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UNITED
STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 10-K
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934 |
For the fiscal year ended December 31, 2022
OR
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934 |
For the transition period from to
Commission file number: 001-38853
NGM BIOPHARMACEUTICALS, INC.
(Exact name of Registrant as specified in its charter)
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Delaware |
26-1679911 |
(State or other jurisdiction of incorporation or
organization) |
(I.R.S. Employer Identification No.) |
333 Oyster Point Boulevard
South San Francisco, California 94080
(Address of principal executive offices and zip code)
Registrant’s telephone number, including area code: (650)
243-5555
Securities registered pursuant to Section 12(b) of the
Act:
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Title of Each Class of Securities Registered |
Trading Symbol |
Name of Each Exchange on Which Registered |
Common Stock, par value $0.001 per share |
NGM |
The Nasdaq Stock Market LLC |
Securities registered pursuant to Section 12(g) of the Act:
None
Indicate by check mark if the registrant is a well-known seasoned
issuer, as defined in Rule 405 of the Securities Act. Yes ☐ No
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Indicate by check mark if the registrant is not required to file
reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐
No ☒
Indicate by check mark whether the registrant (1) has filed all
reports required to be filed by Section 13 or 15(d) of the
Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file
such reports), and (2) has been subject to such filing requirements
for the past 90 days. Yes ☒ No ☐
Indicate by check mark whether the registrant has submitted
electronically every Interactive Data File required to be submitted
pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter)
during the preceding 12 months (or for such shorter period that the
registrant was required to submit such files). Yes ☒ No
☐
Indicate by check mark whether the registrant is a large
accelerated filer, an accelerated filer, a non-accelerated filer, a
smaller reporting company, or an emerging growth company. See the
definitions of “large accelerated filer,” “accelerated filer,”
“smaller reporting company” and “emerging growth company” in Rule
12b-2 of the Exchange Act.
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Large accelerated filer |
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Accelerated filer |
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Non-accelerated filer |
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Smaller reporting company |
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Emerging growth company |
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If an emerging growth company, indicate by check mark if the
registrant has elected not to use the extended transition period
for complying with any new or revised financial accounting
standards provided pursuant to Section 13(a) of the Exchange Act.
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Indicate by check mark whether the registrant has filed a report on
and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section
404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the
registered public accounting firm that prepared or issued its audit
report. ☒
If securities are registered pursuant to Section 12(b) of the Act,
indicate by check mark whether the financial statements of the
registrant included in the filing reflect the correction of an
error to previously issued financial statements. ☐
Indicate by check mark whether any of those error corrections are
restatements that required a recovery analysis of incentive-based
compensation received by any of the registrant’s executive officers
during the relevant recovery period pursuant to § 240.10D-1(b).
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Indicate by check mark whether the registrant is a shell company
(as defined in Rule 12b-2 of the Act). Yes ☐ No ☒
The aggregate market value of the registrant’s common stock held by
non-affiliates of the registrant as of June 30, 2022, the last
business day of the registrant’s most recently completed second
fiscal quarter, was approximately $699 million, calculated
based on the closing price of the registrant’s common stock as
reported by the Nasdaq Global Select Market. Excludes shares of the
registrant’s common stock held as of such date by officers,
directors and stockholders that the registrant has concluded are or
were affiliates of the registrant. Exclusion of such shares should
not be construed to indicate that the holder of any such shares
possesses the power, direct or indirect, to direct or cause the
direction of the management or policies of the registrant or that
such person is controlled by or under common control with the
registrant.
As of February 22, 2023, the number of outstanding shares of
the registrant’s common stock, par value $0.001 per share, was
82,046,499.
DOCUMENTS INCORPORATED BY REFERENCE
Portions of the registrant’s definitive Proxy Statement for the
2023 Annual Meeting of Stockholders to be filed with the U.S.
Securities and Exchange Commission pursuant to Regulation 14A not
later than 120 days after the end of the fiscal year covered by
this Annual Report on Form 10-K are incorporated by reference in
Part III, Items 10-14 of this Annual Report on Form
10-K.
NGM BIOPHARMACEUTICALS, INC.
