Nektar Therapeutics Q2 2026 Earnings Call - ZENITH AD Phase III Launches with $1B Cash Runway
Summary
Nektar Therapeutics has officially initiated the global ZENITH AD Phase III program for rezpegaldesleukin (REZPEG) in atopic dermatitis, marking a critical pivot from development to registration. The company also finalized the design for a single registrational Phase III study in alopecia areata, with initiation planned for early 2027. Management emphasized a differentiated commercial thesis built on a novel Treg agonist mechanism that avoids the safety liabilities of JAK inhibitors and the resistance issues seen with IL-13 blockers. Market research indicates strong physician enthusiasm for a quarterly dosing regimen and a safety profile free of conjunctivitis or increased infection risk, supporting a label that captures both treatment-naive and experienced patients across first, second, and later lines of therapy.
Key Takeaways
- ZENITH AD Phase III program for atopic dermatitis is now active, with two biologic- and JAK-inhibitor-naïve studies enrolling in July and a treatment-experienced study starting by end of September.
- Top-line data from the atopic dermatitis Phase III studies is expected in mid-2028, with a Biologics License Application (BLA) submission targeted for 2029 if results are positive.
- A single registrational Phase III study for alopecia areata, named ZENITH AA, was finalized following FDA alignment and is scheduled to begin in early 2027.
- Nektar holds a robust financial position with $1.02 billion in cash and investments, extending its cash runway into Q3 2028, well past the initial Phase III data readouts.
- REZPEG acts as a Treg agonist, working upstream of inflammatory pathways to restore immune balance, distinguishing it from downstream inhibitors like IL-13 or JAK blockers.
- Market research involving 151 prescribers revealed high enthusiasm for REZPEG’s novel mechanism, with physicians viewing it as a potential first-line option due to its favorable safety and durability profile.
- Physicians prefer REZPEG’s quarterly maintenance dosing in atopic dermatitis and twice-monthly dosing in alopecia areata over daily oral JAK inhibitors, citing better compliance and fewer serious safety concerns like conjunctivitis or infection.
- In atopic dermatitis, REZPEG demonstrated a fivefold increase in EASI-100 (complete skin clearance) rates during the 36-week maintenance period in Phase IIb, with responses deepening over time.
- The Phase III atopic dermatitis program includes secondary endpoints for comorbid asthma (ACQ-5) and allergic rhinitis (SNOT-22), leveraging REZPEG’s upstream mechanism to address multiple inflammatory manifestations simultaneously.
- A Phase II study in type 1 diabetes, sponsored by TrialNet, is ongoing with data from the first cohort expected in 2027, while the company is also developing bispecific TNFR2 agonists like NKTR-0166 for other autoimmune conditions.
Full Transcript
Crystal, Conference Operator, Nektar Therapeutics: Hello, and thank you for standing by. Welcome to the Nektar Therapeutics second quarter 2026 financial results conference call. At this time, all participants are in listen-only mode. After the speaker’s presentation, there will be a question and answer session. Please be advised that today’s conference is being recorded. I would now like to hand the conference over to Vivian Wu from Nektar Investor Relations to kick things off. Please go ahead.
Vivian Wu, Vice President, Investor Relations, Nektar Therapeutics: Thank you, Crystal, and good afternoon, everyone. Thank you for joining us today. On today’s call, you will hear from Howard Robin, our President and Chief Executive Officer, Dr. Jonathan Zalevsky, our Chief Research and Development Officer, and Linda Rubinstein, our Chief Financial Officer. Dr. Mary Tagliaferri, our Chief Medical Officer, will also be available during the Q&A. Before we begin, I would like to remind you that we will be making forward-looking statements regarding our business, including statements related to therapeutic and commercial potential and development plans for rezpegaldesleukin, the timing and expectations for clinical trial, clinical data presentations, and regulatory submissions, regulatory interactions, our expected cash runway, and other statements regarding the future of our business. Because forward-looking statements relate to the future, they are subject to uncertainties and risks that are difficult to predict and many of which are outside of our control.
For a discussion of these risks and uncertainties, please refer to our filings with SEC, including our most recent Form 10-K and subsequent filings. We undertake no obligation to update these forward-looking statements except as required by law. A live webcast and replay of this call will be available on the investor relation section of our website at nektar.com. With that, I will hand the call over to Howard.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Thank you, Vivian. Thank you to everyone for joining us this afternoon. In July, we achieved yet another important milestone in Nektar with the initiation of the global ZENITH AD program, phase III AD program for rezpegaldesleukin, also known as REZPEG, in moderate to severe atopic dermatitis. Following our end of phase II meeting with the FDA, we also finalized the design of a single registrational phase III study for REZPEG in alopecia areata, which we plan to initiate in early 2027. The registrational study designs for REZPEG build on the positive clinical data we have generated in the first half of this year in patients with atopic dermatitis and alopecia areata, and also reflects input from our completed regulatory meetings.
