美國
證券交易委員會
華盛頓特區,20549
表格:
(標記一) | |
根據1934年《證券交易法》第13或15(D)條規定的季度報告 | |
截至本季度末 | |
或 | |
根據1934年證券交易法第13或15(d)條提交的過渡報告 | |
從 到 |
委員會文件號:
(註冊人的確切姓名載於其章程)
(述明或其他司法管轄權 | (稅務局僱主 |
(主要行政辦公室地址) | (郵政編碼) |
(
(註冊人的電話號碼,包括區號)
N/A
(以前的名稱、以前的地址和以前的財年,如果自上次報告以來發生了變化)
根據該法第12(B)條登記的證券: | ||||
每個班級的標題 | 交易代碼 | 註冊的每個交易所的名稱 | ||
|
用複選標記表示註冊人(1)是否在過去12個月內(或註冊人被要求提交此類報告的較短時間內)提交了1934年《證券交易法》第13條或15(D)節要求提交的所有報告,以及(2)在過去90天內是否符合此類提交要求。
用複選標記表示註冊人是否在過去12個月內(或在註冊人被要求提交此類文件的較短時間內)以電子方式提交了根據S-T規則第405條(本章232.405節)要求提交的每個交互數據文件。
用複選標記表示註冊人是大型加速申報公司、加速申報公司、非加速申報公司、較小的報告公司或新興成長型公司。請參閱《交易法》第12b-2條規則中「大型加速申報公司」、「加速申報公司」、「較小申報公司」和「新興成長型公司」的定義。
大型加速文件服務器☐ | 加速文件管理器☐ |
規模較小的報告公司 | |
新興成長型公司 |
如果是一家新興的成長型公司,用複選標記表示註冊人是否已選擇不使用延長的過渡期來遵守根據交易所法案第13(A)節提供的任何新的或修訂的財務會計準則。☐
用複選標記表示註冊人是否是空殼公司(如《交易法》第12b-2條所定義)。是
截至2024年10月31日,註冊人普通股的流通股數(每股面值0.001美元)爲
前瞻性陳述
這份Form 10-Q季度報告包含符合1995年《私人證券訴訟改革法》的前瞻性陳述。我們打算將這些前瞻性陳述納入修訂後的1933年證券法第27A節(「證券法」)和修訂後的1934年證券交易法第21E節(「交易法」)中包含的前瞻性陳述的安全港條款。「預期」、「相信」、「可以」、「繼續」、「可能」、「設計」、「估計」、「預期」、「預測」、「目標」、「打算」、「可能」、「可能」、「計劃」、「可能」、「潛在」、「預測」、「項目」、「應該」、「目標」、「意志」,「將」和類似的表述旨在識別前瞻性表述,儘管並非所有前瞻性表述都使用這些詞語或表述。本季度報告中有關10-Q表的所有陳述,除有關歷史事實的陳述外,均爲前瞻性陳述,包括但不限於以下陳述:
● | 我們對IGALMI的銷售策略TM; |
● | 與我們重新確定優先順序相關的戰略、預期收益和成本節約(如本文所定義); |
● | 我們有能力籌集更多資本,並繼續作爲一家持續經營的企業; |
● | 與我們的寧靜計劃相關的發展; |
● | 我們潛在市場的總規模和相關的基礎估計; |
● | 我們爲候選產品制定的臨床試驗和營銷應用計劃; |
● | 我們研究、開發和商業化當前和未來候選產品的計劃; |
● | 我們計劃尋求在某些候選產品的開發和商業化方面進行合作; |
● | 未來合作的潛在好處; |
● | 爲我們的候選產品獲得和保持監管批准的時機和能力; |
● | 我們與監管機構討論的時間和結果; |
● | IGALMI的市場接受率和程度、臨床效用、處方者數量和處方集獲勝率TM 以及我們獲得營銷批准的任何候選產品; |
● | 我們的商業化、營銷和製造能力和策略,包括任何廣告活動的潛在好處; |
● | 我們對活動、會議、演講和會議的參與以及從中的任何潛在好處; |
● | 我們的知識產權地位和戰略; |
● | 我們對費用、未來收入、資本需求和額外融資需求的估計; |
● | 對我們的子公司OnkosXcel Therapeutics,LLC(「OnkosXcel」)的潛在投資或其他戰略選擇; |
● | 與我們的競爭對手和我們的行業有關的發展; |
● | 遵守我們融資安排下的公約; |
● | 政府法律法規的影響; |
● | 與法律程序和調查有關的事態發展;以及 |
● | 我們與BioXcel LLC的關係。 |
這些前瞻性陳述是基於管理層目前的預期。這些陳述既不是承諾也不是保證,而是涉及已知和未知的風險、不確定因素和其他重要因素,這些風險、不確定因素和其他重要因素可能會導致我們的實際結果、業績或成就與前瞻性陳述明示或暗示的任何未來結果、業績或成就大不相同,包括但不限於在「摘要風險因素」第二部分第1A項中列出的那些。「風險因素」和第一部分,第2項。「管理層對財務狀況和經營結果的討論和分析」以及本季度報告Form 10-Q的其他部分。在我們提交給美國證券交易委員會(「美國證券交易委員會」)的其他文件中,在「風險因素」一欄中討論的這些和其他重要因素可能會導致實際結果與本文件中所作的前瞻性陳述所表明的結果大不相同。鑑於這些不確定性,您不應依賴這些前瞻性陳述作爲對未來事件的預測。雖然我們可能會選擇在未來的某個時候更新前瞻性陳述,但我們不承擔任何這樣做的義務,即使後續事件導致我們的觀點發生變化。
如本季度報告中所述,除非另有說明或上下文另有規定,否則術語「我們」、「公司」或「BTI」指的是BioXcel治療公司,而「BioXcel LLC」指的是公司的前母公司和主要股東BioXcel LLC及其前身BioXcel公司。
3
我們可能會使用我們的網站作爲發佈有關公司的材料信息的渠道。有關公司的財務和其他重要信息通常發佈在公司網站的投資者和媒體部分,並可通過其網站訪問Www.bioxceltherapeutics.com。此外,當您註冊您的電子郵件地址時,您可能會自動收到有關公司的電子郵件警報和其他信息,方法是訪問我們網站投資者和媒體部分的新聞/事件菜單下的「電子郵件警報」選項,網址爲Www.bioxceltherapeutics.com.
彙總風險因素
我們的業務面臨許多風險和不確定性,包括第二部分第1A項中描述的風險和不確定性。本季度報告中的「風險因素」表格10-Q。在投資我們的普通股時,您應該仔細考慮這些風險和不確定性。影響我們業務的主要風險和不確定性包括以下內容:
● | 我們的經營歷史有限,到目前爲止還沒有產生大量的產品收入,這可能會使我們很難評估我們業務迄今的成功和評估我們未來的生存能力。 |
● | 自成立以來,我們已經發生了重大的運營虧損,並預計在可預見的未來,我們將繼續遭受重大運營虧損,可能永遠不會實現或保持盈利。 |
● | 我們的戰略優先順序調整和其他裁員可能無法達到我們預期的結果。 |
● | 我們將需要大量的額外資金,如果我們無法在需要時籌集資金,我們可能會被迫推遲、減少或取消我們的產品開發計劃或商業化努力,或以其他方式尋求戰略替代方案。 此外,未能根據我們的信貸協議的最低資本籌集要求(如本文所定義)籌集額外資金將觸發違約事件。 |
● | 我們有大量的債務和其他合同義務,這可能會損害我們的流動性,限制我們做生意的能力,從而損害我們的業務、運營結果和財務狀況。我們可能沒有足夠的運營現金流來履行我們在融資安排下的義務。 |
● | 我們已經確定了一些條件和事件,這些情況和事件使人對我們作爲一家持續經營的企業繼續下去的能力產生了極大的懷疑。 |
● | 我們在藥物發現和藥物開發方面的經驗有限。 |
● | 與寧靜II第三階段試驗相關的進展可能會影響我們BXCL501的開發計劃的時機以及尋求或獲得監管部門批准的前景,BXCL501用於急性治療可能患有阿爾茨海默病的癡呆症患者的激動症(非每日),還可能使我們面臨額外的風險和不確定性,包括監管、股東或其他行動,投資者信心的喪失,以及對我們普通股交易價格的負面影響。 |
● | 在短期內,我們依賴於伊加爾米TM,以及我們的四個候選產品BXCL501、BXCL502、BXCL701和BXCL702。如果我們無法完成候選產品的臨床開發或獲得市場批准,或無法成功實現商業化伊加爾米TM或者我們的候選產品,無論是單獨還是與協作者合作,或者如果我們在這樣做的過程中遇到重大延誤,我們的業務可能會受到嚴重損害。 |
● | 我們不時宣佈或公佈的臨床試驗的臨時「頂線」和初步數據可能會隨着更多患者數據的獲得而發生變化,並受到審計和驗證程序的影響,這可能會導致最終數據發生重大變化。 |
● | 美國(「U.S.」)的監管審批流程美國食品藥品監督管理局(「FDA」)和類似的外國機構冗長、耗時、昂貴,而且本質上不可預測,如果我們最終無法獲得監管部門對我們候選產品的批准,我們的業務將受到嚴重損害。 |
4
● | 臨床試驗昂貴,難以設計,難以進行,而且結果不確定。 |
● | 我們依靠臨床試驗中的患者登記來繼續開發我們的候選產品。如果我們不能讓患者參加我們的臨床試驗,我們的研發工作可能會受到不利影響。 |
● | 我們估計的騷動事件數量和相應的估計總目標市場受到內在挑戰和不確定性的影響。如果我們高估了我們當前和潛在的未來產品或候選產品的發作次數或總的潛在市場規模,或者如果我們獲得的任何批准是基於對患者群體的狹隘定義,我們的收入和實現盈利的能力可能會受到損害。 |
● | 基於BioXcel LLC的專利藥物發現和開發引擎EvolverAI以及我們自己的AI平台發現和開發候選產品是新穎和未經驗證的,我們不知道我們是否能夠開發出任何具有商業價值的產品。 |
● | 監管機構可能會限制我們開發或實施我們專有人工智能算法的能力,和/或可能會取消或限制我們專有技術的保密性,這可能會對我們的業務、運營結果和財務狀況產生不利影響。 |
● | 儘管FDA已經批准了IGALMITM對於與精神分裂症或雙相情感障礙相關的激越的急性治療,我們仍將面臨對IGALMI的廣泛和持續的監管要求和義務TM以及我們獲得批准的任何候選產品。 |
● | 儘管我們獲得了FDA對IGALMI的批准TM,我們的產品和候選產品可能不會被醫生或醫學界普遍接受,並且可能沒有足夠的保險覆蓋範圍和報銷。 |
● | 如果我們被發現違反了聯邦、州或外國醫療保健「欺詐和濫用」法律,我們可能會被要求支付巨額罰款和罰款,這可能會對我們的業務、財務狀況和運營結果產生不利影響。 |
● | 我們繼續依賴BioXcel LLC爲我們的業務提供某些服務。 |
● | BioXcel LLC對我們的業務方向具有重大影響,我們普通股的集中所有權將防止您和其他股東影響重大決策。 |
● | 我們的候選產品的臨床用品和IGALMI的商業用品的生產在很大程度上依賴於第三方。TM,我們打算依賴第三方生產任何其他經批准的候選產品的商業供應。 |
● | 我們依靠第三方進行臨床前和臨床試驗。如果這些第三方不能成功履行其合同法律和監管職責或在預期的最後期限前完成,我們可能無法獲得監管機構對我們的候選產品的批准或將其商業化,我們的業務可能會受到嚴重損害。 |
● | 數據泄露或網絡攻擊可能會擾亂我們的業務、運營和信息技術系統以及財務業績,或者導致公司機密或敏感信息的丟失或泄露。 |
● | 我們現在是,將來也可能是在正常業務過程中或之外受到法律程序、索賠和調查。這樣的訴訟程序, 索賠和調查可能是昂貴和耗時的辯護,可能會導致不利的結果,這可能會對我們的業務、經營業績和財務狀況產生實質性的不利影響,並對我們的普通股價格產生負面影響。 |
5
● | 不利的全球政治或經濟事件和條件可能會對我們的業務、財務狀況或經營結果產生不利影響。 |
● | 我們面臨着與環境、社會和治理事項相關的更多審查相關的風險。 |
● | 保護我們的所有權是困難和昂貴的,我們可能無法確保他們的保護。 |
商標、商號和服務標誌
本季度報告包括我們的商標、商號和服務標誌,包括但不限於“IGALMITM和我們的徽標,它們是我們的財產,受適用的知識產權法保護。僅爲方便起見,本季度報告中可能會出現商標、商標名和服務標記,而不包含®, TM 和 SM但此類引用並不意味着我們或適用所有人在適用法律允許的最大範圍內放棄或不會主張我們或任何適用許可人對這些商標、商號和服務標記的權利。我們無意使用或展示其他方的商標、商號或服務標誌,並且此類使用或展示不應被解釋爲暗示與這些其他方有關係,或由這些其他方背書或贊助我們。
行業和其他數據
除非另有說明,本季度報告中包含的有關我們的行業和我們經營的市場的信息,包括我們的總體預期、市場地位和市場機會,都是基於我們管理層的估計和研究,以及行業和一般出版物以及由第三方進行的研究、調查和研究。雖然我們相信本季度報告中包括的這些第三方出版物、研究、調查和研究的信息是可靠的,但我們不保證這些信息的準確性或完整性,我們也沒有獨立核實這些信息。管理層的估計是根據可公開獲得的信息、他們對我們行業的了解以及他們基於這些信息和知識的假設得出的,我們認爲這些信息和知識是合理的。這些數據涉及一些假設和限制,由於各種因素,這些假設和限制必然會受到高度不確定性和風險的影響,包括本季度報告中「前瞻性陳述」和第二部分第1A項「風險因素」中所述的那些因素。這些因素和其他因素可能導致我們未來的業績和市場預期與我們的假設和估計大不相同。
6
第一部分財務信息
項目1.財務報表
BIOXCEL THERAPEUTICS,Inc.
CONDENSED CONSOLIDATED BALANCE SHEETS
(以千計,每股除外)
9月30日, | ||||||
| 2024 |
| 12月31日 | |||
(未經審計) | 2023 | |||||
資產 |
|
|
|
| ||
流動資產 |
|
|
|
| ||
現金及現金等價物 | $ | | $ | | ||
應收賬款淨額 | |
| | |||
庫存 |
| |
| | ||
預付費用 |
| |
| | ||
其他流動資產 |
| |
| | ||
流動資產總額 | $ | | $ | | ||
財產和設備,淨額 |
| |
| | ||
經營性租賃使用權資產 | | | ||||
其他資產 | | | ||||
總資產 | $ | | $ | | ||
負債和股東(赤字)股權 |
|
|
|
| ||
流動負債 |
|
|
|
| ||
應付賬款 | $ | | $ | | ||
應計費用 |
| |
| | ||
因關聯方的原因 |
| |
| | ||
應計利息 | — | | ||||
其他流動負債 | | | ||||
流動負債總額 | $ | | $ | | ||
經營租賃負債的長期部分 | |
| | |||
衍生負債 | | | ||||
長期債務 | | | ||||
總負債 | $ | | $ | | ||
承付款和或有事項(附註16) | ||||||
股東(赤字)權益 |
|
|
|
| ||
優先股,$ | $ | $ | ||||
普通股,$ | | | ||||
追加實收資本 |
| |
| | ||
累計赤字 |
| ( |
| ( | ||
股東(赤字)權益總額 | $ | ( | $ | ( | ||
負債總額和股東(赤字)權益 | $ | | $ | |
附註是這些簡明綜合財務報表的組成部分。
7
BIOXCEL THERAPEUTICS,Inc.
簡明合併業務報表
(以千計,每股除外)
(未經審計)
截至9月30日的三個月裏, | 截至9月30日的九個月裏, | |||||||||||
| 2024 |
| 2023 |
| 2024 |
| 2023 | |||||
收入 | ||||||||||||
產品收入,淨額 | $ | | $ | | $ | | $ | | ||||
業務費用 |
|
|
|
|
|
| ||||||
銷貨成本 | $ | | $ | | $ | | $ | | ||||
研發 | | | | | ||||||||
銷售,一般和行政 |
| |
| |
| |
| | ||||
重組成本 | | | | | ||||||||
總運營支出 | $ | | $ | | $ | | $ | | ||||
運營虧損 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
其他費用(收入) |
|
|
|
|
|
| ||||||
利息開支 |
| |
| |
| |
| | ||||
利息收入 | ( | ( | ( | ( | ||||||||
其他(收入)費用,淨額 | ( | | ( | ( | ||||||||
淨虧損 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
普通股股東應占每股基本和攤薄淨虧損 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
加權平均流通股--基本和稀釋 |
| |
| |
| |
| |
附註是這些簡明綜合財務報表的組成部分。
8
BIOXCEL THERAPEUTICS,Inc.
股東(虧損)股權變動的濃縮合並報表
(金額以千爲單位)
(未經審計)
額外 | ||||||||||||||
普通股 | 已繳- | 積累 | ||||||||||||
| 股份 |
| 量 |
| 資本 |
| 赤字 |
| 總 | |||||
截至2022年12月31日的餘額 | | $ | | $ | | $ | ( | $ | | |||||
發行普通股,扣除發行成本 | | | | — | | |||||||||
股票補償 | — | — | | — | | |||||||||
股票期權的行使 | | — | | — | | |||||||||
受限制股票單位的歸屬,扣除員工納稅義務 | | — | ( | — | ( | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2023年3月31日餘額 | | $ | | $ | | $ | ( | $ | | |||||
股票補償 | — | — | | — | | |||||||||
發行股票購買證 | — | — | — | — | — | |||||||||
股票期權的行使 | | — | | — | | |||||||||
受限制股票單位的歸屬,扣除員工納稅義務 | | — | — | — | — | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2023年6月30日的餘額 | | $ | | $ | | $ | ( | $ | | |||||
股票補償 | — | — | | — | | |||||||||
股票期權的行使 | | — | — | — | — | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2023年9月30日的餘額 | | $ | | $ | | $ | ( | $ | ( | |||||
額外 | ||||||||||||||
普通股 | 已繳- | 積累 | ||||||||||||
股份 |
| 量 |
| 資本 |
| 赤字 |
| 總 | ||||||
截至2023年12月31日的餘額 | | $ | | $ | | $ | ( | $ | ( | |||||
發行普通股,扣除發行成本 | | | | — | | |||||||||
股票補償 | — | — | | — | | |||||||||
發行股票購買證 | — | — | | — | | |||||||||
發行預籌股票購買證 | — | — | | — | | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2024年3月31日餘額 | | $ | | $ | | $ | ( | $ | ( | |||||
發行普通股,扣除發行成本 | | | | - | | |||||||||
股票補償 | — | — | | — | | |||||||||
受限制股票單位的歸屬,扣除員工納稅義務 | | — | ( | — | ( | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2024年6月30日餘額 | | $ | | $ | | $ | ( | $ | ( | |||||
發行普通股,扣除發行成本 | | | | — | | |||||||||
股票補償 | — | — | | — | | |||||||||
受限制股票單位的歸屬,扣除員工納稅義務 | | — | — | — | — | |||||||||
淨虧損 | — | — | — | ( | ( | |||||||||
截至2024年9月30日餘額 | | $ | | $ | | $ | ( | $ | ( |
9
附註是這些簡明綜合財務報表的組成部分。
BIOXCEL THERAPEUTICS,Inc.
簡明合併現金流量表
(金額以千爲單位)
(未經審計)
截至9月30日的九個月裏, | ||||||
| 2024 |
| 2023 | |||
運營現金流活動: |
|
|
|
| ||
淨虧損 | $ | ( | $ | ( | ||
淨損失與經營活動使用的淨現金對賬 |
|
| ||||
折舊 |
| |
| | ||
債務貼現的增加和融資成本的攤銷 | | | ||||
衍生負債的公允價值變動 | ( | ( | ||||
基於股票的補償費用 |
| |
| | ||
信貸協議的應付實物利息 | | | ||||
設備處置損失 | — | | ||||
經營性租賃使用權資產 | | | ||||
經營性資產和負債的變動 |
|
| ||||
應收賬款 | |
| ( | |||
庫存 |
| |
| ( | ||
預付費用、其他流動資產和其他資產 |
| ( |
| | ||
應付賬款、應計費用、應付關聯方款項和其他流動負債 |
| ( |
| | ||
應計利息 | ( | | ||||
經營租賃負債 | ( | ( | ||||
用於經營活動的現金淨額 | $ | ( | $ | ( | ||
投資現金流活動: |
|
|
|
| ||
購買設備和租賃權改進 | $ | — | $ | ( | ||
投資活動的現金淨額 | $ | — | $ | ( | ||
融資現金流活動: |
|
|
|
| ||
發行普通股及認股權證所得款項 | $ | | $ | | ||
普通股和配股發行的發行成本 | ( | ( | ||||
支付與歸屬限制性股票單位相關的員工稅務義務 | ( | ( | ||||
股票期權的行使 | — | | ||||
融資活動提供的現金淨額 | $ | | $ | | ||
現金和現金等價物淨減少 | $ | ( | $ | ( | ||
現金及現金等值物,期末 |
| |
| | ||
現金及現金等值物,期末 | $ | | $ | | ||
補充現金流信息: |
|
|
|
| ||
發行股票購買證 | $ | | $ | — |
附註是這些簡明綜合財務報表的組成部分。
10
BIOXCEL THERAPEUTICS, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
(amounts in thousands, except per share amounts and where otherwise noted)
(unaudited)
Note 1. Nature of the Business
BioXcel Therapeutics, Inc. (“BTI” or the “Company”) is a biopharmaceutical company utilizing artificial intelligence (“AI”) approaches to develop transformative medicines in neuroscience and immuno-oncology. The Company is focused on utilizing cutting-edge technology and innovative research to develop high-value therapeutics aimed at transforming patients’ lives. BTI employs a unique AI platform to reduce therapeutic development costs and potentially accelerate timelines. The Company’s approach leverages existing approved drugs and/or clinically evaluated product candidates together with big data and proprietary machine learning algorithms to identify new therapeutic indices. BTI management believes this differentiated approach has the potential to reduce the expense and time associated with drug development in diseases with substantial unmet medical needs.
As used in these condensed consolidated financial statements, unless otherwise specified or the context otherwise requires, the terms “BioXcel LLC” refers to the Company’s former parent and current significant stockholder, BioXcel LLC and, its predecessor, BioXcel Corporation. “OnkosXcel” refers to BTI’s wholly owned subsidiary for its advanced immuno-oncology assets, OnkosXcel Therapeutics, LLC.
On April 6, 2022, BTI announced that the United States (“U.S.”) Food and Drug Administration (“FDA”) approved IGALMITM (dexmedetomidine or “Dex”) sublingual film for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder in adults. IGALMITM is approved to be self-administrated by patients under the supervision of a health care provider. On July 6, 2022, BTI announced that IGALMITM, was commercially available in doses of 120 and 180 micrograms.
The Company’s most advanced neuroscience clinical development program is BXCL501. In indications other than those approved by the FDA as IGALMITM, BXCL501 is an investigational proprietary, orally dissolving, film formulation of Dex for the treatment of agitation associated with psychiatric and neurological disorders.
The Company’s most advanced immuno-oncology asset, BXCL701, is an investigational, orally administered systemic innate immune activator for the treatment of a rare form of prostate cancer and advanced solid tumors that are refractory or treatment naïve to checkpoint inhibitors.
BTI was incorporated under the laws of the State of Delaware on March 29, 2017. The Company’s principal office is in New Haven, Connecticut.
Note 2. Basis of Presentation
The accompanying unaudited interim condensed consolidated financial statements do not include all the information and notes required by Generally Accepted Accounting Principles (“GAAP”) in the U.S. The accompanying year-end balance sheet was derived from audited financial statements but does not include all disclosures required by U.S. GAAP. The unaudited interim condensed consolidated financial statements have been prepared on the same basis as the audited annual financial statements and, in the opinion of management, reflect all adjustments, which include only normal recurring adjustments, necessary for the fair statement of the Company’s financial position as of September 30, 2024, the results of its operations for the three and nine months ended September 30, 2024 and 2023 and its cash flows for the nine months ended September 30, 2024 and 2023. The results for the three and nine months ended September 30, 2024 are not necessarily indicative of results to be expected for the year ending December 31, 2024, any other interim periods or any future year or period. The accompanying unaudited interim condensed consolidated financial statements of the Company should be read in conjunction with the audited financial statements and notes
11
thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 filed with the Securities and Exchange Commission on March 22, 2024.
The accompanying condensed consolidated financial statements include the accounts for the Company and all entities where BTI has a controlling financial interest after elimination of all intercompany accounts and transactions and have been prepared in conformity with U.S. GAAP.
As of September 30, 2024, the Company had cash and cash equivalents of $
Under ASC Topic 205-40, Presentation of Financial Statements - Going Concern, management is required at each reporting period to evaluate whether there are conditions and events, considered in the aggregate, that raise substantial doubt about an entity’s ability to continue as a going concern within one year after the date that the financial statements are issued.
The Company’s history of significant losses, its negative cash flows from operations, potential near-term increased covenant-driven payments under its Credit Agreement (as defined in Note 9, Debt and Credit Facilities), its limited liquidity resources currently on hand, and its dependence on its ability to obtain additional financing to fund its operations after the current resources are exhausted, about which there can be no certainty, have resulted in management’s assessment that there is substantial doubt about the Company’s ability to continue as a going concern for a period of at least 12 months from the issuance date of the financial statements included in this Quarterly Report on Form 10-Q.
This going concern evaluation takes into consideration the potential mitigating effect of management’s Reprioritization (as defined in Note 4, Restructuring) and the additional restructuring actions taken in the second and third quarters of 2024. When substantial doubt exists, management evaluates whether the mitigating effect of its plans sufficiently alleviates the substantial doubt about the Company’s ability to continue as a going concern. The mitigating effect of management’s plans, however, is only considered if both (i) it is probable that the plans will be effectively implemented within one year after the date that the financial statements are issued and (ii) it is probable that the plans, when implemented, will mitigate the relevant conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the date that the financial statements are issued. Generally, to be considered probable of being effectively implemented, the plans need to be approved by the Company’s Board of Directors. The Company’s Reprioritization was approved by the Board of Directors on August 8, 2023; however, such plans, including the additional restructuring actions taken in the second and third quarters of 2024, will not mitigate the entity’s ability to continue as a going concern within one year after the date that the financial statements are issued.
The accompanying condensed consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and the satisfaction of liabilities in the normal course of business and does not include any adjustments that may result from the outcome of this uncertainty. The going concern analysis does not consider possible future amendments to or restructuring of the Credit Agreement (as defined in Note 9, Debt and Credit Facilities) or other potential sources of debt or equity capital.
Successful completion of the Company’s development programs and, ultimately, the attainment of profitable operations are dependent upon future events, including obtaining adequate financing to support the Company’s cost structure and operating plan. Management’s plans to improve the Company’s liquidity and reduce its operating expenses and capital requirements include, among other actions, pursuing one or more of the following steps to raise additional capital, none of which can be guaranteed or are entirely within the Company’s control:
● | raise funding through the sale of the Company’s equity securities; |
● | raise funding through third-party investments in or other strategic options for OnkosXcel; |
12
● | raise funding through debt financing and/or restructuring of its existing Credit Agreement; |
● | establish collaborations with potential partners to advance the Company’s product pipeline; |
● | establish collaborations with potential marketing partners; |
● | reduce overhead and headcount to focus on core priorities; and/or |
● | any combination of the foregoing. |
If the Company is unable to raise capital when needed or on acceptable terms, refinance or restructure its existing Credit Agreement or if it is unable to procure collaboration arrangements to advance its programs, the Company would evaluate alternative strategies or initiatives regarding the Company’s future. These options are not limited to but could include plans to discontinue some of its operations or develop and implement a plan, beyond its Reprioritization initiatives, to further extend payables, reduce overhead, scale back or cease some or all of its revised operating plan until sufficient additional capital is raised to support further operations.
Note 3. Summary of Significant Accounting Policies
Use of Estimates
The preparation of financial statements in accordance with U.S. GAAP requires management to make estimates and assumptions that affect amounts reported in the condensed consolidated financial statements and notes thereto. Estimates are used in the following areas, among others: revenue recognition, derivative liabilities, stock-based compensation expense, accrued expenses and income taxes. Although these estimates are based on the Company’s knowledge of current events and actions it may undertake in the future, actual results may ultimately materially differ from these estimates.
Cash and Cash Equivalents
The Company considers all highly liquid investments with an original maturity of three months or less at the date of purchase to be cash equivalents. As of September 30, 2024 and December 31, 2023, cash equivalents were comprised primarily of money market funds. Cash and cash equivalents held at financial institutions may at times exceed federally insured amounts. BTI management believes it mitigates such risk by investing in or through major financial institutions.
Accounts Receivable, Net
Accounts receivable arise from sales of IGALMITM and represent amounts due from distributors and group purchasing organizations (“GPOs”). Payment terms generally range from 30 to 90 days from the date of the sale transaction, and accordingly, do not involve a significant financing component. Receivables from product sales are recorded net of allowances which generally include distribution fees, prompt payment discounts, chargebacks, and credit losses. Allowances for distribution fees, prompt payment discounts and chargebacks are based on contractual terms. The Company estimated the current expected credit losses of its accounts receivable by assessing the risk of loss and available relevant information about collectability, existing contractual payment terms, actual payment patterns of its customers, individual customer circumstances, and reasonable and supportable forecast of economic conditions expected to exist throughout the contractual life of the receivable. Based on its assessment, as of September 30, 2024, the Company determined that an allowance for credit losses was not required.
Concentrations of Credit Risk
The Company sells IGALMITM through a drop-ship program under which orders from hospitals and similar health care institutions are processed through wholesalers, but shipments of the product are sent directly to the individual hospitals and similar health care institutions. BTI also contracts directly with certain hospitals, and GPOs. All trade accounts receivables are due from the distributor that fulfills orders on behalf of the Company and other customers.
13
Inventory
Inventory is stated at the lower of cost or net realizable value. Cost of inventory is determined on a first-in, first-out basis.
BTI capitalizes inventory costs associated with the Company’s products prior to regulatory approval, when, based on management’s judgment, future commercialization is considered probable and the future economic benefit is expected to be realized; otherwise, such costs are expensed as Research and development expense in the Condensed Consolidated Statements of Operations.
The Company performs an assessment of the recoverability of capitalized inventory during each reporting period and writes down any excess and obsolete inventories to their estimated realizable value in the period in which the impairment is first identified. Such impairment charges are recorded within Cost of goods sold in the Condensed Consolidated Statements of Operations. The determination of whether inventory costs will be realizable requires estimates by management. If actual market conditions are less favorable than projected, write-downs of inventory may be required.
Deferred Initial Public Offering Costs
Deferred initial public offering costs of $
Property and Equipment
Property and equipment are recorded at cost and depreciated over the shorter of their remaining lease term or their estimated useful life on a straight-line basis as follows:
Equipment | |
Furniture | |
Leasehold improvements | Lesser of life of improvement or lease term |
Expenditures for maintenance and repairs which do not improve or extend the useful lives of the respective assets are expensed as incurred. When assets are sold or retired, the related cost and accumulated depreciation are removed from their respective accounts and any resulting gain or loss is included within Other (income) expense, net in the Condensed Consolidated Statements of Operations.
Long-lived assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to undiscounted future net cash flows expected to be generated from its use and disposition. Impairment charges are recognized at the amount by which the carrying amount of an asset exceeds the fair value of the asset. Assets to be disposed of are reported at the lower of the carrying amount or the fair value less costs to sell.
Leases
The Company determines if an arrangement is a lease at inception. Operating leases are included in Operating lease right-of-use (“ROU”) assets, Other current liabilities, and the Long-term portion of operating lease liabilities in the Condensed Consolidated Balance Sheets.
ROU assets represent BTI’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Operating lease ROU assets and lease liabilities are recognized at commencement date based on the present value of lease payments over the lease term. The Company uses the implicit rate when readily determinable. As BTI’s leases do not provide an implicit rate, it used an incremental borrowing rate based on the information available at commencement date in determining the present value of lease
14
payments. The operating lease ROU asset also includes any prepaid lease payments made and excludes lease incentives. The Company’s leases may include options to extend the lease; such options are included in determining the lease term when it is reasonably certain that BTI will exercise that option. Lease expense is recognized on a straight-line basis over the lease term.
Debt and Detachable Warrants
Detachable warrants are evaluated for classification as either equity instruments, derivative liabilities, or liabilities depending on the specific terms of the warrant agreement. In circumstances in which debt is issued with equity-classified warrants, the proceeds from the issuance of debt are first allocated to the debt and then the warrants at their estimated fair values. The portion of the proceeds allocated to the warrants are accounted for as paid-in capital and a debt discount. The remaining proceeds, as further reduced by discounts created by the bifurcation of any embedded derivatives, are allocated to the debt. Detachable warrants classified as derivative liabilities are accounted for as indicated under “Derivative Assets and Liabilities” section of this Note and as a debt discount. The Company accounts for debt as liabilities measured at amortized cost and amortizes the resulting debt discount from the allocation of proceeds to interest expense using the effective interest method over the expected term of the debt instrument. The Company considers whether there are any embedded features in debt instruments that require bifurcation and separately accounts for them as derivative financial instruments.
As discussed in Note 9, Debt and Credit Facilities, on April 19, 2022, the Company entered into the Revenue Interest Financing Agreement (the “RIFA”), the terms of which involved significant assumptions and estimates, including future net product sales, in determining interest expense, amortization period of the debt discount, as well as the classification between current and long-term portions. In estimating future net product sales, the Company assessed prevailing market conditions using various external market data against the Company’s anticipated sales and planned commercial activities. Consequently, the Company imputed interest on the carrying value of the debt and records interest expense using an imputed effective interest rate. The Company reassessed the expected payments during each reporting period and accounted for any changes through an adjustment to the effective interest rate on a prospective basis, with a corresponding impact to the classification of the Company’s current and long-term portions of the debt. The RIFA was terminated on December 5, 2023.
Derivative Assets and Liabilities
Derivative assets and liabilities are recorded on the Company`s Condensed Consolidated Balance Sheets at their fair value on the date of issuance and are revalued on each balance sheet date until such instruments are settled or expire, with changes in the fair value between reporting periods recorded as other income or expense within Other (income) expense, net in the Condensed Consolidated Statements of Operations.
The Company does not use derivative instruments for speculative purposes or to hedge exposures to cash flow or market risks. Certain financing facilities entered into by the Company include freestanding financial instruments and/or embedded features that require separate accounting as derivative assets and/or liabilities.
In connection with a registered direct offering completed in March 2024, the Company issued accompanying warrants to purchase
In determining fair value, the Company utilizes valuation techniques that maximize the use of observable inputs and minimize the use of unobservable inputs to the extent possible.
Revenue Recognition
The Company’s revenues consist of product sales of IGALMITM.
BTI recognizes revenue when its customers obtain control of promised goods or services, in an amount that reflects the consideration that the Company expects to receive in exchange for those goods or services. To determine revenue recognition, BTI management performs the following five steps: (i) identify the contract(s) with a customer; (ii)
15
identify the performance obligations in the contract; (iii) determine the transaction price, including variable consideration, if any; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the Company satisfies a performance obligation. Arrangements that include rights to additional goods or services that are exercisable at a customer’s discretion are generally considered options. The Company assesses if these options provide a material right to the customer and if so, they are considered performance obligations. The exercise of a material right may be accounted for as a contract modification or as a continuation of the contract for accounting purposes.
The Company assesses whether the goods or services promised within each contract are distinct to identify those that are performance obligations. This assessment involves subjective determinations and requires management to make judgments about the individual promised goods or services and whether such goods and services are separable from the other aspects of the contractual relationship. Promised goods and services are considered distinct provided that: (i) the customer can benefit from the good or service either on its own or together with other resources that are readily available to the customer and (ii) the Company’s promise to transfer the good or service to the customer is separately identifiable from other promises in the contract.
The Company allocates the transaction price (the amount of consideration it expects to be entitled to from a customer in exchange for the promised goods or services) to each performance obligation and recognizes the associated revenue when (or as) each performance obligation is satisfied. The Company’s estimate of the transaction price for each contract includes all variable consideration to which the Company expects to be entitled.
BTI distributes IGALMITM in the U.S. through arrangements with a distributor, wholesalers, and GPOs. The distributor and wholesalers help process and fulfill orders from hospitals on the Company’s behalf. The Company believes the hospitals are its customers.
The Company recognizes product revenues, net of consideration payable to customers, as well as variable consideration related to certain allowances and accruals that are determined using either the expected value or most likely amount method, depending on the type of the variable consideration, in its condensed consolidated financial statements at the point in time when control transfers to the customer, which is typically when the product has been delivered to the customer’s location. The amount included in the transaction price is constrained to the amount for which it is probable that a significant reversal of cumulative revenue recognized will not occur. The Company’s only performance obligation identified for IGALMITM is to deliver the quantity of product ordered to the location specified by the customer’s order. The Company records shipping and handling costs associated with delivery of product to its customers within Selling, general and administrative expenses on its Condensed Consolidated Statements of Operations. Under the Company’s current product sales arrangements, BTI does not have contract assets (unbilled receivables), as it generally invoices its customer at the time of revenue recognition.
BTI sells IGALMITM at wholesale acquisition cost less any agreed upon discounts, and calculates product revenue net of variable consideration and consideration payable to third parties associated with distribution of product. The Company records reserves, based on contractual terms, for the following components of consideration related to product sold during the reporting period. Calculating these amounts involves estimates and judgments, and the Company reviews these estimates quarterly and records any material adjustments in the period they are identified, which affects net product revenue and earnings in the period such variances occur.
Trade Discounts and Allowances
The Company provides the distributor and wholesalers with discounts for prompt payment and pays fees to the distributor, wholesalers and GPOs related to distribution of the product. BTI expects the relevant third parties to earn these discounts and fees, and therefore it deducts such amounts from gross product revenue and accounts receivable at the time it recognizes the related revenue.