2022 ANNUAL REPORT ON FORM 10-K
TABLE OF CONTENTS
____________________________________
Unless the context suggests otherwise, references in this Annual
Report on Form 10-K (the “Annual Report”) to “us,” “our,” “NGM,”
“NGM Biopharmaceuticals,” “we,” the “Company” and similar
designations refer to NGM Biopharmaceuticals, Inc. and, where
appropriate, its subsidiary.
SPECIAL NOTE REGARDING FORWARD-LOOKING STATEMENTS
This Annual Report on Form 10-K contains forward-looking statements
that involve risks, uncertainties and assumptions that, if they
never materialize or prove incorrect, could cause our results to
differ materially from those expressed or implied by such
forward-looking statements. The statements contained in this Annual
Report on Form 10-K that are not purely historical are
forward-looking statements within the meaning of Section 27A of the
Securities Act of 1933, as amended, or the Securities Act, and
Section 21E of the Securities Exchange Act of 1934, as amended, or
the Exchange Act. Forward-looking statements are often identified
by the use of words such as, but not limited to, "aim,"
“anticipate,” “believe,” “could,” “estimate,” “expect,” “intend,”
“may,” “plan,” “potential,” “predict,” “project,” "seek," “should,”
“will,” “would” or the negative of those terms, and similar
expressions that convey uncertainty of future events or outcomes to
identify these forward-looking statements. Any statements contained
herein that are not statements of historical facts may be deemed to
be forward-looking statements. Forward-looking statements in this
Annual Report include, but are not limited to, statements
about:
•the
success, cost and timing of our product development activities and
clinical trials and the initiation of, enrollment in, availability
of data for and other events related to such clinical
trials;
•our
belief that NGM707 has the potential to reprogram
immunoglobulin-like transcript 4-, or ILT4-, and
immunoglobulin-like transcript 2-, or ILT2-, expressing myeloid
cells to shift them from a suppressive state that restricts
anti-tumor immunity to a stimulatory state that may promote
anti-tumor immunity;
•our
belief that NGM831 has the potential to block the interaction of
the Immunoglobulin-like transcript 3, or ILT3 (also known as
LILRB4), receptor
with fibronectin, as well as other cognate ligands, and
mobilize a patient's own immune system to fight tumors by shifting
myeloid cells from a suppressive state to a stimulatory state
promoting anti-tumor activity;
•our
belief that NGM438 has the potential to potently block the binding
of all collagens to leukocyte-associated immunoglobulin-like
receptor 1, or LAIR1, and to address a key resistance mechanism
that limits tumor responses to current
immunotherapies;
•our
belief that NGM120 may reduce tumor growth and improve
survival;
•our
belief that MK-3655 (NGM313) has the potential to be a treatment
for patients with NASH with early to moderate
fibrosis;
•our
plans to research, develop and commercialize our key programs in
active development, NGM707, NGM831, NGM438 and NGM120, and the
therapeutic potential of those product candidates;
•the
therapeutic potential of our additional programs currently without
significant resource allocation whose further development is
primarily dependent on our ability to secure potential future
collaboration, out licensing, partnering or other business
development arrangements, or BD Arrangements, with third-party
partners and our ability to secure such BD Arrangements on
beneficial terms, if at all;
•our
ability to obtain funding for our operations;
•our
estimates regarding future expenses, revenue, capital requirements
and needs for additional financing, particularly in light of our
estimates of Merck Sharp & Dohme LLC providing further
decreased funding in 2023 and minimal funding
thereafter;
•our
ability to obtain and maintain regulatory approvals for our current
and any of our future product candidates, and any related
restrictions, limitations and/or warnings in the label of any
approved product candidate;
•our
belief regarding the impact of our product candidates’ side effects
and our ability to effectively manage these side
effects;
•the
commercialization of our product candidates, if
approved;
•the
size and growth potential of the markets for our product
candidates, and our ability to serve those markets;
•the
rate and degree of market acceptance of our product candidates, as
well as the reimbursement coverage for our product
candidates;
•regulatory
developments in the United States and other countries;
•our
beliefs with respect to the availability of the accelerated
approval pathway for any marketing applications that we may submit
to the U.S. Food and Drug Administration;
•the
performance of, and our ability to obtain sufficient supply of
clinical trial material in a timely manner from, third-party
suppliers and manufacturers;
•our
beliefs around the competitive landscape for our product candidates
and the success of competing therapies that are or may become
available;
•our
ability to attract and retain key scientific, development and
management personnel;
•our
expectations regarding our ability to obtain, maintain, protect and
enforce intellectual property protection for our product
candidates; and
•the
risks, uncertainties and other factors we identify elsewhere in
this Annual Report on Form 10-K and in our other filings with the
U.S. Securities and Exchange Commission.