JZ will talk more about these designs later on during the call. Importantly, with the first phase III studies in atopic dermatitis now underway, we expect top-line data from these studies in mid 2028, and if positive, expect to submit a BLA in 2029. As a novel Treg agonist mechanism, REZPEG works fundamentally different by acting upstream of multiple inflammatory pathways to restore immune balance. To that end, we continue to evaluate new indications for expansion of REZPEG’s development in the future. Through TrialNet, we are evaluating its potential in type 1 diabetes in an ongoing phase II study. We also believe there are other autoimmune conditions where a Treg mechanism could benefit patients, and we therefore view REZPEG as a potential pipeline and a product. Importantly, the market opportunity and patient need in each of our two lead indications are substantial.
More than 15 million people in the U.S. have moderate to severe atopic dermatitis, and currently fewer than 10% are treated with a systemic therapy. We believe that this market will grow with the introduction of novel mechanisms of action, as was the case in the psoriasis market, and that REZPEG is highly differentiated from the other novel MOAs approved or in development. We know that roughly half of the patients on currently available IL-13-based agents, including DUPIXENT, either do not respond to therapy or lose their response over time. This leaves a large unmet need for a new therapeutic option. We believe REZPEG has the potential to alter the treatment paradigm in this indication by offering a differentiated efficacy and safety profile with a long-term, highly attractive monthly or quarterly maintenance dosing regimen. We recently completed extensive market research, which included our 52-week maintenance data for REZPEG.
The research reinforces our commercial thesis in atopic dermatitis. We interviewed and surveyed 151 high-volume prescribers and key opinion leaders in the U.S. and Europe. A recurrent theme that came up in the research was physician enthusiasm for a novel mechanism of action as compared to overlapping mechanisms of action in the IL-13 class. The REZOLVE-AD data was viewed highly positively, including EASI-75 and Itch NRS responses. The quarterly dosing schedule for maintenance and the EASI-100 rates were called out as notable and differentiating. The data in comorbid asthma was also cited as a key differentiator as physicians see patients with a range of other autoimmune and allergic comorbidities, which could benefit from a Treg therapeutic approach.
Notably, safety was viewed as a key differentiator with no increased risk for infection and no conjunctivitis observed in the REZPEG treatment arms in our phase IIb REZOLVE-AD study. Importantly, 150 out of the 151 physicians interviewed said that injection site reactions were not a hindrance to prescribing or a barrier for patients, and actually preferred a self-resolving short-lived ISR over managing longer duration conjunctivitis. It was clear that physicians would welcome a novel immune modulating mechanism like REZPEG in the treatment paradigm, and that REZPEG would likely be prescribed across first, second, and third line populations. The research supports our decision to pursue a label with our registrational program in atopic dermatitis that captures both treatment-naïve and experienced patients. Turning to the opportunity in alopecia areata, nearly 6.7 million people in the U.S. are affected by the disease, and the large majority currently go untreated.
There are well-known safety challenges associated with JAK inhibitors, which is the only approved class to treat severe patients, and that has limited their use. In spite of that, the market for agents currently approved for alopecia areata is still projected to grow to $5 billion in 2033. More than half of dermatologists are not comfortable prescribing these agents given their boxed warnings and an ongoing monitoring burden. Our REZPEG market research with physicians in alopecia areata reaffirms this hesitation to prescribe JAK inhibitors. In addition to REZPEG’s safety profile observed to date and its novel MOA, physicians and patients in our research cited REZPEG’s twice monthly dosing for alopecia areata patients as more attractive than once daily oral dosing. Physicians also noted the ability to ensure patient compliance with treatment is much higher with an injectable twice monthly regimen.
The research reaffirms our belief that REZPEG has the potential to become a preferred first-line treatment option for patients with severe to very severe alopecia areata. Before I hand the call to JZ, I will note that we ended the quarter in a strong financial position with over $1 billion in cash and investments, and our cash runway extends into the third quarter of 2028, past the initial phase III atopic dermatitis data readouts in mid-2028. Our team is laser-focused on successful execution of our phase III programs and advancing REZPEG to BLA submission as quickly as possible. With that, I’ll turn the call over to JZ.
Dr. Jonathan Zalevsky, Chief Research and Development Officer, Nektar Therapeutics: Thank you, Howard, and good afternoon, everyone. Everything we have learned about REZPEG from the data from the clinical programs to date points to a consistent, and we believe differentiated clinical profile. Meaningful efficacy, a favorable safety profile with dosing as infrequent as once a quarter, and responses that continue to deepen over time. As Howard stated, REZPEG works upstream of the currently approved agents in the diseases we are targeting. It stimulates regulatory T cells and gets closest to natural causal biology to restore the immune balance that is disrupted in autoimmune and inflammatory disease. Rather than blocking a single target or even multiple targets downstream, REZPEG is able to correct TH1, TH2, TH17, and other upstream inflammatory dysfunctions that can drive disease pathology across atopic dermatitis, alopecia areata, and other autoimmune diseases.
