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 skins 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
42
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 persons 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
43
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 skins 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.
44
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 neuralgia
|
|
Phase II completed
|
|
Initiate Phase III during second half of 2005
|
|
EpiCept
|
|
LidoPAIN SP
|
|
Sterile patch
|
|
Surgical incision pain
|
|
Phase III initiated in Germany
|
|
Adolor has announced plans for Phase IIb and
Phase III clinical trials in United States
|
|
Adolor in North America; EpiCept outside of North
America EpiCept retains right to negotiate future co-promotion
agreement
|
|
LidoPAIN BP
|
|
Patch
(non-sterile)
|
|
Acute or recurrent lower back pain
|
|
Phase IIa completed
|
|
Initiate pivotal Phase IIb clinical trial
during second half of 2005
|
|
Endo worldwide; EpiCept
retains right to negotiate future co-promotion agreement
|
|
EpiCept MP/DP
|
|
Spray gel matrix
|
|
Oral mucositis; Dental pain
|
|
Phase II
|
|
Continue Phase II development
|
|
EpiCept
|
|
LidoPAIN TV
|
|
Patch
(non-sterile)
|
|
Tinnitus
|
|
Phase II in Europe
|
|
Continue Phase II development
|
|
EpiCept
|
|
LidoPAIN HM
|
|
Patch
(non-sterile)
|
|
Headache
|
|
Phase II
|
|
Continue Phase II development
|
|
EpiCept
|
We conduct our clinical trials in pain centers
throughout North America and in Europe. There are various ways
in which to assess a subjects 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.
45
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
Datamonitors 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;
|
46
|
|
|
|
|
|
|
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
Note:
p=0.10; (ami + ket vs. placebo)
47
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 trials 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
|
|
|
|
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.
48
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 Datamonitors 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.
49
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 subjects 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
Current Clinical
Initiatives.
Our clinical protocol
for a Phase III clinical trial in Europe was approved by
Germanys 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
50
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 patchs 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
Endos 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
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
Adolors 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
Adolors 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, Endos 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 Endos own back pain product,
so long as, in the case of Endos 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, Endos 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 Adolors 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
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 FDAs 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 sponsors agreement to
conduct additional clinical trials to further assess the
drugs 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
60
criminal penalties. Physicians may prescribe
legally available drugs for uses that are not described in the
drugs 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 FDAs 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.
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.
61
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 Endos 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 Skyepharmas 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.
62
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.
63