RISK FACTOR SUMMARY
Below is a summary of material factors that make an investment in
our common stock speculative or risky. Importantly, this summary
does not address all of the risks and uncertainties that we
face. Additional discussion of the risks and uncertainties
summarized in this risk factor summary, as well as other risks and
uncertainties that we face, can be found under “Risk Factors” in
Part I, Item 1A of this Annual Report on Form 10-K. The below
summary is qualified in its entirety by that more complete
discussion of such risks and uncertainties. You should carefully
consider the risks and uncertainties described under “Risk Factors”
in Part I, Item 1A of this Annual Report on Form 10-K as part of
your evaluation of an investment in our common stock.
•We
need to successfully complete rigorous preclinical and clinical
testing of our product candidates before we can seek regulatory
approval, and the regulatory approval processes of the U.S. Food
and Drug Administration and comparable foreign health authorities
are lengthy and inherently unpredictable, and if we are not
successful at each step of the process, commercialization of our
product candidates will be delayed or prevented.
•Our
product candidates are in early stages of development, with our
most advanced product candidates only in Phase 2
development.
•Our
product candidates may fail to demonstrate safety and efficacy in
ongoing and future clinical trials, may never achieve regulatory
approval and may not be able to be successfully commercialized due
to competition or other factors.
•We
have incurred net losses every year since our inception, we have no
source of product revenue, we expect to continue to incur
significant operating losses and we may never become
profitable.
•All
of our revenue for recent periods has been received from a single
collaboration partner, Merck Sharp & Dohme LLC, or Merck, and
that revenue will be substantially lower in 2023 and minimal
thereafter.
•We
will need significant additional capital to proceed with
development and commercialization of our current and potential
future product candidates and to finance our other operations, and
that additional capital may not be available to us on acceptable
terms, or at all; as a result, we may be required to delay, scale
back or discontinue development of our product candidates or other
operations.
•We
may depend in the future on BD Arrangements with third-party
partners for the development and commercialization of our product
candidates and for revenue and, if we are unable to secure those BD
Arrangements, or if any future BD Arrangements are not successful,
we may not be able to capitalize on the market potential of our
product candidates or continue their development.
•We
may not be able to obtain and maintain relationships with future
partners that are necessary to develop, manufacture and
commercialize some or all of our product candidates.
•While
we may opportunistically consider BD Arrangements to advance
development of our key solid tumor oncology programs, we are
actively seeking, or intend to seek, BD Arrangements with
third-party partners to progress, in whole or in part, the
development of one or more of our other programs whose further
development is primarily dependent on our ability to secure
potential future BD Arrangements, and if we are unable to secure BD
Arrangements to support these programs, which include NGM621,
aldafermin, NGM936, and, once termination of Merck's license is
effective, MK-3655, we are unlikely to be able to advance their
development unless our portfolio prioritization changes and we have
access to the necessary capital to fund such development, and may
discontinue or abandon any or all of these programs altogether, in
which case we will not realize any return on our investments in
those programs.
•BD
Arrangements involve numerous risks, any of which could materially
and adversely affect our business and financial
condition.
•We
rely completely on contract manufacturers for the manufacture of
our product candidates and the process of manufacturing, and
conducting release testing for, our biologic product candidates is
complex, highly regulated and subject to many risks, including our
current reliance on single source manufacturers and suppliers,
difficulties in supply chain, including procuring raw materials and
components and the availability of manufacturing slots, and
difficulties in production, including scaling up and validating
initial production, contamination, equipment failure, improper
installation or operation of equipment, vendor or operator error,
turnover of qualified staff or improper storage conditions, or
difficulties with quality control, product stability or quality
assurance testing, any of which could substantially increase our
costs and limit supply of our product candidates and any future
products needed for clinical trials and
commercialization.