Because regulatory T cells target the underlying immune imbalance of inflammatory and autoimmune diseases, we have seen REZPEG produce very high durability over time. This was our key hypothesis when we developed REZPEG, and it is supported by the data we reported from our monthly and quarterly dosing regimens in our phase II-B program. In our first phase I study, following a 12-week treatment cycle, we observed durability of clinical responses for approximately nine months off treatment, which we have previously published. As Howard mentioned, ZENITH AD, our global phase III program in atopic dermatitis, is now up and running. The first two studies, both in biologic and JAK inhibitor-naïve patients, were initiated, and we started randomizing patients back in July. The planned study in treatment-experienced patients is set to start by the end of September.
As a reminder, each of the two pivotal biologic-naïve studies will enroll 510 adolescent and adult patients aged 12 and older, randomized 2 to 1 to REZPEG at 24 micrograms per kilogram every 2 weeks or placebo. There is a 24-week induction period followed by a 28-week maintenance period through week 52, during which we will evaluate both monthly and quarterly dosing. The third phase III study in treatment-experienced patients has the same design and is expected to support a second-line and later usage in the label. Taken together, the studies are designed to support a potential label in this patient population that captures both naïve and experienced patients spanning first-line, second-line, and later-line usage.
The studies are designed to support U.S. and global registration with an IGA-related primary endpoint for the U.S. and co-primary endpoints of EASI-75 and IGA for significant territories outside the U.S., along with multiplicity-protected secondary endpoints for key patient-reported outcomes such as Itch Numerical Rating Scale or NRS Skin Pain NRS, and Atopic Dermatitis Sleep Scale, or ADSS. As you know, many patients with atopic dermatitis also have other comorbidities, including asthma and allergic rhinitis. As a Treg-based mechanism, REZPEG is designed to work upstream of targeted path. REZPEG is uniquely positioned to simultaneously address multiple autoimmune and inflammatory manifestations at once. To that end, we also include a number of multiplicity protected secondary endpoints that will help us explore this benefit. The first being ACQ-5, which measures improvements in patient-reported asthma symptoms. Approximately 25% of patients with moderate to severe atopic dermatitis also have asthma.
In our phase IIb setting, REZPEG produced statistically significant improvements in ACQ-5 versus placebo, including in patients with uncontrolled asthma at baseline. A second endpoint we’ve included is the Sino-Nasal Outcome Test 22. This is referred to with the acronym SNOT-22, a validated patient-reported measure of sino-nasal symptoms. Rhinitis is a type 2 inflammatory comorbidity found in patients with atopic dermatitis, and up to 30% of patients with atopic dermatitis also have a comorbidity of allergic rhinitis. On this endpoint in our phase IIb study, we measured SNOT-22 for patients with self-reported symptoms and which extended also into patients who had self-reported asthma with rhinitis. We are including SNOT-22 as a secondary endpoint in our phase III studies, and we are excited to share with you that we plan to present the SNOT-22 data from the REZOLVE-AD study at a future medical meeting.
Our strong REZOLVE-AD phase IIb data underlies the design of our phase III program. In REZOLVE-AD, we saw a rapid onset of skin clearance and itch relief early in treatment, and we saw those responses deepen over time rather than plateau. With less frequent monthly and quarterly maintenance dosing, we achieved high rates of complete skin clearance, including up to a fivefold increase in EASI-100 rates during the 36-week maintenance treatment period, a level of response rarely achieved. As Howard said, we expect the first data from the phase III program in mid-2028, and if positive, expect to submit a BLA in 2029. Turning to alopecia areata, we recently held our end of phase II meeting with the FDA, and we received alignment to conduct a single registrational phase III study, which we are calling ZENITH AA.
In the pivotal study we have finalized, 850 adolescent and adult patients aged 12 and older will be randomized to receive REZPEG at 24 micrograms per kilogram every two weeks or placebo, with treatment continuing through 52 weeks. The study will include patients that have a current episode of alopecia areata of up to eight years. This was the inclusion criteria for all of the JAK inhibitor Phase III trials, as well as our Phase IIb randomized placebo-controlled study. We will include both patients who are naive to systemic treatment, including biologics and JAK inhibitors, as well as those who have been treated with a prior systemic agent, provided they have undergone an extended washout period. The primary endpoint will be a SALT score of 20 or less at week 52, which corresponds to 80% or more scalp hair coverage.
This is the established registrational endpoint for patients with severe to very severe alopecia areata at baseline. Key secondary endpoints include SALT scores of 10 or less and 30 or less, along with 50%, 75%, and 90% SALT reductions from baseline, which capture increasing degrees of hair regrowth. You will recall that we observed improvement with REZPEG treatment across all these endpoints in our Phase IIb trial. Patients from the study will also have the ability to roll over into a long-term extension, which will allow us to characterize durability of response on treatment and long-term safety. We plan to initiate the Phase III alopecia areata study in early 2027, and we expect data in the second half of 2029, and if positive, would expect to seek approval in alopecia areata as the second indication shortly following our planned submission in atopic dermatitis.
