, academic institutions, government agencies and
other public and private research organizations. Many of these competitors
have drugs already approved by the FDA or in development and operate larger
research and development programs in these fields than we do.
Although we believe that, if approved, our product candidates will have
favorable features for the treatment of their intended indications, existing
treatments or treatments currently under clinical development that also receive
regulatory approval may possess advantages in competing for market share.
Legal Proceedings
We are not currently involved in any material legal proceedings.
Facilities
Our facilities consist of approximately 12,700 square feet of research and
office space. We lease 9600 square feet located at 270 Sylvan Avenue in
Englewood Cliffs, New Jersey until September 2005 with an option to renew until
September 2010. We also lease 2,766 square feet in Munich, Germany until August
2007, with an automatic year-long extension for an additional three years.
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Employees
Our workforce consists of 13 full-time employees, three of whom hold a Ph.D.
or M.D., and one of whom holds other advanced degrees. Of our total workforce,
six are engaged in research and development, and seven are engaged in business
development, finance and administration. We have no collective bargaining
agreements with our employees, and we have not experienced any work stoppages.
We believe that our relations with our employees are good.
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