•Our
product candidates other than NGM621 and aldafermin are currently
manufactured at a facility in Lithuania. The ongoing conflict
between Russia and Ukraine and the retaliatory measures taken or
that may be taken by the United States, NATO and others against
Russia create global security concerns, including the possibility
of expanded regional or global conflict, and are likely to have
short-term and likely longer-term negative impacts on regional and
global economies, any or all of which could disrupt our supply
chain and adversely affect our ability to conduct ongoing and
future clinical trials of our product candidates and our ability to
raise capital on favorable terms.
•We
may not successfully identify new product candidates to expand our
development pipeline.
•Our
future success depends in part on our ability to attract and retain
highly skilled employees, including members of our current senior
management team, especially our Chief Scientific Officer,
Dr. Jin-Long Chen.
•We
face substantial competition, which may result in others
discovering, developing or commercializing products before, or more
successfully than, us.
•Our
business could be materially and adversely affected in the future
by effects of disease outbreaks, epidemics and pandemics, including
the COVID-19 pandemic.
•Our
success depends in significant part upon our ability to obtain and
maintain intellectual property protection for our products and
technologies.
•Our
principal stockholders, including entities affiliated with The
Column Group, Merck and our management, own a substantial
percentage of our stock and will be able to exert significant
control over matters subject to stockholder approval.
•We
or third parties we rely on or partner with could experience a
cybersecurity incident that could harm our business.
•The
market price of our common stock has been and may continue to be
volatile, and you could lose all or part of your
investment.
•We
continue to incur increased costs as a result of operating as a
public company and our management devotes substantial time to
public company compliance initiatives; for example, we are
obligated to develop and maintain proper and effective internal
control over financial reporting and to comply with the
requirements of Section 404 of the Sarbanes-Oxley Act of
2002.
PART I
Item 1. Business.
Overview of Our Business
We are a biopharmaceutical company focused on discovering and
developing novel, potentially life-changing medicines based on
scientific understanding of key biological pathways underlying
grievous diseases with critical unmet or underserved patient need.
These diseases represent a significant burden for patients and
healthcare systems and, in some cases, are leading causes of
morbidity and mortality. Since the commencement of our operations
in 2008, we have generated a portfolio of product candidates
ranging from early discovery to Phase 2b development. Currently, we
have five programs in active clinical development. Our
biology-centric drug discovery approach is therapeutic area
agnostic and aims to seamlessly integrate interrogation of complex
disease-associated biology and protein engineering expertise to
unlock proprietary insights that are leveraged to generate
promising product candidates and enable their rapid advancement
into proof-of-concept studies. As explorers on the frontier of
life-changing science, we aspire to operate one of the most
productive research and development engines in the
biopharmaceutical industry. All therapeutic candidates in our
pipeline have been generated by our in-house discovery engine led
by biology and motivated by patient need.
For more detailed information about our product candidate pipeline
and their targeted therapeutic areas, see “—Our Pipeline
Programs.”
Our Mission and Strategy
Our mission is to translate complex, powerful biology with rigor
and urgency into life-changing medicines. Our strategy is built on
a straightforward central premise: create an environment that both
allows drug discovery research to thrive by focusing on powerful
human biology unconstrained by therapeutic area or technology
approach and remain grounded in the singular motivation of
delivering impactful medicines to address critical unmet or
underserved needs of patients suffering from grievous diseases. All
therapeutic candidates in our pipeline have been generated by our
in-house discovery engine, led by biology and motivated by patient
need.
Our pipeline is currently divided into two categories with separate
approaches to development strategy and resource allocation in an
effort to enable more of the product candidates in our pipeline to
be advanced as effectively and efficiently as possible. To that
end, we are currently focusing most of our execution efforts and
resources on advancing our clinical-stage solid tumor oncology
programs to potentially rapid proof of concept. For our other
programs that are in therapeutic areas where clinical development
is relatively resource intensive and can have long timelines to
generate proof-of-concept data, due to the need to conserve capital
and prioritize focused execution, we are actively seeking, or
intend to seek, collaboration, out licensing, partnering or other
business development arrangements, or BD Arrangements, with
third-party partners with sufficient resources and relevant domain
expertise to further their development.