We expect to have data from the 24-week off-treatment period of the Phase IIb REZOLVE-AA study in alopecia areata in the fourth quarter of this year. Our objective for measuring patients in the off-treatment period is to determine a maintenance dosing regimen beyond 52 weeks, whether we continue to dose it twice monthly or offer additional once-a-month regimen. As you know, we already have an advantageous dosing schedule of twice monthly as compared to a daily JAK inhibitor. As Howard pointed out earlier, our market research has reinforced for us that both physicians and patients would prefer a less frequent injectable regimen as opposed to daily oral administration. When you couple this dosing regimen advantage with the safety profile observed to date, we believe REZPEG has the potential to become an important first-line treatment for this indication.
In addition, data sets from both our lead programs in atopic dermatitis and alopecia areata have been accepted for oral presentations at the European Academy of Dermatology and Venereology, or EADV, Congress to take place in Vienna in October. These presentations will feature the REZOLVE-AD maintenance data, covering both the patients who maintain their response and those who develop new and deepening responses over time, including complete clearance, as well as the REZOLVE-AA week 52 data. We are grateful for the opportunity to present these data at this important meeting. Beyond our two lead indications, the phase II study of REZPEG in new onset type 1 diabetes, sponsored and funded by TrialNet, is ongoing.
As a reminder, this is the same consortium that ran the foundational studies for TZIELD, the only approved therapy in this setting, and they bring expertise and a deep commitment to finding better options for patients with this disease. We are looking forward to the data from the first cohort of patients in this type 1 diabetes study in 2027. As this program matures, we continue to evaluate additional opportunities for REZPEG in other potential indications. As I mentioned earlier, REZPEG is fundamentally different from therapies that block a single downstream inflammatory mediator. REZPEG acts upstream by expanding regulatory T cells and enhancing their suppressive function, thereby restoring immune tolerance and reestablishing regulatory control over pathogenic immune responses. Our objective is to start a clinical study prior to year-end, which would allow us to evaluate REZPEG’s activity in a new indication.
Turning to our earlier pipeline programs, we are continuing our development of our TNFR2 programs. NKTR-0165 is our bivalent TNFR2 agonist antibody, a molecule with very high specificity for signaling through TNFR2 on Tregs to enhance their ability to regulate the immune system. We believe this mechanism has potential across a range of indications, including MS, ulcerative colitis, and vitiligo. Because NKTR-0165 demonstrated strong monomeric activity, we realized the TNFR2 molecule could be incorporated in the design of bispecific and trispecific constructs in combination with validated targets. Therefore, we are designing a pipeline of TNFR2-containing bispecific molecules that pair TNFR2 agonism with other antibody targets. The first of these programs, NKTR-0166, is a bispecific molecule that combines a TNFR2 agonist epitope with an antagonist epitope previously validated in rheumatology. This dual mechanism gives NKTR-0166 the potential to modify disease pathogenesis across multiple autoimmune settings.
We are continuing our research in both TNFR2 programs and will share more as they progress. With that, I will turn the call over to Linda to review our financial results. Linda?
Linda Rubinstein, Chief Financial Officer, Nektar Therapeutics: Thank you, JZ, and good afternoon, everyone. On today’s call, I will review our quarterly financials for the second quarter of 2026 and our 2026 financial guidance. We ended the second quarter of 2026 with $1.02 billion in cash and investments, with no debt on our balance sheet. In April, we completed an underwritten public offering, resulting in approximately $350 million in net proceeds. We are increasing our cash guidance for year-end 2026, and we now expect to end 2026 with approximately $815 million to $840 million in cash and investments. Turning to the income statement, our second quarter 2026 non-cash royalty revenue totaled $10.1 million. Full-year revenue for 2026 is still expected to total $40 million to $45 million.
Our R&D expenses were $39.1 million for the second quarter of 2026, and we now anticipate full-year R&D expense to range between $210 million and $230 million, including approximately $5 million to $10 million of non-cash depreciation and stock-based compensation expense. As a reminder, we expect R&D expense to increase on a quarterly basis in 2026 as our phase III clinical studies and supporting CMC activities progress. Our G&A expenses were $12.8 million for the second quarter. We continue to expect G&A expenses for the full year 2026 to be between $60 million and $65 million, including approximately $5 million of non-cash depreciation and stock-based compensation expense. Non-cash interest expense for the second quarter was $7.2 million, and we expect non-cash interest expense to total approximately $30 million to $35 million for 2026. Our net loss for the second quarter was $40.6 million, or $1.23 basic and diluted net loss per share.
As I stated earlier, we now expect to end 2026 with between $815 million and $840 million in cash and investments. Our financial position is strong, enabling us to continue investing in our REZPEG atopic dermatitis and alopecia areata program, as well as advancing our TNFR2 agonist antibody program, which includes NKTR-0165 and NKTR-0166. I’ll now turn it over to the operator for Q&A.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. As a reminder, to ask a question, please press star one on your telephone and wait for your name to be announced. To withdraw your question, please press star one again. In the interest of time, we do ask that you please limit yourself to one question at this time. Our first question will come from Yasmeen Rahimi from Piper Sandler. Your line is open.