Government Rebates
IGALMITM is eligible for purchase by, or qualifies for reimbursement from, Medicaid and other U.S. government programs that are eligible for rebates on the price they pay for the product. To determine the appropriate amount to
16
對於這些回扣準備金,BTI將適用的政府折扣應用於這些銷售,並估計其預計將獲得的總回扣部分。本公司在確認相關收入時,從生產總值收入和應收賬款中扣除某些政府回扣;其他政府回扣在BTI確認相關收入時確認爲應計負債。
退單
BTI向與某些GPO相關的醫院提供產品折扣。本公司根據適用安排的條款估計其預期有義務提供的退款。BTI在確認相關收入時,從生產總值收入和應收賬款中扣除此類金額。
產品退貨
該公司向其客戶提供合同退貨權利,包括在產品到期後6個月內和產品到期後最多12個月內退貨的權利,以及不正確發貨和損壞或缺陷產品的權利,該公司預計這種情況將很少見。管理層預計產品退貨將是最低限度的,因此BTI在每次銷售時確認產品退貨的名義津貼。未來,如果上述任何因素和/或產品退貨歷史發生變化,本公司將調整產品退貨免稅額。
BTI在其簡明綜合經營報表中將支付給分銷商的所有費用歸類爲銷售費用、一般費用和行政費用,但上文討論的費用和與倉庫運營有關的費用除外。支付給分銷商的倉庫運營費用在BTI的簡明綜合經營報表上被歸類爲銷售貨物成本。
銷貨成本
銷貨成本包括生產和分配存貨的成本,這些存貨與各自期間的產品收入有關。銷售成本還包括與庫存過剩或陳舊有關的成本,以及支付給分銷商的與倉庫業務有關的成本。
基於股票的薪酬
本公司根據向僱員、非僱員服務供應商及董事作出的所有以股份爲基礎的獎勵的估計公允價值,包括股票期權、BTI限制性股票單位(「BTI RSU」)、OnkosXcel利潤分享單位(「PSU」)、OnkosXcel限制性股票單位(「OnkosXcel RSU」)及BTI績效股票單位(「績效單位」),計量及確認股票薪酬支出。公司2017年度股權激勵計劃(《2017年度計劃》)於2017年8月起施行。本公司2020年激勵獎勵計劃(《2020計劃》)於2020年5月起生效。自2020計劃生效日期起,本公司停止根據2017計劃授予獎勵;然而,2017計劃的條款和條件繼續適用於根據2017計劃授予的任何未完成獎勵。
本公司以股票爲基礎的獎勵於授出日按公允價值估值,該公允價值在採用加速歸屬法的必要服務期間的簡明綜合營運報表中確認爲開支。BTI RSU和Performance Units的估計價值是根據公司在授予日的收盤價計算的。OnkosXcel RSU的估計價值是基於授予日的OnkosXcel估值。股票期權和PSU的估計公允價值是在授予之日使用Black-Scholes定價模型確定的。對於受績效歸屬條件約束的獎勵,當績效條件有可能實現時,公司確認基於股票的薪酬支出。
布萊克-斯科爾斯定價模型受到公司股票價格以及有關變量的假設的影響,這些變量包括但不限於工具的執行價格、無風險率、在獎勵期限內的預期股價波動以及預期獎勵期限。該公司已選擇在發生沒收時對其進行覈算,在獎勵被沒收時沖銷補償成本。
17
研發成本
研發費用包括工資、福利、非現金股票薪酬、設施、用品、對外服務、臨牀研究、與臨牀試驗相關的製造成本以及與公司研發活動直接相關的其他費用。在報告期末,公司估計完成研發目標的進度,並根據向服務提供商支付的金額和時間,可能會記錄相關研發成本的預付或應計費用淨額。隨着獲得更多信息,這些估計可能會發生變化。本公司承擔已發生的研究和開發費用。
該公司的大多數服務提供商每月向BTI開發票,支付所提供服務的欠款。本公司根據管理層當時所知的事實和情況,在簡明綜合財務報表中估計截至每個資產負債表日期的應計費用。BTI管理層定期與服務提供商確認公司估計的準確性,並在必要時進行調整。
儘管管理層預計其估計與實際發生的金額不會有實質性差異,但管理層對所執行服務的狀態和時間相對於所執行服務的實際狀態和時間的理解可能會有所不同,並可能導致BTI報告的金額在任何特定時期過高或過低。
專利費用
與提交及進行專利申請有關的成本於簡明綜合經營報表中於銷售、一般及行政開支中入賬,並因該等開支能否收回而作爲已產生的開支入賬。
金融工具的公允價值
本公司按公允價值計量若干金融資產及負債,公允價值定義爲於計量日期在市場參與者之間的有序交易中出售資產所收取的價格或轉移負債所支付的價格。本公司採用公允價值層次結構,區分(1)基於從獨立來源獲得的市場數據開發的市場參與者假設,或可觀察到的投入,以及(2)實體自己對基於當時可獲得的最佳信息開發的市場參與者假設的假設,或不可觀察的投入。公允價值等級由三個大的等級組成,對相同資產或負債的活躍市場的未調整報價給予最高優先權(第1級),對不可觀察到的投入給予最低優先權(第3級)。公允價值計量必須按照下列三種類別之一進行分類和披露:
● | 1級:在資產或負債計量日期可進入的活躍市場的報價(未調整)。公允價值層次結構賦予1級投入最高優先級。 |
● | 2級:截至報告日期,通過與市場數據的關聯直接或間接可觀察到的投入,包括活躍市場中類似資產和負債的報價以及非活躍市場中的報價。第2級亦包括使用不需要重大判斷的模型或其他定價方法進行估值的資產和負債,因爲模型中使用的輸入假設,如利率和波動率因素,得到了來自活躍報價市場的幾乎整個金融工具期限的容易觀察到的數據的證實。 |
● | 3級:無法觀察到的投入,得到很少或沒有市場活動的支持,並反映出使用了重大的管理判斷。這些價值通常是使用定價模型確定的,而定價模型的假設利用了管理層對市場參與者假設的估計。 |
在確定公允價值時,本公司採用估值技術,最大限度地利用可觀察到的投入,最大限度地減少使用不可觀察到的投入,並在評估公允價值時考慮交易對手信用風險。
18
每股收益(虧損)
每股收益(虧損)是用普通股股東應占淨收益或虧損除以已發行普通股的加權平均數來計算的。稀釋每股收益是通過調整普通股等價物稀釋效應下已發行普通股的加權平均數來計算的。在記錄淨虧損的期間,潛在攤薄證券不會受到影響,因爲這種影響將是反攤薄的。
分部資料
該公司在一個單獨的部門運營。經營分部被確認爲企業的組成部分,其獨立的離散財務信息可供首席運營決策者在做出有關資源分配的決策和評估業績時進行評估。到目前爲止,公司首席運營決策者在公司層面做出了以下決策並評估了業績
近期會計公告
最近採用的會計公告
2016年6月,財務會計準則委員會(FASB)發佈了會計準則更新(ASU)第2016-13號,金融工具--信貸損失(主題326):金融工具信貸損失的計量,以及對初始指導意見的後續修訂(統稱爲「主題326」)。主題326要求對所持金融資產的預期信貸損失進行計量和確認。主題326將在2019年12月15日之後開始的報告期內有效,並允許及早採用。2019年11月,FASB發佈了ASU第2019-10號,金融工具-信貸損失(主題326),衍生品和對沖(主題815)和租賃(主題842)-生效日期,將主題326對公司的生效日期推遲到2023財年。本公司於2023年採用主題326,對其簡明綜合財務報表並無重大影響。
未來期間生效的會計聲明
2023年11月,FASB發佈了ASU 2023-07分部報告,要求在年度和中期基礎上披露增量分部信息。該標準在2023年12月15日之後的幾年內有效,2024年12月15日之後的過渡期內有效,並允許及早採用。該公司目前正在評估對其簡明合併財務報表採用這一指導意見的效果。
2023年12月,FASB發佈了ASU 2023-09《所得稅披露的改進》,其中要求披露司法管轄區支付的分類所得稅,加強有效稅率調節中的披露,並修改其他與所得稅相關的披露。這些修正案在2024年12月15日之後的年度期間生效。該公司目前正在評估對其簡明合併財務報表採用這一指導意見的效果。
注4.重組
2023年8月8日,公司董事會通過了一項基礎廣泛的戰略優先順序調整(簡稱「優先順序調整」)。該公司採取行動減少某些不再被視爲持續運營核心的運營和員工支出,以擴大其現金跑道,推動高潛力臨牀開發和價值創造機會的創新和增長。這些行動包括商業戰略的轉變伊加爾米TM
作爲這一戰略的一部分,公司董事會批准了大約
19
截至2023年12月31日年度的終止費用。截至2023年12月31日,重新確定優先順序的工作已基本完成,其餘費用已在2024年第一季度支付。
2024年5月8日,該公司採取了更多行動,作爲其持續努力的一部分,以保存現金並優先投資於其核心臨牀項目。 作爲這些行動的一部分,該公司開始進一步削減約
2024年9月17日,該公司批准了一項進一步裁員的計劃
注:5.庫存
庫存包括以下內容:
| 9月30日, |
| 12月31日, | |||
| 2024 |
| 2023 | |||
原料 | $ | | $ | | ||
在製品 | — | | ||||
成品 | | | ||||
總庫存 | $ | | $ | |
該公司記錄了庫存減記 $
說明6.財產和設備,淨值
財產和設備,淨包括以下內容:
| 9月30日, |
| 12月31日, | |||
| 2024 |
| 2023 | |||
計算機和設備 | $ | | $ | | ||
傢具 | | | ||||
租賃權改進 | | | ||||
財產和設備總計 | $ | | $ | | ||
累計折舊 | ( | ( | ||||
財產和設備總計,淨值 | $ | | $ | |
折舊費用爲美元
20
說明7.應計費用
應計費用包括以下內容:
| 2024年9月30日 |
| 2023年12月31日 | |||
應計研發費用 | $ | | $ | | ||
應計薪酬和福利 | | | ||||
應計專業費用 |
| |
| | ||
應計稅款 | | | ||||
其他應計費用 | | | ||||
應計重組成本 | | — | ||||
應計費用總額 | $ | | $ | |
注:8.與BioXcel LLC的交易
本公司與BioXcel LLC訂立經修訂及重述並於二零一七年六月三十日生效的分離及共享服務協議(「服務協議」),據此,BioXcel LLC同意向本公司提供若干知識產權訴訟及管理及研發活動。
根據服務協議,我們有權與BioXcel LLC籤訂單獨的合作服務協議,可行使至2024年12月31日,根據該協議,BioXcel LLC將利用其EvolverAI爲我們提供產品識別和相關服務。$
在截至2024年9月30日和2023年9月30日的三個月和九個月,根據服務協議記錄的服務費用如下:
截至9月30日的三個月裏, | 截至9月30日的九個月裏, | |||||||||||
2024 | 2023 | 2024 | 2023 | |||||||||
研發 |
| $ | | $ | | $ | | $ | | |||
銷售,一般和行政 |
| | |
| | | ||||||
總計 | $ | | $ | | $ | | $ | |
截至2024年9月30日,已有
21
說明9.債務和信貸便利
扣除未攤銷折扣和融資成本後的債務包括以下內容:
2024年9月30日 |
| 2023年12月31日 | ||||
信貸協議和擔保 | $ | | $ | | ||
實物支付(「PIK」)利息 | | | ||||
長期債務負債總額 | $ | | $ | | ||
未攤銷債務溢價、折扣和發行成本 | ( | ( | ||||
長期債務總額 | $ | | $ | |
於二零二二年四月十九日,本公司訂立兩項策略性融資協議:(I)本公司作爲借款人、本公司若干附屬公司不時以附屬擔保人身分、貸款方(「貸款人」)及橡樹基金管理有限公司(「OFA」)作爲行政代理訂立的信貸協議及擔保(「信貸協議」);及(Ii)由本公司、買方(「買方」)及作爲行政代理的OFA訂立的收入利息融資協議(「RIFA」;連同信貸協議、「信貸協議」及「OFA融資」)。在OFA貸款下,貸款人和買方同意在兩個OFA貸款之間提供總計高達$
對信貸協議和擔保的棄權和第一修正案
於2023年11月13日,本公司、信貸協議的貸款方及OFA訂立一項豁免及信貸協議及擔保第一修正案(「第一修正案」),規定(I)豁免及修訂信貸協議中有關投資OnkosXcel的契約及(Ii)訂約方進一步修訂信貸協議中的主要財務條款及終止RIFA。根據第一修正案,貸款人同意允許該公司最多投資#美元。
《信貸協議和擔保第二修正案》與RIFA的終止
於2023年12月5日(「第二修正案生效日期」),本公司訂立了「信貸協議第二修正案及擔保及終止收入利息融資協議」(「第二修正案」),進一步修訂了信貸協議。在第二修正案生效之日,對信貸協議進行了修訂,以提供最多$
22
從公司來的。截至2024年9月30日,A-1和A-2部分的混合實際利率約爲
剩餘的部分可以在2024年12月31日之前由公司選擇借款,條件是滿足某些條件,包括監管和財務里程碑。信貸協議的b部分爲#美元。
信貸協議下的貸款不會在2027年4月19日攤銷和到期。公司可在不早於2026年9月21日和不遲於2026年10月21日的情況下要求將到期日延長至2028年4月19日,前提是公司滿足某些條件,包括收到某些監管和財務里程碑。信貸協議項下的借款以
除若干例外情況外,本公司在信貸協議下的責任由BTI現有及其後收購或組織的附屬公司擔保。BTI在信貸協議項下的責任及相關擔保以(I)本公司所有現有及任何未來直接附屬公司的所有股權作質押,及(Ii)本公司及擔保人的所有有形及無形資產的完善擔保權益(但BXCL701附屬公司提供的擔保(定義見下文)爲無抵押擔保除外)作爲擔保,但須受慣常准許留置權及其他經議定的例外情況所規限。
信貸協議載有慣常的陳述和保證,以及慣常的肯定和否定契約,其中除其他事項外,包括對債務、留置權、投資、合併、處置、預付其他債務、股息和其他分配的限制,但某些例外情況除外,包括關於產品商業化和開發活動的特殊例外。本公司還必須遵守某些金融契約,包括(I)爲貸款人在OFA控制的賬戶中維持現金或允許的現金等價物投資,至少(A)最初,$
23
在此期間,上述款項不得少於1,000元。如獲付款,本公司將於該收入契約計量測試日期被視爲已遵守收入契約。任何此類付款將用於預付信貸協議項下的貸款。
儘管有上述規定,信貸協議允許OnkosXcel(連同BTI的附屬公司OnkosXcel Employee Holdings,LLC(「Employee Holdings」)及其各自的附屬公司「BXCL701附屬公司」)接受第三方投資或將其全部或幾乎全部資產轉讓給獨立第三方,在任何情況下均須受信貸協議所載條款及條件的規限,包括託管BTI及其附屬公司(BXCL701附屬公司除外)就該等處置事件而收取的若干收益,並在信貸協議所載情況下強制預付該等託管金額。本公司於BXCL701附屬公司的股權已被質押,以支持其在信貸協議下的責任,而BXCL701附屬公司已在無抵押的基礎上爲BTI在信貸協議下的責任提供直接擔保。然而,BXCL701附屬公司在信貸協議下的質押、擔保及其他義務將在某些商定的事件中解除,包括BXCL701子公司的首次公開募股或由非關聯第三方擁有至少
信貸協議載有此類融資慣常發生的違約事件,這些事件涉及(其中包括)付款違約、違反契諾、違反陳述和擔保、重大債務的交叉違約、與破產相關的違約、判決違約、違反上述財務契諾以及發生某些控制權變更事件。在某些情況下,違約事件會受到慣常的治癒期的約束。信貸協議還包含某些與監管相關的違約事件,這些事件沒有治癒期限。在發生違約事件和任何適用的補救期間後,貸款人將有權在接到通知後終止任何未提取的承諾,並可加速信貸協議項下的所有未償還金額,以及作爲本公司的有擔保債權人可獲得的其他補救措施。
《信貸協議與擔保》的棄權及第三和第四修正案
2024年2月12日,本公司簽訂了《信貸協議與擔保第三修正案》(以下簡稱《第三修正案》),對信貸協議進行了修訂。根據第三修正案,貸款人同意放棄本公司不會收到本公司獨立核數師就本公司截至2023年12月31日的財政年度的財務報表包含「持續經營」或類似的限制、例外或持續經營事項註腳的報告和意見的約定,因此,該事件不應成爲違約事件。作爲第三修正案生效的條件,除其他事項外,公司應至少收到$
於2024年3月20日(「生效日期」),本公司訂立「信貸協議及擔保第四修正案」(「第四修正案」),修訂信貸協議。根據第四修正案,貸款人同意放棄本公司不得從本公司的獨立註冊會計師事務所收到關於本公司截至2023年12月31日的年度財務報表的報告和意見的契約,該報告和意見包含「持續經營」或類似的限制條件。因此,雖然本公司獨立註冊會計師事務所於截至2023年12月31日止財政年度的Form 10-k年度報告中載有一段「持續經營」說明段落,但根據信貸協議,該報告並不構成違約事件。
第四修正案包括公司將獲得的一項契約,(I)在生效日期之後,2024年4月15日或之前,至少
24
價值,由行政代理(定義見信貸協議)在生效日期後訂立的合作交易中自行厘定。爲免生疑問,未能履行上一句第(Ii)款將構成信貸協議下的即時違約事件,沒有任何補救措施或寬限期。
此外,第四修正案規定,如果公司在生效日期之後、2024年9月30日或之前沒有收到至少$
收入利息融資協議
如上所述,RIFA在公司簽訂第二修正案時終止,該修正案修訂了信貸協議(經第一修正案修訂)。這一美元
根據RIFA的條款,購買者將獲得IGALMI™和其他未來的BXCL501產品在美國的淨銷售額的分級收入利息支付,如果有的話,這些產品獲得監管部門的批准銷售,相當於以下範圍的特許權使用費
權證與股權投資權
關於第二修正案的結束,於第二修正案生效日,本公司修訂及重述於2022年4月19日授予貸款人的認股權證,以購買最多
25
修改生效日期,只要信貸協議下的借款尚未償還,購買價爲#美元
作爲信貸協議的一部分,BTI的全資子公司OnkosXcel向貸款人授權證以購買
關於下文討論的第四修正案的結束,公司向貸款人授予新的認股權證,以購買最多
債務的到期日,不包括根據《收入公約》規定的任何強制性付款的影響或達到最低特許權使用費水平,預計如下:
2024年9月30日 |
| |||
2024 | $ | — | ||
2025 | $ | — | ||
2026 | $ | — | ||
2027 | $ | | ||
2028 | $ | — | ||
此後 | $ | — |
26
利息費用如下:
截至三個月 | 止九個月 | ||||||||||
9月30日, | 9月30日, | ||||||||||
2024 | 2023 | 2024 | 2023 | ||||||||
利息開支 | $ | | $ | | $ | | $ | | |||
債務貼現和融資成本攤銷的增加 | | |
| | | ||||||
利息支出總額 | $ | | $ | | $ | | $ | |
BTI確定了某些獨立的金融工具和/或嵌入式特徵,這些工具和/或嵌入特徵需要與OFA貸款下的借款分開覈算。這包括貸款人持有的OnkosXcel認股權證和股權投資權,以及某些看跌/看漲期權。OnkosXcel認股權證和股權投資權不符合美國公認會計原則下的某些範圍例外,主要是因爲根據該工具可發行的公司普通股的行使價和股份數量是可變的,並且該工具符合衍生工具的定義。因此,這些工具在簡明綜合資產負債表中作爲衍生負債入賬。各衍生負債於發行當日按公允價值記錄,並於每個資產負債表日重估,直至該等工具結清或到期爲止,公允價值在報告期之間的變動記入其他(收益)開支內,淨額計入本公司的綜合經營簡表。
關於附註11所述的證券購買協議,普通股融資活動根據ASC 480將負債與權益(「ASC 480」)及ASC 815衍生工具及對沖(「ASC 815」)區分開來,BTI認定所附認股權證不符合權益分類標準,因此被分類爲負債。隨附的認股權證未能滿足按權益和權益分類編制索引的要求,並符合衍生工具的定義。因此,這些工具在截至2024年9月30日的簡明綜合資產負債表中作爲衍生負債入賬。有關衍生負債於發行當日按公允價值入賬,金額爲#美元。
附註11.普通股融資活動
一個與Jefferies LLC(「Jefferies」)訂立的公開市場出售協議(經不時修訂、補充及/或重述,「出售協議」),根據該協議,本公司可發售及出售其普通股股份,總髮行價最高可達$
於2024年3月25日,公司與其中指定的買家(統稱「買家」)簽訂了證券購買協議(「購買協議」)。根據購買協議,公司同意根據表格S-3(文件號333-275261)的有效貨架登記聲明和向證券提交的相關招股說明書補充,以登記直接發行(「發行」)的方式向買家發行和出售
27
香港證券及期貨事務監察委員會於2024年3月25日發出的(《招股章程補編》)
預籌資權證的普通股每股行權價相當於美元。
隨附的認股權證每股普通股的行使價相當於$。
注:12.基於股票的薪酬
2017股權激勵計劃
公司2017年計劃於2017年8月生效。自本公司2020年度計劃生效日期起,本公司停止根據2017年度計劃授予獎勵,但2017年度計劃的條款及條件繼續適用於根據2017年度計劃授予的任何未完成獎勵。
2020年激勵獎勵計劃
公司2020年計劃於2020年5月20日在公司2020年年度股東大會上獲得批准並生效,除非董事會提前終止,否則計劃將一直有效到2030年3月26日。原授權發佈的2020年計劃的金額爲(I)
28
由董事會確定。2020年計劃下可發行股份增加了
根據2020年計劃授予的股票期權的期限爲
截至2024年9月30日,已有
BTI限制性股票單位
下表總結了與BTI RSU相關的活動。
數量 | ||
| 股份 | |
截至2024年1月1日未完成 |
| |
授予 | | |
取消 | ( | |
既得 | ( | |
截至2024年9月30日未完成 | |
截至2024年9月30日的三個月內,公司授予
BTI業績股票單位
下表彙總了與BTI普通股相關的績效單位相關活動。
數量 | ||
| 股份 | |
截至2024年1月1日未完成 |
| |
授予 | | |
取消 | ( | |
截至2024年9月30日未完成 | |
2024年7月,公司授予
2023年10月,公司授予
29
OnkosXcel利潤分享單位
下表總結了與OnkosXcel相關的NSO相關的活動,如下所述。
加權平均 | |||||
數量 | 單價 | ||||
| 單位 | (in整美元) | |||
截至2024年1月1日未完成 |
| | $ | | |
授予 | | $ | | ||
取消 | ( | $ | | ||
沒收 | — | $ | — | ||
截至2024年9月30日未完成 | | ||||
截至2024年9月30日的既得單位 | | $ | |
在2024年間,OnkosXcel Employee Holdings,LLC,一家用於促進向OnkosXcel服務提供商授予股權的管理控股公司
2023年,OnkosXcel Employee Holdings,LLC
2024年期間授予的PSU的公允價值是在授予之日使用Black-Scholes期權定價模型和以下假設估計的。
2024年授予利潤份額單位估值輸入 | ||||
預期波幅 | | % | ||
無風險利率 | | % | ||
預期股息率 | | % | ||
預期期限 | 年份 |
與這些獎勵相關的未確認股票補償費用爲美元
30
OnkosXcel限制性股票單位
下表總結了與OnkosXcel RSU相關的活動。
數量 | ||
| 單位 | |
截至2024年1月1日未完成 |
| |
授予 | — | |
既得 | ( | |
取消 | ( | |
截至2024年9月30日未完成 | | |
於截至2023年12月31日止年度內,本公司授予
BTI股票期權
下文列出了截至2024年9月30日的九個月內公司股票期權活動摘要。
數量 | 加權平均 | |||||
| 股份 |
| 每股價格 |
| ||
截至2024年1月1日未完成 |
| | $ | | ||
授予 | | $ | | |||
沒收 | ( | $ | | |||
取消 | ( | $ | | |||
行使 | — | $ | — | |||
截至2024年9月30日未完成 | | $ | | |||
截至2024年9月30日已授予和可行使的期權 |
| | $ | |
截至2024年9月30日,未償還期權的內在價值爲
截至2024年9月30日歸屬的加權平均授出日每股購股權公允價值爲$
加權平均剩餘合約期爲
31
截至2024年9月30日,與未歸屬BTI股票期權獎勵相關的未確認補償費用爲美元
基於股票的薪酬
截至2024年9月30日和2023年9月30日止九個月期間授予的BTI股票期權的公允價值是使用Black-Scholes定價模型進行估計的,假設如下:
止九個月 | 止九個月 | ||||||||||||
| 2024年9月30日 | 2023年9月30日 | |||||||||||
預期期限 | 年份 | - | 年份 | 年份 | - | 年份 | |||||||
預期股價波幅 | % | - | % | % | - | % | |||||||
無風險利率 | % | - | % | % | - | % | |||||||
預期股息率 | % | - | % | % | - | % |
2023年,公司開始使用普通股的歷史波動率來估計波動率。在2023年之前,波動性是結合上市同行公司的歷史波動性和本公司普通股的歷史波動性來估計的。預計授權期是根據簡化方法估算的,簡化法根據授權期和授權期的中點計算預期期限。本公司使用簡化方法是因爲其沒有足夠的期權行使數據來提供合理的基礎來估計預期期限。預期股息收益率爲
公司確認了與根據2017年計劃和2020年計劃發放的獎勵以及OnkosXcel RSU和PSU有關的基於股票的薪酬支出#美元
截至9月30日的三個月裏, | 截至9月30日的九個月裏, | |||||||||||
2024 | 2023 | 2024 | 2023 | |||||||||
研發 |
| $ | | $ | | $ | | $ | | |||
銷售,一般和行政 |
| | |
| | | ||||||
總計 | $ | | $ | | $ | | $ | |
2020年員工購股計劃
公司2020年度員工購股計劃(「ESPP」)也已通過,並於2020年5月20日在公司2020年度股東大會上生效。ESPP旨在幫助符合條件的公司員工有機會在連續的發售期間通過累計工資扣減以折扣價購買公司普通股。根據ESPP授予的權利最初可供發行的股份總數爲
32
根據《國稅法》第423條(「第423條構成部分」)不得超過
注13.租約
該公司擁有一家
該公司還租賃複印機和信息技術設備等設備。
截至2024年9月30日,經營租賃項下未來的最低年度租賃付款如下:
截至十二月三十一日止的年度: |
| 量 | |
2024年剩餘時間 | $ | | |
2025 | | ||
2026 | | ||
2027 | — | ||
2028 | — | ||
此後 | — | ||
租賃付款總額 | $ | | |
估算利息 | ( | ||
租賃負債總額 | $ | | |
減租賃負債的流動部分 | ( | ||
經營租賃負債的長期部分 | $ | |
公司經營租賃負債的當前部分爲美元
租賃費用爲美元
租賃續訂選項不包括在ROU資產或租賃負債中。
附註14.公允價值計量
本公司根據用於確定公允價值的投入和假設的性質,將其按公允價值計量的資產和負債分爲三個水平。請參閱注3,重要會計政策摘要,了解與公允價值相關的會計政策的更多信息。
由於這些工具的短期性質,現金和現金等價物、應收賬款、淨額和應付賬款的賬面價值接近公允價值。截至2024年9月30日和2023年12月31日,該公司擁有
33
按經常性公平價值計量的衍生負債概述如下。
止九個月 | |||||||||||||||
2024年9月30日 | |||||||||||||||
公平值 | 1級 | 2級 | 3級 | 總 | |||||||||||
衍生負債-股權投資權 | $ | | $ | — | $ | — | $ | | $ | | |||||
衍生負債- OnkosXcel令狀 | | — | — | | | ||||||||||
衍生負債- BTI憑證 | | | — | | |||||||||||
衍生負債總額 | $ | | $ | — | $ | | $ | | $ | |
衍生負債包括OnkosXcel憑證、貸方持有的股權投資權和BTI憑證。衍生負債的公允價值是使用股權投資權的蒙特卡羅模擬模型、OnkosXcel令的二項期權定價和分配模型以及BTI令的Black Scholes模型確定的。
下表列出了截至2024年9月30日止九個月按公允價值計量的第三級負債的變化。可觀察和不可觀察輸入數據均用於確定公司已分類爲第三級類別的頭寸的公允價值。
止九個月 | ||||||
9月30日, | ||||||
2024 | 2023 | |||||
衍生負債,餘額-1月1日 | $ | | $ | | ||
( | ( | |||||
衍生負債,餘額-9月30日 | $ | | $ | |
截至2024年9月30日的三個月和九個月,衍生負債的公允價值變化在簡明綜合經營報表中報告爲其他(收入)費用淨額。
用於計算2024年9月30日股權投資權估計公允價值的輸入如下:
股權投資權 | |||
執行價格相對於成交量加權30日平均值 | | % | |
波動性(年度) | | % | |
鍛鍊的可能性 | | % | |
時間段 | | 年份 | |
估計比30天平均值的溢價 | | % | |
貼現率 | | % |
在估計與OnkosXcel令狀相關的衍生負債的公允價值時,輸入數據包括OnkosXcel有限責任公司單位的第三方公允價值估計以及這些單位的波動性(設定爲
截至2024年9月30日和2023年12月31日,信貸協議的估計公允價值爲美元
2024年配股的公允價值是非經常性公允價值,於發行日期使用布萊克-斯科爾斯定價模型和美元的公允價值確定。
34
根據信貸協議提供資金的金額。這種非經常性衡量被歸類爲第二級。所使用的投入是執行價格#美元。
2023年權證的公允價值爲非經常性公允價值,於發行日期按Black-Scholes定價模型及公允價值#美元厘定。
原始認股權證的公允價值爲非經常性公允價值,於發行日期按Black-Scholes定價模型及公允價值#美元厘定。
所附認股權證於2024年3月25日發行時的公允價值按Black-Scholes定價模型厘定,公允價值爲
說明15.每股淨虧損
每股基本及稀釋淨虧損如下:
截至三個月 | 止九個月 | |||||||||||
| 9月30日, | 9月30日, | ||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
淨損失(分子) | $ | ( | $ | ( | $ | ( | $ | ( | ||||
加權平均股數(分母) | | | | | ||||||||
每股基本和稀釋淨虧損 | $ | ( | $ | ( | $ | ( | $ | ( |
的
潛在稀釋性的未發行證券包括股票期權、RSU、績效單位和BTI配股。截至2024年9月30日和2023年9月30日,該公司擁有已發行的普通股等值股票
35
附註:16.承付款和或有事項
在正常業務過程中,公司可能會不時受到訴訟和監管審查,以及收集信息的要求、詢問和/或調查。除下列事項外,本公司目前並不涉及其認爲有合理可能發生重大損失的任何事項。
2023年7月7日,原告凱特琳·馬丁在美國康涅狄格州地區法院對該公司和某些高管提起集體訴訟,標題如下馬丁訴BioXcel治療公司等人案。,3:23-cv-00915(D.Conn)。2023年10月4日,根據《私人證券訴訟改革法》,法院任命了兩名共同牽頭原告。共同牽頭原告於2023年12月5日提交了經修訂的起訴書,指控違反了1934年證券交易法(以下簡稱交易法)第10(B)和20A條及其下頒佈的美國證券交易委員會第100億.5條。2024年7月11日,法院在沒有偏見的情況下駁回了修改後的起訴書,並於2024年8月1日,共同主導原告提交了第二份修改後的起訴書。修改後的第二份起訴書稱,被告就寧靜II試驗和BXCL501的開發做出了虛假或誤導性的陳述,以擴大與治療某些阿爾茨海默氏症相關焦慮症的適應症。該公司於2024年9月6日採取行動,駁回了第二次修訂後的申訴。法院尚未對這項動議做出裁決。
2023年11月28日,原告Pratheesan Panancerry和Jeffrey Bastress向美國康涅狄格州地區法院提起股東派生訴訟,據稱代表公司並根據標題將Vimal Mehta、Richard I.Steinhart、Peter Mueller、JunBray、SanDeep Laumas、Michael Miller、Michal Votruba和Krishnan Nandabalan作爲被告,將公司視爲名義上的被告Panancerry等人訴Mehta等人案,3:23-cv-1554。在最初的訴訟之後,原告Maria Vomvolakis(3:24-cv-3)和Kelly Fowler(3:24-cv-203)分別在康涅狄格州地區提出了股東衍生品投訴,提出了與Panangerry和Bastress類似的索賠,包括商業侵權和違反1934年證券交易法。這些案件已合併到標題下在Re BioXcel治療公司股東派生訴訟中,3:23-cv-1554(D.Conn.)合併行動目前被擱置。
2024年1月11日,原告Jeremy Smith向美國特拉華州地區法院提起股東派生訴訟,據稱代表公司,根據標題,將Vimal Mehta、Peter Mueller、JunBray、SanDeep Laumas、Michael Miller、Michal Votruba、Richard I.Steinhart、Robert Risinger和Krishnan Nandabalan作爲被告,並將公司列爲名義被告Smith訴Mehta等人案,1:24-cv-00041。在最初的訴訟之後,原告Janice Korff在特拉華州地區提出了一項股東派生訴訟,提出了與Smith(1:24-cv-130)類似的索賠,包括商業侵權和違反1934年《證券交易法》。這些案件已合併到標題下在Re BioXcel治療公司衍生訴訟中,1:24-cv-00041(D Del.)合併行動目前被擱置。
目前,本公司不認爲上述事項中的索賠具有可取之處,並打算積極抗辯;然而,與此訴訟相關的潛在費用和責任尚不確定。
2022年4月,本公司簽署了一項商業供應協議,要求協議前三年的最低年度付款總額爲$
36
第二項:管理層對財務狀況和經營成果的討論和分析
閣下應閱讀以下有關本公司財務狀況及經營業績的討論及分析,以及本報告其他部分所載未經審計的中期簡明綜合財務報表及相關附註,以及本公司截至2023年12月31日止年度的Form 10-k年報所載經審核財務報表及相關附註。除歷史信息外,本討論和分析還包含涉及風險、不確定性和假設的前瞻性陳述。我們的實際結果可能與下文和前瞻性陳述中討論的結果大不相同。可能導致或促成這些差異的因素包括但不限於本管理層《關於財務狀況和經營成果的討論和分析》中討論的因素,列在「綜合風險因素」下的因素,以及第二部分第1A項中「風險因素」一節中討論的因素。這份報告的。除非另有說明或上下文另有規定,以下管理層對財務狀況和經營結果的討論和分析中的所有美元金額均以美元表示,所有美元和股票金額均以千爲單位表示。
概述
我們專注於利用尖端技術和創新研究開發旨在改變患者生活的高價值療法。我們使用各種人工智能平台來降低治療開發成本,並有可能加快開發時間表。我們的方法利用現有的批准藥物和/或臨牀評估的候選產品,以及大數據和專有機器學習算法來識別新的治療適應症。我們相信,這種差異化的方法有可能減少與藥物開發相關的費用和時間,用於治療有大量未得到滿足的醫療需求的疾病。
納斯達克通知
2024年09月16日,本公司收到納斯達克股票市場有限責任公司(以下簡稱「納斯達克」)的函,通知本公司在過去30個工作日內,本公司普通股的買入價(每股面值0.001美元)已收於低於「納斯達克上市規則」第5550(A)(2)條規定的繼續在納斯達克資本市場上市的每股最低買入價要求(以下簡稱「買入價公告」)。投標價格公告對該公司普通股的上市沒有立即影響,該公司普通股繼續在納斯達克資本市場交易,代碼爲「BTAI」。
根據納斯達克上市規則第5810(C)(3)(A)條,本公司有180個歷日或至2025年3月17日(「投標價格遵從日」)恢復合規。爲了重新遵守納斯達克最低投標價格要求,公司普通股的收盤投標價格必須在投標價格遵守日期之前至少連續10個工作日內至少爲每股1.00美元。本公司打算監控其普通股的投標價格,並在其普通股的交易價格沒有達到可能導致本公司在投標價格遵從日之前重新遵守納斯達克最低投標價格規則的水平時,考慮可用的選擇。
如果公司未能在投標價格遵從日之前重新遵守納斯達克的最低投標價格要求,公司可能有資格再獲得180個歷日的遵從期。要符合資格,本公司須符合公開持有股份市值的持續上市要求及納斯達克資本市場的所有其他初始上市標準(投標價格要求除外),並需要在第二個合規期內提供書面通知,表明其擬在第二個合規期內彌補不足之處,例如在必要時進行股票反向拆分。然而,如果納斯達克的員工認爲納斯達克無法彌補這一不足,或者如果本公司在其他方面不符合資格,納斯達克將通知本公司其證券將被除牌。接到通知後,本公司可以對納斯達克員工退市的決定提出上訴。不能保證本公司將有資格獲得額外的180個歷日合規期(如果適用),也不能保證納斯達克員工會在發出退市通知後批准本公司繼續上市的請求。
37
此外,本公司於2024年9月20日收到納斯達克的函件通知本公司,於函件日期前的最後30個工作日,本公司的上市證券最低市值低於根據納斯達克上市規則第5550(B)(2)條(「納斯達克上市規則」)繼續在納斯達克資本市場上市所需的最低3,500美元市值(以下簡稱「市值公告」)。
根據納斯達克上市規則第5810(C)(3)(C)條,本公司有180個歷日,即至2025年3月19日(「市值符合日」),以恢復合規。爲了重新符合上市證券的最低市值要求,公司普通股的市值必須在截至遵守市值之日的180天寬限期內連續10個工作日達到或超過3,500美元萬。如果公司未能在市值合規之日之前重新遵守納斯達克的上市證券最低市值要求,公司將收到其證券被退市的書面通知,屆時公司可以對退市決定提出上訴。
本公司目前正在評估各種替代行動方案,然而,不能保證本公司將成功重新遵守納斯達克繼續上市的要求,或保持其普通股在納斯達克資本市場的上市。
我們的業務
我們最先進的神經科學候選者是BXCL501。非經美國批准的適應症(「美國」)作爲IGALMI™,BXCL501是一種正在開發中的右美託咪啶(或「地塞米松」)的研究、專利和口腔溶解膜劑,用於治療與精神和神經疾病相關的躁動。我們最先進的免疫腫瘤學資產BXCL701是OnkosXcel Treeutics正在開發的一種研究用口服天然免疫激活劑,用於治療侵襲性前列腺癌、胰腺癌和其他固體和液體腫瘤。
2022年4月6日,我們宣佈FDA批准了IGALMITM用於急性治療與成人精神分裂症或雙相情感障礙相關的激動症的舌下膜。伊加爾米TM被批准由患者在醫療保健提供者的監督下自我管理。2022年7月6日,我們宣佈IGALMITM在商業上有120和180微克(「微克」)的劑量。
我們正在繼續開發BXCL501,用於在家庭環境中潛在地急性治療與雙相情感障礙或精神分裂症相關的躁動,以及潛在地在護理和家庭環境中急性治療與可能患有阿爾茨海默病的癡呆症相關的躁動(非日常)。正如下面進一步描述的,我們最近已經取消了BXCL501的某些適應症的開發,包括將BXCL501作爲一種潛在的重度抑鬱症(MDD)輔助治療的開發,以及我們的BXCL701計劃,除非在下面的「免疫腫瘤學」中註明。
2024年9月5日,我們宣佈開始患者入組SERENITY在家試驗。請參閱進一步討論 「我們的神經科學臨牀項目」下面。
2024年9月5日,我們向FDA提交了TRANQUALY In-Care III期試驗的擬議方案,旨在評估60微克劑量的BXCL 501治療阿爾茨海默氏癡呆相關激浪的有效性和安全性。請參閱進一步討論 「我們的神經科學臨牀項目」下面。
2024年10月15日,我們宣佈美國國防部向北卡羅來納大學撥款,資助BXCL 501(舌下右美託咪定)治療急性應激障礙(ASD)的研究。請參閱進一步討論 「額外的神經科學機會」下面。
38
重新確定戰略優先順序
2023年8月8日,我們的董事會批准了一項基礎廣泛的戰略優先順序調整(Reequence Reequence)。我們決心採取行動,減少某些不再被視爲持續運營核心的運營和員工支出,以擴大我們的現金跑道,推動高潛力臨牀開發和價值創造機會的創新和增長。作爲這一戰略的一部分,我們的董事會批准了裁員約60%。預計年化運營費用將減少約8萬美元。截至2023年12月31日,重新確定優先順序的工作基本完成。
由於重新調整了優先順序,公司在截至2023年12月31日的一年中記錄了4,163美元的重組成本。這些費用包括4063美元的遣散費和福利費用以及100美元的合同終止費用。在截至2023年12月31日的一年中,該公司支付了3998美元的遣散費和福利費用以及100美元的合同終止費用。所有剩餘的24美元費用都在2024年第一季度支付。
如注4所述,重組,2024年5月8日,該公司採取了更多行動,作爲其持續努力的一部分,以保存現金並優先投資於其核心臨牀項目。作爲這些行動的一部分,該公司開始進一步裁員約15%的公司當時的現有員工。該公司於2024年5月8日通知了受影響的員工,並記錄了截至2024年6月30日的三個月的總重組成本爲856美元。這些費用包括遣散費和福利費用,所有這些費用都在截至2024年6月30日的三個月期間支付。
臨牀優先順序
如附註4,重組中所述,2024年9月17日,公司批准了一項額外裁員15人的計劃(包括除一名營銷和銷售人員外的所有員工),約佔公司員工總數的28%(「臨牀優先順序」),以擴大其現金跑道,並優先投資於其領先的神經科學資產BXCL501的臨牀開發。該公司估計,與臨牀優先排序有關的總費用約爲1,553美元,主要涉及遣散費和福利費用。因此,公司在2024年第三季度記錄了1,553美元的重組費用,這筆費用包括在2024年9月30日的合併綜合餘額的應計費用中。該公司於2024年10月完成臨牀優先順序,預計在2024年第四季度和2025年第一季度支付相關費用。
伊加爾米TM修訂後的商業化戰略
TM商業團隊將重點轉移到醫院/綜合交付網絡與企業賬戶董事團隊的合同戰略上。調整後的CAD團隊的目標是與大型IDN合作,並利用自上而下的方法推動銷售。隨着時間的推移,預計修訂後的商業努力將使公司能夠繼續以更具成本效益的方式進軍機構市場。IGALMI的商業努力TM在截至2023年12月31日的6個月中,由於人員減少(包括裁撤銷售、營銷和商業運營人員),發佈受到了重大影響。臨牀優先順序裁員可能會對未來的淨收入產生影響。
截至2024年9月30日的9個月,淨收入爲1900美元,比2023年同期的1004美元增長了89%。新客戶的增加和銷售活動的增加反映了使用率的上升,而醫院和IDN似乎正在接受2024年1月實施的永久J-Code,下文將對此進行討論。在截至2024年9月30日的三個月裏,通過傳統銷售和基於數量的合同,CAD團隊創造了214美元的淨收入,低於截至2024年6月30日的三個月的1104美元和582美元。2024年第三季度淨收入的下降
39
2023年10月30日,我們宣佈聯邦醫療保險和醫療補助服務中心(CMS)爲IGALMI分配了新的J代碼TM(J1105),於2024年1月1日生效。J代碼是醫療保健提供者、商業保險計劃和政府付款人用來幫助標準化報銷流程的永久代碼。與使用雜項或未列出的代碼相比,J代碼可以幫助簡化索賠提交,這反過來又可以簡化賬單和報銷流程。IGALMI的J代碼TM已在CMS HCPCS應用摘要和編碼建議中在線發佈,2023年第三季度HCPCS編碼週期。我們相信,這一J代碼將有助於擴大對IGALMI的訪問TM適用於與雙相情感障礙或精神分裂症相關的躁動患者。
如果IGALMITM如果在美國境外獲得批准,我們將考慮通過與第三方合作推出該產品。
我們繼續爲IGALMI進行商業化的努力TM旨在爲推出其他潛在的後續適應症奠定基礎,如果有的話,爲我們的神經科學業務鋪平道路。
我們的神經科學臨牀項目
以下是截至本季度報告10-Q表格的日期,我們的主要神經科學臨牀開發項目的狀況摘要。我們還放慢了我們的主要候選BXCL501產品的臨牀開發進程,如下所述,我們的主要BXCL501臨牀項目的進展取決於適用的資金。
BXCL 501開發
除FDA批准的IGALMI以外的適應症TM、BXCL 501仍然是Dex的一種研究性、專有的口服溶解膜製劑,Dex是一種選擇性阿爾法2受體激動劑,針對的是與壓力相關的行爲(例如激越)的症狀。BXCL 501是我們最先進的神經科學臨牀項目,正在評估與雙相情感障礙或精神分裂症相關的激越的家庭急性治療以及急性
40
作爲一種具有舌下或口腔給藥途徑的選擇性腎上腺素能藥物,BXCL501設計爲易於給藥,與可能需要幾天或幾周的藥物相比,在包括研究雙相情感障礙、精神分裂症和阿爾茨海默病患者的多個臨牀試驗中顯示出相對較快的起效。我們認爲,這些研究的結果表明,BXCL501具有在不產生過度鎮靜的情況下減少焦慮的潛力。我們還認爲,BXCL501與抗精神病藥物有很大的區別,後者目前被用作一線護理標準治療,儘管經常產生有害的副作用,如過度鎮靜或額外的錐體運動效應。在神經精神疾病和神經退行性疾病中管理患者的焦慮對醫生和照顧者來說是一個巨大的挑戰。我們相信BXCL501有潛力解決這些挑戰,同時爲患者提供有效的治療方案。
我們還認爲,如果BXCL501被批准用於各自的適應症,有可能成爲精神分裂症、雙相情感障礙和阿爾茨海默病等疾病引起的激越的急性治療的護理標準。
此外,考慮到BXCL501的差異化設計及其潛在的作用機制,我們相信BXCL501有潛力治療幾種以激動爲症狀或潛在疾病的疾病或狀況,包括阿片類藥物戒斷、急性應激障礙(ASD)和創傷後應激障礙(PTSD),這些正在由第三方進行臨牀試驗評估。
BXCL501臨牀試驗
寧靜計劃:與I型和II型雙相情感障礙及精神分裂症相關的情緒激動(居家環境)
我們在寧靜III中啓動了BXCL501治療躁動伴雙相情感障礙或精神分裂症患者的臨牀研究,包括兩部分。第一部分與我們的關鍵的寧靜I和II研究相當。在控制良好的住院環境下,採用類似的納入和排除標準,急性激越的精神分裂症或雙相情感障礙患者在雙盲安慰劑對照試驗中隨機接受60微克的BXCL501或安慰劑。第一部分的主要終點是療效,通過服藥後兩小時PEC評分與基線的變化來衡量。第一部分的次要目標是安全性和耐受性。
2023年5月25日,我們報告了研究第一部分的TOPLINE結果。儘管該試驗沒有達到其主要療效終點,但我們認爲,在60微克劑量下觀察到的療效結果,相當於IGALMI批准的最低劑量的一半TM對於住院患者使用(120微克),是有希望的。具體地說,超過50%的人是應答者,定義爲那些PEC得分下降40%或更多的患者。此外,這一人群應答率與在更大的寧靜I和II試驗中觀察到的相同應答率是一致的,並且與劑量成比例。儘管主要療效終點在2小時時與基線相比的PEC評分在2小時內的平均變化在主要終點上沒有統計學意義(p=0.077),但BXCL501在4小時時從統計學上與安慰劑分開(p=0.049)。
Serenity III研究的第二部分旨在評估第一部分中測試的相同劑量,60微克(可選的額外60微克劑量),但在家庭環境中,僅關注安全性。然而,由於試驗在第一部分中沒有達到使用60微克劑量的主要療效終點,我們暫停了第二部分研究的繼續,等待FDA的反饋。我們建議根據我們在10期億試驗中對伴有躁動的精神分裂症患者使用該劑量的臨牀經驗來評估80微克的劑量,並建立藥代動力學和藥效學模型,表明使用80微克的BXCL501劑量可以在家庭使用的安全性和有效性之間提供最佳平衡。TM
41
因此,我們在2024年3月6日與FDA舉行後續會議的請求中,就這項研究修正案的擬議設計徵求了FDA的進一步反饋。
根據FDA在2024年3月6日會議之前和期間的反饋,我們正在推進評估120微克劑量的BXCL501在家中的使用情況,並修改了Serenity III研究的第二部分,我們現在將其稱爲Serenity在家試驗,將安全性作爲主要目標,並將療效測量作爲探索性終點,以支持FDA在2023年11月8日會議上建議的在家環境中用於雙相情感障礙或精神分裂症的激動症的急性治療。我們還計劃進行一項臨牀研究,計劃招募大約25名患者,以評估患者和告密者報告的療效測量之間的關係,使用FDA先前建議的由訓練有素的臨牀醫生評分員進行的PEC量表。
伊加爾米TM根據我們之前在治療單次激越發作時產生的療效數據,已經在120微克劑量下獲得批准。與迄今生成的數據一致,IGALMI的標籤TM目前包括對使用的限制(「Lou」),指出在第一次接種後24小時後缺乏有效性或安全性數據。在2024年3月6日與FDA的C型會議上,我們討論了,除其他事項外,評估BXCL501 120微克的家庭使用,以安全性爲主要目標,以療效測量爲探索性終點,如果成功,是否可以支持sNDA的提交,尋求擴展IGALMI的當前標籤TM120微克,無需當前LOU即可在家中使用和貼標籤。根據FDA的反饋,我們認爲,我們在沒有當前LOU的情況下尋求標籤的能力將部分取決於我們在計劃的研究期間觀察到的激動發作的數量。2024年4月22日,我們宣佈了我們的計劃,在獲得資金的情況下,推進寧靜在家試驗。2024年9月5日,我們宣佈開始招募患者參加我們的寧靜家庭試驗。
寧靜計劃:急性治療與疑似阿爾茨海默病(AAD)所致癡呆相關的躁動
2023年6月29日,我們宣佈了寧靜II的TOPLINE陽性結果,這是一項隨機、雙盲、安慰劑對照的平行小組試驗,評估了BXCL501在輔助生活設施(ALF)和家庭護理環境中急性治療阿爾茨海默病相關激動症的安全性和有效性,這些成年人患有輕度至中度癡呆症,在輔助生活設施(ALF)和家庭護理環境中需要最少的日常生活活動援助。這項試驗給149名患者服用了藥物。對於12周內發生的激越發作,隨機患者自我給予40微克或60微克的BXCL501或安慰劑。主要終點是給藥後2小時第一次治療激越發作時PEC總分與給藥前的變化。關鍵的次級療效終點是研究治療後1小時第一次治療激越發作時的PEC變化,以及研究治療後30分鐘第一次治療激越發作時的PEC變化。
第三階段試驗以60微克的劑量達到其主要療效終點;在2小時內觀察到具有統計學意義和臨牀意義的PEC總分比基線降低7.5點,而服用安慰劑的則爲5.4點(p=0.0112)。60微克劑量也達到了在第一次激越發作期間1小時減少激越症狀的第一個關鍵次要終點(p=0.0185),但沒有達到另一個關鍵次要終點,即30分鐘時PEC評分與基線的變化。
這種劑量的療效得到了幾項輔助措施的支持,包括CGI改善和激動-平靜評估量表。大多數患者(76%)對最初的60微克劑量有反應,並被確定爲「非常」或「非常改善」(CGI-I分別爲1或2),相比之下,服用安慰劑的患者有50%。40微克劑量未達到主要終點,PEC評分較基線降低5.7分。
2023年6月29日,我們還宣佈,我們了解到這項研究中的一名調查員參與了不當行爲,他招募了大約40%的患者。從那時起,我們已經採取措施,進一步調查和評估在這個臨牀地點進行的寧靜II試驗。根據到目前爲止的這些步驟,我們認爲,沒有進一步的不當行爲或欺詐或其他發現,對在相關臨牀試驗地點獲得的資格、安全性或有效性數據的數據完整性或可靠性產生不利影響。
在2023年10月11日與FDA舉行的B型/突破療法指定會議上,我們審查了我們的寧靜臨牀試驗計劃,並討論了支持提交sNDA所需的數據包
42
BXCL501可能被批准用於急性治療ALF和家庭環境中可能患有阿爾茨海默病的輕中度癡呆症患者的激動症。具體地說,我們徵求了FDA的反饋,以了解我們由寧靜I和安寧II組成的數據包,以及之前與FDA討論的臨牀藥理學和毒理學計劃,是否足以支持sNDA提交的關於可能在家庭或ALF環境下使用BXCL501治療可能因阿爾茨海默病而導致的輕到中度癡呆患者的激越,或者,如果不是,還需要哪些額外的數據。根據FDA在這次會議上的反饋,我們了解到FDA將需要額外的療效數據,包括重複療效數據,以及長期安全性數據。因此,我們要求與FDA舉行另一次會議,進一步討論支持sNDA提交所需的額外數據。
2024年2月20日,我們與FDA舉行了B型/突破性治療指定會議。這次會議的最初目的是獲得對一項擬議的居家研究設計的反饋,該研究不包括護理者收集的療效終點,基於我們認爲獲得護理者對療效的評估將是具有挑戰性的。我們認爲,在家庭環境中,沒有經過驗證的照顧者終點來評估阿爾茨海默病患者的療效。因此,我們集中於就我們以安全性爲主要目標的家庭臨牀研究的建議徵求FDA的反饋,並更好地了解需要哪些額外數據才能提交sNDA以支持BXCL501的標籤,以包括對可能患有阿爾茨海默病或僅在護理環境中的這一人群中與癡呆症相關的躁動的急性治療。在其初步回應中,FDA重申了其先前的評論,即我們需要生成額外的療效數據,包括重複劑量的療效數據,以支持sNDA提交,因爲FDA表示,我們擬議的療效數據庫,目前包括在寧靜I和寧靜II中接受60微克BXCL501治療的70名患者,如果沒有額外的數據,將不會包含實質性的有效性證據。FDA建議,在家庭環境下進行任何試驗之前,我們應該在護理機構中生成必要的療效數據。此外,FDA表示,需要生成長期安全數據來支持sNDA提交,包括可能接觸BXCL501長達一年的阿爾茨海默病患者。根據FDA的反饋,我們目前正計劃在我們計劃的寧靜住院第三階段試驗中,在各種相關的護理設施設置和不同嚴重程度的癡呆症中產生額外的第三階段療效和安全性數據。此外,我們計劃在未來與FDA的會議上討論長期安全數據要求的細節。此外,儘管我們在2023年11月宣佈,我們計劃在家庭環境中進行第三階段試驗,以安全爲首要目標(家庭寧靜),但優先考慮擴大數據庫,以產生更多護理設施的療效和安全數據,並視資金情況而定,我們正在重新評估啓動家庭寧靜的時機。
2024年9月5日,我們向FDA提交了我們的寧靜護理第三階段試驗的擬議方案,旨在評估60微克劑量的BXCL501用於與阿爾茨海默氏症相關的激動劑的有效性和安全性。
重度抑鬱障礙(MDD)的輔助治療
我們之前評估了BXCL501作爲MDD的輔助治療。該計劃的最初臨牀研究是一項雙盲、安慰劑對照、多次遞增劑量(MAD)試驗,以評估BXCL501在健康志願者中每日劑量的安全性和耐受性。
作爲2023年8月14日宣佈的優先順序調整的一部分,我們暫停了開發第二階段人類概念驗證試驗設計的計劃,以研究BXCL501作爲潛在的輔助治療及其與一線選擇性5-羥色胺再攝取抑制劑或5-羥色胺去甲腎上腺素再攝取抑制劑聯合使用的潛在促進作用。
兒科研究
2021年6月,我們啓動了一項全球臨牀試驗,旨在評估BXCL501在急性治療與兒童精神分裂症和雙相情感障礙相關的激越方面的安全性和有效性,部分原因是爲了滿足與FDA就批准IGALMI達成的兒科研究要求TM。FDA和歐洲藥品管理局(European Medicines Agency)已經審查了該試驗方案,以履行潛在的承諾,研究BXCL501對13至17歲精神分裂症和10至17歲雙相情感障礙兒童患者的療效。
43
在這項多點、雙盲、安慰劑對照的平行團體試驗中,精神分裂症、分裂情感障礙、雙相I和雙相II障礙患者的登記正在進行中。150名受試者中約有63%已在美國登記,其中95名受試者已完成臨牀試驗。2023年7月,我們停止了在歐洲地區的活動,因爲招生和現場招聘無效。與我們對精神分裂症和雙相情感障礙(寧靜I和寧靜II)的註冊試驗類似,主要終點是兩小時時與基線PEC總分的變化。在重新確定優先順序後,該計劃的美國部分仍然活躍。
2024年10月,我們向FDA提交了延期請求,並計劃提交一份更新的試驗方案,以完成對患有精神分裂症或分裂情感障礙的兒科患者的登記要求。
上市後研究更新
2024年6月25日,我們宣佈了上市後需求研究的陽性結果,評估重複服用180毫克(最高批准劑量)的IGALMI是否會出現耐受性、快速反應或停藥TM。這項研究是一項單臂開放研究,涉及28名與雙相情感障礙或精神分裂症相關的頻繁躁動的住院成人患者,他們在7天內根據需要自我給予180mgIGALMI™。共有83例患者接受治療。這項研究達到了它的目標,並且沒有證據表明有快速耐受、耐受或停藥以及IGALMITM在研究期間總體上耐受性良好。
更多的神經科學機會
BXCL501特許經營權擴張的渠道機會
鑑於BXCL501的差異化設計及其選擇性作用機制,我們相信BXCL501有潛力廣泛適用於多種適應症,在這些適應症中,激動是一種狀況或潛在疾病的症狀。
政府支持的調查員發起的試驗計劃
該公司在急性應激障礙(ASD)、創傷後應激障礙(PTSD)、酒精使用障礙(AUD)和阿片類藥物使用障礙(OUD)方面獲得了開發BXCL501的關鍵機會。這些項目是通過與美國國防部國會指導的醫學研究項目和國家藥物濫用研究所(「NIDA」)的合作協議提供資金的。臨牀和監管職責由康涅狄格州退伍軍人事務部、耶魯大學醫學院、國際RTI、哥倫比亞大學紐約州精神病學研究所和NIDA的臨牀研究人員和監管人員領導。在美國政府支持的臨牀試驗評估的所有潛在適應症中,該公司保留將BXCL501商業化的所有權利。
阿片類藥物使用障礙計劃
正如之前宣佈的那樣,NIDA向哥倫比亞大學提供了一筆贈款,用於資助BXCL501的臨牀測試,作爲診斷爲OUD的患者阿片類藥物戒斷的潛在治療方法。最初的160名患者,三個部位,四個手臂 這項研究的目的是評估BXCL501相對於洛非西定和安慰劑在OUD患者中的安全性和有效性。一個參與這項研究的大多數卵巢癌患者預計都會接觸到芬太尼摻入或與賽拉津有關。到目前爲止,一個所有三個初始網站已經招募、招募和給被診斷爲OUD的身體依賴阿片類藥物的患者服藥,包括處方阿片類藥物。該公司爲這項研究提供藥物產品,該研究由哥倫比亞大學贊助。我們預計,當前研究的結果將被用於選擇推薦劑量的BXCL501,以在由以下機構贊助的稍後的門診第三階段研究中與安慰劑進行比較奈達。
2023年11月6日,我們宣佈,NIDA要求試驗協調員哥倫比亞大學增加第四個站點,以加快試驗完成。 第四個地點的患者篩查和登記程序於3月開始
44
如果結果良好,我們計劃就潛在的註冊途徑徵求FDA的反饋。
酒精使用障礙與創傷後應激障礙共病
2020年12月,美國退伍軍人事務部康涅狄格州醫療保健系統和耶魯大學醫學院獲得了美國國防部國會指導的醫學研究計劃的撥款,總體目標是評估BXCL501在患有創傷後應激障礙的AUD患者中的應用。該公司爲住院患者酒精相互作用研究提供了BXCL501,該研究已經完成。據我們所知,耶魯大學目前正在尋求IRB的批准和FDA的許可,以繼續進行一項試驗,評估BXCL501每天高達80微克Bid,持續28天對被診斷爲輕度、中度或重度AUD且符合合併PTSD標準A的患者的酒精消費、PTSD症狀、認知功能、記憶、睡眠和情緒的影響。患者篩查和登記預計將於2024年第四季度開始。我們相信,這項研究的結果可能被用來爲第三階段研究提供信息,該階段研究打算在聯盟的支持下開始。
急性應激障礙(ASD)計劃
該獎項在2024年9月15日至2026年9月14日期間向北卡羅來納大學創傷恢復研究所提供2800美元,以評估BXCL501降低ASD症狀嚴重程度和/或創傷後神經精神症狀的潛在療效。我們將爲試驗提供BXCL501。
BXCL502開發
BXCL502的配方和進一步的臨牀開發計劃目前被擱置。
利用AI平台的其他候選產品
我們的人工智能平台由一系列定製和特定的人工智能應用程序組成,旨在識別、預測療效和測試具有已知作用機制的後期資產以及相關的藥理學和安全性數據。我們的目標是神經精神和神經罕見疾病,在這些疾病中,化合物要麼可以改善疾病,要麼可以緩解症狀。化合物在相關的疾病模型中進行測試,並根據進入臨牀的潛力和開發的簡易性進行排序。感興趣的疾病領域是與壓力相關的,如激動症,或與癡呆症相關的神經精神症狀,並導致醫療負擔增加。
神經科學知識產權
我們的政策是通過在美國和其他司法管轄區提交與我們的專有技術、發明、改進和候選產品相關的專利申請,保護和加強對我們的業務具有商業重要性的專有技術、發明和改進。我們還依賴與我們的專有技術和候選產品、持續創新和許可內許可相關的商標、商業祕密和技術訣竅。
45
技術和產品。這種依賴預計將發展、維持和加強我們在多個治療領域的新療法和現有療法的新配方方面的專利地位。我們還計劃依靠數據獨佔性、市場獨佔性和專利期延長(如果可用)。
我們已經提交了多項專利系列來保護我們的神經科學計劃,包括BXCL501。截至2024年10月14日,我們的神經科學專利組合包括4項尚未進入國家階段的專利合作條約(「PCT」)申請、15項美國實用程序申請、1項美國臨時申請、1項允許的美國申請、15項已頒發的美國實用程序專利、110項待批准的非美國實用程序申請、23項允許或授予的非美國專利(包括4項在日本)、1項未決的美國外觀設計專利申請以及39項允許或註冊的外觀設計專利(包括2項在日本)。12項美國實用專利針對我們專有的地塞米松和治療攪動的舌下膜配方,被列入美國食品和藥物管理局批准的IGALMI™的治療等效性評估藥物產品(通常被稱爲「橙皮書」),有效期在2037年至2043年之間。在配方家族中,我們已在中國、歐洲、歐亞大陸、日本、墨西哥和美國授予或允許專利,在美國、中國等主要市場正在申請中。我們預計,該系列頒發的專利將不早於2039年到期。我們還提交了與BXCL501相關的其他專利系列的申請。我們有其中一項已獲得歐洲專利,在美國和日本正在申請中,涉及使用舌下Dex治療失眠的方法。我們預計,由這些申請頒發的專利將不早於2035年到期。我們還在包括美國、歐洲、日本和中國在內的主要市場授予了治療激越的方法的專利和正在申請的專利。我們預計,這些申請頒發的專利將在2039年至2043年之間到期。我們還有4%的應用程序用於治療躁狂、抑鬱、壓力和焦慮症。如果專利是從這些案件中發放的,我們預計它們將在2043年或2044年到期。
於2024年8月,本公司收到美國專利商標局(「USPTO」)就美國專利申請號18/600,431(「‘431申請」)發出的豁免通知。‘431申請要求使用右旋美託咪定口腔粘膜製劑治療激動症的方法。這項專利一旦發佈,預計到期日爲2043年1月12日。2024年10月,本公司收到美國專利商標局的問題通知,表明『431申請預計將於2024年11月12日左右作爲美國第12號專利138,247(“』247專利”)頒發。一旦發佈,‘247年專利預計將有資格列入IGALMI™的橙色手冊。
2024年9月,該公司獲得了美國第12,109,140號專利,該專利針對的是治療與精神分裂症或雙相I或II型障礙相關的輕度或中度激越的方法,這些患者患有嚴重的肝臟損害。該專利預計最早將於2043年1月12日到期。
2024年10月,該公司獲得了第12,109,196號美國專利,該專利針對的是使用右旋美託咪定口服制劑治療攪拌的方法。該專利預計最早將於2040年7月17日到期。
個別專利的期限取決於獲得專利的國家的法律術語。在包括美國在內的大多數國家,專利期爲非臨時專利申請最早提交之日起20年。根據FDA批准我們候選產品的時間、期限和細節,我們擁有或許可的美國專利可能有資格根據1984年的《藥品價格競爭和專利期限恢復法》(也稱爲《哈奇-瓦克斯曼法案》)獲得有限的專利期延長。該法案允許最長五年的專利恢復期限,作爲對產品開發和藥品審批監管審查過程中失去的專利期的補償。然而,專利期限恢復不能延長專利的剩餘期限,從產品批准之日起總共不能超過14年。專利期恢復期通常是IND生效日期和新藥申請提交日期之間的時間的一半,加上提交NDA日期和批准該申請之間的時間。只有一項適用於批准的藥物的專利有資格延期,而且延期申請必須在專利到期之前提出。美國專利商標局與FDA協商,審查和批准任何專利期延長或恢復的申請。未來,我們打算爲我們目前擁有或許可的一些專利申請恢復專利期,以延長其當前到期日之後的專利壽命,這取決於提交相關保密協議所涉及的臨牀試驗的預期時長和其他因素。
46
專利的有效期也可以通過《美國法典》第35編第154(B)條中確立的專利協議來延長。PTA的目的是爲了適應USPTO在起訴美國公用事業或工廠專利申請期間造成的延誤。
專利的期限也可以通過終止免責聲明來縮短。通常,終端免責聲明是在未決申請的至少一項權利要求根據先前提交的專利中的至少一項權利要求而顯而易見的情況下提交的(或非法定的明顯型雙重專利拒絕)。
免疫腫瘤學
2022年4月19日,我們宣佈成立一家全資子公司OnkosXcel,以開發腫瘤學中潛在的變革性藥物。OnkosXcel使用專有的人工智能能力來推動創新抗癌療法的資本效率開發。2023年3月14日,我們宣佈,OnkosXcel已祕密地向美國證券交易委員會提交了S-1表格的登記聲明草案,涉及其轉換爲公司後擬首次公開發行普通股的建議。該公司正在繼續評估OnkosXcel的戰略選擇。隨着該公司於2023年8月14日宣佈重新確定優先順序,以下所述的免疫腫瘤學計劃的進一步工作已普遍暫停,以下所述除外。
我們的藥物發現方法利用了我們專有的基於人工智能的研發平台的應用和方法,並輔之以EvolverAI,用於IGALMI的成功開發TM旨在有效地識別和開發免疫腫瘤學候選產品。我們相信BXCL701反映了這種發現方法在免疫腫瘤學中的潛力。BXCL701是一種研究中的口服天然免疫激活劑,在2a期臨牀試驗中顯示出25%的綜合應答率,用於治療表型轉移性去勢耐受前列腺癌(MCRPC)患者。2024年2月12日,該公司宣佈,FDA已將BXCL701的研究與檢查點抑制劑相結合,指定爲快速跟蹤開發計劃,用於治療化療進展且沒有微衛星不穩定證據的轉移性小細胞肺癌患者。我們已經最終確定了一項針對SCNC表型的mCRPC患者的潛在註冊試驗設計,然而,鑑於我們的臨牀優先順序,我們尚未與FDA會面討論這一問題,也沒有計劃在目前啓動這項試驗。
MCRPC常被定性爲「冷」瘤,即具有免疫抑制的腫瘤微環境(「TME」)和低免疫細胞浸潤的腫瘤。目前已批准的針對程序性細胞死亡1(PD-1)或細胞毒性T淋巴細胞相關蛋白4(CTLA-4)的檢查點抑制劑(CPIs)未能顯示出對這種難以治療的腫瘤類型(包括mCRPC)有意義的單劑活性。BXCL701主要是通過抑制二肽基肽酶(DPP)8和9來促進TME中免疫誘導的炎症反應,我們相信這兩種酶可以提供增強的CPIs治療效用。我們相信,BXCL701可能會爲2024年美國大約299,010名男性中約20%的人提供顯著的好處,這些人將被診斷爲前列腺癌,並有望發展爲更具侵襲性的mCRPC形式,其中包括大約20%,即11,960名將發展爲SCNC表型的患者,目前對這些患者的治療選擇有限。免疫檢查點代表了無數的抑制途徑,它們調節抗原誘導的免疫反應的持續時間和強度,並在介導免疫耐受中發揮重要作用。CPIs旨在利用免疫系統中固有的力量,其工作原理是禁用免疫檢查點的抑制功能,允許免疫系統繞過此類癌症的免疫耐受屏障。
47
大多數患者,因爲臨牀益處一般被認爲限於13%至30%的癌症患者,而且起效時間相對較短。
我們認爲,批准的消費物價指數的療效有限,主要是因爲它們在免疫反應的後期階段進行了干預。因此,腫瘤可以利用其他靶點和途徑來創造一種TME,這種TME可以逃避經批准的CPIs帶來的增強的免疫反應。雖然許多針對免疫反應早期階段的藥物正在開發中,以便與CPIs結合使用,但它們的活性僅限於免疫反應的單一成分。相比之下,我們開發了BXCL701,以同時處理免疫反應的多個組件,包括:
● | 樹突狀細胞對腫瘤抗原的提呈:刺激樹突狀細胞向腫瘤引流淋巴轉移。 |
● | T細胞的啓動和激活:加速腫瘤誘導的T細胞的啓動和形成強大的細胞毒性T淋巴細胞(「CTL」)。 |
● | 免疫細胞對腫瘤的侵襲作用:刺激趨化因數的釋放,吸引效應性T細胞,但阻斷調節性T細胞,並誘導NK細胞和中性粒細胞遷移。 |
● | 殺滅腫瘤細胞:誘導表達腫瘤殺傷穿孔素和顆粒酶的CTL和NK細胞的形成,以及能夠選擇性殺傷返回的腫瘤細胞的記憶T細胞的形成。 |
因此,我們認爲BXCL701可能在刺激免疫效應細胞增加腫瘤細胞的激活、增殖和滲透方面具有實用價值,使其與目前批准的CPIs相結合,在一系列實體腫瘤和血液惡性腫瘤中潛在地應用於:
● | 將免疫性冷腫瘤轉化爲對CPIs敏感的腫瘤; |
● | 提高熱點腫瘤對消費物價指數的反應速度和反應深度;以及 |
● | 恢復CPI對以前有反應的腫瘤的敏感性。 |
我們藥物發現計劃的核心是專有的、人工智能驅動的平台技術,我們使用這些技術來識別經批准的療法的新治療用途和臨牀評估中的候選藥物。我們第一個也是最先進的人工智能驅動的發現計劃是我們的先天免疫調製計劃,它支持BXCL701作爲開發候選者的追求。我們相信,該程序的應用爲我們提供了對炎症小體的可操作的見解,炎症小體是負責激活炎症反應的先天免疫系統的一個組成部分。
我們的免疫腫瘤學項目
以下是截至本季度報告10-Q表格的免疫腫瘤學臨牀開發計劃的狀態摘要。我們相信,如果我們的候選產品成功開發並獲得批准,將有可能成爲各自適應症的引人注目的治療選擇。隨着我們在2023年8月14日宣佈戰略優先順序調整,我們免疫腫瘤學計劃的進一步工作已經暫停,但如下所述。
48
利用我們基於人工智能的專有平台的應用和方法所帶來的洞察力,以及我們的行業專業知識,我們正在實施兩項專有發現計劃,以推進我們開發抗癌療法的目標。EvolverAI用於在臨牀評估中識別我們批准的療法和候選產品的新治療用途。第一個計劃,包括一系列適應症的BXCL701,是基於先天免疫調節技術的應用。這一計劃的構建包含了先天免疫系統的關鍵區別特徵,我們相信它得到了我們的開發努力的支持。這種方法推動了BXCL701的開發,我們目前正在進行1b/2a期臨牀概念驗證試驗,評估其作爲治療患有SCNC或腺癌表型的mCRPC的潛在療法。先天免疫調節程序的基礎是BXCL701的S潛力:
● | 將冷腫瘤轉化爲對CPIs敏感的腫瘤; |
● | 提高熱點腫瘤對消費物價指數的反應速度和反應深度;以及 |
● | 恢復CPI對以前有反應的腫瘤的敏感性。 |
BXCL701天然免疫激活劑
BXCL701是一種口服小分子抑制劑,可抑制一類名爲DPPs的酶,特別是DPP8/9和DPP4。抑制DPP8/9啓動了炎症體的激活,並最終激活了天然免疫系統。BXCL701的主要特性包括:
● |
● | 新提出的作用機制可以補充CPIs的活性,使治療能夠治療免疫寒冷的腫瘤以及其他難以治療的癌症,包括復發或難治性腫瘤類型。 |
● | 2期臨牀概念驗證在治療患有腺癌或SCNC表型的mCRPC患者中取得成功。 |
最初對具有SCNC表型的mCRPC的關注旨在提供比當前行業標準更有效的臨牀開發途徑。
49
BXCL701作爲治療mCRPC的潛在藥物
我們相信,BXCL701可能在刺激免疫效應細胞增加腫瘤細胞的激活、增殖和滲透方面具有實用價值,使其能夠與目前批准的CPIs一起用於治療冷腫瘤,如mCRPC。我們選擇將mCRPC作爲BXCL701的適應症,因爲它豐富了DPP突變,這種突變在SCNC表型的腫瘤中尤其常見。
BXCL701正在1b/2a期臨牀概念驗證試驗中進行評估,我們正在贊助該試驗,以調查其與Pembrolizumab聯合使用時的潛在療效。此試用的註冊已完成。
我們收到了FDA對我們擬議的臨牀開發計劃的初步意見,並收到了關於劑量優化的反饋,以便在未來的研究中使用。然而,在公司重新確定優先順序後,任何此類額外試驗的開始都將暫停。我們的1b/2期臨牀試驗的10期億部分是劑量遞增安全導入,採用標準的3 x 3試驗設計來確定推薦的2期劑量(「RP2D」)。在每個21天的治療週期中,第一天靜脈注射200毫克培溴利珠單抗,第一天至第14天每天兩次服用BXCL701,至少兩個週期。在癌症免疫治療學會上公佈的這項10期億試驗的結果這是週年年會,使我們能夠確定0.3毫克,每天兩次,作爲RP2D。