Key elements of our strategy are:
•Systematically
and empirically interrogate complex disease-associated
biology. We
employ unbiased, systematic investigations of complex
disease-associated biology in pursuit of uncovering novel
mechanisms of action and identifying proprietary insights into
critical biological processes and pathways demonstrating powerful
biological effects.
•Remain
biologics-focused, but modality flexible, leveraging a versatile
approach to designing unique solutions for complex
problems. Building
on these biological insights, we deploy our protein and antibody
engineering expertise to create product candidates designed to be
highly specific, to modulate targeted processes and to boost
therapeutic potential. We have an unbiased antibody generation
approach and use an array of modalities and technologies to
optimize the properties of our antibody product candidates and
native proteins.
•Urgently
advance therapies to meet unmet needs. We
seek to move promising product candidates we have discovered and
developed rapidly into proof-of-concept clinical studies and, if
warranted, late-stage development.
•Build
a diversified pipeline, honed with disciplined
prioritization. We
seek to allocate our capital efficiently and strategically and fund
our portfolio based on each program’s scientific and other merits.
Our discipline has been demonstrated by our decision not to proceed
with development activities on multiple potentially viable product
candidates for portfolio management and capital conservation
reasons and to concentrate our resources and focus our execution on
our solid tumor oncology programs.
•Recruit
and retain industry-leading research and development talent.
Our talented and experienced team is the foundation of our company.
We aim to attract outstanding individuals with expertise in
discovery sciences, protein and antibody engineering, pharmacology,
translational medicine and preclinical and clinical development who
are committed to sustaining and enhancing our scientific
excellence, rigor and innovation, our creative clinical development
and our high level of productivity.
•Pursue
BD Arrangements with partners.
Pursuing BD Arrangements has been and is expected to continue to be
a key component of our strategy. Given the breadth of opportunities
that have been, and may in the future be, produced by our discovery
engine, we are actively seeking, or intend to seek, BD Arrangements
with third-party partners to progress, in whole or in part, the
development of one or more of our product candidates. We believe
that this strategy, if successfully implemented, may enable more of
the programs in our pipeline, including those in active development
by us, to be advanced as effectively and efficiently as
possible.
Our Pipeline Programs
Our biology-driven and therapeutic area agnostic discovery engine
has produced a diverse pipeline of product candidates spanning
oncology, retinal disease and liver and metabolic disease. We have
divided our pipeline programs into two distinct categories with
separate approaches to development strategy and resource
allocation.
Key Programs in Active Development
Our pipeline includes four solid tumor oncology programs in active
ongoing clinical development. We are currently focusing most of our
execution efforts and resources on these key programs. We have
intentionally built our clinical capabilities primarily in areas
such as solid tumor oncology that offer development paths that are
relatively resource efficient and have the potential to generate
clinical proof-of-concept data more rapidly than certain other
indications. Subject to our ability to obtain sufficient additional
capital, whether through potential future BD Arrangements or
otherwise, we may in the future pursue development of programs in
other therapeutic areas. While we will opportunistically consider
BD Arrangements to advance development of our key programs, we
intend to invest our resources in their development even in the
absence of BD Arrangements.

ILT2 = immunoglobulin-like transcript 2; ILT4 = immunoglobulin-like
transcript 4; ILT3 = immunoglobulin-like transcript 3; LAIR1 =
leukocyte-associated immunoglobulin-like receptor 1; GFRAL = glial
cell-derived neurotrophic factor receptor alpha-like; PDAC =
pancreatic ductal adenocarcinoma; mCRPC = metastatic
castration-resistant pancreatic cancer
Therapeutic Area: Solid Tumor Oncology
Cancer Disease Overview
Cancer involving solid tumors is a leading cause of death globally
and was responsible for an estimated over nine million deaths in
2020. There were an estimated almost 17 million newly diagnosed
cancer cases around the world in 2020, excluding non-melanoma skin
cancer. By 2040, the number of new cancer cases globally per year
is expected to rise to over 25 million and the number of
cancer-related deaths per year to grow to nearly 15 million,
excluding non-melanoma skin cancer. Cancer was the second leading
cause of death in the United States in 2020, causing over 500,000
deaths that year.