Yasmeen Rahimi, Analyst, Piper Sandler: Good afternoon, team. Congrats on getting the alignment of the ZENITH AA study and kicking that off, so congrats. Great updates. You guys do always a wonderful job helping us think about the next catalyst in terms of thinking about timing, the type of data we will get, and the expectation. I would love to do that ahead of the next important data readout, which will be the withdrawal data that is going to come in the fourth quarter. Could you maybe talk about what your expectations are in terms of what is the size of the cohort, what do you expect to see that would be, and whether any of that off-treatment AA data inform in any way sort of the data collection that will be ongoing in your phase III study?
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Yeah. Thank you. That’s a great question. I’ll let Mary take that question.
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Great. Hi, Yasmeen, and thank you so much for congratulating us on having our phase III program in atopic dermatitis kick off. We’re very excited about that as well. As you know, we have a 24-week follow-up off-treatment period in the REZOLVE-AA study. This is an ongoing part of our trial, and in the fourth quarter, we will have the data. We enrolled 92 patients total into the trial, and then of those 92, 31 went on into our 16-week extension. We do follow every patient who was enrolled into the study for that 24-week off treatment. With respect to the phase III, the most important for us is after 52 weeks of treatment on the phase III alopecia areata registrational study, we will continue to follow those patients in a long-term extension study.
These data will really help to instruct should treatment continue to be on an every 2-week basis, or can we extend that frequency in a maintenance period to a longer time point, such as dosing once a month. We’re really excited to look at those data so we can have more clarity on treatment after 52 weeks in our phase III program. Likewise, in the first quarter of next year, we will have 52-week off-treatment data for our atopic dermatitis phase IIb study. In that, again, we’re really looking to instruct what should the dosing be after 52 weeks of treatment, and are there patients that experience durability of responses beyond, say, a dosing interval that we evaluated in the phase IIb, such as q monthly and every 3 monthly.
We did see, of course, in our phase IIb that patients experienced great durability, and many experienced a deepening of response. Now we want to look at, in this 52-week off treatment, how those responses are maintained and the durability of those responses to see if it’s feasible to extend that dosing interval beyond quarterly.
Yasmeen Rahimi, Analyst, Piper Sandler: Thank you so much, Mary, for the thoughtful color.
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Thanks, Yas.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Samantha Semenkow from Citi. Your line is open.
Samantha Semenkow, Analyst, Citi: Hi. Good afternoon. Thanks very much for taking the question, and thank you for all of the details in the recent market research that you shared in atopic derm. I’m just wondering if you can elaborate a bit more on how physicians are thinking about prescribing REZPEG in the first-line setting. Are there certain patient population or patient characteristics that physicians are identifying that are best suited for REZPEG? Did your market research give any indication on the breakdown of the portion that would be candidates, say, for first line versus second line or later? Thanks very much.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Yeah. Very good question. Look, the market research that we did was extensive, and we want to understand how to position our drug because at some point, it is a completely novel mechanism, and everybody thinks that there is going to have to be a step through IL-13 to ultimately get to something like a Treg mechanism. We do not find that to be the case. I think overall, as I said earlier, there is only about 10% of the population with atopic dermatitis that is being treated with systemic therapies. So it is an enormous upside market potential. Even the patients that are getting IL-13s, which is sort of the gold standard right now, I think about half of those patients either do not respond or fail after a year or so. So there is lots of opportunity for REZPEG as a first-line indication.
Clearly, as a second-line indication, it fits that definition perfectly, since we know how many patients fail IL-13. With a quarterly maintenance dosing regimen, it makes it a very easy drug to take for those patients. I do think we will get a significant share of the first-line market as well once patients get experience. Remember, it does not cause any infection. It does not cause conjunctivitis and those problems. Those side effects are potentially much more serious than mild to moderate self-resolving ISRs. So overall, we are pretty happy about getting our first-line market share.
Samantha Semenkow, Analyst, Citi: Thanks very much.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Jay Olson from Oppenheimer. Your line is open.
Dr. Jonathan Zalevsky, Chief Research and Development Officer, Nektar Therapeutics: Are you thinking about eventually moving into the first-line setting? Thank you.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: I’m sorry. I barely heard that question. Could you say it again louder?
Crystal, Conference Operator, Nektar Therapeutics: Thank you. We’ll take our next question. Our next question comes from Cha Cha Yang from Jefferies. Your line is open.
Cha Cha Yang, Analyst, Jefferies: Hi, team. This is Cha Cha on for Roger. Thank you so much for the updates. As always, very informative and very colorful. I was wondering if you could give us some comments on the pretrial that happened last week, any color that you can give on the outcomes of that, what impact you expect those outcomes to have on your upcoming September trial. Thank you.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Yeah, look, always a good question, but of course, we cannot really comment on an ongoing litigation. I can tell you that a jury trial is scheduled in federal court in San Francisco for September 8th, and we believe we have a very strong position, and that is unfortunately all I can tell you about it at this point. I would love to give you more, but it is difficult to comment on ongoing litigation.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Arthur He from H.C. Wainwright. Your line is open.
Arthur He, Analyst, H.C. Wainwright: Hey, Howard and team. Congrats on progress, and Mary, congrats get the single trial for the AA study sign-off. For that part, I just wonder for the off-drug data in the fourth quarter. For the patient who only finished the 36-week, are we also looking to the data from that part of patients there?