試驗的2a期部分被分成兩個28名患者的試驗隊列,一個隊列由具有SCNC表型的mCRPC患者組成,第二個隊列由具有腺癌表型的mCRPC患者組成。最初,我們專注於將具有SCNC表型的mCRPC作爲BXCL701的主要患者群體,因爲DPP9在大約17%的治療後出現SCNC表型的mCRPC中擴增,而在更廣泛的前列腺癌人群中,這一比例爲5%或更低。然而,我們也觀察到在試驗的10期億部分微衛星穩定的腺癌表型的mCRPC患者的反應。在此基礎上,我們擴大了我們的2a期試驗,將復發的具有SCNC或腺癌表型的mCRPC患者包括在內。兩個隊列都採用了Simon兩階段試驗設計,包括15名試驗參與者和13名額外的患者。這項試驗的2a期部分的主要終點是綜合應答率,確定爲RECIST 1.1應答(定義爲RECIST評分下降30%或以上),和/或前列腺特異性抗原(PSA)水平下降50%或以上,和/或循環腫瘤細胞(CTCs)從5個或更多CTCs/7.5毫升(「ml」)降至低於5個CTCs/7.5毫升。次要終點包括反應持續時間、無進展生存期、總生存期、循環細胞因數的變化以及某些疾病特異性生物標誌物。
我們相信,在BXCL701與培溴利珠單抗聯合應用的2a期試驗中觀察到的結果支持進一步的開發。
我們尤其受到由具有SCNC表型的mCRPC患者組成的隊列中觀察到的結果的鼓舞。SCNC隊列的最新2a階段結果在30這是前列腺癌基金會年度科學務虛會(PCF 2023)。BXCL701聯合Pembrolizumab在mCRPC SCNC表型患者中的綜合應答率爲25%(28名可評估患者中有7名),這些患者沒有標準的治療標準。截至2023年9月6日的數據截止日,這些應答者中有5名是RECIST 1.1應答者(4名確診應答和1名未經證實應答),腫瘤大小減少了-45%至-67%,應答持續時間的中位數爲7.6個月。
截至2022年12月19日截止日期,試驗期間觀察到與細胞因數激活一致的不良反應,包括髮熱、噁心、寒戰、疲勞、頭痛和頭暈,一般爲輕度至中度。據報道,6名試驗參與者經歷的SAE與BXCL701或Pembrolizumab有關或可能與BXCL701或培溴珠單抗有關。
2023年10月10日,我們報道了SCNC患者2a期試驗的總體生存率(OS)結果爲陽性。BXCL701與Pembrolizumab聯合使用顯示了引人注目的中位OS和12個月
50
存活率。截至2023年9月6日的數據截止點,可評估的SCNC患者(n=28)的中位OS爲13.6個月(95%可信區間10.9-NR),12個月存活率爲56.5%。
2024年2月12日,該公司宣佈,FDA將BXCL701的研究與檢查點抑制劑相結合,指定爲快速跟蹤開發計劃,用於治療化療進展且沒有微衛星不穩定證據的轉移性SCNC患者。
腺癌隊列的2a期試驗也已經完成。這一試驗隊列的最新結果也在PCF2023上公佈。BXCL701聯合Pembrolizumab在具有腺癌表型的mCRPC患者中顯示出21%的綜合應答率(29名可評估患者中有6名),這些患者的治療選擇有限。截至2023年9月6日的截止日期,這些綜合應答者中有5名是RECIST 1.1應答者(4名確診應答和1名未經證實應答),腫瘤大小從-30%到-99%不等,應答持續時間中值爲19個月。
截至2022年12月19日的截止日期,腺癌隊列中的患者經歷的大部分不良反應是低級別的。觀察到符合細胞因數激活的AES,包括髮熱、肌痛、噁心、寒戰、乏力、呼吸困難、頭痛和頭暈。據報道,5名患者(12%)的SAE可能與BXCL701或Pembrolizumab有關:2例低血壓,1例頭暈,1例外周水腫,1例發熱,1例重症肌無力,1例細胞因數釋放綜合徵。2例(5%)因不良反應停止治療。沒有證據表明BXCL701增強了與CPI相關的免疫相關AEs。下表總結了在腺癌隊列中觀察到的與治療相關的不良反應。
2023年11月8日,我們報道了腺癌患者2a期試驗的陽性OS結果。截至2023年9月6日的數據截止日,在可評估的腺癌患者(n=29)中,BXCL701聯合培溴利珠單抗顯示中位OS爲15.5個月(95%可信區間9.6-NR),12個月生存率爲59.3%。
BXCL701作爲治療小細胞肺癌的潛在藥物
鑑於BXCL701在正在進行的SCNC臨牀試驗中表現出的活性,我們對BXCL701治療小細胞肺癌的潛力感到鼓舞。我們正在考慮進行一項潛在的1b/2期劑量遞增安全引入研究,以努力建立使用阿替唑單抗的RP2D。
BXCL701作爲其他癌症的潛在治療藥物
除了將BXCL701與CPIs結合用於治療免疫冷腫瘤mCRPC外,我們還在開發BXCL701,用於治療胰腺癌和其他免疫活性較強或「非冷」但仍被視爲難以治療的實體腫瘤,以及血液系統惡性腫瘤。我們相信,當BXCL701和CPIs聯合使用時,其協同潛力可以增加癌細胞對增強免疫反應的敏感性,潛在地增加CPIs的臨牀益處,其治療這些腫瘤類型的單藥療效通常被限制在13%至30%的癌症患者之間,而且治療反應的持續時間通常很短。因此,我們設想BXCL701的潛在治療優勢是提高冷腫瘤對CPI療法的敏感性,使其能夠潛在地治療包括胰腺癌、乳腺癌、結直腸癌和卵巢癌在內的一系列癌症,並增強其他癌症對CPI的反應深度。此外,根據臨牀前的觀察,BXCL701對某些白血病細胞具有直接的細胞毒活性,我們已經啓動了針對復發或難治性急性髓系白血病(AML)的臨牀開發。
51
胰腺癌
美國癌症協會估計,2024年,美國將診斷出大約66,440例胰腺癌。我們正在支持一項由喬治敦·隆巴迪綜合癌症中心(Georgetown Lombardi)贊助的第二階段研究人員贊助的試驗(「IST」),旨在評估BXCL701與培溴利珠單抗聯合治療胰腺癌的效果。這種疾病的五年存活率不到10%,是所有癌症中最低的之一,幾乎沒有治療方案可供選擇。胰腺癌是DPP過度表達和擴增水平最高的腫瘤之一。臨牀前模型顯示,在胰腺癌腫瘤微環境中,BXCL701抑制DPP和抗PD-1抗體之間存在協同作用。在這些臨牀前觀察的基礎上,喬治敦隆巴迪公司啓動了一項第二階段的IST,以評估BXCL701與Pembrolizumab(安全導入)聯合使用時的安全性,並估計先前治療的轉移性胰腺導管腺癌的18周無進展存活率(有效性階段的主要目標)。這項試驗於2023年第三季度開始。2024年2月6日,我們宣佈完成了試驗的安全引入部分的患者登記。作爲試驗安全引入的一部分,前六名患者已經入選,並將接受爲期六週的安全窗口期觀察。然後,這項試驗預計將有大約39名患者進入其有效階段,採用Simon 2階段單臂開放標籤設計(19名患者處於第1階段,20名患者處於第2階段)。患者將接受放射檢查和腫瘤標誌物的監測,以進行反應評估。在治療過程中還將收集腫瘤活檢和血液樣本,以更好地了解聯合治療的潛在作用機制。試驗的人工概念驗證部分於2024年上半年開始。2024年4月24日,我們宣佈了一篇題爲《BXCL701和培溴利珠單抗在轉移性胰腺導管腺癌患者中的II期試驗:初步發現》的摘要,被選爲2024年5月31日至6月4日在伊利諾伊州芝加哥舉行的2024年美國臨牀腫瘤學會(ASCO)年會的海報會議上的演示文稿。研究人員報告說,截至適用的截止日期,一名患者在18周時沒有進展,三名患者的血清CA19-9水平大幅下降,這是一種可能與T細胞浸潤增加相關的腫瘤標誌物,在接受聯合治療的六名患者中,一名患者的部分反應最佳。
復發或難治性AML
美國癌症協會估計,2024年,美國將有大約20,800例新確診的急性髓細胞白血病病例。我們正在支持由達納-法伯癌症研究所(「達納-法伯」)贊助的10期億列表,該列表旨在評估BXCL701的使用情況,以及目前治療復發或難治性急性髓細胞白血病的護理標準。我們認爲,BXCL701引發的下垂可能具有針對AML的強大的單藥細胞毒作用。我們還認爲DPP9拷貝數可能提供一個可操作的生物標誌物,因爲已觀察到高拷貝數與BXCL701在人AML細胞系中的毒性相關。DPP8/9抑制已被證明對THP-1細胞、從AML患者培養的單核細胞癌細胞具有細胞毒作用,但對其他細胞株沒有影響,這表明AML對這些抑制劑具有特殊的脆弱性,我們相信這些抑制劑可以用於治療。在這些臨牀前觀察的基礎上,戴納-法伯公司啓動了一項10期億試驗,以評估BXCL701的安全性,並確定BXCL701作爲單一藥物的最大耐受量或RP2D。這項試驗於2023年第一季度開始。在這項10期億試驗成功完成後,我們預計戴納-法伯公司將進行進一步的研究,結合護理標準確定BXCL701‘S在急性髓細胞白血病中的客觀有效率。
其他潛在的抗癌計劃
我們與德克薩斯大學MD安德森癌症中心合作,在2a期試驗中評估了BXCL701與培溴利珠單抗聯合應用對晚期實體癌患者的潛在療效。這項開放標籤試驗的設計包括兩個隊列,並納入了兩個階段的配置,如果在最初的9名患者中至少有一名患者觀察到RECIST 1.1完全緩解或部分緩解,則允許將患者登記擴大到每個隊列中總共17名患者。第一組納入了以前沒有接受過CPI治療的患者,第二組由CPI治療無效或在接受CPI治療期間復發的患者組成,這意味着第二組患者預計不會對CPI治療有進一步的反應。試驗參與者在21天週期的第1天接受200毫克的培溴利珠單抗治療,在第一個週期的第1天到第7天每天服用0.2毫克的BXCL701。在第一個週期的第8天到第14天,劑量增加到0.3毫克,在第一個週期和隨後的週期中。
52
結合CPI,在第一階段完成時,在CPI幼稚組和CPI難治/復發隊列中各有一名患者注意到反應,包括CPI初治組、微衛星穩定型子宮內膜癌、PD-L1陰性(CPS<1)和CPI難治性葡萄膜黑色素瘤的部分反應。這些初步結果在2021年美國臨牀腫瘤學會年會(ASCO 2021)上公佈。這項試驗的患者登記工作於2022年第三季度完成。
我們相信BXCL701可能在乳腺癌中有潛在的應用,因爲它與單抗治療的結合在臨牀前疾病模型中產生了令人鼓舞的體內數據,在那裏觀察到了增強的抗體依賴的細胞毒性。
FDA已批准BXCL701孤兒藥物指定用於治療AML、IIb至IV期黑色素瘤、胰腺癌和軟組織肉瘤。由於我們考慮BXCL701的S用於代表未得到滿足的醫療需求的其他適應症的治療潛力,我們打算爲BXCL701申請額外的孤兒藥物名稱。
生物標記物開發計劃旨在補充BXCL701管理
我們還積極參與識別和開發預測性生物標誌物,我們相信這些標誌物可以與BXCL701一起用於預測患者對各種靶向適應症的治療反應的可能性。根據AML患者的初步數據,我們認爲DPP9拷貝數可能與BXCL701應答率相關,DPP9拷貝數增加的患者發生BXCL701細胞毒性的可能性更大。我們正在尋求將其用於我們的生物標記物發現活動,作爲一種潛在的伴隨診斷。在癌症免疫治療學會的38這是在年度會議(SITC 2023)上,我們公佈了SCNC患者2a期試驗的數據,表明DPP9過度表達是BXCL701和pembrolizumab聯合治療具有SCNC表型的mCRPC患者的潛在療效預測生物標誌物。
免疫腫瘤學知識產權
截至2024年10月14日,我們已提交多項專利系列以保護我們的免疫腫瘤學計劃,其中包括針對將BXCL701與免疫檢查點抑制劑一起使用的方法的核心專利系列,該專利已在美國、日本、澳大利亞、加拿大、俄羅斯、中國、印度、臺灣、南非、墨西哥、新西蘭、歐洲和阿拉伯聯合酋長國獲得批准。這一系列的其他申請正在主要市場等待。該家族頒發的專利預計最早將於2036年到期。我們在美國又頒發了一項專利,旨在根據生物標記物和治療某些癌症的方法來選擇患者,預計到期日期不早於2039年。針對選擇患者的相應歐洲專利案件已經發佈,預計不會早於2039年到期。
BXCL701與各種其他分子、生物標記物和給藥方案的聯合應用是其他應用的方向。我們還針對BXCL701的新配方、不同的給藥方案、使用方法、聯合療法以及治療小細胞肺癌的方法,應用了四種PCT。我們也有一個針對生物標記物的臨時申請。我們預計,PCT和臨時申請發出的任何專利都將在2043年至2044年之前到期。
53
呈列基準
公司的簡明綜合財務報表是根據美國公認會計原則編制的。
我們運營業績的組成部分
產品收入,淨額
收入與IGALMI的銷售有關TM並反映出自2022年7月商業推出以來市場準入有限。收入是扣除回扣、按存儲容量使用計費、折扣和其他調整後的淨額。在2022年第四季度,我們開始直接與GPO等中介機構簽約。
經營成本及開支
銷貨成本
銷售商品的成本主要涉及生產、包裝和向客戶交付產品的成本,以及與庫存過剩或過時相關的成本。
研究與開發
我們的研發費用反映了與確定我們的臨牀前和臨牀候選產品相關的成本。支出主要包括我們研發人員的工資、福利和非現金股票薪酬、與進行我們非臨牀研究和臨牀試驗的合同研究組織和地點達成的協議產生的成本、從事研發活動的外部顧問的成本、差旅費用、獲取、開發和製造臨牀前和臨牀試驗材料和實驗室用品的成本,以及折舊和其他費用。支付給BioXcel LLC的款項也包括在研發費用中。與提供毒理學、藥理學、研究和發現、生物標記物研究和類似服務等非臨牀服務的第三方相關的成本包括在研究和開發費用的專業費用類別中。
我們按所發生的費用來支付研究和開發費用。
截至2024年9月30日和2023年9月30日的三個月和九個月,我們按計劃劃分的研發成本如下:
截至三個月 | 止九個月 | |||||||||||
9月30日, | 9月30日, | |||||||||||
2024 | 2023 | 2024 | 2023 | |||||||||
直接外部成本 | ||||||||||||
BXCL 501 | $ | 2,089 | $ | 9,857 | $ | 10,112 | $ | 41,335 | ||||
BXCL 701 | 208 | 1,528 |
| 1,638 | 6,291 | |||||||
其他研發計劃 | 197 | 1,212 |
| 663 | 3,492 | |||||||
直接外部成本總額 | $ | 2,494 | $ | 12,597 | $ | 12,413 | $ | 51,118 | ||||
內部人員費用 | 2,109 | 6,179 | 10,497 | 20,223 | ||||||||
直接成本總價 | $ | 4,603 | $ | 18,776 | $ | 22,910 | $ | 71,341 | ||||
間接成本和間接費用 | 498 | 843 | 1,624 | 3,051 | ||||||||
研發費用總額 | $ | 5,101 | $ | 19,619 | $ | 24,534 | $ | 74,392 |
54
銷售、一般和行政
銷售、一般和行政費用主要包括銷售、行政和行政人員的工資、福利和基於非現金股票的薪酬。銷售、一般和行政費用還包括尋求知識產權專利保護的法律費用、審計和稅務服務的專業費用以及保險費。我們還可能產生遵守公司治理、內部控制、投資者關係和披露以及適用於上市公司的類似要求的成本。
由於我們在2024年完成了重組活動,我們預計由於IGALMI重組後的商業化計劃,我們的銷售、一般和管理費用將繼續下降TM並降低了人員成本。
重組成本
2023年8月8日,我們的董事會批准了重新排序。我們採取行動減少某些不再被視爲持續運營核心的運營和員工支出,以擴大我們的現金跑道,推動高潛力臨牀開發和價值創造機會的創新和增長。這些行動包括在機構環境中改變IGALMI™的商業戰略,減少醫院內的商業化費用,暫停不再被確定爲持續運營核心的計劃,以及確定BXCL501的家庭治療設置機會的優先順序。
作爲這一戰略的一部分,公司董事會批准了公司裁員約60%的計劃。公司於2023年8月14日通知了受影響的員工。預計年度運營費用將減少約8萬美元。
由於重新調整了優先順序,該公司在截至2023年12月31日的一年中記錄了4163美元的重組成本。這些費用包括以現金支付的4063美元的遣散費和福利以及100美元的合同終止費用。在截至2023年12月31日的一年中,該公司支付了3998美元的遣散費和福利費用以及100美元的合同終止費用。截至2023年12月31日,重新排序基本完成,剩餘費用在截至2024年3月31日的三個月內支付。
2024年5月8日,該公司採取了更多行動,作爲其持續努力的一部分,以保存現金並優先投資於其核心臨牀項目。作爲這些行動的一部分,該公司開始進一步裁員約15%的公司當時的現有員工。該公司於2024年5月8日通知了受影響的員工,並記錄了截至2024年6月30日的三個月的總重組成本爲856美元。這些費用包括遣散費和福利費用,所有這些費用都在截至2024年6月30日的三個月期間支付。
2024年9月17日,該公司批准了一項額外裁員15人的計劃,約佔公司員工總數的28%(「臨牀優先排序」),以延長其現金跑道,並優先投資於其領先的神經科學資產BXCL501的臨牀開發。該公司估計,與臨牀優先排序有關的總費用約爲1,553美元,主要涉及遣散費和福利費用。本公司於2024年10月完成臨牀優先次序,並預計於2024年第四季度支付大部分相關費用
隨着優先次序的調整和其他重組活動的完成,公司截至2024年9月30日的現金和現金等價物爲40,837美元,這將使公司能夠爲其運營提供資金,並滿足2024年底之前的流動性要求。
其他費用(收入)
其他(收入)開支主要包括與本公司於2022年4月訂立的信貸協議有關的利息成本、衍生金融工具的公允價值變動,以及主要由貨幣市場基金組成的現金及現金等價物所賺取的利息收入。由於我們根據信貸協議提供的貸款在2023年12月之後實行浮動利率,因此未來的利息支出可能會增加
55
amendment to the Credit Agreement and, if we meet required milestones, we may draw down additional funds under the Credit Agreement.
Recently Issued Accounting Pronouncements
A description of recently issued accounting pronouncements is set forth in Note 3 to the condensed consolidated financial statements included elsewhere in this Quarterly Report on Form 10-Q.
Results of Operations
Comparison of the Three Months Ended September 30, 2024 and 2023
Product Revenue, Net
Commercial sales of IGALMITM launched in July 2022. As part of the Company’s Reprioritization, the IGALMITM commercial team shifted focus to a hospital/contracting strategy with a CAD team. The goal of the realigned CAD team is to work with large IDNs and drive sales utilizing a top-down approach, allowing the Company to continue to make inroads into the institutional market in a more cost-efficient manner. IGALMITM product revenue, net was $214 and $341 in the three months ended September 30, 2024 and 2023, respectively. The decrease in sales was primarily due to timing of re-orders from exisiting customers.
Cost of Goods Sold
Cost of goods sold for the three months ended September 30, 2024 and 2023, were $1,170 and $512, respectively. Cost of goods sold is related to the costs to produce, package and deliver IGALMITM to customers, as well as costs related to excess or obsolete inventory. We entered into a commercial supply agreement with ARx, LLC (“ARx”) pursuant to which ARx has agreed to exclusively manufacture and supply us with all of our worldwide demand of film formulation of Dex to be used for the commercial supply of IGALMITM and for ongoing clinical trials of our product candidate BXCL501, subject to certain alternative supply provisions. The increase in Cost of goods sold for the three months ended September 30, 2024 is the result of higher charges for reserves for excess or obsolete inventory compared to the same period in 2023. Charges for reserves for excess or obsolete inventory were $1,157 and $495 in the three months ended September 30, 2024 and 2023, respectively.
Research and Development Expense
Research and development expenses for the three months ended September 30, 2024 and 2023 were as follows:
Three months ended | |||||||||||||
September 30, | |||||||||||||
| 2024 |
| 2023 |
| Change | % Change | |||||||
Personnel and related costs | $ | 1,225 | $ | 4,534 | $ | (3,309) | (73) | % | |||||
Non-cash stock-based compensation |
| 884 |
| 1,645 |
| (761) | (46) | % | |||||
Professional fees |
| 1,316 |
| 3,341 |
| (2,025) | (61) | % | |||||
Clinical trials expense |
| 1,014 |
| 7,858 |
| (6,844) | (87) | % | |||||
Chemical, manufacturing and controls cost |
| 207 |
| 1,534 |
| (1,327) | (87) | % | |||||
Travel and other costs |
| 455 |
| 707 |
| (252) | (36) | % | |||||
Total research and development expenses | $ | 5,101 | $ | 19,619 | $ | (14,518) | (74) | % |
The overall decrease of $14,518 for the three months ended September 30, 2024 relative to the same period in 2023 was primarily attributable to:
● | Decreased clinical trials expense as a result of reduced costs associated with the wind down of the SERENITY III study evaluating BXCL501 for at-home use for the acute treatment of agitation related to schizophrenia and |
56
bipolar disorders, as well as the TRANQUILITY II and III study of BXCL501 for the potential treatment of agitation in patients with Alzheimer’s disease. |
● | Decreased professional fees due to lower pharmacology costs, research and discovery costs, toxicology, and consulting costs. |
● | Decreased personnel and related costs as a result of our Reprioritization and the further reduction in force in May 2024. |
● | Decreased chemistry, manufacturing and controls (“CMC”) costs associated with producing materials for our clinical trials of BXCL501 and BXCL701 for the treatment of prostate and lung cancers due to decreased clinical trial activities. |
Following IGALMITM’s approval by the FDA, we capitalize costs related to commercial production of IGALMITM as inventory and expense those CMC costs related to clinical trials.
Selling, General and Administrative Expense
Selling, general and administrative expenses for the three months ended September 30, 2024 and 2023 were as follows:
Three months ended |
| ||||||||||||
September 30, |
| ||||||||||||
| 2024 |
| 2023 |
| Change |
| % Change | ||||||
Personnel and related costs | $ | 953 | $ | 7,796 | $ | (6,843) | (88) | % | |||||
Non-cash stock-based compensation |
| 981 | 2,369 |
| (1,388) | (59) | % | ||||||
Professional fees |
| 4,285 | 9,186 |
| (4,901) | (53) | % | ||||||
Commercial and marketing | 279 | 2,989 | (2,710) | (91) | % | ||||||||
Insurance |
| 403 | 396 |
| 7 | 2 | % | ||||||
Travel and other costs |
| 782 | 1,608 |
| (826) | (51) | % | ||||||
Total selling, general and administrative expenses | $ | 7,683 | $ | 24,344 | $ | (16,661) | (68) | % |
The overall decrease of $16,661 for the three months ended September 30, 2024, relative to the same period in 2023 was primarily attributable to:
● | Decreased personnel and related costs as a result of the Reprioritization and the further reduction in force in May 2024. |
● | Decreased professional fees as a result of lower legal costs and the write-off of the OnkosXcel deferred IPO costs in 2023. |
● | Decreased commercial and marketing expense as result of higher spending in 2023 related to media, marketing and data and business analytics costs associated with commercialization of IGALMITM. |
● | Decreased travel and other costs as a result of the commercial launch activities that occurred in 2023 and the Reprioritization impact on 2024. |
● | Decreased non-cash stock based compensation costs as a result of the Reprioritization and other restructuring actions. |
57
Restructuring Costs
Restructuring costs charged in the three months ended September 30, 2024 was $1,553 related to the Clinical Prioritization approved in September 2024. Restructuring costs charged in the three months ended September 30, 2023 was $4,163 related to the Strategic Reprioritization approved in August 2023.
Other Expense (Income)
Interest expense increased to $3,790 for the three months ended September 30, 2024 from $3,252 in the same period in 2023 primarily due to higher debt balances and interest rates under the Credit Agreement. The expense was partially offset by lower interest income earned on lower levels of cash and cash equivalents that were held primarily in short-term money market funds. Interest income decreased to $616 for the three months ended September 30, 2024 compared to $1,068 for three months ended September 30, 2023, due to lower average cash balances during the year. Other (income) expense, net is primarily associated with changes in fair value of derivative financial instruments for the period, which relate to instruments associated with the Credit Agreement and the March 2024 registered direct equity offering.
Comparison of the Nine Months Ended September 30, 2024 and 2023
Product Revenue, Net
IGALMITM product revenue, net was $1,900 and $1,004 in the nine months ended September 30, 2024 and 2023, respectively. The increase in sales was primarily due to a single large order received from a GPO during the second quarter of 2024, as well as increased market penetration, resulting from the implementation of our new sales strategy.
Cost of Goods Sold
Cost of goods sold for the nine months ended September 30, 2024 and 2023, were $1,311 and $546, respectively. Cost of goods sold is primarily related to the costs to produce, package and deliver IGALMITM to customers, as well as costs related to excess or obsolete inventory. The increase in Cost of goods sold for the nine months ended September 30, 2024 was the result of the increase in the units sold compared to the same prior year period and the increase in the reserve for excess and obsolete inventory. Charges for reserves for excess or obsolete inventory were $1,202 and $495 in the nine months ended September 30, 2024 and 2023, respectively.
Research and Development Expense
Research and development expenses for the nine months ended September 30, 2024 and 2023 were as follows:
Nine months ended |
| ||||||||||||
September 30, |
| ||||||||||||
| 2024 |
| 2023 |
| Change |
| % Change | ||||||
Personnel and related costs | $ | 8,050 | $ | 15,383 | $ | (7,333) | (48) | % | |||||
Non-cash stock-based compensation |
| 2,446 |
| 4,840 |
| (2,394) | (49) | % | |||||
Professional fees |
| 4,079 |
| 12,606 |
| (8,527) | (68) | % | |||||
Clinical trials expense |
| 6,915 |
| 31,578 |
| (24,663) | (78) | % | |||||
Chemical, manufacturing and controls cost |
| 1,534 |
| 7,374 |
| (5,840) | (79) | % | |||||
Travel and other costs |
| 1,510 |
| 2,611 |
| (1,101) | (42) | % | |||||
Total research and development expenses | $ | 24,534 | $ | 74,392 | $ | (49,858) | (67) | % |
58
The overall decrease of $49,858 for the nine months ended September 30, 2024 relative to the same period in 2023 was primarily attributable to:
● | Decreased clinical trials expense as a result of reduced costs associated with the wind down of the SERENITY III study evaluating BXCL501 for at-home use for the acute treatment of agitation related to schizophrenia and bipolar disorders, as well as the TRANQUILITY II study of BXCL501 for the potential treatment of agitation in patients with Alzheimer’s disease. |
● | Decreased professional fees due to lower pharmacology costs, research and discovery costs, toxicology and consulting costs. |
● | Decreased personnel and related costs as a result of our Reprioritization and further reduction in force in May 2024. |
● | Decreased chemistry, manufacturing and controls (“CMC”) costs associated with producing materials for our clinical trials of BXCL501 and BXCL701 for the treatment of prostate and lung cancers due to decreased clinical trial activities. |
● | Decreased non-cash stock based compensation costs as a result of the Reprioritization and other restructuring actions. |
Selling, General and Administrative Expense
Selling, general and administrative expenses for the nine months ended September 30, 2024 and 2023 were as follows:
Nine months ended |
| ||||||||||||
September 30, |
| ||||||||||||
| 2024 |
| 2023 |
| Change |
| % Change | ||||||
Personnel and related costs | $ | 6,642 | $ | 25,816 | $ | (19,174) | (74) | % | |||||
Non-cash stock-based compensation |
| 3,908 | 10,175 |
| (6,267) | (62) | % | ||||||
Professional fees |
| 15,069 | 17,998 |
| (2,929) | (16) | % | ||||||
Commercial and marketing | 907 | 12,166 | (11,259) | (93) | % | ||||||||
Insurance | 1,195 | 1,347 | (152) | (11) | % | ||||||||
Travel and other costs |
| 2,677 | 6,308 |
| (3,631) | (58) | % | ||||||
Total selling, general and administrative expenses | $ | 30,398 | $ | 73,810 | $ | (43,412) | (59) | % |
The overall decrease of $43,412 for the nine months ended September 30, 2024, relative to the same period in 2023 was primarily attributable to:
● | Decreased personnel and related costs as a result of the Reprioritization. |
● | Decreased professional fees, primarily related to the expensing of the OnkosXcel deferred IPO costs in 2023 and reductions in consulting fees. |
● | Decreased commercial and marketing expense as result of higher spending in 2023 related to media, marketing and data and business analytics costs associated with commercialization of IGALMITM. |
● | Decreased travel and other costs as a result of the commercial launch activities that occurred in 2023 and the Reprioritization impact on 2024. |
● | Decreased non-cash stock based compensation costs as a result of the Reprioritization and other restructuring actions. |
59
Restructuring Costs
Restructuring costs charged in the nine months ended September 30, 2024 was $2,409 related to the reductions in force approved in May and September 2024. Restructuring costs of $4,163 were charged in the nine months ended September 30, 2023.
Other Expense (Income)
Interest expense increased to $11,097 for the nine months ended September 30, 2024 from $9,879 in the same period in 2023 primarily due to higher debt balances and interest rates under the Credit Agreement. The expense was partially offset by lower interest income earned on lower levels of cash and cash equivalents that were held primarily in short-term money market funds. Interest income decreased to $2,234 for the nine months ended September 30, 2024 compared to $4,703 for nine months ended September 30, 2023, due to lower average cash balances during the year. Other (income) expense, net is primarily associated with changes in fair value of derivative financial instruments for the period, which relate to instruments associated with the Credit Agreement and the March 2024 registered direct equity offering.
Inflation
Inflation generally affects us by increasing our cost of labor and clinical trial costs. We do not believe that inflation has had a material effect on our results of operations during the periods presented. For a discussion of inflationary risks to our future revenues under the Inflation Reduction Act, see “Healthcare reform measures could hinder or prevent our product candidates’ commercial success.” in Part II, Item 1A, “Risk Factors” elsewhere in this Quarterly Report on Form 10-Q.
Liquidity and Capital Resources
As of September 30, 2024, we had cash and cash equivalents of $40,387, working capital of $22,235 and stockholders’ deficit of $85,633. Net cash used in operating activities was $57,218 and $128,143 for the nine months ended September 30, 2024 and 2023, respectively. We incurred losses of approximately $48,740 and $156,797 for the nine months ended September 30, 2024 and 2023, respectively. We will need to generate significant product revenues to achieve profitability. Our history of significant losses, negative cash flows from operations, potential near-term increased covenant-driven amortization payments or full repayment obligations under our Credit Agreement, the regulatory event of default triggers under the Credit Agreement, other funding requirement covenants under the Credit Agreement, limited liquidity resources currently on hand, and dependence on our ability to obtain additional financing to fund our operations after the current resources are exhausted, about which there can be no certainty, have resulted in management’s assessment that there is substantial doubt about our ability to continue as a going concern for a period of at least 12 months from the issuance date of the financial statements included in this Quarterly Report on Form 10-Q.
Successful completion of the Company’s development programs and, ultimately, the attainment of profitable operations are dependent upon future events, including obtaining adequate financing to support the Company’s cost structure and operating plan. Management’s plans to improve the Company’s liquidity and reduce its operating expenses and capital requirements include, among other things, pursuing one or more of the following steps to raise additional capital, none of which can be guaranteed or are entirely within the Company’s control:
●raise funding through the sale of the Company’s equity securities;
●raise funding through third-party investments in or other strategic options for OnkosXcel;
●raise funding through debt financing and/or restructuring of its existing Credit Agreement;
●establish collaborations with potential partners to advance the Company’s product pipeline;
●establish collaborations with potential marketing partners;
●reduce overhead and headcount to focus on core priorities, and/or
●any combination of the foregoing.
We require additional funding to continue as a going concern. There are no assurances that we will be successful in obtaining an adequate level of financing as and when needed to finance our operations on terms acceptable to us or at
60
all, particularly when there is market uncertainty or an economic downturn or if other events make investment in our securities less appealing. If we are unable to secure adequate additional funding as and when needed on acceptable or commercially reasonable terms, we may have to significantly delay, scale back or discontinue the development and commercialization of one or more product candidates. In addition, there are various macro-economic trends affecting the financing markets whose impact on our liquidity and future funding requirements are uncertain as of the filing date of this Quarterly Report on Form 10-Q. We will need substantial additional funding, and if we are unable to raise capital when needed, we could be compelled to pursue alternative options, including, without limitation, implementing further workforce reductions, reducing or ceasing product development programs and advancement of our clinical trials and product candidates, selling our assets or seeking other strategic alternatives. See “Risks Related to Financial Position and Need for Additional Capital — We will need substantial additional funding, and if we are unable to raise capital when needed, we could be forced to delay, reduce or eliminate our product development programs or commercialization efforts or otherwise seek strategic alternatives.” in Part II. Item 1A., “Risk Factors” elsewhere in this Quarterly Report on Form 10-Q. Further, if we are unable to raise additional capital or successfully consummate a strategic transaction, we may trigger an event of default under our Credit Agreement. See “Risks Related to Financial Position and Need for Additional Capital — We have identified conditions and events that raise substantial doubt regarding our ability to continue as a going concern.” in Part II. Item 1A., “Risk Factors” elsewhere in this Quarterly Report on Form 10-Q.
Sources of Liquidity
We have primarily focused our efforts on raising capital and building the products in our pipeline, and, although we generate revenue from sales of IGALMITM, we do not expect to generate positive cash flows from operations in the near term. Since our inception, our operations have been financed primarily from proceeds from the sale of equity securities, including our initial public offering, private placements of our common stock, registered offerings of our common stock, an Open Market Sale Agreement (the “Sale Agreement”) with Jefferies LLC (“Jefferies”), and borrowings under strategic financing arrangements (as described below). We have not yet established an ongoing source of revenue sufficient to cover our operating costs and will need to do so in future periods.
Financing Agreements
In April 2022, we entered into two financing agreements: the Credit Agreement and the RIFA. Pursuant to the Credit Agreement, the Lenders originally agreed to provide us up to $135,000 in senior secured term loans to us. On April 28, 2022, we borrowed the first $70,000 tranche of loans under the Credit Agreement. Pursuant to the RIFA, the Purchasers agreed to provide us with up to $120,000 in financing for our near-term commercial activities of IGALMITM, development and commercialization of BXCL501 and other general corporate purposes. On July 8, 2022, we drew down the first tranche of $30,000 under the RIFA. In connection with the Credit Agreement, we granted to the Lenders (i) warrants to purchase up to 278 shares of our common stock (the “Original Warrants”), (ii) rights to purchase up to $5,000 of our common stock and (iii) warrants to purchase up to 175 individual ownership units (i.e., not in thousands) in OnkosXcel (the “OnkosXcel Warrants”).
In November 2023, we, the Lenders and OFA entered into a Waiver and First Amendment to Credit Agreement and Guaranty (the “First Amendment”) that provided for, among other things, a waiver and a modification to the covenant in the Credit Agreement regarding investments in OnkosXcel, pursuant to which we are permitted to invest up to a maximum of $30,000 at any time outstanding in OnkosXcel, increased from the $25,000 at any time outstanding. The First Amendment waived any defaults or events of default arising under the Credit Agreement due to a breach prior to the date of the First Amendment of the OnkosXcel investment covenant, or a breach of our obligation to notify OFA of such default, including our investment in an amount in excess of what was previously permitted under the OnkosXcel investment covenant. In connection with the First Amendment, we paid to the Lenders a fee of $180 (representing 0.25% of the loans outstanding under the Credit Agreement on the date of the First Amendment) and agreed to pay to the Lenders an exit fee equal to 0.25% of the loans under the Credit Agreement repaid upon maturity or prepayment of the loans.
In December 2023, we entered into the Second Amendment to Credit Agreement and Guaranty and Termination of Revenue Interest Financing Agreement (the “Second Amendment”) with the Lenders and OFA, as administrative agent. The Second Amendment terminated the RIFA and converted the financing previously provided to us thereunder to term
61
loans under the Credit Agreement. In addition, the Second Amendment replaced the Credit Agreement’s existing “Tranche B” and “Tranche C” term loan opportunities with three new tranches aggregating up to $100,000 in potential funding:
● | A $20,000 “Tranche B” term loan available upon satisfaction of the following conditions on or before December 31, 2024: (i) us raising an aggregate of at least $40,000 after the date of the First Amendment from (a) equity proceeds or (b) a bona fide contract with a governmental authority to use BXCL501 for opioid withdrawal, (ii) initiation of a new clinical trial in the TRANQUILITY program based on our meeting with the FDA held on October 11, 2023, and (iii) the total pro forma indebtedness outstanding under the Credit Agreement as a percentage of our trailing 30-day market capitalization being less than 30%; |
● | A $30,000 “Tranche C” term loan available upon satisfaction of the following conditions on or before December 31, 2025: (i) either (a) receipt of approval from the FDA of an sNDA in respect of the use of BXCL501 for the acute treatment of agitation associated with dementia or (b) the receipt of approval from the FDA of an sNDA in respect of the use of BXCL501 for (x) the acute treatment of agitation associated with schizophrenia in adults and (y) the acute treatment of agitation associated with bipolar I or II disorder in adults, in each case, in the community/at home setting without the requirement for administration under the supervision of a healthcare provider, and (ii) the total pro forma indebtedness outstanding under the Credit Agreement as a percentage of our trailing 30-day market capitalization being less than 30%; and |
● | A $50,000 “Tranche D” term loan available upon satisfaction of the following conditions on or before December 31, 2025: (i) the conditions precedent to the borrowing of Tranche C (as described in the preceding bullet point) have been satisfied, and (ii) our total net revenue attributable to sales of BXCL501 (for the avoidance of doubt, including any revenues attributable to use of BXCL501 for opioid withdrawal) for the trailing twelve consecutive month period exceeding a specified amount. |
In addition, pursuant to the Second Amendment, the Lenders agreed to permit the Company to invest up to a maximum of $30,865 at any time outstanding in OnkosXcel, increased from $30,000. The Second Amendment also modified the interest rate of the loans provided under the Credit Agreement to be a floating rate per annum equal to the secured overnight financing rate (“SOFR”) (subject to a SOFR floor of 2.5% and a cap of 5.5%) plus 7.5%.