NGM707, NGM831 and NGM438: Our Myeloid Reprogramming and Checkpoint
Inhibition Portfolio Designed to Enhance Anti-Tumor
Immunity
Over the past decade, advances in cancer immunotherapy have driven
significant improvements in clinical outcomes, especially in
certain cancer types that are immunogenic, or capable of provoking
an immune response. In particular, T cell checkpoint inhibitors,
including immune checkpoint inhibitors targeting Programmed Cell
Death Protein 1 and Programmed Cell Death Protein Ligand 1, or PD-1
and PD-L1, respectively, are designed to inhibit immune checkpoint
pathways. When turned “on,” these pathways act as “brakes” on
anti-tumor immune responses, enabling tumors to evade detection and
destruction by the immune system. T cell checkpoint inhibitors
essentially work to “release” the “brakes” by turning off those
pathways. However, the overall response rate to PD-1/PD-L1
inhibitors is typically only 20% to 30% and many cancer patients
who initially experience a full or partial response using T cell
checkpoint inhibitors may eventually experience cancer
progression.
Our cancer research is currently focused on an emerging area of
immuno-oncology research known as myeloid checkpoint inhibition.
The tumor microenvironment, or TME, is composed of both cancerous
and non-malignant cells. There is an abundance of myeloid cells
present in the TME of many tumor types. While myeloid cells play a
critical role in the immune system, in the tumor they can
contribute to the inhibition of anti-tumor immune responses using
multiple mechanisms, including suboptimal T-cell priming, T-cell
suppression and physical exclusion of immune cells from the cancer
cells. In essence, they serve as myeloid checkpoints, keeping the
“brakes on” and enabling tumors to evade the immune system and
drive resistance to cancer therapies. Our focus is on promoting
myeloid reprogramming - switching myeloid cells in the TME from an
immunosuppressive state to a stimulatory state that enhances
anti-tumor immunity by releasing the “brake” and allowing these
myeloid cells to potentially play a pivotal role in anti-tumor
activity by acting to both kill cancer cells directly as well
through the recruitment and activation of tumor-directed T
cells.
We have built a portfolio of three myeloid checkpoint inhibitor
product candidates, NGM707, NGM831 and NGM438, targeting four
receptors whose elevated expression in myeloid cells in the TME has
been associated with poor patient responses to T cell checkpoint
inhibitors. NGM707, NGM831 and NGM438 are wholly-owned programs.
Although all three programs were originally researched and
developed under a collaboration agreement with funding from Merck
Sharp & Dohme LLC, or Merck, we have had the sole right, at our
sole discretion, to independently research, develop and
commercialize each of them, at our sole expense, since March 2022,
subject to the payment to Merck of low single-digit royalties on
commercial sales of any resulting products. See “Licensing and
Collaboration Arrangements—Merck Collaboration.”
NGM707: ILT2/ILT4 Dual Antagonist Antibody
Overview of NGM707
NGM707, the lead asset in our myeloid reprogramming and checkpoint
inhibition portfolio, is a dual antagonist monoclonal antibody that
is designed to improve patient immune responses to tumors by
inhibiting both Immunoglobulin-like transcript 2, or ILT2 (also
known as LILRB1), and Immunoglobulin-like transcript 4, or ILT4
(also known as LILRB2), receptors. We believe NGM707 has the
potential to reprogram ILT4- and ILT2-expressing myeloid cells to
shift them from a suppressive state that restricts anti-tumor
immunity to a stimulatory state that may promote anti-tumor
immunity. Blocking ILT2 also may reverse inhibition of
ILT2-expressing lymphoid cells to further stimulate anti-tumor
immune responses.