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Yeah. Hi, Arthur. Yes, we will be looking at those patients as well as those patients that completed the 52 weeks of treatment. Obviously, I think what will be most instructive and valuable to our decision-making will be those patients, there were 31 of them, that went into the 16-week extension. But we will be looking at all the 92 patients that we randomized into the study and providing an update on the totality of the findings.
Arthur He, Analyst, H.C. Wainwright: Okay, thanks. So just one quick phrasing. So when you are talking to the FDA, do they put some requirement for a medium or minimal duration for the current episode for the alopecia patient?
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Yeah. Thank you for asking. We will be following the same convention as JAK inhibitors, and our study design did provide for patients that have up to 8 years of their current episode. We do know that there are some other people who have looked at a more enriched patient population that only have a current episode of up to 4 years duration of their current episode. However, we don’t think that reflects the actual population of patients with alopecia areata, and we want to have a very broad label. So we did design a study that will include both patients who are JAK inhibitor naive and JAK inhibitor experienced. We will have adolescent patients as well as adult patients, and we will be looking at patients who have a duration of their current episode less than 4 years and 4-8 years.
We think having the broadest label has the greatest commercial potential as well as serving the broadest proportion of patients, and certainly a study that’s in line with the prior JAK inhibitor studies.
Arthur He, Analyst, H.C. Wainwright: Awesome. Thanks, Mary.
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Thanks, Arthur.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Mayank Mamtani from B. Riley Securities. Your line is open.
Mayank Mamtani, Analyst, B. Riley Securities: Yes, thanks for taking our questions, and appreciate all the level of detail. Two-part question. On the EADV, what is the incremental data set that we should expect? If there is a chance off-treatment REZOLVE-AA data could also be presented because it is October 1st, technically fourth quarter, and that also could help with the enthusiasm for enrollment in your global alopecia Phase III. On the maintenance atopic derm data, just based on your Phase I-B where we got EASI-75 up to nine months, can you just highlight what are the differences in this off-treatment versus what we saw in your Phase I-B, and should we also expect to see some of the EASI-100 responders maybe keep that off-treatment remission?
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Great. Thanks, Mayank, for your questions. Certainly as JZ mentioned, we are really pleased to have the two oral presentations accepted at EADV. I think this really highlights the promise of our novel mechanism of action and, of course, the strength of our clinical data. When we submitted the abstracts, of course, we did not have the 24-week follow-up data, and therefore, of course, our abstract does not include this portion of our study. The study is still ongoing and blinded. That being said, it is possible that we could include the 24-week data. As you mentioned, this could be very valuable and of significant interest. We cannot make that decision today. If we do have the data readout in time and we are ready, we would love to include those data as well in our oral presentation by Dr. David Rosmarin at EADV.
But again, at this time, we cannot make that commitment because the trial is still ongoing, and we have not even locked that part of the database. Thank you for asking. It is a possibility, but again, it is not in our abstract. With respect to your second question about the maintenance data and the data 52 weeks off treatment for the phase II-B in atopic dermatitis, you are correct. We did show off treatment data from our phase I-B for 9 months. The difference here is now we will have 3 additional months of follow-up post-withdrawal from drug. We think that this is extremely important to us to look at, again, that durability of those responses. Again, we will be able to look at the EASI-75, and as you mentioned, the EASI-100 and the EASI-90.
We did see consistently that patients continued to improve with ongoing REZPEG treatment, and we did see this deepening of response. Now we want to look at these patients being off treatment, and we will be able to look at the 9-month time mark like we did in the phase I-B as well as 52 weeks off treatment. This will be extremely valuable to look at the optimal dosing. After 52 weeks of treatment, can patients have less frequent maintenance dosing? For some patients, that could be longer than every 3 months. We are really excited to look at those data and really closely examine the durability of those responses. So thank you for asking those two questions.
Mayank Mamtani, Analyst, B. Riley Securities: Very helpful and comprehensive. Thank you.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Julian Harrison from BTIG. Your line is open.
Julian Harrison, Analyst, BTIG: Hi, thank you for taking the questions and congrats on all the recent progress. First, I am wondering if you have any updated views on REZPEG’s competitive positioning in alopecia areata in light of a recent dataset last month from another non-JAK treatment option in development in the broader space. Then taking a step back, keeping in mind REZPEG’s pipeline and a product potential, I am wondering if you have thought at all about supporting any signal-seeking efforts on an IIT basis. I am sure you have gotten some investigator requests. Is that something you are open to? Are future trials best to keep full control of at Nektar? Thank you.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Yeah, two very good questions. First of all, regarding competition in alopecia areata. Look, the study that was just released, data that was just released, and I will let Mary comment a little more on this, very little difficult to interpret, and it was also a single-arm study, so it was not a blinded study. It is a little difficult to interpret. Quite frankly, it had a patient population that was much less severe or much earlier on in their disease than what we are planning. I think Mary did talk about the difference between 4 years and 8 years, and I will let her comment on that in a moment. To your second question about looking at other indications, yeah, we are in the process of considering which indications we would like to do some pilot studies to get some proof of concept studies.