Following the Second Amendment, we must also comply with certain covenants under the Credit Agreement, including a financial covenant that requires we maintain a minimum cash liquidity amount of $15,000 (or higher upon certain events) and a modified minimum revenue requirement measured on a quarterly basis based on the revenue attributable to BXCL501 for the six consecutive month period ending on the last day of the relevant quarter (the “Revenue Covenant”), subject to cure payments of not less than $1,000 if we fail to meet the minimum revenue requirement. The Revenue Covenant applies beginning with the six-month period ending on December 31, 2024. If we fail to meet the minimum Revenue Covenant for the preceding six-month periods ending on December 31, 2024, March 31, 2025, June 30, 2025 and September 30, 2025, we could be required to make revenue cure payments of up to $4,500, $6,200, $8,500, and $8,500, respectively, plus aggregate prepayment fees of $1,900. Under the Credit Agreement, these cure payments would be due on April 21, 2025, June 6, 2025, September 5, 2025 and December 8, 2025, respectively. We are only permitted to make cure payments for revenue shortfalls up to three times during the term of the Credit Agreement, after which we would default on the Credit Agreement if we are unable to satisfy the minimum revenue requirement for any subsequent fiscal quarter. As of September 30, 2024, we had aggregate principal indebtedness of $106,501 outstanding under the Credit Agreement.
In connection with the closing of the Second Amendment, we amended and restated the Original Warrants granted to the Lenders on April 19, 2022 to purchase up to 278 shares of the Company’s common stock at an exercise price of $20.04 per share. Pursuant to the amendment and restatement of the Original Warrants, dated December 5, 2023 (the “Amended and Restated Original Warrants”), the exercise price of the Original Warrants has been reduced to $3.6452 per share, which represents the arithmetic average of the volume-weighted average price of the Company’s common stock on the Nasdaq Capital Market during the 30 trading days preceding the Second Amendment Effective Date. In addition, the Company granted new warrants to the Lenders to purchase up to 70 shares of the Company’s common
62
stock (the “2023 Warrant Shares”) at an exercise price of $3.6452 per share (the “2023 Warrants”). The Original Warrants and the 2023 Warrants will expire on April 19, 2029 and may be net exercised at the holder’s election.
On March 20, 2024 (the “Effective Date”), we entered into the Fourth Amendment to the Credit Agreement (“the Fourth Amendment”), pursuant to which the Lenders waived the covenant that we not receive a report and opinion from our independent registered public accounting firm that contains a “going concern” or similar qualification with respect to our financial statements for the year ended December 31, 2023. Accordingly, while our independent registered public accounting firm’s report contained in our Annual Report on Form 10-K for the year ended December 31, 2023 contains a “going concern” explanatory paragraph, it does not constitute an event of default under the Credit Agreement.
The Fourth Amendment includes covenants that we will receive, (i) after the Effective Date and on or before April 15, 2024, at least $25,000 in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in non-refundable cash consideration from partnering transactions entered into after the Effective Date (so long as such partnering transactions would not require us or any of our subsidiaries to make any cash investments in connection with the partnering transactions and no such cash investments are made), and (ii) after the Effective Date and on or before November 30, 2024, at least $50,000 (for the avoidance of doubt, inclusive of amounts previously counted toward the preceding clause (i)) in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent (as defined in the Credit Agreement) in its sole discretion ) from partnering transactions entered into after the Effective Date. Failure to perform this covenant would constitute (A) a default under the Credit Agreement and (B) an event of default under the Credit Agreement, subject to a cure period, in the case of clause (i) of the preceding sentence, until May 15, 2024 (for the avoidance of doubt, failure to perform clause (ii) would constitute an immediate event of default under the Credit Agreement without any cure or grace period).
In addition, the Fourth Amendment provides that if we have not, after the Effective Date and on or before September 30, 2024, received at least $40,000 in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions entered into after the Effective Date, the “Minimum Liquidity Amount” (as defined in the Credit Agreement) that we are required to maintain at all times will increase to $25,000 from $15,000, unless and until we have received, after the Effective Date and on or before November 30, 2024, at least $50,000 in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions entered into after the Effective Date. As of the date of this filing, we still need to raise (i) approximately an additional $10,000 in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions by September 30, 2024 in order to prevent such an increase in the Minimum Liquidity Amount that we are required to maintain under our Credit Agreement and (ii) approximately an additional $20,000 in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions by November 30, 2024 in order to prevent triggering an event of default under our Credit Agreement. Even if we raise the foregoing amounts within these timeframes, we may need to raise additional capital to continue as a going concern, and failure to continue as a going concern in connection with our Annual Report on Form 10-K for the fiscal year ended December 31, 2024 could trigger an event of default under our Credit Agreement, and the lenders could exercise their rights and remedies under the Credit Agreement. As of September 30, 2024, the Company had satisfied $32,687 of the $40,000 required to maintain the Minimum Liquidity Amount and the $50,000 gross proceeds requirement. As a result, the Minimum Liquidity Amount of $15,000 increased to $25,000 as of September 30, 2024.
In connection with the Fourth Amendment, on the Effective Date, we granted new warrants to the Lenders to purchase up to 100 shares of our common stock (the “2024 Warrant Shares”) at an exercise price of $3.0723 per share (the “2024 Warrants”), which represents a 10% premium over the arithmetic average of the volume-weighted average price of our common stock on the Nasdaq Capital Market during the 30 trading days preceding the Effective Date. The 2024 Warrants will expire on April 19, 2029 and may be net exercised at the holder’s election.
63
In addition, pursuant to the Credit Agreement, the Lenders have the right to purchase shares of our common stock, so long as borrowings under the Credit Agreement are outstanding, for a purchase price of $5,000 at a price per share equal to a 10% premium to the volume-weighted average price of the common stock over the 30 trading days prior to the Lenders’ election to proceed with such equity investment (the “Equity Investment Right”). We entered into a registration rights agreement with the Lenders (as amended and restated in connection with the Second Amendment, the “Amended and Restated Registration Rights Agreement”) and filed registration statements on Form S-3 to register the shares issuable upon exercise of the Original Warrants, 2023 Warrants and, if issued, the shares related to the Equity Investment Right, for resale. The maximum shares of our common stock issuable under the Original Warrants, the 2023 Warrants and the Lenders’ Equity Investment Right is 5,852. On the Effective Date, we further amended and restated the Amended and Restated Registration Rights Agreement (the “Second Amended and Restated Registration Rights Agreement”) with the Lenders. Pursuant to the Second Amended and Restated Registration Rights Agreement, we agreed to register the 2024 Warrant Shares for resale.
As part of entering into the Credit Agreement, OnkosXcel, a wholly owned subsidiary of BTI, granted the OnkosXcel Warrants to the Lenders to purchase 175 individual limited liability company units. The strike price of the OnkosXcel Warrants is formulaic based on the value of OnkosXcel at the time of exercise and can only be exercised upon occurrence of an equity related liquidity event for OnkosXcel of at least $20,000. The exercise price per unit of the OnkosXcel Warrants will be set upon the earlier of the closing of the next sale (or series of related sales) by OnkosXcel of equity securities of OnkosXcel with aggregate proceeds of not less than $20,000 to unrelated third parties (the “Next Equity Financing”) at an exercise price per unit equal to a 10% premium over the price per unit of the equity securities sold by OnkosXcel in such Next Equity Financing or, in the event of a sale of OnkosXcel prior to the Next Equity Financing or an initial public offering constituting the Next Equity Financing, the lesser of (x) 75% of the fair value of the consideration to be paid for a unit upon the consummation of such transaction and (y) 150% of the valuation applicable to the initial profits units issued by OnkosXcel after the closing of the Credit Agreement. The OnkosXcel Warrants are transferable with approval from BTI, which cannot be unreasonably withheld, expire on April 19, 2029, and may be net exercised at the holder’s election.
See Note 9, Debt and Credit Facilities included elsewhere in this Quarterly Report on Form 10-Q for additional information relating to the Credit Agreement and RIFA, including applicable interest rates, payment obligations and certain restrictive and financial covenants thereunder. As of September 30, 2024, we were in compliance with all restrictive and financial covenants under the Credit Agreement.
ATM Program
In May 2021, we entered into the Sale Agreement with Jefferies pursuant to which we could offer and sell shares of our common stock, having an aggregate offering price of up to $100,000, from time to time, through an “at the market offering” program under which Jefferies will act as sale agent. On November 1, 2023, we entered into an amendment to the Sale Agreement with Jefferies to increase the size of the “at the market offering” program; pursuant to the Sale Agreement, as amended, we can offer and sell shares of our common stock having an aggregate offering price of up to $150,000 (excluding any shares of common stock already sold in the “at the market offering” program prior to the date of the amendment), from time to time, through an “at the market offering” program under which Jefferies will act as sale agent. During the year ended December 31, 2023, we sold 1,408 shares under the Sale Agreement for net proceeds of $26,221. For the three months ended September 30, 2024, we sold 361 shares under the Sale Agreement for gross proceeds of $468 and received proceeds of $453, net of issuance costs of $14. For the nine months ended September 30, 2024, we sold 3,847 shares under the Sale Agreement for gross proceeds of $7,682 and received proceeds of $7,451, net of issuance costs of $231.
Common Stock Financing Activities
As discussed in Note 11, Common Stock Financing Activities included elsewhere in this Quarterly Report on Form 10-Q, on March 25, 2024, the Company entered into a Securities Purchase Agreement (the “Purchase Agreement”) with the purchasers named therein (collectively, the “Purchasers”). Pursuant to the Purchase Agreement, the Company agreed to issue and sell to the Purchasers in a registered direct offering (the “Offering”) under an effective shelf registration statement on Form S-3 (File No. 333-275261) and a related prospectus supplement filed with the Securities and Exchange Commission on March 25, 2024 (the “Prospectus Supplement”) an aggregate of 3,055 shares
64
(the “Shares”) of common stock, par value $0.001 per share, and accompanying warrants (the “Accompanying Warrants”) to purchase up to 3,055 shares of common stock at an offering price of $2.901 per Share and Accompanying Warrant and pre-funded warrants (the “Pre-Funded Warrants”) to purchase up to 5,565 shares of common stock and Accompanying Warrants to purchase up to 5,565 shares of common stock, at an offering price of $2.900 per share underlying each Pre-Funded Warrant and Accompanying Warrant, which equals the offering price per Share and Accompanying Warrant less the $0.001 exercise price per share of the Pre-Funded Warrants. The Pre-Funded Warrants and Accompanying Warrants are not listed on the Nasdaq Capital Market or any other securities exchange or trading system and the Company does not intend to list them. On March 27, 2024, The Company received $25,000 of gross proceeds from the Offering. During the third quarter of 2024, the Company received $467 of gross proceeds from the issuance of the Company’s common stock. The Company intends to use the proceeds from these financings, together with its existing cash and cash equivalents, to fund planned clinical trials of BXCL501, commercialization activities for IGALMI™ and for working capital and other general corporate purposes.
The Pre-Funded Warrants have an exercise price per share of common stock equal to $0.001 per share. The exercise price and the number of shares of common stock issuable upon exercise of the Pre-Funded Warrants are subject to appropriate adjustments in the event of certain stock dividends and distributions, stock splits, stock combinations, reclassifications or similar events affecting the common stock. The Pre-Funded Warrants are exercisable at any time after the date of issuance. For the three months ended September 30, 2024, we received $2 for the exercise of 1,705 Pre-funded Warrants.For the nine months ended September 30, 2024, we received $6 for the exercise of 5,565 Pre-funded Warrants.
The Accompanying Warrants have an exercise price per share of common stock equal to $3.20 per share. The exercise price and the number of shares of common stock issuable upon exercise of the Accompanying Warrants are subject to appropriate adjustments in the event of certain stock dividends and distributions, stock splits, stock combinations, reclassifications or similar events affecting the Common Stock. The Accompanying Warrants will be exercisable at any time after the date of issuance and will expire on the fifth anniversary of the date of issuance. The Accompanying Warrants failed to meet the requirements to be indexed to equity and equity classified, and meet the definition of a derivative instrument. Therefore, these instruments are recorded as Derivative liabilities in the Condensed Consolidated Balance Sheet as of September 30, 2024. Therre were no exercises of the Accompanying Warrants as of September 30, 2024.
Cash Flows
Nine months ended September 30, | ||||||
| 2024 |
| 2023 | |||
Cash (used in) provided by: | ||||||
Operating activities | $ | (57,218) | $ | (128,143) | ||
Investing activities | $ | — | $ | (20) | ||
Financing activities | $ | 32,384 | $ | 24,399 |
Operating Activities
Net cash used in operating activities for the nine months ended September 30, 2024 was $57,218 and was primarily attributable to our net loss of $48,740, a $736 decrease in Accrued interest, a $997 decrease in Accounts payable, accrued expenses, due to related parties and other current liabilities a $1,017 increase in Prepaid expenses, other current assets and other assets, and a $16,884 change in the fair value of derivative liabilities, partially offset by a $466 decrease in Inventory, a $67 decrease in Accounts receivable, $6,355 of non-cash stock-based compensation, and $3,821 of payable-in-kind interest. The decrease in cash used in operating activities compared to the prior year reflects our actions taken under the Reprioritization.
Net cash used in operating activities for the nine months ended September 30, 2023 was $128,143 and was primarily attributable to our net loss of $156,797, which was due to our being in the early stages of commercial launch of IGALMITM and our continued product development efforts, in part offset by $15,015 of non-cash stock-based compensation, a $9,098 increase in accounts payable, accrued expenses due to related parties, and other current
65
liabilities, a $1,724 decrease in prepaid expenses, other current assets and other assets, and a $1,153 increase in accrued interest.
Investing Activities
Net cash used in investing activities for the nine months ended September 30, 2024 and 2023 was $0 and $20, respectively.
Financing Activities
Net cash provided by financing activities for the nine months ended September 30, 2024, was $32,384 and was attributable to $25,000 in proceeds received from the March 2024 registered direct offering and net proceeds received from the sale of common stock under the Sale Agreement with Jefferies of $7,451.
Net cash provided by financing activities for the nine months ended September 30, 2023 was $24,399 and was primarily attributable to net proceeds received from the sale of common stock under the Sale Agreement with Jefferies of $23,918 and the exercise of stock options.
Operating Capital and Capital Expenditure Requirements
We expect to continue to incur significant operating losses at least for the next several years as we commercialize IGALMITM and as we expand our clinical trials of and seek marketing approval focused on BXCL501 while pursuing development of additional product candidates for BXCL502, BXCL701 and BXCL702. We expect to continue to incur net losses in the near term. Our net losses may fluctuate significantly from quarter-to-quarter and year-to-year, depending on the timing of our planned clinical trials and our expenditures on other research and development activities.
We have based our projections of operating capital requirements on assumptions that may prove to be incorrect, and we may use all of our available capital resources sooner than we expect. Because of the numerous risks and uncertainties associated with research, development, and commercialization of pharmaceutical products, we are unable to estimate the exact amount of our operating capital requirements. We anticipate that our expenses will increase substantially as we:
● | initiate and continue our clinical development of our product candidates; |
● | conduct additional research and development with our product candidates; |
● | seek to identify, acquire, license, develop and commercialize product candidates; |
● | integrate acquired technologies into a comprehensive regulatory and product development strategy; |
● | maintain, expand and protect our intellectual property portfolio; |
● | hire scientific, clinical, quality control and administrative personnel and utilize professional services, including consultants, lawyers, and accountants; |
● | add operational, financial and management information systems and personnel, including personnel to support our drug development and commercial efforts; |
● | seek regulatory approvals for any product candidates that successfully complete clinical trials; |
● | fully develop a sales, marketing and distribution infrastructure and scale up external manufacturing capabilities to commercialize IGALMITM and any product candidates for which we may obtain regulatory approval; and |
● | continue to operate as a public company. |
We believe that our existing cash and cash equivalents as of September 30, 2024 will not be sufficient to enable us to fund operating expenses and capital expenditure requirements for at least the next 12 months from the date of the issuance of the condensed consolidated financial statements included in this Quarterly Report on Form 10-Q, including funding our ongoing research and development and commercialization efforts. In particular, after giving effect to the Reprioritization and other restructuring actions, we believe that our cash and cash equivalents of $40,387 as of September 30, 2024 will allow us to fund our operations and meet our liquidity requirements to the end of 2024. We expect that we will need to obtain substantial additional funding to fund our ongoing operations and planned trials. To the extent that we raise additional capital through the sale of common stock, convertible securities or other equity
66
securities, the ownership interests of our existing stockholders may be materially diluted, and the terms of these securities could include liquidation or other preferences that could adversely affect the rights of our existing stockholders. In addition, debt financing, if available, would result in increased fixed payment obligations and may involve agreements that include restrictive covenants that limit our ability to take specific actions, such as incurring additional debt, making capital expenditures, or declaring dividends, which could adversely impact our ability to conduct our business. Our failure to raise capital as and when needed would have a negative impact on our financial condition and our ability to pursue our business strategy. If we are unable to raise capital when needed or on attractive terms, we could be forced to significantly delay, scale back or discontinue the development or commercialization of our product candidates, seek collaborators at an earlier stage than otherwise would be desirable or on terms that are less favorable than might otherwise be available, and relinquish or license, potentially on unfavorable terms, our rights to our product candidates that we otherwise would seek to develop or commercialize ourselves. We can provide no assurance that will be successful in obtaining additional necessary resources and, if we are unable to fund our operations, including our clinical trials, we may need to focus on advancing fewer of our product candidates or otherwise consider strategic alternatives.
Contractual Obligations and Commitments
In April 2022, the Company signed a commercial supply agreement that requires minimum annual payments for the first three years of the agreement that in aggregate total $10,000 for the three-year period, of which $5,000 was originally due in year ended 2024. On July 11, 2024, the Company entered into an amendment to the commercial supply agreement (the “Product Supply Agreement Amendment”) that reduces the specified minimum annual payment payable by the Company over the next three years starting in 2024 and, thereafter, for a specified interval, provides for minimum annual payments to the extent that the Company receives approval of a supplemental new drug application (“sNDA”) or a new drug application (“NDA”) from the FDA for enumerated indications. The Company’s renegotiated agreement reduces the minimum commitment for 2024 to $1,000 and thereafter for the term of the agreement in annual amounts ranging from $2,000 to $5,000 subject, in certain instances, to the extent that the Company receives approval of an sNDA or NDA from the FDA for enumerated indications. In accordance with the Product Supply Agreement Amendment, the minimum commitments were reduced to $1,000, $2,000 and $2,000 in the years 2024, 2025, and 2026. In addition, the Company agreed to make a reconciliation payment of $1,200 in the third quarter of 2024 for full settlement for amounts due prior the July 11, 2024 amendment.
In February 2022, we signed a distribution agreement with a third-party to distribute product related to BXCL501 in the U.S. The distributor will be paid defined fees for its services under the agreement, which can be terminated by either party for cause. The distribution agreement can also be terminated by us without cause, subject to payment of agreed upon termination fees.
BTI leases office space for its corporate headquarters at 555 Long Wharf Drive, New Haven, Connecticut (the “HQ Lease”). The HQ Lease expires in February 2026. The Company has an option to renew the HQ Lease for one additional five-year term. Payments under the HQ Lease are fixed. The Company has approximately $551 of payments remaining under the HQ Lease. For additional details, see Note 13, Leases in the Notes to Condensed Consolidated Financial Statements included in this Quarterly Report on Form 10-Q for additional information relating to the Company’s leases.
In addition, we are obligated to make quarterly interest payments under our Credit Agreement, respectively, as well as potential Revenue Covenant cure payments under the Credit Agreement. For additional details, see Note 9, Debt and Credit Facilities in the Notes to Condensed Consolidated Financial Statements included in this Quarterly Report on Form 10-Q for additional information relating to the Company’s debt payment obligations. See also “— Sources of Liquidity” for additional information regarding anticipated amendments to the Company’s debt payment obligations.
Critical Accounting Policies and Estimates
Our critical accounting policies and estimates are described in “Management’s Discussion and Analysis of Financial Condition and Results of Operations-Critical Accounting Policies and Estimates” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2023. We have reviewed and determined that those critical accounting policies and estimates remain our critical accounting policies and estimates as of and for the nine months
67
ended September 30, 2024. No material changes were made to our existing critical accounting policies and estimates during the period presented. Refer to Note 3, Summary of Significant Accounting Policies in the Notes to Condensed Consolidated Financial Statements elsewhere in this Form 10-Q.
Item 3. Quantitative and Qualitative Disclosures about Market Risk
Foreign Exchange Risk
As of September 30, 2024, we had $40,387 of cash and cash equivalents. Our cash and cash equivalents are primarily held in money market funds that hold U.S. government cash equivalent instruments. We do not participate in any foreign currency hedging activities and have limited exposure to other derivative financial instruments, primarily resulting from the terms and conditions of the Credit Agreement. We did not recognize any significant exchange rate losses during the three months ended September 30, 2024 and 2023.
We do not believe that our cash and cash equivalents have significant risk of default or illiquidity. While we believe our cash and cash equivalents do not contain material market risk, we cannot provide absolute assurance that in the future our investments will not be subject to adverse changes in market value. In addition, we maintain significant amounts of cash at one or more financial institutions that exceed federally insured limits. In the event of a failure of any of the financial institutions where we maintain our cash and cash equivalents, there can be no assurance that we will be able to access uninsured funds in a timely manner or at all.
Interest Rate Risk
The loans under the Credit Agreement bear interest at a variable annual rate of the Secured Overnight Financing Rate (“Term SOFR”) (but not less than 2.5% or more than 5.5%) plus 7.5% payable quarterly. Consequently, we have material interest rate exposure due to our indebtedness, however this risk is hedged in part by the floor and ceiling on Term SOFR rates.
Capital Market Risk
We currently do not have substantial product revenues and depend on funds raised through other sources. One source of funding includes future debt or equity offerings. Our ability to raise funds in this manner depends upon, among other things, capital market forces affecting our stock price, and on the state of the capital markets generally.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
Our management, with the participation of our Chief Executive Officer and Chief Financial Officer (our principal executive officer and principal financial officer, respectively), evaluated the effectiveness of our disclosure controls and procedures as of September 30, 2024. The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the “Exchange Act”), means controls and other procedures of a company that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported, within the time periods specified in the rules and forms of the SEC. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by a company in the reports that it files or submits under the Exchange Act is accumulated and communicated to the company’s management, including its principal executive and principal financial officers, as appropriate to allow timely decisions regarding required disclosure. Management recognizes that any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving their objectives and management necessarily applies its judgment in evaluating the cost-benefit relationship of possible controls and procedures.
Based on the evaluation of our disclosure controls and procedures as of September 30, 2024, our Chief Executive Officer and Chief Financial Officer concluded that, as of such date, our disclosure controls and procedures were effective at the reasonable assurance level.
68
Changes in Internal Control over Financial Reporting
There were no changes in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) under the Exchange Act) during the three months ended September 30, 2024 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
69
PART II. OTHER INFORMATION
Item 1. Legal Proceedings
From time to time, we may be subject to litigation and claims arising in the ordinary course of business, which could have a material adverse effect on our business, operating results, cash flows or financial condition. Please refer to Note 16, Commitments and Contingencies of our unaudited condensed consolidated financial statements in Part I, Item 1 of this Quarterly Report on Form 10-Q for information regarding material legal proceedings.
In addition, in February 2024, we became aware that the SEC had initiated a formal investigation involving the Company and certain of its directors and officers. This formal investigation relates to the Company’s public disclosures, including about product sales and the receipt of a Form 483 by an investigator at one of the Company’s clinical trial sites in the TRANQUILITY II study, and trading in the securities of the Company. We are cooperating fully with the investigation including producing documents, and current and former officers and employees of the Company have testified before the SEC. We cannot predict or determine whether any proceeding may be instituted by the SEC in connection with its investigation or the outcome of any proceeding that may be instituted, or the effects any such proceeding could have on the Company’s business or financing efforts.
Item 1A. Risk Factors
You should carefully consider the risks described below, as well as general economic and business risks and the other information in this Quarterly Report on Form 10-Q and our Annual Report on Form 10-K for the fiscal year ended December 31, 2023. The occurrence of any of the events or circumstances described below or other adverse events could have a material adverse effect on our business, results of operations and financial condition and could cause the trading price of our common stock to decline. Additional risks or uncertainties not presently known to us or that we currently deem immaterial may also harm our business.
Risks Related to Financial Position and Need for Additional Capital
We have a limited operating history and have not generated substantial product revenues to date, which may make it difficult to evaluate the success of our business and to assess our future viability.
We were incorporated in March 2017 and our operations to date have been largely focused on staffing our Company, raising capital, advancing the development of our product candidates, including conducting clinical and preclinical studies and establishing our commercial organization. We have only one product approved for commercial sale, and have limited experience in obtaining marketing approvals, manufacturing products on a commercial scale, and conducting sales and marketing activities necessary for successful commercialization. Consequently, predictions about our future success or viability may not be as accurate as they could be if we had a longer operating history or a history of successfully commercializing products.
We expect our financial condition and operating results to continue to fluctuate from quarter to quarter and year to year due to a variety of factors, many of which are beyond our control. We are focused primarily on research and development while continuing to support IGALMITM commercial activities. We may encounter unforeseen expenses, difficulties, complications and delays, and may not be successful in such a transition.
We have incurred significant operating losses since inception and anticipate that we will continue to incur substantial operating losses for the foreseeable future and may never achieve or maintain profitability.
Since our inception, we have incurred significant operating losses. Our net loss was $48.7 million and $156.8 million for the nine months ended September 30, 2024 and 2023, respectively. As of September 30, 2024, we had a stockholders’ deficit of approximately $85.6 million. We expect to continue to incur significant expenses and increasing operating losses for the foreseeable future. We have only one product candidate approved for marketing in the U.S., none in any other jurisdiction, and may never receive approval beyond the one product approved to date. It could be several years, if ever, before we have a commercialized product that generates significant revenues through sales of IGALMITM or our product candidates, if approved. As a result, we are uncertain when or if we will achieve
70
profitability and, if so, whether we will be able to sustain it. The net losses we incur may fluctuate significantly from quarter to quarter and year to year. We anticipate that our expenses may increase in the long term as we:
● | evaluate the development of our product candidates; |
● | conduct preclinical studies and clinical trials for our current product candidates and any future product candidates that we may pursue; |
● | continue to develop, maintain, expand and protect our intellectual property portfolio; |
● | pursue regulatory approvals for our current and future product candidates that successfully complete clinical trials; |
● | develop an appropriate sales, marketing, and distribution infrastructure to commercialize IGALMITM and any other product candidates for which we may obtain marketing approval; |
● | potentially hire additional clinical, commercial, regulatory, scientific and finance personnel; and |
● | incur additional legal, accounting and other expenses in operating as a public company. |
To become and remain profitable, we must develop and commercialize more products or product candidates with significant market potential. This will require us to be successful in a range of challenging activities, including completing clinical trials of our product candidates, developing commercial scale manufacturing processes, obtaining marketing approval, manufacturing, marketing, and selling IGALMITM and any current and future product candidates for which we may obtain marketing approval, and satisfying any post-marketing requirements. We may never succeed in any or all of these activities and, even if we do, we may never generate sufficient revenue to achieve profitability.
Although we have obtained U.S. FDA approval for IGALMITM, because of the numerous risks and uncertainties associated with product development, we are unable to accurately predict the timing or amount of expenses or when, or if, we will obtain marketing approval to commercialize any additional product candidates. If we are required by the FDA, or other regulatory authorities such as the European Medicines Agency (“EMA”) to perform studies and trials in addition to those currently expected, or if there are any delays in the development, or in the completion of any planned or future preclinical studies or clinical trials of our current or future product candidates, our expenses could increase and profitability could be further delayed. For example, developments with respect to our TRANQUILITY program evaluating BXCL501 in patients with dementia due to probable Alzheimer’s disease may increase the likelihood that we experience such costs or delays, as discussed in the risk factor below entitled: “Developments relating to our TRANQUILITY II Phase 3 trial may impact the timing of our development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease.”
Even if we do achieve profitability, we may not be able to sustain or increase profitability on a quarterly or annual basis.
Our failure to become and remain profitable would decrease the value of our Company and could impair our ability to raise capital, maintain our research and development efforts, expand our business or continue our operations. A decline in the value of our Company also could cause you to lose all or part of your investment.
Our strategic reprioritization and other workforce reductions may not achieve our intended outcome.
In August 2023, we announced a broad-based strategic reprioritization (the “Reprioritization”) and have taken further restructuring actions since then. As part of these efforts, we have taken actions to reduce certain operational and workforce expenses that are no longer deemed core to our ongoing operations in order to extend our cash runway and drive innovation and growth in high potential clinical development and value creating opportunities. These actions include a shift in commercial strategy for IGALMITM in the institutional setting, a reduction of in-hospital commercialization expenses, a suspension of programs no longer determined to be core to ongoing operations, and a
71
prioritization on at-home treatment setting opportunities for BXCL501. As part of this strategy, we reduced our workforce by approximately 60%. As of December 31, 2023, the Reprioritization was substantially completed.
The reduction in force may result in unintended consequences and costs, such as the loss of institutional knowledge and expertise, attrition beyond the intended number of employees, decreased morale among our remaining employees, and the risk that we may not achieve the anticipated benefits of the reduction in force. In addition, while positions have been eliminated, certain functions necessary to our operations remain, and we may be unsuccessful in distributing the duties and obligations of departed employees among our remaining employees. The reduction in workforce could also make it difficult for us to pursue, or prevent us from pursuing, new opportunities and initiatives due to insufficient personnel, or require us to incur additional and unanticipated costs to hire new personnel to pursue such opportunities or initiatives. The workforce reduction could also harm our reputation, making our ability to recruit skilled personnel difficult. If we are unable to realize the anticipated benefits from the reduction in force, or if we experience significant adverse consequences from the reduction in force, our business, financial condition, and results of operations may be materially adversely affected.
In addition, we may not realize the benefits of or there may be unanticipated costs associated with our Reprioritization. As a result of the Reprioritization, including our strategic refocus, we may not generate material revenues from IGALMITM in the near term because our commercial force will be significantly reduced. If we are unable to commercialize IGALMITM in a different setting or unable to develop, receive marketing approval for and successfully commercialize BXCL501, BXCL701 and any of our other product candidates on our own or with any future collaborator, or experience delays because of any of these factors or otherwise, our business could be materially and substantially harmed.
In addition, because we have limited financial and managerial resources, under our Reprioritization, we intend to focus on specific product candidates, indications and development programs. We may also conduct several clinical trials for our product candidates in parallel over the next several years, which may make our decision as to which product candidates to focus on more difficult. As a result, we may forgo or delay pursuit of opportunities with other product candidates or other indications that could have had greater commercial potential or likelihood of success. Our resource allocation decisions may cause us to fail to capitalize on viable commercial products or profitable market opportunities. Our spending on current and future research and development programs and product candidates for specific indications may not yield any commercially viable products. If we do not accurately evaluate the commercial potential or target market for a particular product candidate, we may relinquish valuable rights to that product candidate through future collaborations, licenses and other similar arrangements in cases in which it would have been more advantageous for us to retain sole development and commercialization rights to such product candidate. If we are not successful in increasing our efficiency as a result of this Reprioritization, our efforts to develop and commercialize our product candidates may be delayed or halted and our business could be materially adversely impacted.
In May and September 2024, we initiated further workforce reductions, and we may undertake further similar cost-saving initiatives, which may include additional restructuring or workforce reductions. These types of cost-reduction activities can be complex and result in unintended consequences and costs, including decreased employee morale, loss of institutional knowledge and expertise and adversely impact our business.
We will need substantial additional funding, and if we are unable to raise capital when needed, we could be forced to delay, reduce or eliminate our product development programs or commercialization efforts or otherwise seek strategic alternatives. In addition, the failure to raise additional financing in accordance with the minimum capital raising requirements of our Credit Agreement (as defined herein) would trigger an event of default thereunder.
We will require additional future funding to support current and anticipated future expenses. We currently anticipate continuing to develop and conduct clinical trials with respect to our current and any future product candidates; seek to identify and develop additional product candidates; acquire or in-license other product candidates or technologies; seek regulatory approvals for our product candidates that successfully complete clinical trials, if any; establish sales, marketing, distribution and other commercial infrastructure to support the commercialization of products for which we may obtain marketing approval; require the manufacture of larger quantities of product candidates for clinical development and, potentially, commercialization; maintain, expand and protect our intellectual
72
property portfolio; hire and retain limited additional personnel, such as clinical, quality control and scientific personnel; add operational, financial and management information systems and personnel, including personnel to support our product development and help us comply with our obligations as a public company; and add equipment and physical infrastructure to support our research and development programs.
We have been and may continue to be required to expend significant funds to continue to commercialize IGALMITM in the U.S. and advance the development of BXCL501, BXCL701, BXCL502 and our other product candidates. In addition, while we may seek one or more collaborators for future development of our current product candidates or any future product candidates that we may develop for one or more indications, we may not be able to enter into a collaboration for any of our product candidates for such indications on suitable terms, on a timely basis or at all. In any event, our existing cash will not be sufficient to fund all of the efforts that we plan to undertake or to fund the completion of development of our product candidates or our other preclinical programs. Accordingly, we will be required to obtain further funding through public or private equity offerings, debt financings, collaborations and licensing arrangements or other sources. We may also seek third-party investments in or other strategic options for our subsidiary, OnkosXcel. Further financing may not be available to us on acceptable terms, or at all. In addition, we are reliant on the financial institutions with which we hold our cash and cash equivalents. If such institutions were to close, we may not be able to recover all of our cash or cash equivalents held at such institutions. Moreover, market volatility, credit crises, adverse macroeconomic conditions, such as high interest or inflation rates, or other factors, as well as Company-specific factors such as the progress of our development pipeline, adverse clinical events or results, regulatory investigations, or ongoing or potential legal proceedings, could also adversely impact our ability to access capital as and when needed. Our failure to raise capital as and when needed would have a negative impact on our financial condition and our ability to pursue our business strategy.
Management believes that, after giving effect to the Reprioritization and other restructuring actions, the Company’s cash and cash equivalents of $40.4 million as of September 30, 2024 will allow the Company to fund its operations and meet its liquidity requirements through the end of 2024. However, the ultimate expected cost benefit resulting from the Reprioritization and other cost-saving initiatives cannot be assured, and there can be no assurance that we will be able to extend our cash runway by meeting the conditions for additional funding under the terms of our Credit Agreement (defined below) or otherwise. In addition, the failure to raise additional financing in accordance with the minimum capital raising requirements of our Credit Agreement would trigger an event of default thereunder. The Fourth Amendment to our Credit Agreement includes covenants that we will receive, (i) after March 20, 2024, which is the effective date of the Fourth Amendment, and on or before April 15, 2024, at least $25.0 million in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in non-refundable cash consideration from partnering transactions entered into after March 20, 2024 (so long as such partnering transactions would not require us or any of our subsidiaries to make any cash investments in connection with the partnering transactions and no such cash investments are made), and (ii) after March 20, 2024 and on or before November 30, 2024, at least $50.0 million (for the avoidance of doubt, inclusive of amounts previously counted toward the preceding clause (i)) in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent (as defined in the Credit Agreement) in its sole discretion from partnering transactions entered into after March 20, 2024. Failure to perform this covenant would constitute (A) a default under the Credit Agreement and (B) an event of default under the Credit Agreement, subject to a cure period in the case of clause (i) of the preceding sentence, until May 15, 2024. For the avoidance of doubt, failure to perform clause (ii) would constitute an immediate event of default under the Credit Agreement without any cure or grace period.
Furthermore, our estimate as to how long we expect our existing cash to be able to continue to fund our operations is based on assumptions that may prove to be wrong, and we could use our available capital resources sooner than we currently expect. Further, changing circumstances, some of which may be beyond our control, could cause us to consume capital significantly faster than we currently anticipate, and we may need to seek additional funds sooner than planned. Our future funding requirements, both short-term and long-term, will depend on many factors, including:
● | the scope, progress, timing, costs, and results of clinical trials of our product candidates, including any delays that have occurred or may occur due to the recent developments with the TRANQUILITY program; |
73
● | our ability to enter into and the terms and timing of any collaborations, licensing agreements or other arrangements; |
● | the costs, timing and outcome of seeking regulatory approvals; |
● | the costs of commercialization activities for IGALMITM and for any of our product candidates that receive marketing approval, to the extent such costs are not the responsibility of any future collaborators, including the costs and timing of establishing product sales, marketing, distribution and manufacturing capabilities; |
● | revenue received from commercial sales of IGALMITM and our current and future product candidates; |
● | the costs of preparing, filing and prosecuting patent applications, maintaining and protecting our intellectual property rights and defending against intellectual property related claims; |
● | the number of future product candidates that we pursue and their development requirements; |
● | changes in regulatory policies or laws that may affect our operations; |
● | changes in physician acceptance or medical society recommendations that may affect commercial efforts; |
● | the costs of acquiring potential new product candidates or technology; |
● | the costs of operating as a public company; |
● | the extent to which our operations continue; |
● | the costs of legal proceedings and investigations; and |
● | costs associated with any adverse market conditions or other macroeconomic factors. |
As we continue our research and development activities, we will require additional resources to continue as a going concern. We can provide no assurance that we will successfully obtain additional resources to improve our financial condition. If we are unable to obtain necessary additional capital, we could be compelled to pursue alternative options, including, without limitation, implementing further workforce reductions, reducing or ceasing product development programs and advancement of our clinical trials and product candidates, selling our assets or seeking other strategic alternatives.
We have significant indebtedness and other contractual obligations that could impair our liquidity, restrict our ability to do business and thereby harm our business, results of operations and financial condition. We may not have sufficient cash flow from operations to satisfy our obligations under the Credit Agreement.
As of September 30, 2024, we had aggregate principal indebtedness of $106.5 million outstanding under our Credit Agreement and Guaranty (as amended, the “Credit Agreement”) by and among the Company, as the borrower, certain subsidiaries of the Company from time to time party thereto as subsidiary guarantors, the lenders party thereto (the “Lenders”), and Oaktree Fund Administration LLC (“OFA”) as administrative agent.
Restrictive covenants in the Credit Agreement place limits on our ability to conduct our business. The Credit Agreement contains customary representations and warranties and customary affirmative and negative covenants, including, among other things, restrictions on indebtedness, liens, investments, mergers, dispositions, prepayment of other indebtedness, and dividends and other distributions, subject to certain exceptions, including specific exceptions with respect to product commercialization and development activities. In addition, certain events, including receipt of a warning letter from the FDA, may constitute an event of default. We must also comply with certain covenants under the Credit Agreement, including a financial covenant that requires we maintain a minimum cash liquidity amount of $25 million as of September 30, 2024 (as described in the Fourth Amendment to the Credit Agreement described in Note 9, Debt and credit facilities in the condensed consolidated financial statements included elsewhere in this Quarterly
74
Report on Form 10-Q) and a minimum revenue requirement measured on a quarterly basis based on the revenue attributable to BXCL501 for the nine consecutive month period ending on the last day of the relevant quarter, subject to cure payments of not less than $1.0 million if we fail to meet the minimum revenue requirement. The minimum revenue requirement applies beginning with the preceding nine-month period ending on December 31, 2024, and ranges from approximately $4.5 million for the fourth quarter of 2024 to approximately $47.9 million for the first quarter of 2027. If we fail to meet the minimum revenue requirements for the preceding six-month periods ending on December 31, 2024, March 31, 2025, June 30, 2025 and September 30, 2025, we could be required to make revenue cure payments for the revenue shortfalls of up to $4.5 million, $6.2 million, $8.5 million, and $8.5 million, respectively, plus aggregate prepayment fees of $1.9 million. Under the Credit Agreement, these cure payments would be due on April 21, 2025, June 6, 2025, September 5, 2025 and December 8, 2025, respectively. We are only permitted to make cure payments for revenue shortfalls up to three times during the term of the Credit Agreement, after which we would default on the Credit Agreement if we are unable to satisfy the minimum revenue requirement for any subsequent fiscal quarter. In addition, certain events, including certain regulatory events and any “going concern” or similar qualification in a report of the Company’s independent registered public accountants relating to the Company’s annual financial statements, constitute an event of default under the Credit Agreement. The report of our independent registered public accounting firm included in the Annual Report on Form 10-K for the year ended December 31, 2023 contains a “going concern” explanatory paragraph. In March 2024 we entered into a Fourth Amendment to the Credit Agreement, pursuant to which the Lenders waived compliance with this covenant with respect to the report contained in the Annual Report on Form 10-K for the year ended December 31, 2023. The Fourth Amendment to the Credit Agreement also includes other covenants relating to minimum cash liquidity covenants and minimum capital raising requirements and failure to comply with such obligations, or other obligations required under the Credit Agreement, could trigger an event of default. Certain change of control events can also trigger an event of default under the Credit Agreement, including control by any entity or group of entities, other than BioXcel LLC and its affiliates, that acquires 35% or more of our voting capital stock. In addition, the Fourth Amendment to the Credit Agreement provides that if the Company has not, after the Effective Date and on or before September 30, 2024, received at least $40.0 million in gross proceeds from the issuance of its common stock, warrants and/or pre-funded warrants, and/or cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions entered into after the Effective Date, the “Minimum Liquidity Amount” (as defined in the Credit Agreement) that we are required to maintain at all times will increase to $25.0 million from $15.0 million, unless and until we have received, after the Effective Date and on or before November 30, 2024, at least $50.0 million in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants, and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions entered into after the Effective Date. As a result of raising less than $40.0 million as of September 30, 2024, the Minimum Liquidity Amount is $25.0 million as of September 30, 2024. In connection with the closing of the Fourth Amendment discussed below, we granted new warrants to the Lenders to purchase up to 100 shares of its common stock (the “2024 Warrant Shares”) at an exercise price of $3.0723 per share (the “2024 Warrants”), which represents a 10% premium over the arithmetic average of the volume-weighted average price of the Company’s common stock on the Nasdaq Capital Market during the 30 trading days preceding the Effective Date. The 2024 Warrants will expire on April 19, 2029 and may be net exercised at the holder’s election. As of the date of this filing, we still need to raise (i) approximately an additional $10.0 million in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions by September 30, 2024 in order to prevent such an increase in the Minimum Liquidity Amount that we are required to maintain under our Credit Agreement and (ii) approximately an additional $20.0 million in gross proceeds from the issuance of our common stock, warrants and/or pre-funded warrants and/or in cash and/or non-cash consideration (measured at fair market value, as determined by the Administrative Agent in its sole discretion) from partnering transactions by November 30, 2024 in order to prevent triggering an event of default under our Credit Agreement. Even if we raise the foregoing amounts within these timeframes, we may need to raise additional capital to continue as a going concern, and failure to continue as a going concern in connection with our Annual Report on Form 10-K for the fiscal year ended December 31, 2024 could trigger an event of default under our Credit Agreement, and the lenders could exercise their rights and remedies under the Credit Agreement.
Our ability to make scheduled payments or payments to maintain compliance with covenants or to restructure or refinance these and other outstanding debt obligations depends on our financial and operating performance, including
75
growth in revenue from IGALMITM and BXCL501, which will be affected by prevailing economic, industry and competitive conditions and by financial, business and other factors beyond our control. A failure to pay our debt, fixed costs and other obligations or a breach of our contractual obligations or other event of default could result in a variety of adverse consequences, including the acceleration of our obligations or the exercise of remedies by our creditors and lessors. In such a situation, it is unlikely that we would be able to cure our breach, fulfill our obligations, make required payments or otherwise cover our fixed costs, which would have a material adverse effect on our business, results of operations and financial condition.
In addition, historically we have relied on debt and equity financings as our primary sources of liquidity. If our future cash flows and capital resources are insufficient to fund our debt service obligations, we may be forced to reduce or delay expenditures, sell assets, seek additional capital or seek to restructure or refinance our indebtedness. Any refinancing or restructuring of our indebtedness could be at higher interest rates and may require us to comply with more onerous covenants. These alternative measures may not be successful and may not permit us to meet our scheduled or any accelerated debt service obligations. In the absence of such cash flows and resources, we could face substantial liquidity problems and might be required to sell material assets or pursue other strategic alternatives to attempt to meet our debt service obligations.
We have identified conditions and events that raise substantial doubt regarding our ability to continue as a going concern.
As of September 30, 2024, we had $40.4 million in cash and cash equivalents. Based on our existing cash, cash equivalents and lack of current availability under our funding facilities, we do not believe we have sufficient cash on hand to support current operations and service our debt obligations for at least one year from the date of issuance of the audited consolidated financial statements appearing in this Quarterly Report on Form 10-Q. This condition raises substantial doubt about our ability to continue as a going concern for at least one year from the date that our financial statements for the nine months ended September 30, 2024 are issued. In order to mitigate the current and potential future liquidity issues, we have undertaken the Reprioritization and may, among other things, seek to raise capital through the issuance of common stock, or by restructuring, refinancing, and/or amending the terms of the Credit Agreement (including with respect to regulatory related events of default that do not contain a cure period) or pursue other strategic alternatives. However, such transactions may not be successful and we may not be able to raise additional equity and/or financing necessary to meet our obligations. Moreover, our Credit Agreement contains covenants that we may be unable to comply with and which could result in the acceleration of our debt service obligations, further reducing our capital resources and ability to fund our operations. As such, there can be no assurance that we will be able to continue as a going concern and we may be forced to delay, reduce or discontinue our product development programs or commercialization efforts in order to preserve cash. For additional cost-saving and other strategic initiatives we may be compelled to pursue, see the risk factor entitled, “We will need substantial additional funding, and if we are unable to raise capital when needed, we could be forced to delay, reduce or eliminate our product development programs or commercialization efforts or otherwise seek strategic alternatives.” Further, if we are unable to raise additional capital or successfully consummate a strategic transaction, we may trigger an event of default under our Credit Agreement.
We currently do not meet certain of Nasdaq Capital Market’s continued listing requirements and other Nasdaq rules. If we are unable to regain compliance, we are likely to be delisted. Delisting could negatively affect the price of our common stock, which could make it more difficult for us to raise capital or for you to sell our common stock.
We are required to meet the continued listing requirements of the Nasdaq Capital Market and other Nasdaq rules. For example, we are required to maintain a minimum bid price for our listed common stock of $1.00 per share (the “Bid Price Requirement”) and maintain minimum market value of listed securities of at least $35.0 million (the “Market Value requirement”). We are not currently in compliance with either of the Bid Price Requirement or the Market Value Requirement as described further in Part I, Item 2, “Management’s Discussion and Analysis of Financial Condition and Results of Operations.” We continue to evaluate various alternative courses of action to regain compliance with the Bid Price Requirement and the Market Value Requirement, however, there can be no assurance that we will be able to
76
satisfy the Nasdaq Capital Market’s continued listing requirements, or, if we regain compliance, maintain compliance with the applicable Nasdaq continued listing requirements.
Delisting from the Nasdaq Capital Market would cause us to pursue eligibility for trading of these securities on other markets or exchanges, or on the “pink sheets.” In such case, our stockholders’ ability to trade, or obtain quotations of the market value of our common stock would be severely limited because of lower trading volumes and transaction delays. These factors could contribute to lower prices and larger spreads in the bid and ask prices of these securities. There can be no assurance that our securities, if delisted from the Nasdaq Capital Market in the future, would be listed on a national securities exchange, a national quotation service, the over-the-counter markets or the pink sheets. Delisting from the Nasdaq Capital Market, or even the issuance of a notice of potential delisting, would also result in negative publicity, make it more difficult for us to raise additional capital, adversely affect the market liquidity of our securities, decrease securities analysts’ coverage of us or diminish investor, supplier and employee confidence.
Risks Related to the Discovery and Development of Product Candidates
We have limited experience in drug discovery and drug development.
Prior to the acquisition of our product and product candidates, we were not involved in and had no control over their preclinical and clinical development. In addition, we are relying upon the parties we acquired our product candidates from to have conducted research and development in accordance with the applicable protocol, legal, regulatory and scientific standards, accurately reported the results of all clinical trials conducted prior to our acquisition of the applicable product candidate, and correctly collected and interpreted the data from these studies and trials. To the extent any of these activities did not occur, our expected development time and costs could increase, which could adversely affect our prospects for marketing approval of, and receiving any future revenue from, these product candidates.
Developments relating to our TRANQUILITY II Phase 3 trial may impact the timing of our development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease.
Following our discovery of principal investigator misconduct at one of the clinical sites in our TRANQUILITY II Phase 3 clinical trial, we initiated an investigation into the issues associated with the trial. This principal investigator had previously been subject to a December 2022 FDA inspection of her clinical site in connection with the TRANQUILITY II clinical trial. At the conclusion of this inspection, the FDA issued an FDA Form-483 identifying three inspectional observations. These observations related to the principal investigator’s failure to adhere to the informed consent form approved by the Institutional Review Board for a limited number of subjects whose records the FDA reviewed, maintain adequate case histories for certain patients whose records the FDA reviewed, and adhere to the investigational plan in certain instances. For example, the FDA cited the principal investigator’s delay in informing the sponsor’s medical monitor or pharmacovigilance safety vendor of an SAE, for one of the subjects, which report was made to our vendor outside of the 24 hour time period prescribed by the clinical trial protocol. The principal investigator for this clinical site responded to the FDA observations within the time period requested. The FDA inspection remains open, however, as the FDA has not issued an Establishment Inspection Report.
In May 2023, it came to our attention that this same principal investigator in the TRANQUILITY II clinical trial may have fabricated email correspondence around the time of the FDA inspection, purporting to demonstrate that the investigator timely submitted to our pharmacovigilance safety vendor a report of an SAE from a different subject than the one cited in the FDA Form-483, and purporting to show that the vendor had confirmed receipt. Upon receipt of this information, we promptly initiated an investigation and received confirmation that the principal investigator fabricated the email correspondence related to the timing of the reporting of this SAE to our pharmacovigilance vendor to make it appear as though this SAE had been timely reported as required by the clinical trial protocol. This principal investigator has not participated in any other clinical trial sponsored or conducted by us. Both we and the principal investigator’s employer have reported this incident to the FDA.
Since that time, we have taken steps to further investigate and evaluate the conduct of the TRANQUILITY II trial at this clinical site. Based on these steps to date, we believe that there have been no further instances of misconduct or
77
fraud or other findings that adversely impact the data integrity or reliability of the eligibility, safety, and efficacy data obtained at the clinical trial site in question. However, the FDA may not accept or agree with our conclusions or analyses or may interpret or weigh their importance differently. Further, if we or the FDA determine that there are issues with data integrity and/or compliance with good clinical practice (“GCP”) requirements at the trial site, we may be unable to use some or all of the subject data generated at this clinical site to support a marketing application. Any issues identified at this trial site may also be identified at other trial sites. If all of the data from this clinical trial site were discarded, the TRANQUILITY II trial would no longer be adequately powered for statistical significance or would not be considered adequately well-controlled by the FDA, and in either case, we would need to conduct a new comparable clinical trial before we are able to seek any approval of BXCL501 for use in patients with acute agitation (non-daily) due to dementia in probable Alzheimer’s disease. If a substantial portion of the data were discarded, similar outcomes may also occur.
The primary efficacy endpoint in TRANQUILITY II was the change in PEC score, which is a measurement of agitation severity captured by trained raters during an agitation episode. While change in PEC score has been used to support the approval of IGALMI for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder in adults, it has not been used as a primary endpoint to support the approval of a drug candidate for the treatment of agitation associated with Alzheimer’s Disease. Prior to initiating our TRANQUILITY II trial, we believe we reached alignment with FDA regarding the use of PEC scores as a primary endpoint to assess individual agitation episodes in dementia patients. In the normal course, we have been in communication with the FDA regarding the data and information needed to further support the consistency of the measurement of PEC ratings, and we believe that we have generated sufficient data to demonstrate such consistency. Following submission of certain data on PEC score from a separate study of raters assessing video vignettes, the FDA expressed certain concerns with respect to the reliability of PEC scores in that study. The FDA has requested that we provide additional information to support the consistency of the measurement of PEC ratings to assess the treatment of agitation associated with Alzheimer’s Disease. While we believe that we have generated sufficient data to demonstrate such consistency, and we plan to submit these data and analyses to the FDA, if the FDA disagrees, it may require that we provide more information to demonstrate consistency in the measurement of PEC scores and/or may require that we generate additional data to support the reliability of PEC score measurements in our TRANQUILITY II trial. There can be no assurances that any information or and data we provide to FDA will sufficiently demonstrate the consistency and reliability of the PEC-score data from our TRANQUILITY II trial, or that our PEC-score data will not represent a potential review issue in connection with any application we may submit to FDA.
In addition, we are continuing to seek feedback from the FDA with respect to our TRANQUILITY program. For example, on February 20, 2024, we held a Type B/Breakthrough Therapy designation meeting with the FDA. The original purpose of this meeting was to obtain feedback on the design of a proposed at-home study that did not include caregiver-collected efficacy endpoints, based on our belief that obtaining caregiver assessments of efficacy would be challenging. We believe there are no validated caregiver endpoints for assessing efficacy in Alzheimer’s disease patients in the at-home setting. As a result, we focused on requesting feedback from the FDA regarding our proposal for an at-home clinical study with safety as the primary objective, and to better understand what additional data would be required to submit an sNDA to support labeling for BXCL501 to include the acute treatment of agitation associated with dementia in probable Alzheimer’s disease or, in the alternative, in this population in the care setting only. In its preliminary responses, the FDA reiterated its prior comments that we generate additional efficacy data, including repeat-dose efficacy data, to support an sNDA submission, as the FDA indicated that our proposed efficacy database, which currently includes the 70 patients who have been treated with 60 mcg of BXCL501 in TRANQUILITY I and TRANQUILITY II, would not contain substantial evidence of effectiveness absent additional data. The FDA advised that we generate the necessary efficacy data in care facilities prior to conducting any trials in the at-home setting. In addition, the FDA indicated the need to generate long-term safety data to support an sNDA submission, including from probable Alzheimer’s disease patients exposed to BXCL501, for up to one year. We have received the final meeting minutes from the FDA, which we believe are consistent with the FDA’s preliminary responses and the subsequent meeting discussion. Based on the FDA’s feedback, we are currently planning to generate additional Phase 3 efficacy and safety data, in a variety of relevant care-facility settings and across severity of dementia, including through, among other things, conducting our planned TRANQULITY In-Care Phase 3 trial. In addition, we plan to discuss the details of the requirement for long-term safety data at a future meeting with the FDA. Also, although we announced in November 2023 that we were planning to conduct a Phase 3 trial in the at-home setting, with safety as the primary objective (TRANQUILITY At Home), given the priority to expand the database to generate additional efficacy and safety data in
78
care facilities, we are re-evaluating the timing for initiating TRANQUILITY At Home. Conducting any new clinical trial can take significant time, funding and resources, and there are no assurances we could raise sufficient capital or have the liquidity and resources to conduct further clinical trials in our TRANQUILITY program, including our planned TRANQUILITY In-Care Trial. Any new clinical trials conducted in our target patient populations may have different safety or efficacy results from the topline data the Company previously announced for the TRANQUILITY II clinical trial. Further, any government investigation, disqualification, or debarment of, or proceeding or action against the principal investigator, or any government investigation, proceeding or action against us, could further delay development and approval of BXCL501 for this indication, and otherwise have a material adverse effect on us, our financial condition (including triggering a potential event of default under our Credit Agreement), results of operations and prospects.
We have limited clinical data supporting potential safety or efficacy of BXCL501 for use in the at-home setting.
In August 2023, we announced our intention to pursue a strategic reprioritization of our commercialization and development efforts (the “Reprioritization”), including among other things, a shift in focus to primarily develop BXCL501 for use in expanded settings, including the at-home setting and care facilities, for the acute treatment of agitation in patients with dementia due to probable Alzheimer’s disease and the acute treatment of agitation in schizophrenia and bipolar patients in the at-home setting. Although we have conducted several clinical trials that evaluated BXCL501 in the institutional setting, we have limited data supporting BXCL501’s potential use in the at-home setting. In particular, we have not conducted a clinical trial evaluating the at-home use of BXCL501 in the acute treatment of agitation in patients with dementia due to probable Alzheimer’s disease.
Although we may seek additional feedback from the FDA regarding the potential of our ongoing, planned or completed clinical trials to support submission of one or more sNDAs and to support a label for use in the home, it is possible that the FDA may not consider the data from such studies adequate to support such submissions. For example, on October 11, 2023, we received feedback from the FDA that TRANQUILITY I and TRANQUILITY II alone are not sufficient to support an sNDA submission for the use of BXCL501 to treat acute agitation (non-daily) in patients with dementia due to probable Alzheimer’s disease in either the at-home setting or care facilities, and the FDA indicated that we should, among other things, conduct a further clinical trial to evaluate safety and collect efficacy data of BXCL501 before we are able to submit an sNDA seeking approval of BXCL501 for use in such populations.
For a description of recent developments relating to our TRANQUILITY program, please see the prior risk factor, “Developments relating to our TRANQUILITY II Phase 3 trial may impact the timing of our development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease.” We cannot provide assurance that we will be able to seek or obtain approval of BXCL501 for treatment of agitation in patients with dementia due to probable Alzheimer’s disease in the at-home setting based on this updated development plan.
Although we continue to seek feedback from the FDA with respect to our TRANQUILITY program, the FDA may not agree that any trial designs we propose are sufficient to establish both the safety and efficacy of BXCL501 for the acute treatment of agitation associated with dementia due to probable Alzheimer’s disease in either a care setting or an at-home setting. For example, to assess safety, the FDA has indicated that we need to expose more patients to BXCL501 for a longer period of time and that an efficacy trial of a shorter duration, combined with the patients in its previous trials, would not support submissions of an sNDA. Further, to assess efficacy in the home setting, the FDA may determine that we cannot rely on our previous studies of BXCL501 for this proposed indication since those studies were conducted in assisted living facilities and they are not comparable to the at-home setting. The FDA may also require us to seek approval for BXCL501 for use in care facilities prior to seeking any approval for at-home use in the targeted AD patient population. In particular, we are planning to generate additional Phase 3 safety and efficacy data in a variety of relevant care-facility settings, including by conducting our planned TRANQUILITY In-Care trial, but even if our planned clinical efforts are successful and even if we are able to obtain approval of BXCL501 for use in patients with dementia due to probable Alzheimer's disease in the care setting, we cannot provide assurance that we will be able to seek or obtain approval of BXCL501 for the treatment of agitation in patients with dementia due to probable Alzheimer’s disease in the at-home setting based on these data and we expect that we will be required to generate additional data to evaluate the at-home use of BXCL501 in our targeted Alzheimer's dementia population before we are able to seek approval for such at-home use in this population, if ever. In addition, the FDA may determine that we
79
cannot rely on the data from our prior TRANQUILITY II Phase 3 trial to support an sNDA as a result of potential data integrity issues at the trial site, as the FDA may not agree with our belief that data reliability and integrity remain intact. See Part II, Item 1A, “Risk Factors—Risks Related to the Discovery and Development of Product Candidates—Developments relating to its TRANQUILITY II Phase 3 trial may impact the timing of its development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease” for additional information. If the FDA does not accept the data from our prior TRANQUILITY II Phase 3 trial, we could be required to conduct additional clinical trials beyond those we currently contemplate, which would increase our costs and delay potential submission of an sNDA for BXCL501 which in turn would adversely affect our financial position and operations.
Accordingly, if the FDA reaches these conclusions or otherwise finds that our proposed clinical studies would not adequately evaluate the safety and efficacy of BXCL501 for the acute treatment of agitation associated with dementia due to probable Alzheimer’s disease in an at-home setting and/or care setting, we may need to evaluate more patients for a longer period of time to demonstrate the safety and efficacy of BXCL501.
With respect to our SERENITY program, we also held a Type C Meeting with the FDA on March 6, 2024 to obtain further feedback on our proposed changes to the design of SERENITY III Part 2, including with respect to the trial endpoints, and to discuss the content and format of a potential sNDA submission to expand the label of IGALMITM 120 micrograms to the acute treatment of agitation associated with schizophrenia and bipolar disorders in the outpatient setting. IGALMITM is already approved at the 120 mcg dose based on efficacy data that we previously generated in treating a single episode of agitation. Consistent with the data generated to date, the label for IGALMITM currently includes a limitation on use (“LOU”), noting the lack of efficacy or safety data beyond 24 hours following the first dose. During our March 6, 2024 Type C meeting with the FDA, we discussed, among other things, whether evaluating the at-home use of BXCL501 120 mcg, with safety as the primary objective and efficacy measures as exploratory endpoints, if successful, could support the submission of an sNDA seeking expansion of the current label for IGALMITM 120 mcg to allow at-home use and labeling without the current LOU. Based on current FDA feedback, we have amended the Part 2 of the SERENITY III protocol to evaluate the safety and efficacy of the 120 mg dose in the at-home setting, and now refer to this revised trial as the SERENITY At-Home trial. We believe that our ability to seek labeling without the current LOU will depend, in part, on the number of agitation episodes we observe during our planned study period. Even if our planned SERENITY At-home trial is successful in demonstrating safety in the at-home setting, and even if the IGALMITM 120 mcg label is expanded to allow outpatient use, there is no guarantee that we will observe and/or treat a sufficient number of agitation episodes during the study period to support removal of the current LOU.
Any modifications to our proposed trial designs, whether by us or by the FDA would delay our initiation of such proposed trials, increase the costs of any trial that we do conduct and delay any potential submission of an sNDAs for BXCL501. Requirements to conduct additional clinical trials evaluating BXCL501 in support of our planned sNDAs seeking approvals for BXCL501 for our targeted patient populations in at-home settings would increase our costs, and in either case, such modifications or requirements could have a material adverse effect on our prospects and results of operations.
In the near term, we are dependent on the success of IGALMITM, and the development of four of our product candidates, BXCL501, BXCL502, BXCL701 and BXCL702. If we are unable to complete the clinical development of or obtain marketing approval for our product candidates or successfully commercialize IGALMITM and our other product candidates, either alone or with a collaborator, or if we experience significant delays in doing so, our business could be substantially harmed.
We currently have only one product that has received regulatory approval and may never be able to develop additional marketable product candidates. We are continuing to invest a significant portion of our efforts and our available financial resources in the development of our product candidate, BXCL501 and may in the future reprioritize commercialization of IGALMITM or the development of other product candidates. However, we have limited experience in drug development and commercialization, and our prospects are substantially dependent on our ability, or that of any future collaborator, to develop, obtain marketing approval for and successfully commercialize product candidates in one or more additional disease indications. We have also slowed the clinical development process of our
80
lead product candidates, and progression of our lead clinical programs is subject to applicable funding. See Part I, Item 2. “Management’s Discussion and Analysis of Financial Condition and Results of Operations — Overview.”
The success of IGALMITM, and of BXCL501, BXCL701, BXCL502 and our other product candidates will depend on several factors, including the following:
● | acceptance of an investigational new drug application (“IND”) by the FDA or acceptance of comparable applications by foreign regulatory authorities allowing us to conduct clinical trials of our product candidates in the U.S. or in foreign jurisdictions; |
● | initiation, progress, timing, costs and results of clinical trials of our product candidates and potential product candidates, including any delays caused by the developments relating to the TRANQUILITY program, and any additional trials we may need to conduct prior to seeking approvals for BXCL501 in at-home and/or care facilities; |
● | demonstration of safety and efficacy of our product candidates to the satisfaction of the FDA, or any comparable foreign regulatory authority, and sufficient for marketing approval; |
● | the timing and performance of our current and future collaborators; |
● | the nature of any required post-marketing clinical trials or other commitments to applicable regulatory authorities; |
● | establishment of supply arrangements with third-party raw materials suppliers and manufacturers; |
● | establishment of arrangements with third-party manufacturers to obtain finished drug product that is appropriately packaged for sale; |
● | adequate ongoing availability of raw materials and drug product for clinical development and any commercial sales; |
● | obtaining and maintaining patent, trade secret protection and regulatory exclusivity, both in the U.S. and internationally; |
● | protection of our rights in our intellectual property portfolio; |
● | successful launch of commercial sales following any marketing approval; |
● | a continued acceptable safety profile following any marketing approval; |
● | commercial acceptance by patients, the medical community and third-party payors; and |
● | our ability to compete with other therapies. |
Many of these factors are beyond our control, including the results of clinical trials, the time required for the FDA, or any comparable foreign regulatory authorities, to review any regulatory submissions we may make, potential threats to our intellectual property rights and the manufacturing, marketing and sales efforts of any future collaborator. If we are unable to commercialize IGALMITM or develop, receive marketing approval for and successfully commercialize BXCL501, BXCL701 and our other product candidates, on our own or with any future collaborator, or experience delays because of any of these factors or otherwise, our business could be substantially harmed.
81
Interim “top-line” and preliminary data from our clinical trials, that we announce or publish from time to time, may change as more patient data become available and are subject to audit and verification procedures that could result in material changes in the final data.
From time to time, we may publicly disclose top-line or preliminary data from our clinical trials, which is based on a preliminary analysis of then-available data. The results and related findings and conclusions based on such preliminary data are subject to change, and have in the past changed, following a more comprehensive review of the data related to the particular study or trial. We also make assumptions, estimations, calculations and conclusions as part of our analyses of data, and we may not have received or had the opportunity to fully and carefully evaluate all data. As a result, the top-line or preliminary results that we report may differ from future results of the same studies, or different conclusions or considerations may qualify such results, once additional data have been received and fully evaluated. Top-line or preliminary data also remain subject to audit and verification procedures that may result in the final data being materially different from the top-line or preliminary data we previously published. As a result, top-line and preliminary data should be viewed with caution until the final data are available.
From time to time, we may also disclose interim data from our preclinical studies and clinical trials. Interim data from clinical trials that we may complete are subject to the risk that one or more of the clinical outcomes may materially change as patient enrollment continues and more patient data become available. Adverse differences between interim data and final data could significantly harm our business prospects. Further, disclosure of interim data by us or by our competitors could result in volatility in the price of our common stock.
Further, others, including regulatory agencies, may not accept or agree with our assumptions, estimates, calculations, conclusions or analyses or may interpret or weigh the importance of data differently, which could impact the value of the particular program, the approvability or commercialization of the particular product candidate or product and our Company in general. In addition, the information we choose to publicly disclose regarding a particular study or clinical trial is based on what is typically extensive information, and you or others may not agree with what we determine is material or otherwise appropriate information to include in our disclosure.
If the interim, top-line or preliminary data that we report differ from actual results, or if others, including regulatory authorities, disagree with the conclusions reached, our ability to obtain approval for, and commercialize, our product candidates may be harmed, which could harm our business, operating results, prospects or financial condition.
The regulatory approval processes of the FDA and comparable foreign authorities are lengthy, expensive and inherently unpredictable, and if we are ultimately unable to obtain regulatory approval for our product candidates, our business will be substantially harmed.
The time required to obtain approval by the FDA and comparable foreign authorities is unpredictable but typically takes many years following the commencement of clinical trials and depends upon numerous factors, including the substantial discretion of the regulatory authorities. The results of preclinical studies and early clinical trials of our product candidates may not be predictive of the results of later-stage clinical trials. Product candidates in later stages of clinical trials may fail to show the desired safety and efficacy traits despite having progressed through preclinical studies and initial clinical trials. It is not uncommon for companies in the biopharmaceutical industry to suffer significant setbacks in advanced clinical trials due to nonclinical findings made while clinical studies are underway and safety or efficacy observations made in clinical studies, including previously unreported adverse events. Our future clinical trial results may not be successful, and notwithstanding any potential promising results in earlier studies, we cannot be certain that we will not face similar setbacks. The historical failure rate for product candidates in our industry is high. In addition, approval policies, regulations, or the type and amount of clinical data necessary to gain approval may change during a product candidate’s clinical development and may vary among jurisdictions. We obtained regulatory approval for our first product candidate for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder, which is in the early stages of commercialization. It is possible that none of our other product candidates, or any product candidates we may seek to develop in the future, will ever obtain regulatory approval.
Our current product candidates, or any that may be developed in the future, could fail to receive regulatory approval for many reasons, including the following:
82
● | the FDA, or comparable foreign regulatory authorities, may disagree with the design or implementation of our clinical trials; |
● | we may be unable to demonstrate to the satisfaction of the FDA, or comparable foreign regulatory authorities, that a product candidate is safe and effective for its proposed indication; |
● | the results of clinical trials may not meet the level of statistical significance required by the FDA, or comparable foreign regulatory authorities, for approval; |
● | the FDA, or comparable foreign regulatory authorities, may disagree with our interpretation of data from preclinical studies or clinical trials; |
● | the data collected from clinical trials of our product candidates may not be sufficient to support the submission of an NDA or other submission or to obtain regulatory approval in the U.S. or elsewhere; |
● | the FDA, or comparable foreign regulatory authorities, may disagree that our changes to branded reference drugs meet the criteria for the 505(b)(2) regulatory pathway or comparable foreign regulatory pathways; |
● | the FDA, or comparable foreign regulatory authorities, may fail to approve the manufacturing processes or facilities of third-party manufacturers with which we contract for clinical and commercial supplies; and |
● | the approval policies or regulations of the FDA, or comparable foreign regulatory authorities, may significantly change in a manner rendering our clinical data insufficient for approval. |
We have limited experience in completing clinical trials of product candidates. Consequently, we may not have the necessary capabilities, including adequate staffing, to successfully manage the execution and completion of clinical trials we initiate in a way that leads to our obtaining marketing approval for our product candidates in a timely manner, or at all. This lengthy approval process as well as the unpredictability of future clinical trial results may result in our failing to obtain regulatory approval to market our product candidates, which would significantly harm our business, results of operations and prospects.
In addition, even if we were to obtain approval, regulatory authorities may approve our product candidates for fewer or more limited indications than we request, may not approve the price we intend to charge for our products, may grant approval contingent on the performance of costly post-marketing clinical trials, may approve a product candidate with a label that does not include the labeling claims necessary or desirable for the successful commercialization of that product candidate or may restrict its distribution. Any of the foregoing scenarios could materially harm the commercial prospects for our product candidates.
We have only submitted one NDA to the FDA and have not submitted any similar marketing applications to comparable foreign authorities, for any product candidate, and we cannot be certain that our product candidates currently in development, or any than may be developed in the future, will be successful in clinical trials or receive regulatory approval. Further, our product candidates currently in development, or any that may be developed in the future, may not receive regulatory approval even if we believe they are successful in clinical trials. If we do not receive regulatory approvals for additional product candidates, we may not be able to continue our operations. For any regulatory approvals to market one or more of our product candidates, our revenues will be dependent, in part, upon the size of the markets in the territories for which we gain regulatory approval and have commercial rights. If the markets for patients that we are targeting for IGALMITM or our other product candidates are not as significant as we estimate, we may not generate significant revenues from sales of IGALMITM or such other product candidates, if approved.
We plan to seek regulatory approval to commercialize our product candidates in the U.S., the European Union (“EU”) and in additional foreign countries. While the scope of regulatory approval is similar in other countries, to obtain separate regulatory approval in many other countries we must comply with numerous and varying regulatory requirements of such countries regarding safety and efficacy and governing, among other things, clinical trials and commercial sales, pricing and distribution of our product candidates, and we cannot predict success in these jurisdictions.
83
In addition, the FDA’s and other regulatory authorities’ policies with respect to clinical trials may change and additional government regulations may be enacted. For instance, the regulatory landscape related to clinical trials in the EU recently evolved. The EU Clinical Trials Regulation (“CTR”), which was adopted in April 2014 and repeals the EU Clinical Trials Directive, became applicable on January 31, 2022. While the Clinical Trials Directive required a separate clinical trial application (“CTA”), to be submitted in each member state in which the clinical trial takes place, to both the competent national health authority and an independent ethics committee, the CTR introduces a centralized process and only requires the submission of a single application for multi-center trials. The CTR allows sponsors to make a single submission to both the competent authority and an ethics committee in each member state, leading to a single decision per member state. The assessment procedure of the CTA has been harmonized as well, including a joint assessment by all member states concerned, and a separate assessment by each member state with respect to specific requirements related to its own territory, including ethics rules. Each member state’s decision is communicated to the sponsor via the centralized EU portal. Once the CTA is approved, clinical study development may proceed. The CTR foresees a three-year transition period. The extent to which ongoing and new clinical trials will be governed by the CTR varies. For clinical trials whose CTA was made under the Clinical Trials Directive before January 31, 2022, the Clinical Trials Directive will continue to apply on a transitional basis for three years. Additionally, sponsors could choose to submit a CTA under either the Clinical Trials Directive or the CTR until January 31, 2023 and, if authorized, those are governed by the Clinical Trials Directive until January 31, 2025. By that date, all ongoing trials will become subject to the provisions of the CTR.
If we are slow or unable to adapt to changes in existing requirements or the adoption of new requirements or policies governing clinical trials, our development plans may be impacted.
Clinical trials are expensive, time-consuming, difficult to design, difficult to conduct, and involve an uncertain outcome.
Before obtaining marketing approval from the FDA, or other comparable foreign regulatory authorities, for the sale of our product candidates, we must complete preclinical development and extensive clinical trials to demonstrate the safety and efficacy of our product candidates, in accordance with applicable law and regulations. Failure can occur at any time during the clinical trial process. Although we are planning for certain clinical trials relating to BXCL501, BXCL701, BXCL502 and our other product candidates, there can be no assurance that the FDA, or other comparable foreign regulatory authorities, will accept our proposed trial designs as sufficient to establish the safety and/or efficacy of our product candidates.
We may experience delays in our clinical trials and we do not know whether planned clinical trials will begin on time, need to be redesigned, enroll patients on time or be completed on schedule, if at all. Clinical trials can be delayed for a variety of reasons, including delays related to:
● | the FDA, or comparable foreign regulatory authorities, disagreeing as to the design or implementation of our clinical studies; |
● | obtaining regulatory allowances or authorizations to commence a trial or consensus with regulatory authorities on trial designs; |
● | reaching agreement on acceptable terms with prospective contract research organizations (“CROs”) and clinical trial sites, the terms of which can be subject to extensive negotiation and may vary significantly among different CROs and trial sites; |
● | obtaining institutional review board approval at each site, or independent ethics committee approval at any sites outside the U.S.; |
● | dependence on the needs and timing of third-party collaborators; |
● | changes to clinical trial protocols; |
● | recruiting suitable patients to participate in a trial in a timely manner and in sufficient numbers; |
84
● | clinical sites deviating from trial protocol or dropping out of a trial; |
● | addressing patient safety concerns that arise during the course of a trial; |
● | having patients complete a trial or return for post-treatment follow-up; |
● | imposition of a clinical hold by regulatory authorities, including as a result of unforeseen safety issues or side effects or failure of trial sites to adhere to regulatory requirements; |
● | the occurrence of SAEs in trials of the same class of agents conducted by other companies or institutions; |
● | subjects choosing an alternative treatment for the indications for which we are developing our product candidates, or participating in competing trials; |
● | adding a sufficient number of clinical trial sites; |
● | manufacturing sufficient quantities of a product candidate for use in clinical trials; |
● | lack of adequate funding to initiate or continue clinical trials; |
● | selection of clinical end points that require prolonged periods of clinical observation or analysis of the resulting data; |
● | a facility manufacturing our product candidates or any of their components being ordered by the FDA, or comparable foreign regulatory authorities, to temporarily or permanently shut down due to violations of current good manufacturing practice (“cGMP”) regulations or other applicable requirements, or infections or cross-contaminations of product candidates in the manufacturing process; |
● | any changes to our manufacturing process that may be necessary or desired; |
● | third-party clinical investigators losing the licenses or permits necessary to perform our clinical trials, not performing our clinical trials on our anticipated schedule or consistent with the clinical trial protocol, GCPs or other regulatory requirements; or |
● | third-party contractors not performing data collection or analysis in a timely or accurate manner; third-party contractors not complying with training and trial protocol; or third-party contractors becoming debarred or suspended or otherwise penalized by the FDA, such as in the case of the recent events relating to the TRANQUILITY II clinical trial, or other government or regulatory authorities, for violations of regulatory requirements, in which case, we may need to find a substitute contractor, and we may not be able to use some or all of the data produced by such contractors in support of our marketing applications. |
We could encounter delays if a clinical trial is suspended or terminated by us, by the IRBs of the institutions in which such trials are being conducted, by the Data Safety Monitoring Board (“DSMB”) for such trial or by the FDA or other regulatory authorities. Such authorities may impose such a suspension or termination due to a number of factors, including failure to conduct the clinical trial in accordance with regulatory requirements or our clinical protocols, inspection of the clinical trial operations or trial site by the FDA or other regulatory authorities resulting in the imposition of a clinical hold, unforeseen safety issues or adverse side effects, failure to demonstrate a benefit from using a drug, changes in governmental regulations or administrative actions or lack of adequate funding to continue the clinical trial. Furthermore, we rely on CROs and clinical trial sites to ensure the proper and timely conduct of our clinical trials and, while we have agreements governing their committed activities, we have limited influence over their actual performance, which increases the risk that such CROs or trial sites may fail to perform in accordance with regulatory requirements, clinical trial protocols or with the agreements governing their services to us. For example, investigator misconduct affecting our TRANQUILITY II trial, which evaluated BXCL501 in patients with probable Alzheimer’s disease, may have a material adverse impact on our development program for BXCL501 in these patients, as described more fully in the risk factor above entitled: “Developments relating to our TRANQUILITY II Phase 3 trial
85
may impact the timing of our development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease.”
Further, conducting clinical trials in foreign countries, as we may do for our current and future product candidates, presents additional risks that may delay completion of our clinical trials. These risks include the failure of enrolled patients in foreign countries to adhere to clinical protocol due to differences in health care services or cultural customs, managing additional administrative burdens associated with foreign regulatory schemes, as well as political and economic risks relevant to such foreign countries. For example, current geopolitical conflicts in Eastern Europe and the Middle East may adversely impact our ability to conduct trials in those regions and elsewhere.
If we experience delays in the completion of, or termination of, any clinical trial of our product candidates, the commercial prospects of our product candidates will be harmed, and our ability to generate product revenues from any of these product candidates will be delayed. In addition, any delays in completing our clinical trials will increase our costs, slow down our product candidate development and approval process and jeopardize our ability to commence product sales and generate revenues. Any of these occurrences may harm our business, financial condition and prospects significantly. In addition, many of the factors that cause, or lead to, a delay in the commencement or completion of clinical trials may also ultimately lead to the denial of regulatory approval of our product candidates.
We depend on enrollment of patients in our clinical trials to continue development of our product candidates. If we are unable to enroll patients in our clinical trials, our research and development efforts could be adversely affected.
The timely completion of clinical trials in accordance with their protocols depends, among other things, on our ability to enroll a sufficient number of patients who remain in the study until its conclusion. We may experience difficulties in patient enrollment in our clinical trials for a variety of reasons. Patient enrollment is affected by many factors including the size and nature of the patient population, the proximity of patients to clinical sites, the eligibility criteria for the trial, the design of the clinical trial, the size of the patient population required for analysis of the trial’s primary endpoints, our ability to recruit clinical trial investigators with the appropriate competencies and experience, our ability to obtain and maintain patient consents, the risk that patients enrolled in clinical trials will drop out of the trials before completion, and competing clinical trials and clinicians’ and patients’ perceptions as to the potential advantages of the drug being studied in relation to other available therapies, including any new drugs that may be approved for the indications we are investigating. Many pharmaceutical companies are conducting clinical trials in patients with the disease indications that our product candidates are designed to target. As a result, we must compete with them for clinical sites, physicians and the limited number of patients who fulfill the stringent requirements for participation in clinical trials. Also, due to the confidential nature of clinical trials, we do not know how many of the eligible patients may be enrolled in competing studies and who are consequently not available to us for our clinical trials. Our clinical trials may be delayed or terminated due to the inability to enroll enough patients. The delay or inability to meet planned patient enrollment may result in increased costs and delay or termination of our trials, which could have a harmful effect on our ability to develop products.
Our product candidates may cause undesirable side effects or have other properties that could delay or prevent their regulatory approval, limit the commercial profile of an approved label, or result in significant negative consequences following marketing approval.
Undesirable side effects caused by our product candidates could cause us or regulatory authorities to interrupt, delay or halt clinical trials and could result in a more restrictive label or the delay or denial of regulatory approval by the FDA or other comparable foreign authorities. The clinical evaluation of BXCL501, BXCL502, BXCL701, BXCL702 and our other product candidates in patients, in many cases, is ongoing and it is possible that there may be side effects associated with their use. Results of our trials could reveal a high and unacceptable severity and prevalence of these or other side effects. For example, in our Phase 2 clinical trial of BXCL701 for the treatment of emergent neuroendocrine prostate cancer, one patient experienced acidosis with a fatal outcome. Although the clinical investigator could not determine that the fatality was related to treatment with BXCL701, it is possible that BXCL701 could be tied to unacceptable side effects in the future.
86
If we observe drug-related AEs or other unacceptable safety concerns in clinical trials, we, the FDA, the IRBs at the institutions in which our studies are conducted, or the DSMB could suspend or terminate our clinical trials or the FDA, or comparable foreign regulatory authorities, could order us to cease clinical trials or deny approval of our product candidates for any or all targeted indications. For example, the FDA placed Point Therapeutics, Inc.’s IND for BXCL701 on clinical hold following an increase in observed mortality in patients receiving BXCL701 in a Phase 3 trial in patients with non-small cell lung cancer. Though we believe that this result was caused by, among other things, an imbalance in the disease severity of patients enrolled in the active arm of the clinical trial, there is no guarantee that excess mortality will not be observed in future clinical studies. Treatment-related side effects could also affect patient recruitment or the ability of enrolled patients to complete the clinical trial or result in potential product liability claims. In addition, these side effects may not be appropriately recognized or managed by the treating medical staff. We expect to have to train medical personnel using our product candidates to understand the side effect profiles observed in our clinical trials and upon commercialization of any of our product candidates that may receive regulatory approval. Inadequate training in recognizing or managing the potential side effects of our product candidates could result in patient injury or death. Any of these occurrences may harm our business, financial condition and prospects significantly.
Additionally, if we or others later identify undesirable side effects caused by IGALMITM or any other product candidate that receives marketing approval, a number of potentially significant negative consequences could result, including:
● | regulatory authorities may withdraw approvals of such products; |
● | we may be required to recall a product or change the way such a product is administered to patients; |
● | additional restrictions may be imposed on the marketing or distribution of the particular product or the manufacturing processes for the product or any component thereof; |
● | regulatory authorities may require additional warnings on the label, such as a “black box” warning or contraindication; |
● | we may be required to implement Risk Evaluation and Mitigation Strategies (“REMS”) or create a medication guide outlining the risks of such side effects for distribution to patients, or similar risk management measures; |
● | we could be sued and held liable for harm caused to patients; |
● | our product may become less competitive; and |
● | our reputation may suffer. |
Any of these events could prevent us from achieving or maintaining market acceptance of the particular product or product candidate, if approved, and could significantly harm our business, results of operations and prospects.
The discovery and development of product candidates based on EvolverAI, BioXcel LLC’s proprietary pharmaceutical discovery and development engine, and our AI platform is novel and unproven, and we do not know whether we will be able to develop any products of commercial value.
We are leveraging our own AI platform and BioXcel LLC’s EvolverAI, a proprietary pharmaceutical discovery and development engine, to create a pipeline of neuroscience and immuno-oncology product candidates for patients whose diseases have not been adequately addressed to date by other approaches and to design and conduct efficient clinical trials with a higher likelihood of success. While we believe that applying our AI platform and BioXcel LLC’s EvolverAI to create medicines for defined patient populations may potentially enable drug research and clinical development that is more efficient than conventional drug research and development, our approach is novel. Although we obtained FDA approval for IGALMITM, because our approach is novel, the cost and time needed to develop our product candidates is difficult to predict, and our efforts may not result in the discovery and development of commercially viable medicines. We may also be incorrect about the effects of our product and product candidates on
87
the diseases of our defined patient populations, which may limit the utility of our approach or the perception of the utility of our approach. Furthermore, our estimates of our defined patient populations available for study and treatment may be lower than expected, which could adversely affect our ability to conduct clinical trials and may also adversely affect the size of any market for medicines we may successfully commercialize. Our approach may not result in time savings, higher success rates or reduced costs as we expect it to, and if not, we may not attract collaborators or develop new drugs as quickly or cost effectively as expected and therefore we may not be able to commercialize our approach as originally expected.
The Company’s AI platform and BioXcel LLC’s EvolverAI may fail to help us discover and develop additional potential product candidates.
Any drug discovery that we are conducting using the Company’s AI platform and BioXcel LLC’s EvolverAI may not be successful in identifying compounds that have commercial value or therapeutic utility. The Company’s AI platform and BioXcel LLC’s EvolverAI may initially show promise in identifying potential product candidates, yet fail to yield viable additional product candidates for clinical development or potential commercialization for a number of reasons, including:
● | research programs to identify new product candidates will require substantial technical, financial and human resources, and we may be unsuccessful in our efforts to identify new product candidates. If we are unable to identify suitable additional compounds for preclinical and clinical development, our ability to develop product candidates and obtain product revenues in future periods could be compromised, which could result in significant harm to our financial position and adversely impact our stock price; |
● | compounds found through the Company’s AI platform and BioXcel LLC’s EvolverAI may not demonstrate efficacy, safety or tolerability; |
● | potential product candidates may, on further study, be shown to have harmful side effects or other characteristics that indicate that they are unlikely to receive marketing approval and achieve market acceptance; |
● | competitors may develop alternative therapies that render our potential product candidates non-competitive or less attractive; or |
● | a potential product candidate may not be capable of being produced at an acceptable cost. |
Regulators may limit our ability to develop or implement our proprietary AI algorithms and/or may eliminate or restrict the confidentiality of our proprietary technology, which could have an adverse effect on our business, results of operations, and financial condition.
Our future success depends on our ability to continue to develop and implement our proprietary AI algorithms and models, and to maintain the confidentiality of this technology. Changes to existing regulations, their interpretation or implementation, or new regulations could impede our use of this technology or require that we disclose our proprietary technology to our competitors, which could impair our competitive position and result in an adverse effect on our business, results of operations and financial condition.
We obtained Fast Track designation for certain of our product candidates, and we may seek Fast Track designation for other indications or for our other product candidates, but we might not receive such designations, and even if we do, such designations may not actually lead to a faster development or regulatory review or approval process.
If a product candidate is intended for the treatment of a serious condition and nonclinical or clinical data demonstrate the potential to address unmet medical need for this condition, a product sponsor may apply for FDA Fast Track designation. The sponsor of a Fast Track product candidate has opportunities for more frequent interactions with the applicable FDA review team during product development and, once an NDA is submitted, the product candidate may be eligible for priority review if the relevant criteria are met. An NDA for a Fast Track product candidate may also be eligible for rolling review, where the FDA may consider for review sections of the NDA on a rolling basis before the
88
complete application is submitted, if the sponsor provides a schedule for the submission of the sections of the NDA, the FDA agrees to accept sections of the NDA and determines that the schedule is acceptable, and the sponsor pays any required user fees upon submission of the first section of the NDA. We obtained Fast Track designation for BXCL501 for the acute treatment of mild-to-moderate agitation associated with schizophrenia, bipolar disorder, and dementia, and we further obtained Fast Track designation for BXCL701, in combination with a checkpoint inhibitor, for the treatment of patients with metastatic SCNC with progression on chemotherapy and no evidence of microsatellite instability, and we may seek additional Fast Track designation for BXCL501 or BXCL701 or for one or more of our other product candidates, but we might not receive such designations from the FDA. However, even if we receive Fast Track designation, Fast Track designation does not ensure that we will receive marketing approval or that approval will be granted within any particular timeframe. We may not experience a faster development or regulatory review or approval process with Fast Track designation compared to conventional FDA procedures. In addition, the FDA may withdraw Fast Track designation if it believes that the designation is no longer supported by data from our clinical development program. Fast Track designation alone does not guarantee qualification for the FDA’s priority review procedures.
A Breakthrough Therapy designation by the FDA, even if granted for any of our product candidates, may not lead to a faster development or regulatory review or approval process and it does not increase the likelihood that our product candidates will receive marketing approval.
We obtained Breakthrough Therapy Designation for BXCL501 for the acute treatment of agitation associated with dementia, and we may seek additional Breakthrough Therapy designations for our product candidates if the clinical data support such a designation for one or more product candidates. A Breakthrough Therapy is defined as a drug or biologic that is intended, alone or in combination with one or more other drugs or biologics, to treat a serious or life-threatening disease or condition and preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies on one or more clinically significant endpoints, such as substantial treatment effects observed early in clinical development. For product candidates that have been designated as Breakthrough Therapies, interaction and communication between the FDA and the sponsor of the trial can help to identify the most efficient path for clinical development while minimizing the number of patients placed in ineffective control regimens. Product candidates designated as Breakthrough Therapies by the FDA also receive the benefits associated with Fast Track designation, including the potential for rolling review of an NDA.
Designation as a Breakthrough Therapy is within the discretion of the FDA. Accordingly, even if we believe one of our product candidates meets the criteria for designation as a Breakthrough Therapy, the FDA may disagree and instead determine not to make such designation. In any event, the receipt of a Breakthrough Therapy designation for a product candidate may not result in a faster development process, review or approval compared to drugs considered for approval under non-expedited FDA review procedures and does not assure ultimate approval by the FDA. In addition, even if one or more of our product candidates qualify as breakthrough therapies, the FDA may later decide that the product no longer meets the conditions for qualification or decide that the period for FDA review or approval will not be shortened.
89
If the FDA does not conclude that our product candidates satisfy the requirements for the 505(b)(2) regulatory approval pathway, or if the requirements for approval of any of our product candidates under Section 505(b)(2) are not as we expect, the approval pathway for our product candidates will likely take significantly longer, cost significantly more and encounter significantly greater complications and risks than anticipated, and in any case may not be successful.
We intend to seek FDA approval through the 505(b)(2) regulatory pathway for certain of our product candidates. The Hatch-Waxman Act added Section 505(b)(2) to the Federal Food, Drug and Cosmetic Act (“FDCA”). Section 505(b)(2) permits the filing of an NDA where at least some of the information required for approval comes from studies that were not conducted by or for the applicant. If the FDA does not allow us to pursue the 505(b)(2) regulatory pathway for our product candidates as anticipated, we may need to conduct additional clinical trials, provide additional data and information and meet additional standards for regulatory approval. If this were to occur, the time and financial resources required to obtain FDA approval for our product candidates would likely substantially increase. Moreover, the inability to pursue the 505(b)(2) regulatory pathway could result in new competitive products reaching the market faster than our product candidates, which could materially adversely impact our competitive position and prospects. Even if we are allowed to pursue the 505(b)(2) regulatory pathway for a product candidate, we cannot assure you that we will receive the requisite or timely approvals for commercialization of such product candidate. In addition, we expect that our competitors will file citizens’ petitions with the FDA in an attempt to persuade the FDA that our product candidates, or the clinical studies that support their approval, contain deficiencies. Such actions by our competitors could delay or even prevent the FDA from approving any NDA that we submit under Section 505(b)(2).
If we are required by the FDA, or similar regulatory authorities, to obtain approval (or clearance, or certification) of a companion diagnostic device in connection with approval of one of our product candidates, and we do not obtain, or face delays in obtaining approval (or clearance, or certification) of a companion diagnostic device, we will not be able to commercialize the product candidate, and our ability to generate revenue will be materially impaired.
According to FDA guidance, if the FDA determines that a companion diagnostic device is essential to the safe and effective use of a novel therapeutic product or indication, the FDA generally will not approve the therapeutic product or new therapeutic product indication if the companion diagnostic is not also approved or cleared for that indication. If a satisfactory companion diagnostic is not commercially available, we may be required to create or obtain one that would be subject to regulatory approval requirements. For example, we may decide to collaborate with patient diagnostic companies during our clinical trial enrollment process for BXCL701 to help identify patients with tumor gene alterations that we believe may be most likely to respond to treatment with BXCL701. The process of obtaining or creating such diagnostic is time consuming and costly.
Companion diagnostics are developed in conjunction with clinical programs for the associated product and are subject to regulation as medical devices by the FDA and comparable foreign regulatory authorities, and, to date, the FDA has generally required premarket approval of companion diagnostics for cancer therapies. Generally, when a companion diagnostic is essential to the safe and effective use of a therapeutic product, the FDA requires that the companion diagnostic be approved before or concurrent with approval of the therapeutic product and before a product can be commercialized. The approval of a companion diagnostic as part of the therapeutic product’s labeling limits the use of the therapeutic product to only those patients who express the specific genetic alteration that the companion diagnostic was developed to detect. In January 2024, the FDA announced that it intends to initiate the process to reclassify most in vitro diagnostic tests (“IVDs”) that are currently Class III into Class II, including companion diagnostic IVDs. If such reclassification efforts occur, any companion diagnostics that are the subject of the down-classification may no longer require premarket approval, but rather may be marketed pursuant to the generally less burdensome 510(k) clearance process. However, there is no assurance that any companion diagnostic required for our pharmaceutical development programs will benefit from the reclassification, or that the reclassification, even if it does occur, will result in a shorter timeline to development or marketing of the companion diagnostic.
If the FDA, or a comparable foreign regulatory authority, requires approval (or certification or clearance) of a companion diagnostic for any of our product candidates, whether before or after the product candidate obtains marketing approval, we and/or third-party collaborators may encounter difficulties in developing and obtaining approval (or clearance, or certification) for these companion diagnostics. Any delay or failure by us or third-party collaborators to develop or obtain regulatory approval (or clearance, or certification) of a companion diagnostic could
90
delay or prevent approval or continued marketing of our related product candidates. We may also experience delays in developing a sustainable, reproducible and scalable manufacturing process for the companion diagnostic or in transferring that process to commercial partners or negotiating insurance reimbursement plans, all of which may prevent us from completing our clinical trials or commercializing our product candidates, if approved, on a timely or profitable basis, if at all.
Approval, clearance or certification of companion diagnostics may be subject to further legislative or regulatory reforms notably in the EU. On May 25, 2017, the new In Vitro Medical Devices Regulation No. 2017/746 (“IVDR”) entered into force. The IVDR repeals and replaces the EU In Vitro Diagnostic Medical Devices Directive. Unlike directives, which must be implemented into the national laws of the EU member states, regulations are directly applicable (i.e., without the need for adoption of EU member states laws implementing them) in all EU member states and are intended to eliminate current differences in the regulation of medical devices among EU member states. The IVDR, among other things, is intended to establish a uniform, transparent, predictable and sustainable regulatory framework across the EU for medical devices and ensure a high level of safety and health while supporting innovation. The IVDR became effective in May 2022. However, on October 14, 2021, the European Commission proposed a “progressive” roll-out of the IVDR to prevent disruption in the supply of in vitro diagnostic medical devices. The European Parliament and Council adopted the proposed regulation on December 15, 2021. The IVDR has applied since May 26, 2022, but there is a tiered system extending the grace period for many devices (depending on their risk classification) before they have to be fully compliant with the regulation.
The regulation of companion diagnostics in the EU is subject to further requirements since the IVDR became applicable as it introduced a new classification system for companion diagnostics. Companion diagnostics will have to undergo a conformity assessment by a notified body. Before it can issue an EU certificate, the notified body must seek a scientific opinion from the EMA on the suitability of the companion diagnostic to the medicinal product concerned if the medicinal product falls exclusively within the scope of the centralized procedure for the authorization of medicines, or the medicinal product is already authorized through the centralized procedure, or a marketing authorization (“MA”) application for the medicinal product has been submitted through the centralized procedure. For other substances, the notified body can seek the opinion from a national competent authority or the EMA.
These modifications may make it more difficult and costly for us to obtain regulatory clearances, approvals or certifications for our companion diagnostics or to manufacture, market or distribute our products after clearance, approval or certification is obtained.
Although the FDA has approved IGALMITM for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder, we will still face extensive and ongoing regulatory requirements and obligations for IGALMITM and for any product candidates for which we obtain approval.
Any regulatory approvals that we may receive for IGALMITM or any of our product candidates will require the submission of reports to regulatory authorities and surveillance to monitor the safety and efficacy of the product, may contain significant limitations related to use restrictions for specified age groups, warnings, precautions or contraindications, and may include burdensome post-approval study or risk management requirements. For example, the FDA-approved label for IGALMITM includes certain warnings and precautions regarding hypotension, orthostatic hypotension, bradycardia, somnolence, and QT interval prolongation. The FDA may also require a REMS to approve a product candidate, which could entail requirements for a medication guide, physician training and communication plans or additional elements to ensure safe use, such as restricted distribution methods, patient registries and other risk minimization tools.
In addition, the manufacturing processes, labeling, packaging, distribution, AE reporting, storage, advertising, promotion, import, export and recordkeeping for IGALMITM are and will remain subject to extensive and ongoing regulatory requirements. These requirements include submissions of safety and other post-marketing information and reports, registration, and on-going compliance with cGMPs, and GCPs for any clinical trials that we conduct post-approval. In addition, manufacturers of drug products and their facilities are subject to continual review and periodic, unannounced inspections by the FDA and other regulatory authorities for compliance with cGMP regulations and standards. If we or a regulatory authority discover previously unknown problems with a product, such as AEs of unanticipated severity or frequency, or problems with the facilities where the product is manufactured, a regulatory
91
authority may impose restrictions on that product, the manufacturing facility or us, including requiring recall or withdrawal of the product from the market or suspension of manufacturing.
In addition, discovery of previously unknown AEs or other problems with our products, manufacturers or manufacturing processes or failure to comply with regulatory requirements, may yield various results, including:
● | restrictions on manufacturing such products; |
● | restrictions on the labeling or marketing of products; |
● | restrictions on product manufacturing, distribution or use; |
● | requirements to conduct post-marketing studies or clinical trials; |
● | warning letters or untitled letters; |
● | withdrawal of the products from the market; |
● | refusal to approve pending applications or supplements to approved applications that we submit; |
● | recall of products; |
● | fines, restitution or disgorgement of profits or revenues; |
● | suspension or withdrawal of marketing approvals; |
● | refusal to permit the import or export of our products; |
● | product seizure; or |
● | injunctions or the imposition of civil or criminal penalties. |
Further, the policies of the FDA and other regulatory authorities may change, and additional government regulations may be enacted that could impose extensive and ongoing regulatory requirements and obligations on any product candidate for which we obtain marketing approval. We also cannot predict the likelihood, nature or extent of government regulation that may arise from future legislation or administrative or executive action, either in the U.S. or abroad.
The FDA and other regulatory agencies actively enforce the laws and regulations prohibiting the promotion of off-label uses.
The FDA and other regulatory authorities strictly regulate marketing, labeling, advertising and promotion of prescription drugs. These regulations include standards and restrictions for direct-to-consumer advertising, industry-sponsored scientific and educational activities, promotional activities involving the internet and off-label promotion. Any regulatory approval that the FDA or any other regulatory authority may grant is limited to those specific diseases and indications for which a product is deemed to be safe and effective. For example, the FDA-approved label for IGALMITM is currently limited to the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder in adults to be self-administrated by patients under the supervision of a health care provider.