Look, we were very successful in the lupus study when we looked at the data on a weight-based dosing rather than a fixed-based dosing. I think there is a potential for working in cutaneous lupus as well. There is a number of other indications, just as we are doing in type 1 diabetes, that could warrant a, whether it is an investigator-sponsored trial, you lose a little bit of control there perhaps, or it is our own pilot studies. I do think that to support the value of a T-reg mechanism, I do think there is other indications that we will be looking at. I will let Mary come back to your first question for some more insights.
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Yeah, sure. Hi, Julian. Howard mentioned this in our prepared remarks. We view the alopecia areata market as very large, and certainly, these patients are underserved by JAK inhibitors. I think as seasoned biotech executives, clinicians, and scientists, we love innovation, and we love to see innovation in a space where there is huge potential for growth. That being said, as Howard mentioned, the Q32 results are really difficult to interpret. It was a small, only 33 patients, open-label study with no placebo. As we have mentioned now twice, enrolling a selective patient population and restricting eligibility really skews results in the favor of any drug that is being tested. By contrast, our phase IIb study was randomized. It was placebo-controlled. We looked at more than one dose. We allowed a broad patient population that was consistent with JAK inhibitor studies, so the generalizability has greater potential.
And we had a very standard phase IIb trial that then was recognized by the FDA as being sufficient to move forward into a phase III study. Ultimately, we remain very encouraged by our efficacy and safety profile, and I know the dermatology community at large is really looking forward to beginning enrollment in our study in the first quarter of next year for these reasons. Thanks for asking.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question will come from Mark Crump from TD Cowen. Your line is open.
Mark Crump, Analyst, TD Cowen: Hi. Thanks for taking my questions, and congrats on all the progress and getting the phase III up and running. Maybe just, Howard, you touched a little bit about kind of the different unmet needs in the AD market, particularly as you think about treatment naive versus experienced patients. Just how do you guys view that as likely to impact the relative enrollment pace for these phase IIIs and the two different kinds of labors of phase III, different patient sizes, but also different levels of unmet needs?
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Yeah. Good question. I certainly think, look, with the absence of OX40s, it certainly limits the opportunities for new mechanisms of action. I think REZPEG is obviously unique in that sense. I do not think patient enrollment will be an issue there. I think it will actually go fairly quickly. I cannot tell you exactly what it will look like. We just started the studies, but I am hopeful that it goes fairly quickly, recognizing that as a new mechanism goes, there is really nothing else at the moment. We will see what the STAT6 data looks like, upcoming data. But I do not think that is as complete a mechanism as REZPEG. I can let JZ comment on that a little bit if he would like. But overall, I do not think people understand how large this market is. Let us assume the market by 2033 is probably $35 billion, and that is 10% of the patients getting treated.
I think, look, there’s other good drugs out there. I mean, Apogee’s drug is certainly a good drug. I think STAT6 could be a very important mechanism. But the fact of the matter is, the market is enormous, and if you have a novel mechanism, you should be able to get a reasonable market share of a market that at 10% of the patients being treated is already planned to be $35 billion. I’ll let JZ comment a little bit on why we think REZPEG is probably one of the best opportunities in treating a disease like AD.
Dr. Jonathan Zalevsky, Chief Research and Development Officer, Nektar Therapeutics: Yeah. Hey, Mark, and thanks, Howard. I think that this point was touched on briefly kind of first. One of the things that our market research showed us is that we would have good first-line penetration. That’s really because pretty much the entirety of the available approaches that physicians have, and even the pipelines, including agents like STAT6, they’re really all targeting the same pathway, right? They’re in a very TH2 dominant inhibitory state. They may be acting on more than one node, but they’re acting really on the singular pathway. Our market research really showed us that a new MOA was extremely important for physicians. Many indicated they would use a new MOA first. We think this will really help position REZPEG nicely.
As you heard about our phase III study designs, they’re really taking advantage of not just what we’ve learned, but really even strengthening on where we saw the greatest differentiation in our phase II data. They’re pushing that even more to give REZPEG a really big opportunity for a very highly differentiated label at the end of this registrational program. Thanks for the question.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question comes from Jessica Fye from J.P. Morgan. Your line is open.
Jessica Fye, Analyst, J.P. Morgan: Hey, guys. Good afternoon. Thanks for taking my questions. Can you expand a little bit on your expectations for REZPEG’s effect size in biologic-experienced patients compared to biologic-naive patients in AD? How should we think about benchmarking the biologic-experienced AD phase III trial that you are running? Is Ebglyss a good comp there, or if not, what should we think about? Thank you.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Okay, thank you for the question. It is a very good question. I will let either J.Z. or Mary answer it in a little more detail, but I can tell you that we looked very closely at whether there is any biological reason, any mechanistic reason why a patient who fails IL-13 would not respond to a completely different mechanism. We could not find one. I think we should be successful in treating experienced patients. I am going to let J.Z. and Mary comment a little more on that.
Dr. Mary Tagliaferri, Chief Medical Officer, Nektar Therapeutics: Yeah, I could just start, and J.Z. can finish. Jessica, I think you are bringing up a very important point. Lebrikizumab was studied in the ADapt study, and these were patients treated with lebrikizumab after DUPIXENT, and there was no diminution of efficacy. 57% of the DUPIXENT-exposed patients who were treated with lebrikizumab had an EASI-75 at week 16, and in the lebrikizumab phase III studies, the ADvocate 1 and the ADvocate 2, the EASI-75 at week 16 was 52% and 59% in that naive population. The ADapt study did include patients who also had an inadequate response to DUPIXENT. Given this precedence, this trial data, and the REZPEG mechanism of action that augments the regulatory networks rather than just blocking a single downstream inflammatory mediator, we do expect the efficacy in the biologic and JAK inhibitor-experienced patients to be very similar to the naive patients.
I will let J.Z. expand further if you want on the mechanism of action, J.Z..
Dr. Jonathan Zalevsky, Chief Research and Development Officer, Nektar Therapeutics: No, thank you. I think you touched on a lot of the key points. Our mechanism with the Treg induction, if anything, is meant to really help patients for whom inhibition of IL-13 or IL-4 and 13 is no longer adequate to control their disease. This is one of the greatest features of a Treg approach, it acts upstream of all of those factors. We look forward to continuing to elaborate on this. You raised a very important point, which is that while the ADapt study is useful, as Mary explained, it is an open-label, single-arm study. There has not really been a true benchmark published, for example, for placebo in this patient population. All of these are all things that are going to be components of some potential data to be reported.
If Sanofi reports the results of their rituximab study in this patient population, that was designed as a randomized controlled trial. That will create one important piece of information for the placebo. Overall, we are extremely excited to have this third study as part of our registrational program. We expect REZPEG has a very, very good opportunity to be efficacious in this patient population for all the reasons we have explained. With the study like that under REZPEG’s belt as part of our BLA, it really allows us to have a much more differentiated label for REZPEG.
Jessica Fye, Analyst, J.P. Morgan: Thank you.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. Our next question will come from Andy Hsieh from William Blair. Your line is open.
Andy Hsieh, Analyst, William Blair: Oh, great. Thanks for taking our question. You mentioned about the physician survey that you did. It is super helpful for you to share with us. I am curious if you have probed the group about durability as a means for differentiation. Is there a time that these physicians are looking at either the 3-month or 6-month time frame? My second question has to do with the type 1 diabetes trial that you are running with TrialNet. It seems like REZPEG is being treated for 6 months, but the primary endpoint is measured at 12 months. Can we infer from that that there is a little bit of off-treatment effect that we can extrapolate from the trial? Thank you.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Sure. Very good questions. I will let Mary answer the question regarding the TrialNet diabetes type 1 study. Excuse me. I can tell you from our market research, time duration for onset of action was important, but the most important thing is long-term durability. You could see that if you look at our maintenance data, the results keep getting stronger and stronger, and I expect that they will continue that way. I think one of the other things that was very important to physicians was a manageable side effect profile. As I said, ISRs did not concern them at all. They were actually much more concerned about infections and conjunctivitis than they were ISRs. But overall, a durability of response that continues to improve was very important to the physicians. Mary, do you want to take the question on the type 1 diabetes trial?
Dr. Jonathan Zalevsky, Chief Research and Development Officer, Nektar Therapeutics: Yeah. Thanks, Howard. I will do that. Yes, I want to describe a little bit about how that study is designed. If you recall the teplizumab studies, the CD3 antibody. The way that works is it is a very short treatment course, right? It is just a few cycles at the very beginning. But that actually is enough to alter the whole trajectory of the disease. TrialNet was very excited that they could dose longer with REZPEG than they did with teplizumab. That was exciting for them. They selected a 6-month course. The mixed meal tolerance test and C-peptide levels, they are measured throughout through a year. They are measured both during the treatment as well as the 6 months after the treatment.
But again, the whole theory and understanding of the disease, its progression, and the worsening that people have is it is well understood that a course of intervention will change the whole slope of the disease and provide the therapeutic benefit that we are looking for. That is why the study was designed this way. It is very much right in the sweet spot of how these kinds of type 1 diabetes studies are done.
Andy Hsieh, Analyst, William Blair: Thank you. That’s helpful. Thank you.
Crystal, Conference Operator, Nektar Therapeutics: Thank you. I’m showing no further questions from our phone lines. I’d now like to pass it back to Howard Robin for any closing remarks.
Howard Robin, President and Chief Executive Officer, Nektar Therapeutics: Well, thank you everyone for joining us today. It’s not often that a company develops a new MOA that has the potential to greatly help patients in need. I want to thank our employees for their diligence and commitment, and also our shareholders for their continued support. Stay tuned, and thank you very much again. Good afternoon.
Crystal, Conference Operator, Nektar Therapeutics: This concludes today’s conference call. Thank you for your participation. You may now disconnect. Everyone, have a wonderful day.