While physicians in the U.S. may choose, and are generally permitted, to prescribe drugs for uses that are not described in the product’s labeling and for uses that differ from those tested in clinical trials and approved by the regulatory authorities, our ability to promote the products is narrowly limited to those indications that are specifically approved by the FDA. These “off-label” uses are common across medical specialties and may constitute an appropriate treatment for some patients in varied circumstances. For example, other formulations of Dex, the active ingredient in IGALMITM, have been approved for uses beyond those authorized in IGALMITM approved labeling, such as for use in
92
sedation of surgical patients, and we are continuing to develop BXCL501 for potential use in patients with dementia, MDD, Alzheimer’s disease and other indications. We do not market or promote IGALMITM for these uses.
Regulatory authorities in the U.S. generally do not regulate the behavior of physicians in their choice of treatments. Regulatory authorities do, however, restrict communications by pharmaceutical companies on off-label use. If we are found to have promoted our products for any off-label uses, the U.S. federal government (and other foreign governments) could levy civil, criminal and/or administrative penalties, and seek fines against us. The FDA, or other regulatory authorities, could also require that we enter into a consent decree or a corporate integrity agreement, or seek a permanent injunction against us under which specified promotional conduct is monitored, changed or curtailed. If we cannot successfully manage the promotion of IGALMITM or our product candidates, if approved, we could become subject to significant liability, which would materially adversely affect our business and financial condition.
Disruptions at the FDA and other government agencies caused by funding shortages or global health concerns could hinder their ability to hire, retain or deploy key leadership and other personnel, or otherwise prevent new or modified products from being developed, approved or commercialized in a timely manner or at all, which could negatively impact our business.
The ability of the FDA and foreign regulatory authorities to review and approve new products can be affected by a variety of factors, including government budget and funding levels, statutory, regulatory and policy changes, the FDA’s or foreign regulatory authorities’ ability to hire and retain key personnel and accept the payment of user fees, and other events that may otherwise affect the FDA’s or foreign regulatory authorities’ ability to perform routine functions. Average review times at the FDA and foreign regulatory authorities have fluctuated in recent years as a result of some of these aforementioned issues. In addition, government funding of other government agencies that fund research and development activities is subject to the political process, which is inherently fluid and unpredictable. Disruptions at the FDA and other agencies, such as the EMA, following its relocation to Amsterdam and corresponding staff changes, may also slow the time necessary for new drug or modifications to approved drugs to be reviewed and/or approved by necessary government agencies, which would adversely affect our business. For example, over the last several years, the U.S. government has shut down several times and certain regulatory agencies, such as the FDA, have had to furlough critical FDA employees and stop critical activities.
Separately, in response to the COVID-19 pandemic, the FDA postponed most inspections of domestic and foreign manufacturing facilities at various points. Even though the FDA has since resumed standard inspection operations, any resurgence of the virus or emergence of new variants may lead to inspectional or administrative delays. If a prolonged government shutdown occurs, or if global health concerns prevent the FDA or other regulatory authorities from conducting their regular inspections, reviews or other regulatory activities, it could significantly impact the ability of the FDA or other regulatory authorities to timely review and process our regulatory submissions, which could have a material adverse effect on our business.
We may conduct certain of or portions of our clinical trials for our product candidates outside of the U.S. and the FDA may not accept data from such trials, in which case our development plans will be delayed, which could materially harm our business.
We may choose to conduct one or more of our clinical trials or a portion of our clinical trials for our product candidates outside the U.S. The acceptance of study data from clinical trials conducted outside the U.S. or another jurisdiction by the FDA or comparable foreign regulatory authority may be subject to certain conditions or may not be accepted at all. In cases where data from foreign clinical trials are intended to serve as the sole basis for marketing approval in the U.S., the FDA will generally not approve the application on the basis of foreign data alone unless (i) the data are applicable to the U.S. population and U.S. medical practice; (ii) the trials were performed by clinical investigators of recognized competence and pursuant to GCP regulations; and (iii) the data may be considered valid without the need for an on-site inspection by the FDA, or if the FDA considers such inspection to be necessary, the FDA is able to validate the data through an on-site inspection or other appropriate means. In addition, even where the foreign study data are not intended to serve as the sole basis for approval, if the clinical trial was not otherwise subject to an IND, the FDA will not accept the data as support for an application for marketing approval unless the study was conducted in accordance with GCP requirements and the FDA is able to validate the data from the study through an on-site inspection if deemed necessary. Many foreign regulatory authorities have similar approval requirements. In
93
addition, such foreign trials would be subject to the applicable local laws of the foreign jurisdictions where the trials are conducted. There can be no assurance that the FDA or any comparable foreign regulatory authority will accept data from trials conducted outside of the U.S. or the applicable jurisdiction. If the FDA or any comparable foreign regulatory authority does not accept such data, it would result in the need for additional trials, which could be costly and time-consuming, and could result in current or future product candidates that we may develop not receiving approval for commercialization in the applicable jurisdiction.
We may be subject to extensive regulations outside the U.S. and may not obtain marketing approvals for products in Europe and other jurisdictions.
In addition to regulations in the U.S., should we or our collaborators pursue marketing approvals for IGALMITM, and for BXCL501, BXCL502, BXCL701, BXCL702 and our other product candidates internationally, we and our collaborators will be subject to a variety of regulations in other jurisdictions governing, among other things, clinical trials and any commercial sales and distribution of our products. Whether or not we, or our collaborators, obtain FDA approval for a product, we must obtain the requisite approvals from regulatory authorities in foreign countries prior to the commencement of clinical trials or marketing of the product in those countries. The requirements and process governing the conduct of clinical trials, product licensing, pricing and reimbursement vary from country to country.
We expect to pursue marketing approvals for IGALMITM, and may pursue marketing approvals for BXCL501, BXCL502, BXCL701, BXCL702 and our other product candidates in Europe and other jurisdictions outside the U.S. with collaborative partners. The time and process required to obtain regulatory approvals and reimbursement in Europe and other jurisdictions may be different from those in the U.S. Also, regulatory approval in one jurisdiction does not ensure approvals in any other jurisdiction; however, negative regulatory decisions in any jurisdiction may have a negative impact on the regulatory process in other jurisdictions.
Following a national referendum and enactment of legislation by the government of the United Kingdom (“UK”), the UK formally withdrew from the EU on January 31, 2020 and ratified a trade and cooperation agreement governing its future relationship (commonly referred to as “Brexit”). The agreement, which was applied provisionally from January 1, 2021 and entered into force on May 1, 2021, addresses trade, economic arrangements, law enforcement, judicial cooperation and a governance framework including procedures for dispute resolution, among other things. Because the agreement merely sets forth a framework in many respects and requires complex additional bilateral negotiations between the UK and the EU as both parties continue to work on the rules for implementation, significant political and economic uncertainty remains about how the precise terms of the relationship between the parties will differ from the terms before withdrawal.
Since January 1, 2021, the UK operates under a distinct regulatory regime to the EU. EU pharmaceutical laws only apply in respect of the UK to Northern Ireland (as set out in the Protocol on Ireland/Northern Ireland). EU laws which have been transposed into UK law through secondary legislation continue to be applicable as “retained EU law”. While the UK has indicated a general intention that new laws regarding the development, manufacture and commercialization of medicinal products in the UK will align closely with EU law, there are limited detailed proposals for future regulation of medicinal products. The trade and cooperation agreement includes specific provisions concerning medicinal products, which include the mutual recognition of cGMP, inspections of manufacturing facilities for medicinal products and cGMP documents issued (such mutual recognition can be rejected by either party in certain circumstances) but does not foresee wholesale mutual recognition of UK and EU pharmaceutical regulations. For example, it is not clear to what extent the UK will adopt legislation aligned with, or similar to, the EU CTR which became applicable on January 31, 2022 and which significantly reforms the assessment and supervision processes for clinical trials throughout the EU. On January 17, 2022, the UK Medicines and Healthcare products Regulatory Agency (“MHRA”) launched an eight-week consultation on reframing the UK legislation for clinical trials which aimed to streamline clinical trials approvals, enable innovation, enhance clinical trials transparency, enable greater risk proportionality, and promote patient and public involvement in clinical trials. The MHRA responded to the consultation on March 21, 2023 and confirmed that it would bring forward changes to the legislation. The final legal texts introduced by the UK Government will ultimately determine the extent to which the UK clinical trials framework aligns with or diverges from the EU CTR. A decision by the UK not to closely align its regulations with the new approach that will be adopted in the EU may have an effect on the cost of conducting clinical trials in the UK as opposed to other countries.
94
Therefore, there remains political and economic uncertainty regarding to what extent the regulation of medicinal products will differ between the UK and the EU in the future. Any divergences will increase the cost and complexity of running our business, including with respect to the conduct of clinical trials. Brexit also materially impacted the regulatory regime with respect to the approval of our product candidates. Great Britain is no longer covered by the EU’s procedures for the grant of MAs (Northern Ireland is covered by the centralized authorization procedure and can be covered under the decentralized or mutual recognition procedures). As of January 1, 2021, all existing centralized MAs were automatically converted into UK MAs effective in Great Britain and issued with a UK MA number on January 1, 2021 (unless MA holders opted out of this scheme). A separate MA is now required to market drugs in Great Britain. It is currently unclear whether the regulator in the UK, the MHRA, is sufficiently prepared to handle the increased volume of MA applications that it is likely to receive. Any delay in obtaining, or an inability to obtain, any regulatory approvals, as a result of Brexit or otherwise, would prevent us from commercializing our product candidates in Great Britain and restrict our ability to generate revenue and achieve and sustain profitability. If any of these outcomes occur, we may be forced to restrict or delay efforts to seek regulatory approval in Great Britain for our product candidates, which could significantly and materially harm our business. Any of these factors could have a significant adverse effect on our business, financial condition, results of operations and prospects.
If we are found in violation of federal, state or foreign health care “fraud and abuse” laws, we may be required to pay significant fines and penalties, including, without limitation, debarment, suspension or exclusion from participation in federal, state or similar health care programs, which may adversely affect our business, financial condition and results of operations.
In the U.S., we are subject to various federal and state health care “fraud and abuse” laws, including anti- kickback laws, false claims laws and other laws intended to reduce fraud and abuse in federal and state health care programs, which could affect us, and our ability to successfully commercialize our products in the U.S. We may have to comply with similar laws and regulations outside the U.S. These laws include:
● | the federal Anti-Kickback Statute makes it illegal for any person, including a prescription drug manufacturer (or a party acting on its behalf), to knowingly and willfully solicit, receive, offer or pay any remuneration that is intended to induce the referral of business, including the purchase, order or prescription of a particular drug for which payment may be made under a federal health care program, such as Medicare or Medicaid. A person or entity does not need to have actual knowledge of this statute or specific intent to violate it to have committed a violation; |
● | false claims laws prohibit anyone from knowingly and willfully presenting or causing to be presented for payment to third-party payers, including government payers, claims for reimbursed drugs or services that are false or fraudulent, claims for items or services that were not provided as claimed, or claims for medically unnecessary items or services. Cases have been brought under false claims laws alleging that off-label promotion of pharmaceutical products or the provision of kickbacks has resulted in the submission of false claims to governmental health care programs. In addition, the government may assert that a claim, including items or services resulting from a violation of the federal Anti-Kickback Statute, constitutes a false or fraudulent claim for purposes of the false claims laws. Further, private individuals have the ability to bring actions on behalf of the government under the federal False Claims Act; |
● | the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) prohibits persons or entities from knowingly and willfully executing a scheme to defraud any health care benefit program, including private payers, or knowingly and willfully falsifying, concealing or covering up a material fact or making any materially false, fictitious or fraudulent statement in connection with the delivery of or payment for health care benefits, items or services. Similar to the federal Anti- Kickback Statute, a person or entity does not need to have actual knowledge of these statutes or specific intent to violate them to have committed a violation; |
● | federal civil monetary penalties laws, which impose civil fines for, among other things, the offering or transfer of remuneration to a Medicare or state health care program beneficiary if the person knows, or should know, it is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of services reimbursable by Medicare or a state health care program, unless an exception applies; |
95
● | federal consumer protection and unfair competition laws, which broadly regulate marketplace activities and activities that potentially harm consumers; |
● | the federal physician sunshine requirements under the Patient Protection and Affordable Care Act, (“ACA”), which requires certain manufacturers of drugs, devices, biologics, and medical supplies to report annually to the Centers for Medicare & Medicaid Services (“CMS”) information related to payments and other transfers of value to physicians (defined to include doctors, dentists, optometrists, podiatrists and chiropractors), certain non-physician practitioners (physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, anesthesiologist assistants, and certified nurse midwives), and teaching hospitals, and ownership and investment interests held by physicians and their immediate family members; |
● | state law equivalents of each of the above federal laws, such as anti-kickback and false claims laws, which may apply to items or services reimbursed by any third-party payor, including commercial insurers; state laws that require pharmaceutical companies to comply with the pharmaceutical industry’s voluntary compliance guidelines and the applicable compliance guidance promulgated by the federal government, or otherwise restrict payments that may be made to health care providers and other potential referral sources; and state laws that require drug manufacturers to report information related to payments and other transfers of value to physicians and other health care providers or marketing expenditures and pricing information; and |
● | European and other foreign law equivalents of each of the laws, including reporting requirements detailing interactions with and payments to health care providers. |
The risk of our being found in violation of these laws is increased by the fact that many of them have not been fully interpreted by the regulatory authorities or the courts, and their provisions are open to a variety of interpretations. Any action against us for violation of these laws, even if we successfully defend against it, could cause us to incur significant legal expenses and divert our management’s attention from the operation of our business. If our operations are found to be in violation of any of the laws described above or any other governmental laws and regulations that apply to us, we may be subject to penalties, including civil and criminal penalties, damages, fines, the curtailment or restructuring of our operations, the exclusion from participation in federal and state or foreign health care programs, additional reporting obligations and oversight if we become subject to a corporate integrity agreement or other agreement to resolve allegations of non-compliance with these laws, any of which could adversely affect our ability to market our products and adversely impact our financial results.
We may be unable to maintain sufficient clinical trial liability insurance.
Our inability to retain sufficient clinical trial liability insurance at an acceptable cost to protect against potential liability claims could prevent or inhibit our ability to conduct clinical trials for product candidates we develop. We may be unable to obtain appropriate levels of such insurance. Even if we do secure clinical trial liability insurance for our programs, we may not be able to achieve sufficient levels of such insurance. Any claim that may be brought against us could result in a court judgment or settlement in an amount that is not covered, in whole or in part, by our insurance or that exceeds the limits of our insurance coverage. We have supplemented our clinical trial coverage with product liability coverage in connection with the commercial launch of IGALMITM and expect that we would similarly supplement our coverage for any of our other product candidates that may receive regulatory approval, but we may be unable to obtain such increased coverage on acceptable terms or at all. If we are found liable in a clinical trial lawsuit or a product liability lawsuit in the future, we will have to pay any amounts awarded by a court or negotiated in a settlement that exceed our coverage limitations or that are not covered by our insurance, and we may not have, or be able to obtain, sufficient capital to pay such amounts.
96
Risks Related to Commercialization of Our Product Candidates
If our products do not gain market acceptance or if we fail to accurately forecast demand or manage our inventories, our business will suffer because we might not be able to fund future operations.
A number of factors may affect the market acceptance of our products or any other products or product candidates we develop or acquire, including, among others:
● | the price of our products relative to other products for the same or similar treatments; |
● | the perception by patients, physicians and other members of the health care community of the effectiveness, utility and safety of our products for their indicated applications and treatments; |
● | our ability to fund our sales and marketing efforts; and |
● | the effectiveness of our sales and marketing efforts, including our strategic refocus to hospital/IDNs as part of the Reprioritization. |
If our products do not gain market acceptance, we may not be able to fund future operations, including developing, testing and obtaining regulatory approval for new product candidates and expanding our sales and marketing efforts for our approved products, which would cause our business to suffer.
We plan to continue to commercialize IGALMI TM sublingual film for the acute treatment of agitation associated with schizophrenia or bipolar I or II disorder, to be self-administered by patients under the supervision of a healthcare provider, which is our only approved product to date. However, in connection with the Reprioritization, we significantly reduced the resources devoted to commercialization of IGALMI TM and it is possible that will have adverse consequences on the revenue that we are able to generate from IGALMI TM. Revenues for IGALMI TM for the year ended December 31, 2023 and nine months ended September 30, 3024 were $1.4 million and $1.9 million, respectively. If our commercial products do not gain market acceptance, we may not be able to fund future operations, including developing, testing and obtaining regulatory approval for an sNDA for other BXCL501 indications, including in the at-home setting for the acute treatment of agitation (non-daily) associated with dementia due to probable Alzheimer’s disease, or for other product candidates that it may develop. Our results of operations could be materially harmed if we are unable to successfully commercialize IGALMI TM for any currently or additionally approved indications or any future product candidates that we may have approved. We may experience concentration of a limited number of customers for sales of IGALMI TM. For example, we sold $735,000 to a single customer during the second quarter of 2024. If any such customers change their business requirements or purchasing behavior our business, financial condition, and results of operations may be adversely affected. Furthermore, sales to customers may fluctuate significantly, and sales from one period may not be indicative of future results.
Our results of operations could be materially harmed if we are unable to accurately forecast customer demand for IGALMITM and manage our inventory. To ensure adequate inventory supply, we must forecast inventory needs and place orders with our suppliers based on our estimates of future demand for IGALMITM. Our ability to accurately forecast demand for IGALMITM could be negatively affected by many factors, including our failure to accurately manage the effects of product introductions by competitors, an increase or decrease in customer demand for IGALMITM or for products of our competitors, our failure to accurately forecast customer acceptance of new products, unanticipated changes in general market conditions or regulatory matters, and weakening of economic conditions or consumer confidence in future economic conditions. Inventory levels in excess of customer demand may result in inventory write-downs or write-offs, which would cause our gross margin to be adversely affected and could impair the strength of our brand. Conversely, if we underestimate customer demand for IGALMITM, our third-party contract manufacturer may not be able to deliver products to meet our requirements, and this could result in damage to our reputation and customer relationships. In addition, if we experience a significant increase in demand, additional supplies of raw materials or additional manufacturing capacity may not be available when required on terms that are acceptable to us, or at all, or suppliers or our third-party manufacturers may not be able to allocate sufficient capacity in order to meet our increased requirements, which could have an adverse effect on our ability to meet customer demand for IGALMITM and our results of operations.
97
We seek to maintain sufficient levels of inventory to protect ourselves from supply interruptions. As a result, we are subject to the risk that a portion of our inventory will become obsolete or expire, which could have a material adverse effect on our earnings and cash flows due to the resulting costs associated with the inventory impairment charges and costs required to replace such inventory.
Our estimated number of episodes of agitation and our corresponding estimated total addressable market are subject to inherent challenges and uncertainties. If we have overestimated the number of episodes or the size of our total addressable market for our current and potential future products or product candidates, or if any approval that we obtain is based on a narrower definition of the patient population, our revenue and ability to achieve profitability may be harmed.
We have based our potential market opportunity on a number of internal and third-party estimates and resources, including, without limitation, management’s estimates and research, as well as industry and general publications and research, surveys and studies conducted by third parties, which may be incorrect. Our estimated potential market opportunity is based on estimates of episodes of agitation across our indications, and these estimated episodes of agitation are also based on internal and third-party estimates and market resources using data self-reported by patients. The conditions supporting our assumptions or estimates and the market data supporting these assumptions and estimates may change at any time or otherwise be inaccurate, thereby reducing the predictive accuracy of these underlying factors. Our total addressable market will ultimately depend upon, among other things, the number of actual treatable episodes, the diagnosis criteria included in the final label for each of our product candidates, if approved for sale for these indications, acceptance by the medical community and patient access, drug pricing and reimbursement. The number of patients and treatable episodes in the United States and other major markets and elsewhere may turn out to be materially lower than expected, the number of treatable episodes may be significantly fewer than total episodes experienced, patients may not be otherwise amenable to treatment with our product candidates or new patients may become increasingly difficult to identify or gain access to, all of which would harm our results of operations and our business. For example, our estimates of the monthly average episodes for patients diagnosed with bipolar disorder and patients diagnosed with schizophrenia and, therefore, our estimated total addressable market are based on third-party market surveys which differ from an observational study in the EU of inhaled loxapine for the treatment of agitation in patients with schizophrenia or bipolar disorder conducted which found that only 40% of enrolled patients reported agitation episodes in the six-month study period. If third-party or internally generated data prove to be inaccurate or we make errors in our assumptions based on that data, our total addressable market may be meaningfully smaller than we have estimated, our future growth opportunities and sales growth may be impaired, any of which could have a material adverse effect on our business, financial condition and results of operations.
We obtained Orphan Drug Designation for BXCL701 for the treatment of pancreatic cancer, melanoma, acute myeloid leukemia and soft tissue sarcoma and we may seek Orphan Drug Designation for other indications or product candidates, and we may be unable to maintain the benefits associated with Orphan Drug Designation, including the potential for market exclusivity, and may not receive Orphan Drug Designation for other indications or for our other product candidates.
Regulatory authorities in some jurisdictions, including the U.S. and EU, may designate drugs intended for relatively small patient populations as orphan drugs. Under the Orphan Drug Act, the FDA may designate a drug as an orphan drug if it is a drug intended to treat a rare disease or condition, which is generally defined as a patient population of fewer than 200,000 individuals in the U.S., or a patient population greater than 200,000 individuals in the U.S. where there is no reasonable expectation that the cost of developing the drug will be recovered from sales in the U.S. In the EU, orphan drug designation is granted by the European Commission based on a scientific opinion of the EMA’s Committee for Orphan Medicinal Products. A medicinal product may be designated as orphan if its sponsor can establish that (i) the product is intended for the diagnosis, prevention or treatment of a life-threatening or chronically debilitating condition; (ii) either (a) such condition affects no more than 5 in 10,000 persons in the EU when the application is made, or (b) the product, without the benefits derived from orphan status, would not generate sufficient return in the EU to justify investment; and (iii) there exists no satisfactory method of diagnosis, prevention or treatment of such condition authorized for marketing in the EU, or if such a method exists, the medicinal product will be of significant benefit to those affected by the condition. The application for orphan designation must be submitted before the application for MA.
98
In the U.S., orphan drug designation entitles a party to financial incentives such as opportunities for grant funding towards clinical trial costs, tax advantages and user-fee waivers. In addition, if a product that has orphan drug designation subsequently receives the first FDA approval for the disease or condition for which it has such designation, the product is entitled to orphan drug exclusivity. Orphan drug exclusivity in the U.S. provides that the FDA may not approve any other applications, including a full NDA, to market the same drug for the same disease or condition for seven years. In limited circumstances, the applicable exclusivity period is 10 years in the EU. The EU exclusivity period can be reduced to six years if, at the end of the fifth year, it is established that a drug no longer meets the criteria for orphan drug designation or if the drug is sufficiently profitable so that market exclusivity is no longer justified.
In January 2021, the FDA granted Orphan Drug Designation to BXCL701 for the treatment of soft tissue sarcoma. In September 2019, the FDA granted Orphan Drug Designation to BXCL701 for the treatment of acute myeloid leukemia. Prior to 2019, the FDA granted Orphan Drug Designation to BXCL701 for the treatment of pancreatic cancer and melanoma. We may seek Orphan Drug Designations for BXCL701 in other diseases or conditions or for other product candidates. There can be no assurances that we will be able to obtain such designations.
Even if we, or any future collaborators, obtain orphan drug designation for a product candidate, we, or they, may not be able to obtain or maintain orphan drug exclusivity for that product candidate. We may not be the first to obtain marketing approval of any product candidate for which we have obtained orphan drug designation for the orphan- designated indication due to the uncertainties associated with developing pharmaceutical products, and it is possible that another company also holding orphan drug designation for the same product candidate will receive marketing approval for the same disease or condition before we do. If that were to happen, our applications for that disease or condition may not be approved until the competing company’s period of exclusivity expires. In addition, exclusive marketing rights in the U.S. and abroad may be limited if we seek approval for an indication broader than the orphan-designated disease or condition or may be lost if the FDA or foreign regulatory authorities later determines that the request for designation was materially defective or if we are unable to assure sufficient quantities of the product to meet the needs of patients with the rare disease or condition. Further, even if we, or any future collaborators, obtain orphan drug exclusivity for a product, that exclusivity may not effectively protect the product from competition because different drugs with different active ingredients may be approved for the same disease or condition. Even after an orphan drug is approved, the FDA or foreign regulatory authorities can subsequently approve the same drug with the same active ingredient for the same condition if the FDA or foreign regulatory authorities conclude that the later drug is clinically superior in that it is shown to be safer, more effective or makes a major contribution to patient care or the manufacturer of the product with orphan exclusivity is unable to maintain sufficient product quantity. Orphan drug designation neither shortens the development or regulatory review time of a drug, nor gives the drug any advantage in the regulatory review or approval process and does not prevent competitors from obtaining approval of the same product candidate as ours for indications other than those in which we have been granted orphan drug designation.
If we are unable to develop satisfactory sales and marketing capabilities, we may not succeed in commercializing IGALMITM or any product candidate for which we may obtain regulatory approval.
We have limited experience in marketing and selling drug products. We have not entered into arrangements for the sale and marketing of IGALMITM, BXCL501, BXCL502, BXCL701, BXCL702 or any other product candidate. Typically, pharmaceutical companies would employ groups of sales representatives and associated sales and marketing staff numbering in the hundreds to thousands of individuals to call on the large number of physicians and hospitals. Following our Reprioritization, we may need to rebuild a commercial sales and marketing team if we seek to modify our commercial strategy for IGALMITM or initiate commercial sales for any product candidate in the future, which will likely require significant cost. We may seek to collaborate with a third-party to market our drugs or may seek to market and sell our drugs by ourselves. If we seek to collaborate with a third-party, we cannot be sure that a collaborative agreement can be reached on terms acceptable to us. We may also need to hire additional personnel skilled in marketing and sales for our direct marketing and selling efforts. We cannot be sure that we will be able to acquire, or establish third-party relationships to provide, any or all of these marketing and sales capabilities. The maintenance and expansion of our direct sales force or establishment of a contract sales force, or a combination thereof, as applicable, to market our products is expensive and time-consuming and could delay any product launch. In addition, reputational harm from the Reprioritization may adversely impact our efforts to hire personnel skilled in marketing and sales. Further, we can give no assurances that we will be able to maintain a direct and/or contract sales force for any period of time or that our sales efforts will be sufficient to grow our revenues or that our sales efforts will ever lead to profits. A direct sales force has
99
in the past subjected and may in the future subject us to higher fixed costs than those of companies that market competing products through independent third parties, due to the costs that we bear associated with employee benefits, training, and managing sales personnel. As a result, we could be at a competitive disadvantage. Additionally, these fixed costs may slow our ability to reduce costs if needed, which could have a material adverse effect on our business, financial condition, and results of operations.
We operate in a highly competitive and rapidly changing industry.
Biopharmaceutical product development is highly competitive and subject to rapid and significant technological advancements. Our success is highly dependent upon our ability to in-license, acquire, develop and obtain regulatory approval for new and innovative products on a cost-effective basis and to market them successfully. In doing so, we face and will continue to face intense competition from a variety of businesses, including large, fully integrated, well-established pharmaceutical companies who already possess a large share of the market, specialty pharmaceutical and biopharmaceutical companies, academic institutions, government agencies and other private and public research institutions in the U.S., the EU and other jurisdictions.
Many of the companies against which we are competing or against which we may compete in the future have significantly greater financial resources and expertise in research and development, manufacturing, preclinical testing, conducting clinical trials, obtaining regulatory approvals and marketing approved drugs than we do. These third parties compete with us in recruiting and retaining qualified scientific and management personnel, establishing clinical trial sites and patient registration for clinical trials, as well as in acquiring technologies complementary to, or necessary for, our programs. Mergers and acquisitions in the biopharmaceutical industry could result in even more resources being concentrated among a small number of our competitors.
Competition may further increase as a result of advances in the commercial applicability of technologies and greater availability of capital for investment in these industries. Our competitors may succeed in developing, acquiring or licensing, on an exclusive basis, products that are more effective or less costly than any product candidate that we may develop.
Established biopharmaceutical companies may invest heavily to accelerate discovery and development of novel compounds or to in-license novel compounds that could make our product candidates less competitive. In addition, any new product that competes with an approved product must demonstrate compelling advantages in efficacy, convenience, tolerability and safety to overcome price competition and to be commercially successful. Accordingly, our competitors may succeed in obtaining patent protection, discovering, developing, receiving FDA approval for or commercializing drugs before we do, which would have an adverse impact on our business and results of operations.
The availability of our competitors’ products could limit the demand and the price we are able to charge for products and product candidates, if any, that we commercialize. The inability to compete with existing or subsequently introduced drugs would harm our business, financial condition and results of operations.
Although we obtained FDA approval for IGALMITM, our products and product candidates may not be accepted by physicians or the medical community in general, and there may be insufficient insurance coverage and reimbursement.
There can be no assurance that IGALMITM, or BXCL501, BXCL502, BXCL701, BXCL702 and our other product candidates or any other product candidate successfully developed by us, independently or with partners, if approved, will be accepted by physicians, hospitals and other health care facilities. IGALMITM competes, and BXCL501, BXCL502, BXCL701, BXCL702 and any future product candidates we develop will compete, with a number of products manufactured and marketed by major pharmaceutical and biotechnology companies. The degree of market acceptance of IGALMITM and any drugs we develop depends on a number of factors, including:
● | our demonstration of the clinical efficacy and safety of our products and product candidates; |
● | timing of market approval and commercial launch of our products and product candidates; |
● | the clinical indication(s) for which our products and product candidates are approved; |
100
● | product label and package insert requirements; |
● | advantages and disadvantages of our products and product candidates compared to existing therapies; |
● | continued interest in and growth of the market for anti-cancer or anti-agitation drugs; |
● | strength of sales, marketing, and distribution support; |
● | product pricing in absolute terms and relative to alternative treatments; |
● | future changes in health care laws, regulations, and medical policies; and |
● | availability of coverage and reimbursement in select jurisdictions, and future changes to coverage and reimbursement policies of government and third-party payors. |
Significant uncertainty exists as to the coverage and reimbursement status of IGALMITM or any product candidate for which we obtain regulatory approval. In the U.S. and other countries, sales of IGALMITM and any other products for which we receive regulatory approval for commercial sale will depend in part on the availability of coverage and reimbursement from third-party payors. Third-party payors include government health administrative authorities, such as Medicaid and Medicare, managed care providers, private health insurers and other organizations.
Third-party payors are increasingly challenging the prices charged for medical products and services. It will be time consuming and expensive for us to go through the process of seeking coverage and reimbursement from Medicare and private payors. IGALMITM and any other products for which we receive regulatory approval may not be considered cost-effective, and coverage and reimbursement may not be available or sufficient to allow us to sell our proposed products on a profitable basis. Further federal, state and foreign government proposals and health care reforms are likely which could limit the prices that can be charged for IGALMITM and the product candidates that we develop and may further limit our commercial opportunities. Our results of operations could be materially adversely affected by proposed health care reforms, by the Inflation Reduction Act and other drug pricing legislation in the U.S., by the possible effect of such current or future legislation on amounts that private insurers will pay and by other health care reforms that may be enacted or adopted in the future.
Health care reform measures could hinder or prevent our product candidates’ commercial success.
The U.S. government and other governments have shown significant interest in pursuing health care reform. Any government-adopted reform measures could adversely impact the pricing of health care products and services in the U.S. or internationally and the amount of reimbursement available from governmental agencies or other third-party payors for IGALMITM and the product candidates that we develop. The continuing efforts of the U.S. and foreign governments, insurance companies, managed care organizations and other payors of health care services to contain or reduce health care costs may adversely affect our ability to set prices for our products, which we believe are fair, and our ability to generate revenues and achieve and maintain profitability.
New laws, regulations and judicial decisions, or new interpretations of existing laws, regulations and decisions, that relate to health care availability, methods of delivery or payment for products and services, or sales, marketing or pricing, may limit our potential revenue, and we may need to revise our research and development programs. The pricing and reimbursement environment may change in the future and become more challenging due to several reasons, including policies advanced by the current executive administration in the U.S., new health care legislation or fiscal challenges faced by government health administration authorities. Specifically, in both the U.S. and some foreign jurisdictions, there have been a number of legislative and regulatory proposals to change the health care system in ways that could affect our ability to sell our products profitably.
For example, in the U.S., the ACA, which was enacted in 2010, has substantially changed the way health care is financed by both government health plans and private insurers, and significantly impacts the pharmaceutical industry. For example, the ACA imposed a non-deductible excise tax on pharmaceutical manufacturers or importers that sell branded prescription drugs to government programs. In addition, as part of the ACA’s provisions closing a funding gap
101
that existed in the Medicare Part D prescription drug program, manufacturers are required to provide a discount on branded prescription drugs for drugs provided to certain beneficiaries who fall within the “donut hole.” Similarly, the ACA increased the level of Medicaid rebates payable by manufacturers of brand-name drugs from 15.1% to 23.1% of the average manufacturer price and required collection of rebates for drugs paid by Medicaid managed care organizations. The ACA also included changes to the Public Health Service’s 340B drug pricing program (the “340B program”) including expansion of the list of eligible covered entities that may purchase drugs under the program.
Since its enactment, there have been judicial, executive and Congressional challenges to certain aspects of the ACA. On June 17, 2021, the U.S. Supreme Court dismissed the most recent judicial challenge to the ACA brought by several states without specifically ruling on the constitutionality of the ACA. Thus, the ACA will remain in effect in its current form.
In addition, other legislative changes have been proposed and adopted in the U.S. since the ACA was enacted. These changes include the Budget Control Act of 2011, which resulted in aggregate reductions of Medicare payments to providers, which went into effect on April 1, 2013, and, due to subsequent legislative amendments to the statute, will remain in effect through 2032, unless additional Congressional action is taken. Furthermore, the American Taxpayer Relief Act of 2012, further reduced Medicare payments to several types of providers, including hospitals, and increased the statute of limitations period for the government to recover overpayments to providers from three to five years. More recently, on March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 into law, which eliminates the statutory Medicaid drug rebate cap, beginning January 1, 2024.
Most significantly, on August 16, 2022, President Biden signed the Inflation Reduction Act of 2022 (“IRA”) into law. This statute marks the most significant action by Congress with respect to the pharmaceutical industry since adoption of the ACA in 2010. Among other things, the IRA requires manufacturers of certain drugs to engage in price negotiations with Medicare (beginning in 2026), with prices that can be negotiated subject to a cap; imposes rebates under Medicare Part B and Medicare Part D to penalize price increases that outpace inflation (first due in 2023); and replaces the Part D coverage gap discount program with a new discounting program (beginning in 2025). The IRA permits the Secretary of the Department of Health and Human Services (“HHS”) to implement many of these provisions through guidance, as opposed to regulation, for the initial years. On August 29, 2023, HHS announced the list of the first ten drugs that will be subject to price negotiations. HHS has issued and will continue to issue guidance implementing the IRA, although the Medicare drug price negotiation program is currently subject to legal challenges. While the impact of the IRA on the pharmaceutical industry and our business cannot yet be fully determined, it is likely to be significant.
The cost of prescription pharmaceuticals in the U.S. will likely continue to be the subject of considerable discussion. Members of Congress and the Biden Administration have indicated they will continue to pursue further legislative or administrative measures to control prescription drug costs. There have been several Congressional inquiries, as well as legislative and regulatory initiatives and executive orders designed to, among other things, bring more transparency to product pricing, review the relationship between pricing and manufacturer patient programs, and reform government program reimbursement methodologies for drug products. We cannot predict with certainty what impact any federal or state health reforms will have on us, but such changes could impose new or more stringent regulatory requirements on our activities or result in reduced reimbursement for our products, any of which could adversely affect our business, results of operations and financial condition.
Individual states in the U.S. continue to consider and have enacted legislation to limit the growth of health care costs, including the cost of prescription drugs and combination products. A number of states have either implemented or are considering implementation of drug price transparency legislation that may prevent or limit our ability to take price increases at certain rates or frequencies. Requirements under such laws include advance notice of planned price increases, reporting price increase amounts and factors considered in taking such increases, wholesale acquisition cost information disclosure to prescribers, purchasers, and state agencies, and new product notice and reporting. Such legislation could limit the price or payment for certain drugs, and a number of states are authorized to impose civil monetary penalties or pursue other enforcement mechanisms against manufacturers who fail to comply with drug price transparency requirements, including the untimely, inaccurate, or incomplete reporting of drug pricing information. If we are found to have violated state law requirements, we may become subject to penalties or other enforcement mechanisms, which could have a material adverse effect on our business. Furthermore, there has been increased interest
102
by third-party payors and governmental authorities in reference pricing systems and publication of discounts and list prices.
It is likely that federal and state legislatures within the U.S. and foreign governments will continue to consider changes to existing health care legislation. We cannot predict the reform initiatives that may be adopted in the future or whether initiatives that have been adopted will be repealed or modified. The continuing efforts of governments, insurance companies, managed care organizations and other payors of health care services to contain or reduce costs of health care may adversely affect the demand for IGALMITM and any other drug products for which we may obtain regulatory approval, our ability to set a price that we believe is fair for our products, our ability to obtain adequate coverage and reimbursement approval for a product, our ability to generate revenues and achieve or maintain profitability, and the level of taxes that we are required to pay.
In the EU, similar developments may affect our ability to profitably commercialize our product candidates, if approved. In addition to continuing pressure on prices and cost containment measures, legislative developments at the EU or member state level may result in significant additional requirements or obstacles that may increase our operating costs. The delivery of healthcare in the EU, including the establishment and operation of health services and the pricing and reimbursement of medicines, is almost exclusively a matter for national, rather than EU, law and policy. National governments and health service providers have different priorities and approaches to the delivery of health care and the pricing and reimbursement of products in that context. In general, however, the healthcare budgetary constraints in most EU member states have resulted in restrictions on the pricing and reimbursement of medicines by relevant health service providers. Coupled with ever-increasing EU and national regulatory burdens on those wishing to develop and market products, this could prevent or delay marketing approval of our product candidates, restrict or regulate post-approval activities and affect our ability to commercialize our product candidates, if approved. In markets outside of the U.S. and EU, reimbursement and healthcare payment systems vary significantly by country, and many countries have instituted price ceilings on specific products and therapies.
On December 13, 2021, Regulation No 2021/2282 on Health Technology Assessment (“HTA”) amending Directive 2011/24/EU, was adopted. While the regulation entered into force in January 2022, it will only begin to apply from January 2025 onwards, with preparatory and implementation-related steps to take place in the interim. Once applicable, it will have a phased implementation depending on the concerned products. The regulation intends to boost cooperation among EU member states in assessing health technologies, including new medicinal products as well as certain high-risk medical devices, and providing the basis for cooperation at the EU level for joint clinical assessments in these areas. It will permit EU member states to use common HTA tools, methodologies, and procedures across the EU, working together in four main areas, including joint clinical assessment of the innovative health technologies with the highest potential impact for patients, joint scientific consultations whereby developers can seek advice from HTA authorities, identification of emerging health technologies to identify promising technologies early, and continuing voluntary cooperation in other areas. Individual EU member states will continue to be responsible for assessing non-clinical (e.g., economic, social, ethical) aspects of health technology, and making decisions on pricing and reimbursement.
If we fail to comply with reporting and payment obligations under the Medicaid Drug Rebate Program or other governmental pricing programs in the U.S., we could be subject to additional reimbursement requirements, penalties, sanctions and fines, which could have a material adverse effect on our business, results of operations and financial condition.
We participate in the Medicaid Drug Rebate Program (“MDRP”) and other federal and state government pricing programs in the U.S., and we may participate in additional government pricing programs in the future. These programs generally require manufacturers to pay rebates or otherwise provide discounts to government payors in connection with drugs that are dispensed to beneficiaries of these programs. As a condition of having federal funds being made available for covered outpatient drugs under Medicaid and Medicare Part B, a manufacturer must enroll in the MDRP. Under this program, we must pay a rebate to state Medicaid programs for each unit of our covered outpatient drug dispensed to a Medicaid beneficiary and paid for by a state Medicaid program. Medicaid drug rebates are based on pricing data that we must report on a monthly and quarterly basis to CMS. For the MDRP, this data includes the average manufacturer price (“AMP”) for each drug and, in the case of an innovator product, like IGALMITM, the best price. If we become aware that our MDRP price reporting submission for a prior period was incorrect or has changed as a result of
103
recalculation of the pricing data, we must resubmit the corrected data for up to three years after the data originally was due. Further, under the IRA, AMP figures we report will also be used to calculate a rebate on Medicare Part D utilization, triggered by price increases that outpace inflation. If we fail to provide information timely or are found to have knowingly submitted false information to the government, we may be subject to civil monetary penalties and other sanctions, including termination from the MDRP, which would result in payment not being available for our covered outpatient drugs under Medicaid or, if applicable, Medicare Part B. Failure to make necessary disclosures and/or to identify overpayments additionally could result in allegations against us under the Federal False Claims Act and other laws and regulations.
Federal law requires that a manufacturer that participates in the MDRP also participate in the 340B program in order for federal funds to be available for the manufacturer’s drugs under Medicaid and Medicare Part B, and we participate in the 340B program. The 340B program is administered by the Health Resources and Services Administration (“HRSA”) and requires us to charge statutorily defined covered entities no more than the 340B “ceiling price” for our covered outpatient drugs used in an outpatient setting. These 340B program covered entities include a variety of community health clinics and other entities that receive health services grants from the Public Health Service, as well as hospitals that serve a disproportionate share of low-income patients. The 340B ceiling price is calculated using a statutory formula, which is based on the AMP and rebate amount for the covered outpatient drug as calculated under the MDRP. In general, products subject to Medicaid price reporting and rebate liability are also subject to the 340B ceiling price calculation and discount requirement. We must report 340B ceiling prices to HRSA on a quarterly basis, and HRSA publishes them to 340B covered entities. HRSA has finalized regulations regarding the calculation of the 340B ceiling price and the imposition of civil monetary penalties on manufacturers that knowingly and intentionally overcharge covered entities for 340B eligible drugs. HRSA has also finalized an administrative dispute resolution process through which 340B covered entities may pursue claims against participating manufacturers for overcharges, and through which manufacturers may pursue claims against 340B covered entities for engaging in unlawful diversion or duplicate discounting of 340B drugs. In addition, legislation may be introduced that, if passed, would further expand the 340B program, such as adding further covered entities or requiring participating manufacturers to agree to provide 340B program discounted pricing on drugs used in an inpatient setting.
In order to be eligible to have drug products paid for with federal funds under Medicaid and Medicare Part B and purchased by certain federal agencies and grantees, we also must participate in the U.S. Department of Veterans Affairs (“VA”) Federal Supply Schedule (“FSS”) pricing program. Under the VA/FSS program, we must report the Non-Federal Average Manufacturer Price (“Non-FAMP”) for our covered drugs to the VA and charge certain federal agencies no more than the Federal Ceiling Price, which is calculated based on Non-FAMP using a statutory formula. These four agencies are the VA, the U.S. Department of Defense, the U.S. Coast Guard, and the U.S. Public Health Service (including the Indian Health Service). We must also pay rebates on products purchased by military personnel and dependents through the TRICARE retail pharmacy program. If we fail to provide timely information or are found to have knowingly submitted false information, we may be subject to civil monetary penalties.
Individual states continue to consider and have enacted legislation to limit the growth of health care costs, including the cost of prescription drugs and combination products. A number of states have either implemented or are considering implementation of drug price transparency legislation that may prevent or limit our ability to take price increases at certain rates or frequencies. Requirements under such laws include advance notice of planned price increases, reporting price increase amounts and factors considered in taking such increases, wholesale acquisition cost information disclosure to prescribers, purchasers, and state agencies, and new product notice and reporting. Such legislation could limit the price or payment for certain drugs, and a number of states are authorized to impose civil monetary penalties or pursue other enforcement mechanisms against manufacturers who fail to comply with drug price transparency requirements, including the untimely, inaccurate, or incomplete reporting of drug pricing information. If we are found to have violated state law requirements, we may become subject to penalties or other enforcement mechanisms, which could have a material adverse effect on our business.
Pricing and rebate calculations are complex, vary among products and programs, and are often subject to interpretation by manufacturers, governmental or regulatory agencies, and the courts. The terms, scope and complexity of these government pricing programs change frequently, as do interpretations of applicable requirements for pricing and rebate calculations. Responding to current and future changes may increase our costs and the complexity of compliance will be time-consuming. Any required refunds to the U.S. government or responding to a government
104
investigation or enforcement action would be expensive and time consuming and could have a material adverse effect on our business, results of operations and financial condition. Price recalculations under the MDRP also may affect the ceiling price at which we may be required to offer products under the 340B program. Civil monetary penalties can be applied if we are found to have knowingly submitted any false price or product information to the government, if we fail to submit required price data on a timely basis, or if we are found to have charged 340B program covered entities more than the statutorily mandated ceiling price. In the event that CMS were to terminate our Medicaid rebate agreement, pursuant to which we participate in the MDRP, no federal payments would be available under Medicaid or Medicare for our covered outpatient drugs. We cannot assure you that price data submissions we make will not be found to be incomplete or incorrect.
Risks Related to Our Relationship with BioXcel LLC
BioXcel LLC has significant influence over the direction of our business, and the concentrated ownership of our common stock will prevent you and other stockholders from influencing significant decisions.
As of September 30, 2024, BioXcel LLC owned approximately 19% of the economic interest and voting power of our outstanding common stock and BioXcel LLC is controlled by BioXcel Holdings, Inc. Our Chief Executive Officer and member of our board of directors, Vimal Mehta, Ph.D., is the Chief Executive Officer, President, Treasurer and Secretary and a member of the board of managers of BioXcel LLC and Chief Executive Officer, President, Treasurer and Secretary and the sole member of the board of directors of BioXcel Holdings, Inc. See “The management of and beneficial ownership in BioXcel LLC by our executive officers and our directors may create, or may create the appearance of, conflicts of interest.” below. Even though BioXcel LLC controls less than a majority of the voting power of our outstanding common stock, it may influence the outcome of such corporate actions so long as it owns a significant portion of our common stock.
Approval of commercial terms between us and BioXcel LLC does not preclude the possibility of stockholder litigation, including but not limited to derivative litigation nominally against BioXcel LLC and against its directors and officers and also against us and our directors and officers.
The commercial terms of the Separation and Shared Services Agreement (as amended and/or restated and in effect as of the date hereof, the “Services Agreement”), and the Amended and Restated Asset Contribution Agreement (as amended and/or restated and in effect as of the date hereof, the “Contribution Agreement”), that we entered into with BioXcel LLC have not been negotiated by persons consisting solely of disinterested directors.
No assurance can be given that any equity or debt holder of BioXcel LLC or the Company will not claim in a lawsuit that such terms in fact are not in the best interests of BioXcel LLC or the Company and its applicable equity holders, that the directors and officers of BioXcel LLC or the Company breached their fiduciary duties in connection with such agreements and that any disclosures by the Company to its stockholders regarding these agreements and the relationship between BioXcel LLC and us did not satisfy applicable requirements. In any such instance, we and our directors and officers may also be named as defendants and we would have to defend ourselves and our directors and officers. While we would seek indemnification from BioXcel LLC under the terms of these agreements against any damages or other costs, which could be substantial, no such indemnification has yet been agreed to or may be agreed to and be in effect. Further, any such litigation would be time-consuming and would divert focus and resources from the development of our product candidates and our business, including but not limited to possibly delaying our clinical trials due to our management having to spend time and attention on such litigation.
We continue to depend on BioXcel LLC to provide us with certain services for our business.
We rely, in part, on BioXcel LLC and access to its EvolverAI, to complement our in-house, uniquely integrated AI-to-drug-development capability. EvolverAI is a research and development engine created and owned by BioXcel LLC, to identify, research and develop potential product candidates in neuroscience and immuno-oncology. We negotiated the Services Agreement with BioXcel LLC pursuant to which BioXcel LLC agreed to perform certain intellectual property prosecution and management and research and development activities for us utilizing its EvolverAI.
105
Under the Services Agreement, we have an option, exercisable until December 31, 2024, to enter into a separate collaborative services agreement with BioXcel LLC pursuant to which BioXcel LLC shall perform product identification and related services for us utilizing its EvolverAI. We agreed to pay BioXcel LLC $18,000 per month from March 13, 2023, to December 31, 2024 in exchange for this option. We agreed to negotiate any such collaborative services agreement in good faith and to incorporate reasonable market-based terms, including consideration for BioXcel LLC reflecting a low, single-digit royalty on net sales and reasonable development and commercialization milestone payments, provided that (i) development milestone payments shall not exceed $10 million in the aggregate and not be payable prior to proof of concept in humans and (ii) commercialization milestone payments shall be based on reaching annual net sales levels, be limited to 3% of the applicable net sales level, and not exceed $30 million in the aggregate.
In addition, at the time of our initial public offering (“IPO”), BioXcel LLC granted us (i) a first right to negotiate exclusive rights to any additional product candidates in the fields of neuroscience and immuno-oncology that BioXcel LLC may identify on its own and not in connection with BioXcel LLC’s provision of services to us under the Services Agreement and (ii) an exclusivity agreement in the neuroscience and immuno-oncology fields whereby BioXcel LLC agreed not develop drugs, or engage in preclinical discovery for the purpose of developing drugs, in the neuroscience and immuno-oncology fields for or on behalf of a third party, utilizing EvolverAI or otherwise. This first right to negotiate and exclusivity period expired on March 12, 2023, and there is no assurance that we will extend the terms of the agreement. We are continuing to assess our ongoing business needs.
On September 19, 2023, the Company, Krishnan Nandabalan, Ph.D., InveniAI LLC (“Inveni”) and Invea Therapeutics, Inc. (“Invea”) and the other parties thereto entered into a non-compete agreement pursuant to which Dr. Nandabalan, Inveni and Invea agreed not to compete with the Company and its controlled affiliates in the fields of neuroscience and immuno-oncology for a period of five years from September 19, 2023 and not to solicit employees of the Company or its controlled affiliates for a period of two years from September 19, 2023. Inveni and Invea are subsidiaries of BioXcel LLC.
If our rights under the Services Agreement were to become limited or if we are otherwise precluded from conducting research and development using EvolverAI, or if BioXcel LLC, Inveni or Invea do not fulfill their obligations under the agreements, such development could materially adversely affect our future operating results, financial condition, and prospects. Furthermore, certain individuals conducting services on our behalf are not our employees, and we cannot control whether they devote sufficient time, skill and resources to our ongoing development programs. We also cannot ensure that BioXcel LLC retains sufficient resources or personnel or otherwise to conduct its operations. BioXcel LLC may also have relationships with other commercial entities, including our competitors, for whom they may also be conducting research and development activities, which could impede their ability to devote appropriate time to our research and development programs. BioXcel LLC is not currently restricted from using EvolverAI to perform drug discovery services for our direct competitors, and if we do not extend the exclusivity period in the neuroscience and immuno-oncology fields, this could harm our competitive position and adversely affect our future operating results and financial condition.
The management of and beneficial ownership in BioXcel LLC may create, or may create the appearance of, conflicts of interest.
Our Chief Executive Officer and member of our board of directors, Vimal Mehta, Ph.D., is the Chief Executive Officer, President, Treasurer and Secretary and a member of the board of managers of BioXcel LLC and Chief Executive Officer, President, Treasurer and Secretary and the sole member of the board of directors of BioXcel Holdings, Inc. Additionally, as of September 30, 2024, Dr. Mehta, through his beneficial ownership of BioXcel LLC, beneficially owned approximately 21.3% of the Company. The management and ownership of BioXcel LLC by Dr. Mehta may create the appearance of, conflicts of interest when Dr. Mehta is faced with decisions that could have different implications for BioXcel LLC than the decisions have for us, including decisions that relate to our Services Agreement and Contribution Agreement, as well as potential agreements relating to future product candidates and AI-related services or collaborations. Any perceived conflicts of interest resulting from investors questioning the independence of our management or the integrity of corporate governance procedures may materially affect our stock price and expose us to litigation risk.
106
Any disputes that arise between us and BioXcel LLC with respect to our past and ongoing relationships could harm our business operations.
Disputes may arise between BioXcel LLC and us in a number of areas relating to our past and ongoing relationships, including:
● | intellectual property, technology and business matters, including failure to make required technology transfers and failure to comply with contractual provisions applicable to BioXcel LLC and us; |
● | labor, tax, employee benefit, indemnification and other matters arising from the separation of BTI from BioXcel LLC; |
● | distribution and supply obligations; |
● | employee retention and recruiting; |
● | business combinations involving us; |
● | sales or distributions by BioXcel LLC of all or any portion of its ownership interest in us; |
● | the nature, quality and pricing of services BioXcel LLC has agreed to provide us; and |
● | business opportunities that may be attractive to both BioXcel LLC and us. |
We entered into the Services Agreement with BioXcel LLC related to the separation of our business operations from those of BioXcel LLC that contains certain limitations on BioXcel LLC’s ability to control various aspects of our business and operations, notwithstanding BioXcel LLC’s substantial ownership position. This agreement may be amended upon agreement between us and BioXcel LLC.
BioXcel LLC may experience challenges with the acquisition, development, enhancement, or deployment of technology necessary for EvolverAI. We may face similar challenges with other AI platforms that we utilize, including our own in-house proprietary platform.
BioXcel LLC operates in businesses that require sophisticated computer systems and software for data collection, data processing, cloud-based platforms, analytics, statistical projections and forecasting, mobile computing, social media analytics and other applications and technologies. BioXcel LLC seeks to address its technology risks by increasing its reliance on the use of innovations by cross-industry technology leaders and adapt these for their pharmaceutical, biotechnology, biopharmaceutical, diagnostic, medical device and contract research and manufacturing clients. Some of the technologies supporting the industries they serve are changing rapidly and we must continue to adapt to these changes in a timely and effective manner at an acceptable cost. They also must continue to deliver data to their clients in forms that are easy to use while simultaneously providing clear answers to complex questions. We also utilize our own in-house AI platform.
There can be no guarantee that we or BioXcel LLC will be able to develop, acquire or integrate new technologies, that these new technologies will meet our and BioXcel LLC’s needs or achieve our expected goals, or that we will be able to do so as quickly or cost-effectively as our competitors. Significant technological change could render BioXcel LLC’s EvolverAI or other AI platforms that we utilize obsolete. BioXcel LLC’s and our continued success will depend on the ability to adapt to changing technologies, manage and process ever-increasing amounts of data and information and improve the performance, features and reliability of these services in response to changing client and industry demands. If EvolverAI or other AI and machine learning models that we use are incorrectly designed, do not operate properly, the data we use to train them is incomplete, inadequate or biased in some way, or if we do not have sufficient rights to use the data on which our AI and machine learning models rely, the performance of our products, services and businesses, as well as our reputation, could suffer or we could incur liability through the violation of laws, third-party privacy rights or contracts to which we are a party. BioXcel LLC or we may experience difficulties that could delay or prevent the successful design, development, testing, and introduction of advanced versions of EvolverAI, limiting our
107
ability to identify new product candidates. New services, or enhancements to existing EvolverAI services, may not adequately meet our requirements. Any of these failures could have a material adverse effect on our operating results and financial condition.
Risks Related to Our Reliance on Third Parties
We are substantially dependent on third parties for the manufacture of our clinical supplies of our product candidates and our commercial supplies of IGALMITM, and we intend to rely on third parties to produce commercial supplies of any other approved product candidate. Therefore, our development of our products could be stopped or delayed, and our commercialization of any future product could be stopped, delayed or made less profitable if third-party manufacturers fail to obtain approval of the FDA or comparable regulatory authorities or fail to provide us with drug product in sufficient quantities or at acceptable prices.
We entered into a commercial supply agreement with ARx, LLC (“ARx”) pursuant to which ARx has agreed to exclusively manufacture and supply us with all of our worldwide demand of film formulation of Dex to be used for the commercial supply of IGALMITM and for ongoing clinical trials of our product candidate BXCL501, subject to certain alternative supply provisions. If ARx is unable or ceases to produce our supply of Dex in sufficient quantities as and when needed or if the ARx agreement becomes too costly, our business would be harmed because there can be no assurance that we will be able to identify or enter into agreements with alternative suppliers on a timely basis on acceptable terms, if at all. An interruption in our ability to sell our products to customers could occur if we encounter delays or difficulties in securing Dex, or if the quantity or quality supplied does not meet our specifications, or if we cannot then obtain an acceptable substitute. If any of these events occur, our business and operating results could be harmed. Our specified minimum annual payment could adversely affect our cash flows in the future, such as in times when we have sufficient inventory and would otherwise be able to use our cash for other purposes.
The manufacture of biotechnology and pharmaceutical products is complex and requires significant expertise, capital investment, process controls and know-how. Common difficulties in biotechnology and pharmaceutical manufacturing may include: sourcing and producing raw materials, transferring technology from chemistry and development activities to production activities, validating initial production designs, scaling manufacturing techniques, improving costs and yields, establishing and maintaining quality controls and stability requirements, eliminating contaminations and operator errors, and maintaining compliance with regulatory requirements. We do not currently have nor do we plan to acquire the infrastructure or capability internally to produce an adequate supply of compounds to meet future requirements for clinical trials and commercialization of our products or to produce our products in accordance with cGMP prescribed by the FDA or similar foreign requirements. Drug manufacturing facilities are subject to inspection before the FDA or foreign regulatory authorities will issue an approval to market a new drug product, and ARx, the Patheon pharma services division of Thermo Fisher Scientific Inc., and any other manufacturers that we may use must adhere to the cGMP or similar foreign regulations prescribed by the FDA or foreign regulatory authorities.
As such, these third-party manufacturers will be required to comply with cGMPs, and other applicable laws and regulations. We have no control over the ability of these third parties to comply with these requirements, or to maintain adequate quality control, quality assurance and qualified personnel. If the FDA or any other applicable regulatory authorities do not approve the facilities of these third parties for the manufacture of our other product candidates or any products that we may successfully develop, or if it withdraws any such approval, or if our suppliers or contract manufacturers decide they no longer want to supply or manufacture for us, we may need to find alternative manufacturing facilities, in which case we might not be able to identify manufacturers for clinical or commercial supply on acceptable terms, or at all. Any of these factors would significantly impact our ability to develop, obtain regulatory approval for or market our product candidates and adversely affect our business.
We, ARx, the Patheon pharma services division of Thermo Fisher Scientific Inc., and/or our other third-party manufacturers may be adversely affected by developments outside of our control, and these developments may delay or prevent further manufacturing of our products. Adverse developments may include labor disputes, resource constraints, shipment delays, inventory shortages, lot failures, unexpected sources of contamination, lawsuits related to our manufacturing techniques, equipment used during manufacturing, or composition of matter, unstable political environments, acts of terrorism, war, natural disasters, and other natural and man-made disasters. If we, ARx, the
108
Patheon pharma services division of Thermo Fisher Scientific Inc., or our other third-party manufacturers were to encounter any of the above difficulties, or otherwise fail to comply with contractual obligations, our ability to provide any product for clinical trial or commercial purposes would be jeopardized. This may increase the costs associated with completing our clinical trials and commercial production. Further, production disruptions may cause us to terminate ongoing clinical trials and/or commence new clinical trials at additional expense. We may also have to take inventory write-offs and incur other charges and expenses for products that fail to meet specifications or pass safety inspections. Moreover, as a result of the COVID-19 pandemic, third-party manufacturers have been and may in the future be affected, which could disrupt their activities and, as a result, we could face difficulty sourcing key components necessary to produce supply of our commercial product and product candidates, which may negatively affect our preclinical and clinical development activities. If production difficulties cannot be solved with acceptable costs, expenses, and timeframes, we may be forced to abandon our clinical development and commercialization plans, which could have a material adverse effect on our business, prospects, financial condition, and the value of our securities.
We, or third-party manufacturers on whom we rely, including ARx, may be unable to successfully scale-up manufacturing of our product and product candidates in sufficient quality and quantity, which would delay or prevent us from developing our product candidates and commercializing any approved products.
In order to conduct clinical trials of our product candidates and commercialize any approved product candidates, we, or our manufacturers, including ARx, and the Patheon pharma services division of Thermo Fisher Scientific Inc., will need to manufacture them in large quantities. We, or our manufacturers, may be unable to successfully increase the manufacturing capacity for any of our approved products or product candidates in a timely or cost-effective manner, or at all. In addition, quality issues may arise during scale-up activities. If we, or any of our manufacturers, are unable to successfully scale up the manufacture of our approved products or product candidates in sufficient quality and quantity, the development, testing, and clinical trials of that product candidate may be delayed or infeasible, and regulatory approval or commercial launch of any resulting product may be delayed or not obtained, which could significantly harm our business. If we are unable to obtain or maintain third-party manufacturing for commercial supply of our approved products, or to do so on commercially reasonable terms, we may not be able to develop and commercialize our approved products or product candidates successfully.
Our failure to find third-party collaborators to assist or share in the costs of product development could materially harm our business, financial condition, and results of operations.
Our strategy for the development and commercialization of our proprietary products and product candidates may include the formation of collaborative arrangements with third parties. Collaborators have significant discretion in determining the efforts and resources they apply and may not perform their obligations as expected. Potential third-party collaborators include biopharmaceutical, pharmaceutical and biotechnology companies, academic institutions and other entities. Third-party collaborators may assist us in:
● | funding research, preclinical development, clinical trials and manufacturing; |
● | seeking and obtaining regulatory approvals; and |
● | successfully commercializing IGALMITM or product candidates. |
If we are not able to establish collaboration agreements, we may be required to undertake product development and commercialization at our own expense. Such an undertaking may limit the number of product candidates that we will be able to develop, significantly increase our capital requirements and place additional strain on our internal resources. Our failure to enter into collaborations could materially harm our business, financial condition and results of operations.
In addition, our dependence on licensing, collaboration and other agreements with third parties may subject us to a number of risks. These agreements may not be on terms that prove favorable to us and may require us to relinquish certain rights in our product candidates. To the extent we agree to work exclusively with one collaborator in a given area, our opportunities to collaborate with other entities could be curtailed. Lengthy negotiations with potential new collaborators may lead to delays in the research, development or commercialization of product candidates. The decision by our collaborators to pursue alternative technologies or the failure of our collaborators to develop or commercialize
109
successfully any product candidate to which they have obtained rights from us could materially harm our business, financial condition and results of operations.
We rely on third parties to conduct our preclinical and clinical trials. If these third parties do not successfully perform their contractual legal and regulatory duties or meet expected deadlines, we may not be able to obtain regulatory approval for or commercialize our product candidates and our business could be substantially harmed.
We have relied upon and plan to continue to rely upon third-party medical institutions, clinical investigators, contract laboratories and other third-party CROs to monitor and manage data for our ongoing preclinical and clinical programs. We rely on these parties for execution of our preclinical and clinical trials, and control only certain aspects of their activities. Nevertheless, we are responsible for ensuring that each of our studies is conducted in accordance with the applicable protocol, legal, regulatory and scientific standards, and our reliance on the CROs does not relieve us of our regulatory responsibilities. We and our CROs are required to comply with GCPs, which are regulations and guidelines enforced by the FDA, the competent authorities of the European Economic Area (“EEA”) countries and comparable foreign regulatory authorities for all of our products in clinical development.
Regulatory authorities enforce these GCPs through periodic inspections of trial sponsors, principal investigators and trial sites. If regulatory authorities determine that we or any of our CROs failed to comply with applicable GCPs, the clinical data generated in our clinical trials may be deemed unreliable and the FDA, the EMA or comparable foreign regulatory authorities may require us to perform additional clinical trials before approving our marketing applications. We cannot assure you that upon inspection by a given regulatory authority, such regulatory authority will determine that any of our clinical trials comply with GCP regulations. In addition, our clinical trials must be conducted with product produced under cGMP and similar foreign regulations. Any failure, whether by us or our CROs, to comply with these regulations may require us to repeat clinical trials, which would delay the regulatory approval process.
In addition, if any of our relationships with our third-party CROs terminate, we may not be able to enter into arrangements with alternative CROs or to do so on commercially reasonable terms. In addition, our CROs are not our employees, and except for remedies available to us under our agreements with such CROs, we cannot control whether they devote sufficient time and resources to our on-going clinical, nonclinical and preclinical programs. If CROs do not successfully carry out their contractual duties or obligations or meet expected deadlines, if they need to be replaced or if the quality or accuracy of the clinical data they obtain is compromised due to the failure to adhere to our clinical protocols, regulatory requirements or for other reasons, our clinical trials may be extended, delayed or terminated and we may not be able to obtain regulatory approval for or successfully commercialize our product candidates. For example, investigator misconduct during our TRANQUILITY II trial evaluating BXCL501 in patients with probable Alzheimer’s disease could require us to conduct additional clinical trials before we are able to seek or obtain approval for BXCL501 for use in this patient population, as described more fully in the risk factor above entitled: “Developments relating to our TRANQUILITY II Phase 3 trial may impact the timing of our development plans for, and prospects for seeking or obtaining regulatory approval of, BXCL501 for the acute treatment of agitation (non-daily) associated with dementia in patients with probable Alzheimer’s disease.” As a result, our results of operations and the commercial prospects for our product candidates would be harmed, our costs could increase and our ability to generate revenues could be delayed.
Many of the third parties with whom we contract may also have relationships with other commercial entities, including our competitors, for whom they may also be conducting clinical trials or other drug development activities that could harm our competitive position. If the third parties conducting our GCP preclinical studies or our clinical trials do not perform their contractual duties or obligations, experience work stoppages, do not meet expected deadlines, terminate their agreements with us or need to be replaced, or if the quality or accuracy of the clinical data they obtain is compromised due to their failure to adhere to our clinical trial protocols or to GCPs, or for any other reason, we may need to enter into new arrangements with alternative third parties. Switching or adding CROs involves additional cost and requires management time and focus. In addition, there is a natural transition period when a new CRO commences work. As a result, delays occur, which can materially impact our ability to meet our desired clinical development timelines. Though we carefully manage our relationships with our CROs, there can be no assurance that we will not encounter similar challenges or delays in the future or that these delays or challenges will not have a material adverse impact on our business, financial condition and prospects.
110
Risks Related to Our Business and Industry
Pandemics, epidemics or outbreaks of an infectious disease, such as COVID-19, may materially and adversely impact our business, including our preclinical studies and clinical trials.
As a result of outbreaks from variants of COVID-19, or other pandemics, epidemics or outbreaks of infectious disease, we may experience disruptions that could severely impact our business, preclinical studies and clinical trials, including:
● | delays or difficulties in initiating, operating and completing our clinical trials; |
● | interruption of key clinical trial activities, such as clinical trial site data monitoring, due to limitations on travel imposed or recommended by governments, employers and others or interruption of clinical trial subject visits and study procedures, which may impact the integrity of subject data and clinical study endpoints; |
● | interruption or delays in the operations of the FDA or other regulatory authorities, which may impact review and approval timelines; |
● | interruption of, or delays in receiving, supplies of our product candidates from our contract manufacturing organizations due to staffing shortages, production slowdowns or stoppages and disruptions in delivery systems; and |
● | other interruptions or delays to our sourced discovery and clinical activities. |
If we or any of the third parties with whom we engage were to experience shutdowns or other business disruptions from COVID-19 or other pandemics, epidemics or outbreaks of infectious disease, our ability to conduct our business in the manner and on the timelines presently planned could be materially and negatively impacted.
Unfavorable global political or economic events and conditions could adversely affect our business, financial condition or results of operations.
Our results of operations could be adversely affected by general conditions in the world, and their impact on the global economy and in the global financial markets. The global economy, including credit and financial markets, has recently experienced extreme volatility and disruptions, including severely diminished liquidity and credit availability, rising interest and inflation rates, declines in consumer confidence, declines in economic growth, increases in unemployment rates and uncertainty about economic stability. A severe or prolonged economic downturn or recession and a continued increase in inflation rates or interest rates could result in a variety of risks to our business, and our ability to raise additional capital when needed on acceptable terms, if at all. There can be no assurance that further deterioration in credit and financial markets and confidence in economic conditions will not occur. A weak or declining economy could also strain our suppliers, possibly resulting in supply disruption, or cause our customers to delay making payments for our services. Increased inflation rates and related increases in interest rates can adversely affect us by increasing our costs, including labor and employee benefit costs. In addition, events such as pandemics, epidemics, or outbreaks of an infectious disease may materially and adversely impact our business if we or any of the third parties with whom we engage were to experience shutdowns or other business disruptions. Furthermore, geopolitical conflicts and war, such as the current military conflict between Russia and Ukraine and the war between Israel and Hamas, could disrupt or otherwise adversely impact our operations and those of third parties upon which we rely. Related sanctions, export controls or other actions have and may in the future be initiated by nations including the U.S., the EU or Russia (e.g., potential cyberattacks, disruption of energy flows, etc.), which could adversely affect our business and/or our supply chain, our CROs, CMOs and other third parties with which we conduct business. Any of the foregoing could harm our business and we cannot anticipate all of the ways in which the current economic climate and financial market conditions could adversely impact our business.
Our future success may depend on our ability to attract and retain qualified personnel, including consultants.
We are dependent on the principal members of our management and scientific teams. Our success and the execution of our operating strategy, to the extent we continue operations, depend largely on the continued service of our
111
employees. In addition to our employees, we have access to certain of BioXcel LLC’s employees and resources through the various agreements we have with BioXcel LLC. We have expanded our management team to include an operational ramp-up of additional technical staff required to achieve our business objectives. We will need to retain such employees, and may need to continue to expand our managerial, commercial, operational, technical, and scientific, financial, and other resources to manage our operations and clinical trials, continue our research and development activities, and any approved product candidates. Our management and scientific personnel, systems and facilities currently in place may not be adequate to support our future growth.
We may utilize the services of third-party vendors to perform tasks including preclinical and clinical trial management, statistics and analysis, regulatory affairs, medical advisory, market research, formulation development, chemistry, manufacturing and control activities, other drug development functions, legal, auditing, financial advisory, and investor relations. Because we rely on numerous consultants to outsource many key functions of our business, we will need to be able to effectively manage these consultants to ensure that they successfully carry out their contractual obligations and meet expected deadlines. However, if we are unable to effectively manage our outsourced activities or if the quality or accuracy of the services provided by consultants is compromised for any reason, our clinical trials may be extended, delayed or terminated, and we may not be able to obtain regulatory approval for our product candidate or otherwise advance our business. There can be no assurance that we will be able to manage our existing consultants or find other competent outside contractors and consultants on economically reasonable terms, or at all. If we are not able to recruit and retain qualified personnel, we may be unable to successfully implement the tasks necessary to further develop and commercialize our product candidate and, accordingly, may not achieve our research, development and commercialization goals.
We depend on our senior management team, and the loss of one or more of our executive officers or key employees or an inability to attract and retain highly skilled employees could adversely affect our business.
Our success depends largely upon the continued services of our key executive officers, including Vimal Mehta, our Chief Executive Officer, President and a member of our Board, as well as the other principal members of our management, scientific, clinical teams and commercial readiness teams. We do not maintain “key person” insurance for any of these executive officers or any of our other key employees. We also rely on our leadership team in the areas of research and development, marketing, services and selling, general and administrative functions. From time to time, there may be changes in our executive management and leadership teams resulting from the hiring or departure of executives or other key employees, which could disrupt our business. The replacement of one or more of our executive officers or other key employees would likely involve significant time and costs and may significantly delay or prevent the achievement of our business objectives.
To continue to execute our business strategy, we also must attract and retain highly skilled personnel. We might not be successful in maintaining our unique culture and continuing to attract and retain qualified personnel. We have, from time to time, had difficulty hiring and retaining highly skilled personnel with appropriate qualifications, including as a result of the Reprioritization and related consequences for our reputation. We may experience such difficulties in the future, and any further restructuring or related reduction in force could exacerbate such difficulties. The pool of qualified personnel with experience working within the biopharmaceutical and biotechnology market is limited overall. In addition, many of the companies with which we compete for experienced personnel have greater resources than we have.
Furthermore, prior workforce reductions and any future similar cost-saving initiatives may make it difficult for us to maintain valuable aspects of our culture, retain institutional knowledge and expertise, to prevent a negative effect on employee morale or attrition beyond our planned reduction in headcount, and to attract competent personnel who are willing to embrace our culture in the future. Our executive officers and other employees are at-will employees, which means they may terminate their employment relationship with us at any time, and their knowledge of our business and industry would be extremely difficult to replace. We may not be able to retain the services of any members of our senior management or other key employees. If we do not succeed in retaining and motivating existing employees or attracting well-qualified employees in the future, our business, financial condition and results of operations could be materially and adversely affected.
112
In addition, in making employment decisions, particularly in the biotechnology and high-technology industries, job candidates often consider the value of the stock options or other equity instruments they are to receive in connection with their employment. Volatility in the price of our stock might, therefore, adversely affect our ability to attract or retain highly skilled personnel. Furthermore, the requirement to expense the fair value of stock options and other equity instruments might discourage us from granting the size or type of stock option or equity awards that job candidates require to join our Company. If we fail to attract new personnel or fail to retain and motivate our current personnel, our business and future growth prospects could be severely harmed.
We may acquire other companies or technologies, which could divert our management’s attention, result in dilution to our stockholders and otherwise disrupt our operations and adversely affect our operating results.
We may in the future seek to acquire or invest in businesses, applications and services or technologies that we believe could complement or expand our services, enhance our technical capabilities or otherwise offer growth opportunities. The pursuit of potential acquisitions may divert the attention of management and cause us to incur various expenses in identifying, investigating and pursuing suitable acquisitions, whether or not they are consummated.
In addition, we do not have any experience in acquiring other businesses. If we acquire additional businesses, we may not be able to integrate the acquired personnel, operations and technologies successfully, or effectively manage the combined business following the acquisition. We also may not achieve the anticipated benefits from the acquired business due to a number of factors, including:
● | inability to integrate or benefit from acquired technologies or services in a profitable manner; |
● | unanticipated costs or liabilities associated with the acquisition; |
● | difficulty integrating the accounting systems, operations and personnel of the acquired business; |
● | difficulties and additional expenses associated with supporting legacy products and hosting infrastructure of the acquired business; |
● | difficulty converting the customers of the acquired business onto our platform and contract terms, including disparities in the revenue, licensing, support or professional services model of the acquired company; |
● | diversion of management’s attention from other business concerns; |
● | adverse effects to our existing business relationships with business partners and customers as a result of the acquisition; |
● | the potential loss of key employees; |
● | use of resources that are needed in other parts of our business; and |
● | use of substantial portions of our available cash to consummate the acquisition. |
In addition, a significant portion of the purchase price of companies we acquire may be allocated to acquired goodwill and other intangible assets, which must be assessed for impairment at least annually. In the future, if our acquisitions do not yield expected returns, we may be required to take charges to our operating results based on this impairment assessment process, which could adversely affect our results of operations.
Acquisitions could also result in dilutive issuances of equity securities or the incurrence of debt, which could adversely affect our operating results. In addition, if an acquired business fails to meet our expectations, our operating results, business and financial position may suffer.
113
Our employees may engage in misconduct or other improper activities, including noncompliance with regulatory standards and requirements and insider trading.
We are exposed to the risk of employee fraud or other misconduct. Misconduct by employees could include intentional failures to comply with any regulations applicable to us, to provide accurate information to regulatory authorities, to comply with manufacturing standards we have established, to comply with federal and state health care fraud and abuse laws and regulations, or to report financial information or data accurately or disclose unauthorized activities to us. In particular, sales, marketing and business arrangements in the health care industry are subject to extensive laws and regulations intended to prevent fraud, misconduct, kickbacks, self-dealing and other abusive practices. These laws and regulations may restrict or prohibit a wide range of pricing, discounting, marketing and promotion, sales commission, customer incentive programs and other business arrangements. Employee misconduct could also involve the improper use of information obtained during clinical trials, which could result in regulatory sanctions and serious harm to our reputation. We have adopted a Code of Business Conduct and Ethics, but it is not always possible to identify and deter employee misconduct, and the precautions we take to detect and prevent this activity may not be effective in controlling unknown or unmanaged risk.
Business interruptions could adversely affect future operations, revenues, and financial conditions, and may increase our costs and expenses.
Our operations, and those of our directors, advisors, contractors, consultants, CROs, and collaborators, could be adversely affected by earthquakes, floods, hurricanes, typhoons, extreme weather conditions, fires, water shortages, power failures, business systems failures, medical epidemics, and other natural and man-made disaster or business interruptions. Our phones, electronic devices and computer systems and those of our directors, advisors, contractors, consultants, CROs, and collaborators are vulnerable to damages, theft and accidental loss, negligence, unauthorized access, terrorism, war, electronic and telecommunications failures, and other natural and man- made disasters. Several of our employees conduct business outside of our headquarters and leased or owned facilities. These locations may be subject to additional security and other risk factors due to the limited control of our employees. If such an event as described above were to occur in the future, it may cause interruptions in our operations, delay research and development programs, clinical trials, regulatory activities, manufacturing and quality assurance activities, sales and marketing activities, hiring, training of employees and persons within associated third parties, and other business activities. For example, the loss of clinical trial data from completed or future clinical trials could result in delays in our regulatory approval efforts and significantly increase our costs to recover or reproduce the data.
Likewise, we will rely on third parties, including ARx, to manufacture IGALMITM and our product candidates and to conduct clinical trials, and similar events as those described in the prior paragraph relating to their business systems, equipment and facilities could also have a material adverse effect on our business. To the extent that any disruption or security breach were to result in a loss of, or damage to, our data or applications, or inappropriate disclosure of confidential or proprietary information, we could incur liability and the further development and commercialization of our product candidate could be delayed or altogether terminated.
Data breaches or cyber-attacks could disrupt our business operations and information technology systems or those of third parties on which we rely, adversely impact our financial results, or result in the loss or exposure of confidential or sensitive product candidate, clinical trial, employee, or Company information.
We collect and maintain information in digital form that is necessary to conduct our business, and we are increasingly dependent on information technology systems and infrastructure to operate our business, including our mobile and web-based applications, our e-commerce platform and our enterprise software. In the ordinary course of our business, we collect, store and transmit large amounts of confidential information, including intellectual property, proprietary business information, clinical trial data, and personal information (collectively, “Confidential Information”) of customers and our employees and contractors. It is critical that we do so in a secure manner to maintain the confidentiality and integrity of such Confidential Information.
Our information technology systems and those of third parties on which we rely have been and may in the future be attacked or breached by individuals or organizations intending to obtain our Confidential Information; harm or disrupt our business operations; or otherwise misappropriate information or Company funds. A security compromise of our
114
information technology systems or business operations, or those of third parties on which we rely, could occur through a variety of methods such as from cyber-attacks and cyber-intrusions over the Internet, misconfigurations, “bugs” or other vulnerabilities, malware, computer viruses, email spoofing, attachments to e-mails, persons inside or outside our organization or persons with access to systems inside our organization. The risk of such intrusions, threats to data and information technology systems and breaches has generally increased as the number, intensity and sophistication of attempted attacks and intrusions from around the world have increased.
While we maintain some of our own critical information technology systems, we also depend on third parties to provide important information technology services relating to several key business functions. Our measures to prevent, detect and mitigate these threats, including password protection, firewalls, backup servers, threat monitoring and periodic penetration testing, may not be successful in preventing a data breach or limiting the effects of a breach. Because the techniques used to obtain unauthorized access to, or to sabotage, systems change frequently and often are not recognized until launched against a target, we may be unable to anticipate these techniques or implement adequate preventative measures. We may also experience security breaches that may remain undetected for an extended period. Even if identified, we may be unable to adequately investigate or remediate incidents or breaches due to attackers increasingly using tools and techniques that are designed to circumvent controls, to avoid detection, and to remove or obfuscate forensic evidence.
Furthermore, the security measures employed by third-party service providers may prove to be ineffective at preventing breaches of their systems. Any attack that results in disruptions to our operations, or the unauthorized release or loss of Confidential Information, could have a material adverse effect on our business reputation, increase our costs and expose us to material legal claims and liability (such as class actions) and result in regulatory investigations and enforcement actions, fines and penalties, negative reputational impacts that cause us to lose existing or future customers, and/or significant incident response, system restoration or remediation and future compliance costs. If the unauthorized release or loss of Confidential Information were to occur, our operations and financial results and our share price could be adversely affected. Although we maintain insurance for our business, the coverage under our policies may not be adequate to compensate us for all losses that may occur.
Actual or perceived failures to comply with applicable data protection, privacy and security laws, regulations, standards and other requirements could adversely affect our business, results of operations, and financial condition.
The global data protection landscape is rapidly evolving, and we are or may become subject to numerous state, federal and foreign laws, requirements and regulations governing the collection, use, disclosure, retention, and security of personal data, such as information that we may collect in connection with clinical trials in the U.S. and abroad. Additionally, our use of AI and machine learning may be subject to laws and evolving regulations regarding the use of AI or machine learning, controlling for data bias, and anti-discrimination, and we may not always be able to anticipate how to respond to these laws or regulations. Further, there is an increase in litigation in a number of jurisdictions, including the United States, relating to the use of AI, particularly generative AI. New laws regulating AI are at an advanced stage of the legislative process in the EU, and it is possible that new laws and regulations will be adopted in the United States and in other non-U.S. jurisdictions, or that existing laws and regulations may be interpreted in ways that would affect the operation of our learning platforms, online testing business and data analytics and the way in which we use AI and machine learning technology.
In Europe, on December 8, 2023, the European Union legislators reached a political agreement on the EU Artificial Intelligence Act (“EU AI Act”) which establishes a comprehensive, risk-based governance framework for AI in the EU market. The EU AI Act is expected to enter into force in 2024, and the majority of the substantive requirements will apply two years later. The EU AI Act will apply to companies that develop, use and/ or provide AI in the EU and includes requirements around transparency, conformity assessments and monitoring, risk assessments, human oversight, security, accuracy, general purpose AI and foundation models, and proposes fines for breach of up to 7% of worldwide annual turnover. In addition, on September 28, 2022, the European Commission proposed two Directives seeking to establish a harmonized civil liability regime for AI in the EU. Once fully applicable, this regulatory framework is expected to have a material impact on the way AI is regulated in the EU, and together with developing guidance and/ or decisions in this area, may affect our use of AI and our ability to provide, improve or commercialize our services, require additional compliance measures and changes to our operations and processes, result in increased compliance costs and potential increases in civil claims against us, and could adversely affect our business, operations
115
and financial condition. Implementation standards and enforcement practices are likely to remain uncertain for the foreseeable future, and we cannot yet determine the impact future laws, regulations, standards, or perception of their requirements may have on our business. This evolution may create uncertainty in our business, affect our ability to operate in certain jurisdictions or to collect, store, transfer use and share personal information, necessitate the acceptance of more onerous obligations in our contracts, result in liability or impose additional costs on us. The cost of compliance with these laws, regulations and standards is high and is likely to increase in the future. Any failure or perceived failure by us to comply with federal, state or foreign laws or regulation, our internal policies and procedures or our contracts governing our processing of personal information could result in negative publicity, government investigations and enforcement actions, claims by third parties and damage to our reputation, any of which could have a material adverse effect on our operations, financial performance and business.
As our operations and business grow, we may become subject to or affected by new or additional data protection laws and regulations and face increased scrutiny or attention from regulatory authorities. In the U.S., HIPAA imposes, among other things, certain standards relating to the privacy, security, transmission, and breach reporting of individually identifiable health information. Most healthcare providers, including research institutions from which we obtain patient health information, are subject to privacy and security regulations promulgated under HIPAA. If we are determined to act as a covered entity or business associate under HIPAA and be directly regulated under HIPAA, any person acting on our behalf may be prosecuted under HIPAA’s criminal provisions either directly or under aiding-and-abetting or conspiracy principles. Consequently, depending on the facts and circumstances, we could face substantial criminal penalties if we knowingly receive individually identifiable health information from a HIPAA-covered healthcare provider or research institution that has not satisfied HIPAA’s requirements for disclosure of individually identifiable health information.
Certain states have also adopted comparable privacy and security laws and regulations, some of which may be more stringent than HIPAA. Such laws and regulations will be subject to interpretation by various courts and other governmental authorities, thus creating potentially complex compliance issues for us and our future customers and strategic partners. For example, the California Consumer Privacy Act, as amended by the California Privacy Rights Act (collectively, the “CCPA”), requires covered businesses that process the personal information of California residents to, among other things: provide certain disclosures to California residents regarding the business’s collection, use, and disclosure of their personal information; receive and respond to requests from California residents to access, delete, and correct their personal information, or to opt out of certain disclosures of their personal information, and enter into specific contractual provisions with service providers that process California resident personal information on the business’s behalf. If we are subject to or affected by HIPAA, the CCPA, or other domestic privacy and data protection laws, any liability from failure to comply with the requirements of these laws could adversely affect our financial condition.
In Europe, the General Data Protection Regulation (“GDPR”) went into effect in May 2018 and imposes strict requirements for processing the personal data of individuals within the EEA. Companies that must comply with the GDPR face increased compliance obligations and risk, including more robust regulatory enforcement of data protection requirements and potential fines for noncompliance of up to €20 million or 4% of the annual global revenues of the noncompliant company, whichever is greater. Among other requirements, the GDPR regulates transfers of personal data subject to the GDPR to third countries that have not been found to provide adequate protection to such personal data, including the U.S., and the efficacy and longevity of current transfer mechanisms between the EEA, and the United States remains uncertain. On July 10, 2023, the European Commission adopted its Adequacy Decision in relation to the new EU-US Data Privacy Framework (“DPF”), rendering the DPF effective as a GDPR transfer mechanism to U.S. entities self-certified under the DPF. We expect the existing legal complexity and uncertainty regarding international personal data transfers to continue. In particular, we expect the DPF Adequacy Decision to be challenged and international transfers to the United States and to other jurisdictions more generally to continue to be subject to enhanced scrutiny by regulators. As supervisory authorities issue further guidance on personal data export mechanisms, including circumstances where the standard contractual clauses cannot be used, and/or start taking enforcement action, we could suffer additional costs, complaints and/or regulatory investigations or fines, and/or if we are otherwise unable to transfer personal data between and among countries and regions in which we operate, it could affect the manner in which we provide our services, the geographical location or segregation of our relevant systems and operations, and could adversely affect our financial results.
116
Further, since January 1, 2021, companies have had to comply with the GDPR and also the UK GDPR, which, together with the amended UK Data Protection Act 2018, retains the GDPR in UK national law. The UK GDPR mirrors the fines under the GDPR (i.e., fines up to the greater of £17.5 million or 4% of global turnover). On October 12, 2023, the UK Extension to the DPF came into effect (as approved by the UK Government), as a data transfer mechanism from the UK to U.S. entities self-certified under the DPF.
Although we work to comply with applicable laws, regulations and standards, our contractual obligations and other legal obligations, these requirements are evolving and may be modified, interpreted and applied in an inconsistent manner from one jurisdiction to another, and may conflict with one another or other legal obligations with which we must comply. Any failure or perceived failure by us or our employees, representatives, contractors, consultants, collaborators, or other third parties to comply with such requirements or adequately address privacy and security concerns, even if unfounded, could result in additional cost and liability to us, damage our reputation, and adversely affect our business and results of operations.
Increased scrutiny of and evolving expectations for environmental, social and governance (“ESG”) initiatives may impose additional costs or otherwise adversely impact our business.
There has been an increased focus from investors, capital providers, shareholder advocacy groups, other market participants, customers, and other stakeholder groups regarding companies’ ESG initiatives. While we may at times engage in voluntary initiatives (such as voluntary disclosures, certifications, or goals, among others) or commitments to improve the ESG profile of our Company and/or offerings, such initiatives or achievements of such commitments may be costly and may not have the desired effect. Additionally, some investors may use third-party or proprietary ESG ratings to guide their investment strategies and, in some cases, may choose not to invest in us if they believe our ESG practices are inadequate. The criteria by which companies’ ESG practices are assessed are evolving, which could result in greater expectations of us and cause us to undertake costly initiatives to satisfy such new criteria. Alternatively, if we elect not to or are unable to satisfy new criteria or do not meet the criteria, some investors may conclude that our policies with respect to ESG are inadequate and choose not to invest in us.
If our ESG practices do not meet evolving investor or other stakeholder expectations and our standards, reputation, ability to attract or retain employees and desirability as an investment or business partner could be negatively impacted. Similarly, our failure or perceived failure to adequately pursue or fulfill any ESG goals and objectives or to satisfy various reporting standards, if any, could expose us to additional regulatory, social or other scrutiny, the imposition of unexpected costs, or damage to our reputation, which in turn could have a material adverse effect on our business and could cause the market value of our common stock to decline.
Our failure to successfully acquire, develop and market additional product candidates or approved drug products could impair our ability to grow.
As part of our growth strategy, we may evaluate, acquire, license, develop and/or market third-party products or product candidates and technologies. Our internal research capabilities are limited and we may be dependent upon pharmaceutical and biotechnology companies, academic scientists and other researchers to sell or license products or technology to us. The success of this strategy depends partly upon our ability to identify, select and acquire promising pharmaceutical product candidates and products. The process of proposing, negotiating and implementing a license or acquisition of a product candidate or approved product is lengthy and complex. Other companies, including some with substantially greater financial, marketing and sales resources, may compete with us for the license or acquisition of product candidates and approved products. We have limited resources to identify and execute the acquisition or in-licensing of third-party products, businesses and technologies and integrate them into our current infrastructure. Moreover, we may devote resources to potential acquisitions or in-licensing opportunities that are never completed, or we may fail to realize the anticipated benefits of such efforts. We may not be able to acquire the rights to additional product candidates on terms that we find acceptable, or at all.
In addition, future acquisitions may entail numerous operational and financial risks, including:
● | exposure to unknown liabilities; |
117
● | disruption of our business and diversion of our management’s and technical personnel’s time and attention to develop acquired products or technologies; |
● | incurrence of substantial debt or dilutive issuances of securities to pay for acquisitions; |
● | higher than expected acquisition and integration costs; |
● | increased amortization expenses; |
● | difficulty and cost in combining the operations and personnel of any acquired businesses with our operations and personnel; |
● | impairment of relationships with key suppliers or customers of any acquired businesses due to changes in management and ownership; and |
● | inability to retain key employees of any acquired businesses. |
Any product candidate that we acquire may require additional development efforts prior to commercial sale, including extensive clinical testing and approval by the FDA and applicable foreign regulatory authorities. All product candidates are prone to risks of failure typical of pharmaceutical product development, including the possibility that a product candidate will not be shown to be sufficiently safe and effective for approval by regulatory authorities. In addition, we cannot provide assurance that any products that we develop or approved products that we acquire will be manufactured profitably or achieve market acceptance.
Our ability to use our net operating losses and tax credits to offset future taxable income and income tax liabilities may be limited.
As of December 31, 2023, the Company had federal net operating loss carryforwards (“NOLs”) of approximately $351.3 million and state NOLs of approximately $360.1 million. If not utilized, the federal and state NOLs, which are subject to expiration, will begin to expire in 2037. Federal NOLs generated in taxable years beginning after December 31, 2017 may be carried forward indefinitely but may only be used to offset 80% of our taxable income in future taxable years beginning after December 31, 2020. As of December 31, 2023, we also had approximately $14.3 million of federal orphan drug credits and research and development credits and $1.2 million of state research and development credits, which will begin to expire in 2037 if not utilized. The utilization of such NOLs and tax credits and realization of tax benefits in future years depends upon our having taxable income and income tax liabilities.
In addition, in general, under Sections 382 and 383 of the Internal Revenue Code of 1986, as amended, a corporation that undergoes an “ownership change” is subject to limitations on its ability to utilize its pre-ownership change NOLs and tax credits to offset future taxable income or income tax liabilities. For these purposes, an ownership change generally occurs where the aggregate change in stock ownership, of one or more stockholders or groups of stockholders owning at least 5% of a corporation's stock, exceeds 50 percentage points over a rolling three-year period. We may have experienced ownership changes in the past, and future changes in our stock ownership, many of which are outside of our control, could result in ownership changes in the future. Our state NOLs or tax credits may also be impaired under state law. Accordingly, even if we attain profitability, we may not be able to utilize a material portion of our NOLs or tax credits. We have recorded a full valuation allowance related to our NOLs and other deferred tax assets due to the uncertainty of the ultimate realization of the future benefits of those assets.
Risks Related to Our Intellectual Property
It is difficult and costly to protect our proprietary rights, and we may not be able to ensure their protection. If our patent position does not adequately protect our product candidates, others could compete against us more directly, which would harm our business, possibly materially.
Our commercial success will depend in part on obtaining, maintaining enforcing and defending our patents, trademarks, trade secrets and other intellectual property rights and proprietary technology for our current and future approved products and product candidates, the processes used to manufacture them and the methods for using them, as
118
well as successfully defending these patents against third-party challenges. We are the owner of record of certain patents and patent applications pending in the U.S. and in certain foreign jurisdictions. Patents issued from non-provisional applications, which are typically filed from provisional patent applications or from PCT applications that enter the national phase. Neither provisional patent applications nor PCT applications issue directly as patents. We own PCT patent applications relating to our platform technologies covering methods of use and applications of the platform technologies.
We cannot be certain that any future patents will issue with claims that cover our product candidates. Our ability to stop third parties from making, using, selling, offering to sell or importing our product candidates is dependent upon the extent to which we have rights under valid and enforceable patents, trademarks, trade secrets and other intellectual property rights and proprietary technology that cover these activities.
The patent positions of biotechnology and pharmaceutical companies can be highly uncertain and involve complex legal and factual questions that have been the subject of much litigation in recent years and for which important legal principles remain unresolved. Therefore, the scope of any patent claims that we have or may obtain cannot be predicted with certainty. No consistent policy regarding the breadth of claims allowed in pharmaceutical patents has emerged to date in the U.S. or in foreign jurisdictions outside of the U.S. Changes in either the patent laws or interpretations of patent laws in the U.S. and other countries may diminish the value of our intellectual property. Accordingly, we cannot predict which of our patent applications will issue, the breadth of claims that may be enforced in the patents that may be issued from the applications we currently, or may in the future, own or license from third parties, whether any of the issued patents will be found to be infringed, invalid or unenforceable or will be threatened or challenged by third parties, that any of our issued patents have, or that any of our currently pending or future patent applications that mature into issued patents will include, claims with a scope sufficient to protect our products and services. Further, if any patents we obtain or license are deemed invalid and unenforceable, our ability to commercialize or license our technology could be adversely affected.
Others have filed, and in the future are likely to file, patent applications covering products and technologies that are similar, identical or competitive to ours or important to our business. We cannot be certain that any patent application owned by a third-party will not have priority over patent applications filed or in-licensed by us, or that we or our licensors will not be involved in interference, opposition, reexamination, review, reissue, post grant review or invalidity proceedings before U.S. or non-U.S. patent offices.
The degree of future protection for our proprietary rights is uncertain because legal means afford only limited protection and may not adequately protect our rights or permit us to gain or keep our competitive advantage. For example:
● | others may be able to independently develop, make and commercialize compounds that are similar to, or are alternatives or duplicates of any of our product candidates, but that are not covered by the claims of our patents or are not infringing, misappropriating, or otherwise violating our other intellectual property rights; |
● | we might not have been the first to make the inventions covered by our issued patents or pending patent applications that we license or may own in the future; |
● | we, or our future collaborators, might not have been the first to file patent applications covering certain of our or their inventions; |
● | our pending patent applications or those that we may own in the future may not result in issued patents; |
● | the claims of our issued patents or patent applications when issued may not cover our products or product candidates; |
● | any patents that we obtain may not provide us with any competitive advantages; |
119
● | our competitors might conduct research and development activities in countries where we do not have patent rights and then use the information learned from such activities to develop, manufacture and commercialize competitive products or product candidates for sale in our major commercial markets; |
● | we may not develop additional proprietary technologies that are patentable; |
● | we may choose not to seek patent protection for some of our proprietary technology or product candidates to maintain certain trade secrets or know-how, and a third party may subsequently file a patent covering such trade secrets or know-how; |
● | any granted patents may be held invalid or unenforceable as a result of legal challenges by third parties; and |
● | the patents of others may have an adverse effect on our business. |
Should any of these events occur, they could have a material adverse effect on our business, financial condition, results of operations and prospects.
Obtaining and maintaining patent protection depends on compliance with various procedural, document submission, fee payment and other requirements imposed by governmental patent agencies, and our patent protection could be reduced or eliminated for non-compliance with these requirements.
Periodic maintenance, renewal and annuity fees and various other government fees on any issued patent and pending patent application must be paid to the USPTO and foreign patent agencies in several stages or annually over the lifetime of our owned and in-licensed patents and patent applications. In addition, the USPTO and various foreign governmental patent agencies require compliance with various procedural, document submission, fee payment and other requirements during the patent application process. While an inadvertent lapse can in many cases be cured by payment of a late fee or by other means in accordance with the applicable rules, there are situations in which noncompliance can result in abandonment or lapse of the patent or patent application, resulting in partial or complete loss of patent rights in the relevant jurisdiction. Non-compliance events that could result in abandonment or lapse of a patent or patent application include failure to respond to official actions within prescribed time limits, non-payment of fees and failure to properly legalize and submit formal documents. In such an event, potential competitors might be able to enter the market with similar or identical products or technology. If we or our licensors fail to maintain the patents and patent applications covering our product candidates, it would have a material adverse effect on our business, financial condition, results of operations, and prospects.
If we fail to comply with our obligations in the agreements under which we may license intellectual property rights from third parties or otherwise experience disruptions to our business relationships with our licensors, we could lose rights that are important to our business.
We may be required to enter into intellectual property license agreements that are important to our business. These license agreements may impose various diligence, payment, and other obligations on us. For example, we may enter into exclusive license agreements with universities, research institutions, or peer industry third parties pursuant to which we may be required to use commercially reasonable efforts to engage in various development and commercialization activities with respect to licensed products and may need to satisfy specified milestone and royalty payment obligations. If we fail to comply with any obligations under our agreements with any of these licensors, we may be subject to termination of the license agreement in whole or in part; increased financial obligations to our licensors or loss of exclusivity in a particular field or territory, in which case our ability to develop or commercialize products covered by the license agreement will be impaired.
In addition, disputes may arise regarding intellectual property subject to a license agreement, including:
● | the scope of rights granted under the license agreement and other interpretation-related issues; |
● | the extent to which our technology and processes infringe on intellectual property of the licensor that is not subject to the licensing agreement; |
120
● | our diligence obligations under the license agreement and what activities satisfy those obligations; |
● | if a third-party expresses interest in an area under a license that we are not pursuing, under the terms of certain of our license agreements, we may be required to sublicense rights in that area to a third-party, and that sublicense could harm our business; and |
● | the ownership of inventions and know-how resulting from the joint creation or use of intellectual property by our licensors and us. |
If disputes over intellectual property that we have licensed prevent or impair our ability to maintain our current licensing arrangements on acceptable terms, we may be unable to successfully develop and commercialize the affected approved products or product candidates.
We may need to obtain licenses from third parties to advance our research or allow commercialization of our product candidates. We may fail to obtain any of these licenses at a reasonable cost or on reasonable terms, if at all. In that event, we would be unable to further develop and commercialize one or more of our product candidates, which could harm our business significantly.
We may be subject to claims challenging the inventorship or ownership of our patents and other intellectual property.
We or our licensors may be subject to claims that third parties have an interest in our patents, trade secrets, or other intellectual property that we regard as our own or our licensor’s, based on claims that the relevant agreements with employees or consultants obligating them to assign their intellectual property rights to us or our licensor are ineffective or in conflict with prior or competing contractual obligations to assign inventions and intellectual property rights to another employer, to a former employer, or to another person or entity. We may also be subject to claims that our former employees, contractors or collaborators, or other third parties have an ownership interest in our current or future patents, patent applications, or other intellectual property rights, including as an inventor or co-inventor. For example, we or our licensors may have inventorship disputes arise from conflicting obligations of employees, consultants or others who are involved in developing our product candidates. Although it is our policy to require our employees, consultants and contractors who may be involved in the development of intellectual property to execute agreements assigning such intellectual property to us, we may be unsuccessful in executing such an agreement with each party who, in fact, conceives or develops intellectual property rights that we regard as our own, and we cannot be certain that our agreements with such parties will be upheld in the face of a potential challenge, or that they will not be breached, for which we may not have an adequate remedy.
We are not aware of any threatened or pending claims related to these matters, but in the future litigation may be necessary to defend against these and other claims challenging inventorship or our or our licensors’ ownership of our owned or in-licensed patents, trade secrets, or other intellectual property, and it may be necessary or we may desire to obtain a license to a third party’s intellectual property rights to settle any such claim; however, there can be no assurance that we would be able to obtain such license on commercially reasonable terms, if at all. If we or our licensors fail in defending any such claims, in addition to paying monetary damages or a settlement payment, we may lose valuable intellectual property rights, such as exclusive ownership of, or right to use, intellectual property that is important to our product candidates. A court could prohibit us from using technologies, features or other intellectual property rights that are essential to our products or technologies, if such technologies or features are found to incorporate or be derived from the trade secrets or other proprietary information of another person or entity, including another or former employers. An inability to incorporate technologies, features or other intellectual property rights that are important or essential to our products or product candidates could have a material adverse effect on our business, financial condition, results of operations, and competitive position, and may prevent us from developing, manufacturing and/or commercializing our products or technologies. In addition, we may lose valuable intellectual property rights or personnel. Even if we are successful in defending against such claims, litigation could result in substantial costs and be a distraction to management and other employees. Any litigation or the threat thereof may adversely affect our ability to hire employees or contract with independent sales representatives. A loss of key personnel or their work product could hamper or prevent our ability to develop, manufacture and/or commercialize our products or services, which could
121
materially and adversely affect our business, financial condition and results of operations. Any of the foregoing could have a material adverse effect on our business, financial condition, results of operations and prospects.
An NDA submitted under Section 505(b)(2) subjects us to the risk that we may be subject to a patent infringement lawsuit that would delay or prevent the review or approval of our product candidate.
Our product candidates have been or will be submitted to the FDA for approval under Section 505(b)(2) of the FDCA. Section 505(b)(2) permits the submission of an NDA where at least some of the information required for approval comes from studies that were not conducted by, or for, the applicant and on which the applicant has not obtained a right of reference. The 505(b)(2) application would enable us to reference published literature and/or the FDA’s previous findings of safety and effectiveness for a branded reference drug with the same active ingredient. For NDAs submitted under Section 505(b)(2) of the FDCA, the patent certification and related provisions of the Hatch-Waxman Act apply. In accordance with the Hatch-Waxman Act, such NDAs may be required to include paragraph IV certifications, that certify that any patents listed in the FDA’s Orange Book, with respect to any product referenced in the 505(b)(2) application, are invalid, unenforceable or will not be infringed by the manufacture, use or sale of the product that is the subject of the 505(b)(2) NDA.
Under the Hatch-Waxman Act, the holder of patents that the 505(b)(2) application references may file a patent infringement lawsuit after receiving notice of the paragraph IV certification. Filing of a patent infringement lawsuit against the filer of the 505(b)(2) applicant within 45 days of the patent owner’s receipt of notice triggers a one-time, automatic, 30-month stay of the FDA’s ability to approve the 505(b)(2) NDA, unless patent litigation is resolved in the favor of the paragraph IV certification filer, or the patent expires before that time. Accordingly, we may invest a significant amount of time and expense in the development of one or more product candidates only to be subject to significant delay and patent litigation before such product candidates may be commercialized, if at all. In addition, a 505(b)(2) application 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 branded reference drug product has expired. The FDA may also require us to perform one or more additional clinical studies or measurements to support the change from the branded reference drug, which could be time consuming and could substantially delay our achievement of regulatory approvals for such product candidates. The FDA may also reject our future 505(b)(2) submissions and require us to file such submissions under Section 505(b)(1) of the FDCA, which would require us to provide extensive data to establish safety and effectiveness of the drug product for the proposed use and could cause delay and be considerably more expensive and time consuming. These factors, among others, may limit our ability to successfully commercialize our product candidates.
If our intellectual property related to IGALMITM BXCL501, BXCL502, BXCL701, BXCL702 or any future product candidates is not adequate or if we are not able to successfully enforce our intellectual property rights, the commercial value of our products or product candidates may be adversely affected and we may not be able to compete effectively in our market.
Third parties, including our competitors, may currently, or in the future, infringe, misappropriate or otherwise violate our issued patents or other intellectual property rights, and we may file lawsuits or initiate other proceedings to protect or enforce our patents or other intellectual property rights, which could be expensive, time-consuming and unsuccessful. We regularly monitor for unauthorized use of our intellectual property rights and, from time to time, analyze whether to seek enforce our rights against potential infringement, misappropriation or violation of our intellectual property rights. However, the steps we have taken, and are taking, to protect our proprietary rights may not be adequate to enforce our rights as against such infringement, misappropriation or violation of our intellectual property rights. In certain circumstances it may not be practicable or cost-effective for us to enforce our intellectual property rights fully, particularly in certain developing countries or where the initiation of a claim might harm our business relationships. We may also be hindered or prevented from enforcing our rights with respect to a government entity or instrumentality because of the doctrine of sovereign immunity. Our ability to enforce our patent or other intellectual property rights depends on our ability to detect infringement. It may be difficult to detect infringers who do not advertise the components or methods that are used in connection with their products or technologies. Moreover, it may be difficult or impossible to obtain evidence of infringement in a competitor’s or potential competitor’s product or technologies. Thus, we may not be able to detect unauthorized use of, or take appropriate steps to enforce, our
122
intellectual property rights. Any inability to meaningfully enforce our intellectual property rights could harm our ability to compete and reduce demand for our products and product candidates.
Even where laws provide protection, costly and time-consuming litigation could be necessary to enforce and determine the scope of our proprietary rights, and the outcome of such litigation would be uncertain. If we choose to commence a proceeding or litigation to prevent another party from infringing our patents, that party could counterclaim that our patents are invalid or should not be enforced against them. In patent litigation in the United States, defendant counterclaims alleging invalidity and/or unenforceability are commonplace. Grounds for a validity challenge could be an alleged failure to meet any of several statutory requirements, including lack of novelty, obviousness or non-enablement. Grounds for an unenforceability assertion could be an allegation that someone connected with prosecution of the patent withheld relevant information from the USPTO, or made a misleading statement, during prosecution. The outcome following legal assertions of invalidity and unenforceability is unpredictable. With respect to validity, for example, we cannot be certain that there is no invalidating prior art, of which we and the patent examiner were unaware during prosecution. There is a risk that the examiner or court will decide that our patents are invalid or unenforceable, in whole or in part, and that we do not have the right to stop the other party from using the related inventions. There is also the risk that, even if the validity of our patents is upheld, the examiner or court may construe the patent’s claims or other intellectual property narrowly or refuse to stop the other party from using the technology at issue on the grounds that such other party’s activities do not infringe our rights to such patents. In addition, the U.S. Supreme Court has recently modified some tests used by the USPTO in granting patents over the past 20 years, which may decrease the likelihood that we will be able to obtain patents and increase the likelihood of challenge to any patents we obtain or license. Any proceedings or litigation to enforce our intellectual property rights or defend ourselves against claims of infringement of third-party intellectual property rights could be costly and divert the attention of managerial and scientific personnel, regardless of whether such litigation is ultimately resolved in our favor. We may not have sufficient resources to bring these actions to a successful conclusion. If a defendant were to prevail on its legal assertion of invalidity and/or unenforceability against our intellectual property related to a product or a product candidate, we could lose at least part, and perhaps all, of the patent protection on such product or product candidate. Such a loss of patent protection would have a material adverse impact on our business. Moreover, our competitors could counterclaim that we infringe their intellectual property, and some of our competitors have substantially greater intellectual property portfolios than we do. An adverse result in any litigation or administrative proceeding could put one or more of our patents or other intellectual property rights at risk of being invalidated or interpreted narrowly, which could adversely affect our competitive business position, financial condition and results of operations. Moreover, if we are unable to successfully defend against claims that we have infringed the intellectual property rights of others, we may be prevented from using certain intellectual property and may be liable for damages, which in turn could materially adversely affect our business, financial condition or results of operations. Even if we are successful in any litigation, we may incur significant expense in connection with such proceedings, and the amount of any monetary damages may be inadequate to compensate us for damage as a result of the infringement and the proceedings. Further, a court may decide not to grant an injunction against further infringing activity and instead award only monetary damages, which may not be an adequate remedy. Furthermore, the monetary cost of such litigation and the diversion of the attention of our management could outweigh any benefit we receive as a result of the proceedings. Uncertainties resulting from the initiation and continuation of patent litigation or other proceedings could have a material adverse effect on our business. Any of the foregoing may cause us to incur substantial costs, and could place a significant strain on our financial resources, divert the attention of management from our core business and harm our reputation.
Further, because of the substantial amount of discovery required in connection with intellectual property litigation, there is a risk that some of our confidential information could be compromised by disclosure during litigation. There could also be public announcements of the results of hearing, motions, or other interim developments. If securities analysts or investors perceive these results to be negative, it could have a material adverse effect on the price of shares of our common stock.
123
Third parties may initiate legal proceedings alleging that we are infringing, misappropriating or otherwise violating their intellectual property rights, and/or third party claims seeking to invalidate our patents, which would be costly, time consuming and, if successfully asserted against us, may prevent or delay our product development efforts and stop us from commercializing or increase the costs of commercializing our product candidates.
Our commercial success will depend in part on our ability to develop, manufacture or commercialize our products and product candidates without infringing, misappropriating or otherwise violating the intellectual property rights of third parties. There is considerable patent and other intellectual property litigation in the pharmaceutical and biotechnology industries, and companies in the industry have used intellectual property litigation to gain a competitive advantage. We may become party to, or threatened with, adversarial proceedings or litigation regarding intellectual property rights with respect to our products, or the manufacture or use of our product candidates. In addition to infringement claims against us, third parties may also raise similar claims before administrative bodies in the United States or abroad. Such mechanisms include interference proceedings, post grant review, inter partes review, and derivation proceedings before the USPTO and similar proceedings in foreign jurisdictions. If third parties prepare and file patent applications in the United States that also claim technology similar or identical to ours, we may have to participate in interference or derivation proceedings in the USPTO to determine which party is entitled to a patent on the disputed invention. We may also become involved in similar opposition proceedings in the European Patent Office or similar offices in other jurisdictions regarding our intellectual property rights with respect to our products and technology. Since patent applications are confidential for a period of time after filing, we cannot be certain that we were the first to file any patent application related to our product candidates. Such administrative proceedings could result in revocation of or amendment to our patents in such a way that they no longer cover our products or product candidates. With respect to the validity question, for example, we cannot be certain that there is no invalidating prior art, of which we, our patent counsel, and the patent examiner were unaware during prosecution. If a third party were to prevail on a legal assertion of invalidity and/or unenforceability, we may lose at least part, and perhaps all, of the patent protection on our products or technologies. Such a loss of patent protection would have a material adverse impact on our business, financial condition, results of operations, and prospects.
The legal threshold for initiating litigation or contested proceedings is low, so that even lawsuits or proceedings with a low probability of success might be initiated and require significant resources to defend. The costs of these lawsuits could affect our results of operations and divert the attention of managerial and scientific personnel. Some of these third parties may be better capitalized and have more resources than us. There is a risk that a court would decide that we are infringing the third-party’s patents and would order us to stop the activities covered by the patents. In that event, we may not have a viable way around the patent and may need to halt commercialization of the relevant product candidate. In addition, there is a risk that a court will order us to pay the other party damages for having violated the other party’s patents. We also could be ordered to pay substantial damages, including treble damages and attorney’s fees if we are found to be willfully infringing a third party’s patents or other intellectual property rights. In addition, we may be obligated to indemnify our licensors and collaborators against certain intellectual property infringement claims brought by third parties, which could require us to expend additional resources. The pharmaceutical and biotechnology industries have produced a proliferation of patents, and it is not always clear to industry participants, including us, which patents cover various types of products or methods of use. The coverage of patents is subject to interpretation by the courts, and the interpretation is not always uniform. Even if we believe such claims are without merit, a court of competent jurisdiction could hold that these third party patents are valid and enforceable, and infringed by the use of our products and/or technologies, which could have a negative impact on the commercial success of our current and any future products or technologies.
If we are sued for patent infringement, we would need to demonstrate that our products or methods either do not infringe the patent claims of the relevant patent or that the patent claims are invalid, and we may not be able to do this. Proving invalidity is difficult. For example, in the U.S., proving invalidity requires a showing of clear and convincing evidence to overcome the presumption of validity enjoyed by issued patents. Even if we are successful in these proceedings, we may incur substantial costs and divert management’s time and attention in pursuing these proceedings, which could have a material adverse effect on us. If we are unable to avoid infringing the patent rights of others, we may be required to seek a license, which may not be available, defend an infringement action or challenge the validity of the patents in court. Patent litigation is costly and time consuming. We may not have sufficient resources to bring these actions to a successful conclusion. In addition, if we do not obtain a license, develop or obtain non-infringing technology, fail to defend an infringement action successfully or have infringed patents declared invalid, we may incur
124
substantial monetary damages, encounter significant delays in bringing our product candidates to market and be precluded from manufacturing or selling our product candidates.
We cannot be certain that others have not filed patent applications for technology covered by our pending applications, or that we were the first to invent the technology, because:
● | some patent applications in the U.S. may be maintained in secrecy until the patents are issued; |
● | patent applications in the U.S. are typically not published until 18 months after the priority date; and |
● | publications in the scientific literature often lag behind actual discoveries. |
Our competitors may have filed, and may in the future file, patent applications covering technology similar to ours. Any such patent application may have priority over our patent applications, which could further require us to obtain rights to issued patents covering such technologies. If another party has filed U.S. patent applications on inventions similar to ours that claim priority to any applications filed prior to the priority dates of our applications, we may have to participate in an interference proceeding declared by the USPTO to determine priority of invention in the U.S. The costs of these proceedings could be substantial, and it is possible that such efforts would be unsuccessful if, unbeknownst to us, the other party had independently arrived at the same or similar inventions prior to our own inventions, resulting in a loss of our U.S. patent position with respect to such inventions. Other countries have similar laws that permit secrecy of patent applications and may be entitled to priority over our applications in such jurisdictions.
Some of our competitors may be able to sustain the costs of complex patent litigation more effectively than we can because they have substantially greater resources. In addition, any uncertainties resulting from the initiation and continuation of any litigation could have a material adverse effect on our ability to raise the funds necessary to continue our operations.
If we do not obtain patent term extension in the United States under the Hatch-Waxman Act and in foreign countries under similar legislation, thereby potentially extending the term of marketing exclusivity for IGALMITM, or our product candidates, our business may be materially harmed.
Following the approval by the FDA for our NDA to market IGALMITM, we became eligible to seek and sought patent term restoration under the Hatch-Waxman Act for one of the U.S. patents covering our approved product or the use thereof. The Hatch-Waxman Act allows a maximum of one patent to be extended per FDA approved product. Patent term extension also may be available in certain foreign countries upon regulatory approval of our product candidates. Despite seeking patent term extension for our product candidates, we may not be granted patent term extension either in the United States or in any foreign country because of, for example, failing to apply within applicable deadlines, failing to apply prior to expiration of relevant patents or otherwise failing to satisfy applicable requirements. Moreover, the term of extension, as well as the scope of patent protection during any such extension, afforded by the governmental authority could be less than we request.
We may not be able to enforce our intellectual property rights throughout the world.
The laws of some foreign countries do not protect intellectual property rights to the same extent as the laws of the United States. Many companies have encountered significant problems in protecting and defending intellectual property rights in certain foreign jurisdictions. The legal systems of some countries, particularly developing countries, do not favor the enforcement of patents and other intellectual property protection, especially those relating to life sciences. This could make it difficult for us to stop the infringement of our patents or the misappropriation of our other intellectual property rights. For example, many foreign countries have compulsory licensing laws under which a patent owner must grant licenses to third parties.
Proceedings to enforce our patent rights in foreign jurisdictions, whether or not successful, could result in substantial costs and divert our efforts and attention from other aspects of our business. Furthermore, while we intend to protect our intellectual property rights in our expected significant markets, we cannot ensure that we will be able to initiate or maintain similar efforts in all jurisdictions in which we may wish to market our products. Accordingly, our
125
efforts to protect our intellectual property rights in such countries may be inadequate. In addition, changes in the law and legal decisions by courts in the United States and foreign countries may affect our ability to obtain and enforce adequate intellectual property protection for our technology.
Finally, a Unitary Patent and Unified Patent Court (“UPC”) system was implemented in Europe on June 1, 2023. This new regime may present uncertainties for our ability to protect and enforce our patent rights against competitors in Europe. Under the UPC, all European patents, including those issued prior to ratification of the European Patent Package, by default automatically fall under the jurisdiction of the UPC. The UPC provides our competitors with a new forum to centrally revoke our European patents, and allows for the possibility of a competitor to obtain pan-European injunctions. It will be several years before we will understand the scope of patent rights that will be recognized and the strength of patent remedies that will be provided by the UPC. Under the EU Patent Package, we will have the right to opt our patents out of the UPC over the first seven years of the court’s existence, but doing so may preclude us from realizing the benefits of the new unified court.
If our trademarks and trade names are not adequately protected, we may not be able to build name recognition in our markets of interest and our competitive position may be harmed.
Our trademarks could be challenged, invalidated, infringed, and circumvented by third parties, and our trademarks could also be diluted, declared generic or found to be infringing on other marks. If any of the foregoing occurs, we could be forced to re-brand our products or technologies, resulting in loss of brand recognition and requiring us to devote resources to advertising and marketing new brands, and suffer other competitive harm. Third parties may also adopt trademarks similar to ours, which could harm our brand identity and lead to market confusion. Further, there can be no assurance that competitors will not infringe on our trademarks or that we will have adequate resources to enforce our trademarks. At times, competitors may adopt trade names or trademarks similar to ours, thereby impeding our ability to build brand identity and possibly leading to market confusion. Certain of our current or future trademarks may become so well known by the public that their use becomes generic and they lose trademark protection. Over the long term, if we are unable to establish name recognition based on our trademarks and trade names, then we may not be able to compete effectively. Any of the foregoing could have a material adverse effect on our competitive position, business, financial condition, operating results and prospects.
We rely on our trademarks, trade names and brand names, such as “IGALMITM” and our logo, to distinguish our company and our products from our competitors and the products of our competitors, and have registered or applied to register many of these trademarks in the United States and certain countries outside the United States, however, we have not yet registered all of our trademarks in all of our current and potential markets. There can be no assurance that our trademark applications will be approved for registration. During trademark registration proceedings, we may receive rejections. Although we are given an opportunity to respond to those rejections, we may be unable to overcome such rejections. In addition, in proceedings before the USPTO and comparable agencies in many foreign jurisdictions, third parties may also oppose our trademark applications and may seek to cancel trademark registrations or otherwise challenge our use of the trademarks. Opposition or cancellation proceedings may be filed against our trademark filings in these agencies, and such filings may not survive such proceedings. While we may be able to continue the use of our trademarks in the event registration is not available, particularly in the United States, where trademark rights are acquired based on use and not registration, third parties may be able to enjoin the continued use of our trademarks if such parties are able to successfully claim infringement in court. In addition, opposition or cancellation proceedings may be filed against our trademark applications and registrations and our trademarks may not survive such proceedings. If we do not secure registrations for our trademarks, we may encounter more difficulty in enforcing them against third parties than we otherwise would. Our trademarks or trade names may be infringed, circumvented, declared generic or determined to be violating or infringing on other marks.
If we are not able to adequately prevent disclosure of trade secrets and other proprietary information, the value of our technology and products could be significantly diminished.
In addition to patent protection, we also rely on other intellectual property rights, including protection of copyright, trade secrets, know-how and/or other proprietary information to protect our proprietary technologies, especially where we do not believe patent protection is appropriate or obtainable. However, trade secrets are difficult to protect, and some courts are less willing or unwilling to protect trade secrets. To maintain the confidentiality of our trade secrets and
126
proprietary information, we rely in part on confidentiality agreements with our employees, consultants, outside scientific collaborators, sponsored researchers and other advisors to protect our trade secrets and other proprietary information. However, we cannot guarantee that we have entered into such agreements with each party that may have or have had access to our trade secrets or proprietary technology and processes and we may not enter into such agreements with all employees, consultants and third parties who have been involved in the development of our intellectual property rights. Although we generally require all of our employees, consultants, advisors and any third parties who have access to our proprietary know-how, information, or technology to enter into confidentiality agreements, we cannot provide any assurances that all such agreements have been duly executed. In addition, despite the protections we do place on our intellectual property or other proprietary rights, monitoring unauthorized use and disclosure of our intellectual property rights by employees, consultants and other third parties who have access to such intellectual property or other proprietary rights is difficult, and we do not know whether the steps we have taken to protect our intellectual property or other proprietary rights will be adequate. Therefore, we may not be able to prevent the unauthorized disclosure or use of our technical knowledge or other trade secrets by such employees, consultants, advisors or third parties, despite the existence generally of these confidentiality restrictions. These agreements may not effectively prevent disclosure of confidential information and may not provide an adequate remedy in the event of unauthorized disclosure of confidential information. There can be no assurances that such employees, consultants, advisors or third parties will not breach their agreements with us, that we will have adequate remedies for any breach, or that our trade secrets will not otherwise become known or independently developed by third parties, including our competitors. If any of our trade secrets were to be lawfully obtained or independently developed by a competitor, we would have no right to prevent them, or those to whom they communicate it, from using that technology or information to compete with us. If any of our trade secrets were to be disclosed to or independently developed by a competitor, our competitive position would be harmed. The exposure of our trade secrets and other proprietary information would impair our competitive advantages and could have a material adverse effect on our business, financial condition and results of operations. In particular, a failure to protect our proprietary rights may allow competitors to copy our technology, which could adversely affect our pricing and market share.
In addition to contractual measures, we try to protect the confidential nature of our proprietary information by maintaining physical security of our premises and electronic security of our information technology systems. Such security measures may not, for example, in the case of misappropriation of a trade secret by an employee, consultant or other third party with authorized access, provide adequate protection for our proprietary information. Our security measures may not prevent an employee, consultant or other third party from misappropriating our trade secrets and providing them to a competitor, and recourse we take against such misconduct may not provide an adequate remedy to protect our interests fully. Unauthorized parties may also attempt to copy or reverse engineer certain aspects of our products or services that we consider proprietary. Enforcing a claim that a party illegally disclosed or misappropriated a trade secret can be difficult, expensive and time-consuming, and the outcome is unpredictable. Further, we may not be able to obtain adequate remedies for any breach. While we use commonly accepted security measures, trade secret violations are often a matter of state law in the United States, and the criteria for protection of trade secrets can vary among different jurisdictions. If the steps we have taken to maintain our trade secrets are deemed inadequate, we may have insufficient recourse against third parties for misappropriating the trade secret. In addition, trade secrets may be independently developed by others in a manner that could prevent legal recourse by us. If any of our intellectual property rights or confidential or proprietary information, such as our trade secrets, were to be disclosed or misappropriated, or if any such information was independently developed by a competitor, it could have a material adverse effect on our competitive position, business, financial condition, results of operations and prospects.
Furthermore, any license agreements we enter into in the future may require us to notify, and in some cases license back to the licensor, certain additional proprietary information or intellectual property that we developed using the rights licensed to us under these agreements. Any such licenses back to the licensor could allow our licensors to use that proprietary information or intellectual property in a manner that could harm our business. In addition, others may independently discover our trade secrets and proprietary information. For example, the FDA, as part of its transparency initiative, is currently considering whether to make additional information publicly available on a routine basis, including information that we may consider to be trade secrets or other proprietary information, and it is not clear at the present time how the FDA’s disclosure policies may change in the future, if at all. Costly and time-consuming litigation could be necessary to enforce and determine the scope of our proprietary rights, and failure to obtain or maintain trade secret protection could adversely affect our competitive business position. Further, it is possible that others will independently develop the same or similar technology, products or services or otherwise obtain access to our
127
unpatented technology, and in such cases, we could not assert any trade secret rights against such parties. If we fail to obtain or maintain trade secret protection, or if our competitors obtain our trade secrets or independently develop technology or products similar to ours, our competitive market position could be materially and adversely affected. In addition, some courts are less willing or unwilling to protect trade secrets and agreement terms that address non-competition are difficult to enforce in many jurisdictions and might not be enforceable in certain cases.
We may be subject to claims that our employees, consultants or independent contractors have misappropriated the intellectual property rights, including know-how or trade secrets of a third party.
We may be subject to claims that our employees or consultants have wrongfully used for our benefit or disclosed to us confidential information of third parties. As is common in the biotechnology and pharmaceutical industries, we employ individuals who were previously employed at other biotechnology or pharmaceutical companies, including our competitors or potential competitors. Some of these employees, consultants and contractors may have executed proprietary rights, non-disclosure and non-competition agreements in connection with such previous employment or engagement. Although we try to ensure that our employees, consultants and independent contractors do not use the intellectual property rights, proprietary information, know-how, or trade secrets of others in their work for us, and do not perform work for us that is in conflict with their obligations to another employer or any other entity, we may be subject to claims that we or our employees, consultants or independent contractors have, inadvertently or otherwise misappropriated the intellectual property, including know-how, trade secrets or other proprietary information of their former employers or clients. To the extent that our employees, consultants or contractors use intellectual property rights or proprietary information owned by others in their work for us, disputes may arise as to the rights in any related or resulting know-how and inventions. Litigation may be necessary to defend against these claims. If we fail in defending any such claims, in addition to paying monetary damages, we could lose valuable intellectual property rights or personnel, which could adversely impact our business. There is no guarantee of success in defending these claims, and even if we are successful, litigation could result in substantial costs and be a distraction to management.
Our intellectual property may not be sufficient to protect our products from competition, which may negatively affect our business as well as limit our partnership or acquisition appeal.
We may be subject to competition despite the existence of intellectual property we license or own. We can give no assurances that our intellectual property claims will be sufficient to prevent third parties from designing around patents we own or license and developing and commercializing competitive products. The existence of competitive products that avoid our intellectual property could materially adversely affect our operating results and financial condition.
Furthermore, limitations, or perceived limitations, in our intellectual property may limit the interest of third parties to partner, collaborate or otherwise transact with us, if third parties perceive a higher than acceptable risk to commercialization of our products or future products.
Our drug re-innovation approach involves the filing of patent applications covering new methods of use and/or new formulations of previously known, studied and/or marketed drugs. Although the protection afforded by our patent and patent applications may be significant with respect to BXCL501, BXCL502, BXCL701 and BXCL702, when looking at our patents’ ability to block competition, the protection offered by our patents may be, to some extent, more limited than the protection provided by patents claiming the composition of matter of entirely new chemical structures previously unknown. If a competitor were able to successfully design around any method of use and formulation patents we may have in the future, our business and competitive advantage could be adversely affected.
We may elect to sue a third party, or otherwise make a claim, alleging infringement or other violation of patents, trademarks, trade dress, copyrights, trade secrets, domain names or other intellectual property rights that we either own or license from BioXcel LLC. If we do not prevail in enforcing our intellectual property rights in this type of litigation, we may be subject to:
● | paying monetary damages related to the legal expenses of the third party; |
● | facing additional competition that may have a significant adverse effect on our product pricing, market share, business operations, financial condition, and the commercial viability of our products; and |
128
● | restructuring our company or delaying or terminating select business opportunities, including, but not limited to, research and development, clinical trial, and commercialization activities, due to a potential deterioration of our financial condition or market competitiveness. |
A third-party may also challenge the validity, enforceability or scope of the intellectual property rights that we license or own; and the result of these challenges may narrow the scope or claims of or invalidate patents that are integral to our product candidates in the future. There can be no assurance that we will be able to successfully defend patents we own in an action against third parties due to the unpredictability of litigation and the high costs associated with intellectual property litigation, amongst other factors.
Intellectual property rights and enforcement may be less extensive in jurisdictions outside of the U.S.; thus, we may not be able to protect our intellectual property and third parties may be able to market competitive products that may use some or all of our intellectual property.
Changes to patent law, including the Leahy-Smith America Invents Act of 2011 and the Patent Reform Act of 2009 and other future article of legislation, may substantially change the regulations and procedures surrounding patent applications, issuance of patents, and prosecution of patents. We can give no assurances that our patents and those of our licensor, BioXcel LLC, can be defended or will protect us against future intellectual property challenges, particularly as they pertain to changes in patent law and future patent law interpretations.
In addition, enforcing and maintaining our intellectual property protection depends on compliance with various procedural, document submission, fee payment and other requirements imposed by the USPTO, courts and foreign government patent agencies, and our patent protection could be reduced or eliminated for non- compliance with these requirements.
Risks Related to Owning our Common Stock
The price of our common stock may fluctuate substantially.
You should consider an investment in our common stock to be risky, and you should invest in our common stock only if you can withstand a significant loss and wide fluctuations in the market value of your investment. Some factors that may cause the market price of our common stock to fluctuate, in addition to the other risks mentioned in this "Risk Factors" section, are:
● | sale of our common stock by our stockholders, executives, and directors; |
● | volatility and limitations in trading volumes of our shares of common stock; |
● | speculative trading in and short sales of our stock, as well as trading phenomena such as the “short squeeze” and “short and distort” schemes; |
● | our ability to obtain financings to conduct and complete research and development activities including, but not limited to, our clinical trials, and other business activities; |
● | possible delays in the expected recognition of revenue due to lengthy and sometimes unpredictable sales timelines; |
● | the timing and success of introductions of new applications and services by us or our competitors or any other change in the competitive dynamics of our industry, including consolidation among competitors, customers or strategic partners; |
● | network outages or security breaches; |
● | our ability to attract new customers; |
● | customer renewal rates and the timing and terms of customer renewals; |
129
● | our ability to secure resources and the necessary personnel to conduct clinical trials on our desired schedule; |
● | commencement, enrollment or results of our clinical trials for our product candidates or any future clinical trials we may conduct; |
● | changes in the development status of our product candidates; |
● | any delays or adverse developments or perceived adverse developments with respect to our preclinical and clinical trials; |
● | any delay in our submission for studies or product approvals or adverse regulatory decisions, including failure to receive regulatory approval for our product candidates; |
● | unanticipated safety concerns related to the use of our product candidates; |
● | failures to meet external expectations or management guidance; |
● | changes in our capital structure or dividend policy, future issuances of securities, sales of large blocks of common stock by our stockholders; |
● | our cash position; |
● | announcements and events surrounding financing efforts, including debt and equity securities; |
● | our inability to enter into new markets or develop new products; |
● | reputational issues; |
● | competition from existing technologies and products or new technologies and products that may emerge; |
● | announcements of acquisitions, partnerships, collaborations, joint ventures, new products, capital commitments, or other events by us or our competitors; |
● | changes in general economic, political and market conditions in or any of the regions in which we conduct our business; |
● | changes in industry conditions or perceptions; |
● | changes in valuations of similar companies or groups of companies; |
● | analyst research reports, recommendation and changes in recommendations, price targets, and withdrawals of coverage; |
● | departures and additions of key personnel; |
● | disputes and litigations related to intellectual properties, proprietary rights, and contractual obligations; |
● | changes in applicable laws, rules, regulations, or accounting practices and other dynamics; and |
● | other events or factors, many of which may be out of our control. |
In addition, if the market for stocks in our industry or industries related to our industry, or the stock market in general, experiences a loss of investor confidence, the trading price of our common stock could decline for reasons unrelated to our business, financial condition and results of operations. If any of the foregoing occurs, it could cause our stock price to fall and may expose us to lawsuits that, even if unsuccessful, could be costly to defend and a distraction to management.
130
Future sales and issuances of our common stock, including common stock that may be sold following exercise of outstanding warrants, would result in additional dilution of the percentage ownership of our stockholders and could adversely impact the share price of our common stock.
We expect that significant additional capital will be needed in the future to continue our planned operations, including, without limitation, funding our trials and studies, marketing and commercializing our products and funding our operations. Accordingly, we have sold, and in the future may sell, common stock, convertible securities or other equity securities in one or more transactions at prices and in a manner we determine from time to time. To the extent we raise additional capital by issuing additional shares of common stock or securities convertible or exchangeable for our common stock, our stockholders may experience substantial dilution, and new investors could gain rights superior to our existing stockholders.
In March 2024, we issued and sold in a registered direct offering 3,054,609 shares of our common stock, accompanying warrants to purchase up to 8,619,636 shares of our common stock and pre-funded warrants to purchase up to 5,565,027 shares of our common stock (see Note 11, Common Stock Financing Activities in this Quarterly Report on Form 10-Q for additional information). The number of shares of common stock underlying our outstanding warrants is significant in relation to our outstanding common stock (20.3% as of October 23, 2024), which could have a negative effect on the market price of our common stock and make it more difficult for us to raise funds through future equity offerings. In the event these warrants are exercised, our stockholders will experience additional dilution. To the extent outstanding stock options or warrants are exercised, there would be further dilution to our existing stockholders, which could impact the price of our common stock.
Because certain of our stockholders control a significant number of shares of our common stock, they may have significant influence over actions requiring stockholder approval.
As of September 30, 2024, our directors, executive officers and BioXcel LLC, and their respective affiliates, beneficially owned approximately 24.6% of our outstanding shares of common stock. As a result, these stockholders, acting together, would have significant control over the outcome of matters submitted to our stockholders for approval, including the election of directors and any merger, consolidation or sale of all or substantially all of our assets. In addition, these stockholders, acting together, would have significant control over the management and affairs of our Company. Accordingly, this concentration of ownership might harm the market price of our common stock by:
● | delaying, deferring or preventing a change in corporate control; |
● | impeding a merger, consolidation, takeover or other business combination involving us; or |
● | discouraging a potential acquirer from making a tender offer or otherwise attempting to obtain control of us. |
We do not intend to pay cash dividends on our shares of common stock so any returns will be limited to the value of our shares.
We currently anticipate that we will retain future earnings for the development, operation and expansion of our business and do not anticipate declaring or paying any cash dividends for the foreseeable future. Any return to stockholders will therefore be limited to the increase, if any, of our share price.
If we were deemed to be an investment company under the Investment Company Act of 1940, as amended (the “1940 Act”), applicable restrictions could make it impractical for us to continue our business as contemplated and could have a material adverse effect on our business, financial condition and results of operations.
Under Sections 3(a)(1)(A) and (C) of the 1940 Act, a company generally will be deemed to be an “investment company” for purposes of the 1940 Act if (1) it is, or holds itself out as being, engaged primarily, or proposes to engage primarily, in the business of investing, reinvesting or trading in securities or (2) it engages, or proposes to engage, in the business of investing, reinvesting, owning, holding or trading in securities and it owns or proposes to acquire
131
investment securities having a value exceeding 40% of the value of its total assets (exclusive of U.S. government securities and cash items) on an unconsolidated basis. We do not believe that we are an “investment company,” as such term is defined in the 1940 Act.
Notwithstanding Sections 3(a)(1)(A) and (C) of the 1940 Act, we are a research and development company and comply with the safe harbor requirements of Rule 3a-8 of the 1940 Act. We intend to conduct our operations so that we will not be deemed an investment company. However, if we were to be deemed an investment company, restrictions imposed by the 1940 Act, including limitations on our capital structure and our ability to transact with affiliates, could make it impractical for us to continue our business as contemplated and could have a material adverse effect on our business, financial condition and results of operations.
We are a “smaller reporting company” and are able to avail ourselves of reduced disclosure requirements applicable to smaller reporting companies, which could make our common stock less attractive to investors.
We are a smaller reporting company, and we will remain a smaller reporting company until we determine that either (1) our annual revenues are at least $100 million and our voting and non-voting common stock held by non-affiliates is at least $250 million measured on the last business day of our most recent second fiscal quarter, or (2) our voting and non-voting common stock held by non-affiliates is at least $700 million measured on the last business day of our most recent second fiscal quarter. Smaller reporting companies are able to provide simplified executive compensation disclosure, and have certain other reduced disclosure obligations, including, among other things, being required to provide only two years of audited financial statements and not being required to provide selected financial data, supplemental financial information or risk factors. In addition, as a non-accelerated filer, we are exempt from the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act.
We have elected to take advantage of certain of the reduced reporting obligations. We cannot predict whether investors will find our common stock less attractive if we rely on these exemptions. If some investors find our common stock less attractive as a result, there may be a less active trading market for our common stock and our stock price may be reduced or more volatile.
We are and may in the future be subject to legal proceedings, claims and investigations in or outside the ordinary course of business. Such proceedings, claims and investigations could be costly and time-consuming to defend and could result in unfavorable outcomes, which may have a material adverse effect on our business, operating results and financial condition, and negatively affect the price of our common stock.
We are, and may in the future become, subject to various legal proceedings, claims and investigations that arise in or outside the ordinary course of business. For example, on July 7, 2023, plaintiff Katelyn Martin filed a class action complaint against the Company and certain executives in the United States District Court for the District of Connecticut, captioned Martin v. BioXcel Therapeutics, et al., 3:23-cv-00915 (D. Conn). On October 4, 2023, pursuant to the Private Securities Litigation Reform Act, the court appointed two co-Lead Plaintiffs. The co-Lead Plaintiffs filed an amended complaint on December 5, 2023, alleging violations of Sections 10(b) and 20A of the Exchange Act and SEC Rule 10b-5 promulgated thereunder. On July 11, 2024, the Court dismissed the amended complaint without prejudice and, on August 1, 2024, co-Lead Plaintiffs filed a second amended complaint. The second amended complaint alleges that defendants made false or misleading statements regarding the TRANQUILITY II trial and the development of BXCL501 for an expanded indication related to the treatment of certain Alzheimer’s-related agitation. The Company moved to dismiss the second amended complaint on September 6, 2024. The Court has not yet ruled on the motion.
On November 28, 2023, Plaintiffs Pratheesan Panancherry and Jeffrey Bastress filed a stockholder derivative complaint in the United States District Court for the District of Connecticut purportedly on behalf of the Company and against Vimal Mehta, Richard I. Steinhart, Peter Mueller, June Bray, Sandeep Laumas, Michael Miller, Michal Votruba, and Krishnan Nandabalan as Defendants, and the Company as Nominal Defendant under the caption Panancherry et al v. Mehta et al, 3:23-cv-1554. Following the initial action, Plaintiffs Maria Vomvolakis (3:24-cv-3) and Kelly Fowler (3:24-cv-203) each filed separate stockholder derivative complaints in the District of Connecticut raising similar claims as Panancherry and Bastress, including business torts and violations of the Securities Exchange Act of 1934. The cases have been consolidated under the caption In re BioXcel Therapeutics, Inc. Stockholder Derivative Litigation, 3:23-cv-1554 (D. Conn.). The consolidated action is currently stayed.
132
On January 11, 2024, Plaintiff Jeremy Smith filed a stockholder derivative complaint in the United States District Court for the United States District Court for the District of Delaware purportedly on behalf of the Company and against Vimal Mehta, Peter Mueller, June Bray, Sandeep Laumas, Michael Miller, Michal Votruba, Richard I. Steinhart, Robert Risinger, and Krishnan Nandabalan as Defendants, and the Company as Nominal Defendant under the caption Smith v. Mehta et al, 1:24-cv-00041. Following the initial action, Plaintiff Janice Korff filed a stockholder derivative complaint in the District of Delaware raising similar claims as Smith (1:24-cv-130), including business torts and violations of the Securities Exchange Act of 1934. The cases have been consolidated under the caption In re BioXcel Therapeutics, Inc. Derivative Litigation, 1:24-cv-00041 (D. Del.). The consolidated action is currently stayed.
The Company is also cooperating with a formal investigation of the Company and certain of its officers and directors by the SEC, relating to the Company’s public disclosures, including about product sales and the receipt of a Form 483 by an investigator at one of the Company’s clinical trial sites in the TRANQUILITY II study, and trading in the securities of the Company. The Company has produced documents, and current and former officers and employees of the Company have testified before the SEC. The above-captioned proceedings, as well as any investigation or proceeding that may be instituted by the SEC may result in substantial costs or liabilities, as well as a diversion of management’s attention and resources, which could harm our business, result in a decline in the market price of our common stock and impact our financing efforts.
The potential costs and liabilities associated with legal proceedings, claims and investigations involving us or members of our leadership team is uncertain, and the results of such legal proceedings, claims and investigations cannot be predicted with certainty. Lawsuits and other administrative or legal proceedings that may arise can involve substantial costs, including the costs associated with investigation, litigation and possible settlement, judgment, penalty or fine. In addition, lawsuits and other legal proceedings may be time consuming to defend or prosecute and may require a commitment of management and personnel resources that will be diverted from our normal business operations. Also, our insurance coverage may be insufficient, our assets may be insufficient to cover any amounts that exceed our insurance coverage, and we may have to pay damage awards or otherwise may enter into settlement arrangements in connection with such claims. Moreover, we may be unable to continue to maintain our existing insurance at a reasonable cost, if at all, or to secure additional coverage, which may result in costs associated with lawsuits and other legal proceedings being uninsured. Any such payments or settlement arrangements in current or future litigation could have a material adverse effect on our business, operating results or financial condition. Even if the plaintiffs’ claims are not successful, current or future litigation could result in substantial costs and significantly and adversely impact our reputation and divert management’s attention and resources, which could have a material adverse effect on our business, operating results and financial condition, and negatively affect the price of our common stock. In addition, such lawsuits may make it more difficult to finance our operations.
Biotechnology and pharmaceutical companies with publicly traded stock or who obtain funding through the stock market often experience significant stock price volatility, based on events beyond their control, including outcomes of clinical trials, actions of regulators and product approvals. Such further litigation, may result in substantial costs and a diversion of management’s attention and resources, which could harm our business and result in a decline in the market price of our common stock.
Our certificate of incorporation, our bylaws, and Delaware law may have anti-takeover effects that could discourage, delay, or prevent a change in control, which may cause our stock price to decline.
Our amended and restated certificate of incorporation, our amended and restated bylaws and Delaware law could make it more difficult for a third party to acquire us, even if closing such a transaction would be beneficial to our stockholders. We are authorized to issue up to 10 million shares of preferred stock. This preferred stock may be issued in one or more series, the terms of which may be determined at the time of issuance by our board of directors without further action by stockholders. The terms of any series of preferred stock may include voting rights (including the right to vote as a series on particular matters), preferences as to dividend, liquidation, conversion and redemption rights and sinking fund provisions. No preferred stock is currently outstanding. The issuance of any preferred stock could materially adversely affect the rights of the holders of our common stock, and therefore, reduce the value of our common stock. In particular, specific rights granted to future holders of preferred stock could be used to restrict our ability to merge with, or sell our assets to, a third party and thereby preserve control by the present management.
133
Provisions of our amended and restated certificate of incorporation and our amended and restated bylaws and Delaware law also could have the effect of discouraging potential acquisition proposals or making a tender offer or delaying or preventing a change in control, including changes a stockholder might consider favorable. Such provisions may also prevent or frustrate attempts by our stockholders to replace or remove our management. In particular, the certificate of incorporation and bylaws and Delaware law, as applicable, among other things:
● | provide the board of directors with the ability to alter the bylaws without stockholder approval; |
● | place limitations on the removal of directors; |
● | establishing advance notice requirements for nominations for election to the board of directors or for proposing matters that can be acted upon at stockholder meetings; and |
● | provide that vacancies on the board of directors may be filled by a majority of directors in office, although less than a quorum. |
Financial reporting obligations of being a public company in the U.S. are expensive and time-consuming, and our management is required to devote substantial time to compliance matters.
As a publicly traded company we have incurred and will continue to incur significant legal, accounting and other expenses. The obligations of being a public company in the U.S. require significant expenditures and place significant demands on our management and other personnel, including costs resulting from public company reporting obligations under the Exchange Act and the rules and regulations regarding corporate governance practices, including those under the Sarbanes-Oxley Act, the Dodd-Frank Wall Street Reform and Consumer Protection Act, and the listing requirements of the stock exchange on which our securities are listed. These rules require the establishment and maintenance of effective disclosure and financial controls and procedures, internal control over financial reporting and changes in corporate governance practices, among many other complex rules that are often difficult to implement, monitor and maintain compliance with. Moreover, despite reforms made possible by the JOBS Act, the reporting requirements, rules, and regulations will make some activities more time-consuming and costly, particularly as we are no longer an “emerging growth company.” In addition, we expect these and similar rules and regulations to make it more difficult and more expensive for us to obtain director and officer liability insurance and we may be required to incur substantial costs to maintain such insurance. Our continued compliance with applicable requirements and to keep pace with new regulations requires management and other personnel to devote a substantial amount of their time, otherwise we may fall out of compliance and risk becoming subject to litigation or being delisted, among other potential problems.
General Risk Factors
If securities or industry analysts do not publish research or reports, or publish unfavorable research or reports about our business, our stock price and trading volume may decline.
The trading market for our common stock will rely in part on the research and reports that industry or financial analysts publish about us, our business, our markets and our competitors. We do not control these analysts. If securities analysts do not cover our common stock, the lack of research coverage may adversely affect the market price of our common stock. Furthermore, if one or more of the analysts who do cover us downgrade our stock or if those analysts issue other unfavorable commentary about us or our business, which has occurred in the past, our stock price would likely decline. If one or more of these analysts cease coverage of us or fails to regularly publish reports on us, we could lose visibility in the market and interest in our stock could decrease, which in turn could cause our stock price or trading volume to decline and may also impair our ability to expand our business with existing customers and attract new customers.
134
If we fail to comply with the rules under the Sarbanes-Oxley Act related to accounting controls and procedures in the future, or, if we discover material weaknesses and other deficiencies in our internal control and accounting procedures, our stock price could decline significantly and raising capital could be more difficult.
Section 404 of the Sarbanes-Oxley Act requires annual management assessments of the effectiveness of our internal control over financial reporting. If we fail to comply with the rules under the Sarbanes-Oxley Act related to disclosure controls and procedures in the future, or, if we discover material weaknesses and other deficiencies in our internal control and accounting procedures, our stock price could decline significantly and raising capital could be more difficult. We have discovered material weaknesses in the past. If future material weaknesses or significant deficiencies are discovered or if we otherwise fail to achieve and maintain the adequacy of our internal control, we may not be able to ensure that we can conclude on an ongoing basis that we have effective internal controls over financial reporting in accordance with Section 404 of the Sarbanes-Oxley Act. Moreover, effective internal controls are necessary for us to produce reliable financial reports and are important to helping prevent financial fraud. If we cannot provide reliable financial reports or prevent fraud, our business and operating results could be harmed, investors could lose confidence in our reported financial information, and the trading price of our common stock could drop significantly.
Comprehensive tax reform bills could adversely affect our business and financial condition.
In 2017, the U.S. government enacted comprehensive federal income tax legislation that includes significant changes to the taxation of business entities. These changes include, among others, a permanent reduction to the corporate income tax rate. Notwithstanding the reduction in the corporate income tax rate, the overall impact of this tax reform is uncertain, and our business and financial condition could be adversely affected. Future changes in corporate tax rates, the realization of net deferred tax assets relating to our operations, the taxation of any foreign earnings, and the deductibility of expenses under future reform legislation could have a material impact on the value of our deferred tax assets, could result in significant one-time charges, and could increase our future U.S. tax expense.
Item 2. Unregistered Sales of Equity Securities, and Use of Proceeds and Issuer Purchases of Equity Securities
None.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
(a) None.
(b) None.
(c) During the three months ended September 30, 2024, none of our directors or “officers” (as defined under as defined in Rule 16a-1(f) under the Exchange Act) adopted or terminated a “Rule
135
Item 6. Exhibits
Exhibit Number | Description | Form | File No. | Exhibit | Filing Date | Filed/ Furnished Herewith | |
3.1 | Amended and Restated Certificate of Incorporation, as amended. | 10-Q | 001-38410 | 3.1 | 8/10/2021 | ||
3.2 | 8-K | 001-38410 | 3.1 | 6/11/2024 | |||
3.3 | 8-K | 001-38410 | 3.2 | 3/13/2018 | |||
4.1 | 10-K | 001-38410 | 4.5 | 3/22/2024 | |||
4.2 | 10-K | 001-38410 | 4.6 | 3/22/2024 | |||
4.3 | 8-K | 001-38410 | 4.1 | 3/25/2024 | |||
4.4 | 8-K | 001-38410 | 4.2 | 3/25/2024 | |||
10.1+ | 10-Q | 001-38410 | 10.1 | 8/6/2024 | |||
10.2 | Separation Agreement between BioXcel Therapeutics, Inc. and Matthew Wiley, dated October 3, 2024. | 8-K | 001-38410 | 10.1 | 10/9/2024 | ||
10.3 | Consulting Agreement between BioXcel Therapeutics, Inc. and Matthew Wiley, dated October 8, 2024. | 8-K | 001-38410 | 10.2 | 10/9/2024 | ||
10.4 | * | ||||||
10.5 | * | ||||||
10.6 | * | ||||||
10.7 | * | ||||||
31.1 | * | ||||||
31.2 | * | ||||||
32.1 | ** | ||||||
32.2 | ** | ||||||
101.INS | Inline XBRL Instance Document | * | |||||
- the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document | |||||||
101.SCH | Inline XBRL Taxonomy Extension Schema Document | * | |||||
136
101.CAL | Inline XBRL Taxonomy Extension Calculation Linkbase Document | * | |||||
101.DEF | Inline XBRL Taxonomy Extension Definition Linkbase Document | * | |||||
101.LAB | Inline XBRL Taxonomy Extension Label Linkbase Document | * | |||||
101.PRE | Inline XBRL Taxonomy Extension Presentation Linkbase Document | * | |||||
104 | Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101). | * |
* | Filed herewith. |
** | Furnished herewith. |
+ Portions of this exhibit have been omitted pursuant to Item 601(b)(10)(iv) of Regulation S-K.
137
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
BioXcel Therapeutics, Inc. | |
Dated: November 14, 2024 | By: |
/s/ Vimal Mehta | |
Vimal Mehta | |
Chief Executive Officer | |
(Principal Executive Officer) | |
Dated: November 14, 2024 | By: |
/s/ Richard Steinhart | |
Richard Steinhart | |
Chief Financial Officer | |
(Principal Financial Officer) |
138