Clinical Development of NGM707
We are conducting an open-label Phase 1/2 clinical trial evaluating
NGM707 as a monotherapy and in combination with KEYTRUDA®
(pembrolizumab) for the treatment of patients with advanced or
metastatic solid tumors. We expect to enroll approximately 220
patients in this trial. A Phase 1, Part 1a cohort evaluating NGM707
as a monotherapy was initiated in the second quarter of 2021. A
Phase 1, Part 1b cohort evaluating NGM707 in combination with
pembrolizumab was initiated in the second quarter of 2022. Both
Phase 1 cohorts are ongoing and will be followed by Phase 2
expansion cohorts evaluating NGM707 in combination with
pembrolizumab in specific tumor types. In December 2022, we
presented initial data from the Phase 1, Part 1a cohort at the
European Society for Medical Oncology Immuno-Oncology, or ESMO I-O,
Annual Congress. The data indicated that NGM707 was generally well
tolerated across all dose cohorts and demonstrated promising early
signals of anti-tumor activity. In the presentation, we disclosed
that of 24 response-evaluable patients as of November 23, 2022,
best overall responses were a partial response in one patient,
stable disease in six patients and non-complete
response/non-progressive disease in one patient, and that potential
proof-of-mechanism (myeloid reprogramming) was observed in
peripheral blood and tumor biopsies.
NGM707 Patent Portfolio
As of December 31, 2022, we did not own or have a license to any
issued patent that covers NGM707. However, NGM707 and related
compositions-of-matter and methods of use are disclosed in pending
U.S. and international patent applications we have filed. Any
patent that may issue from these applications or any related
applications we file is expected to expire no earlier than 2041,
including any patent issued in the United States, if any, not
including any patent term adjustments and any patent term
extensions.
NGM707 Competition
We believe NGM707 is the most advanced candidate currently in
clinical development targeting both ILT2 and ILT4. We are aware
that ImmunOs Therapeutics AG announced in January 2023 that it will
conduct a Phase 1 trial of its lead program IOS-1002, which
demonstrated the ability to bind to three different immune
checkpoint targets, LILRB1 (ILT2), LILRB2 (ILT4) and KIR3DL1 in
preclinical trials. Additionally, there are several products in
development that target either ILT4 or ILT2. We are aware of four
clinical stage anti-ILT4 programs from Merck, Jounce Therapeutics,
Inc., or Jounce, Immune-Onc Therapeutics, Inc., or Immune-Onc, and
Bristol-Myers Squibb. In September 2020, Merck presented interim
findings from a Phase 1 dose-escalation study evaluating its
investigational anti-ILT4 therapeutic candidate, MK-4830, and Phase
1 results were published in January 2022. Jounce is developing an
anti-ILT4 monoclonal antibody, JTX-8064, and clinical data from its
Phase 1 trial were presented in December 2022. In February 2023,
Jounce announced that as part of a corporate restructuring and
business combination with Redx Pharma Plc it would be seeking
business development opportunities for the future development of
JTX-8064. In September 2021, Immune-Onc initiated a Phase 1 study
of its anti-ILT4 therapeutic candidate, IO-108. OncoResponse, Inc.,
Celldex Therapeutics, Inc. and Invectys Inc. have preclinical
programs targeting ILT4. Biond Biologics Ltd., or Biond, has an
antagonist antibody targeting ILT2, BND-22, which has been licensed
by Sanofi, and a Phase 1 trial commenced in 2021. Agenus Inc. has
an antagonist antibody targeting ILT2, AGEN1571, that entered Phase
1 clinical development in August 2022. Jounce also has a
preclinical program targeting ILT2. Finally, Adanate, Inc. has an
antibody, ADA-01, in early clinical development targeting LILRB
family receptors that may include ILT4 and ILT2.
NGM831: ILT3 Antagonist Antibody
Overview of NGM831
NGM831 is an antagonist antibody that is designed to block the
interaction of Immunoglobulin-like transcript 3, or ILT3 (also
known as LILRB4) receptor, with fibronectin, as well as other
cognate ligands. ILT3 is a fibronectin-binding inhibitory immune
receptor that receives signals from the extracellular matrix to
directly promote myeloid cell suppression. ILT3 is expressed on a
variety of immune cells including tumor-associated myeloid cells,
with particularly high expression on tolerogenic dendritic cells,
or DCs, myeloid-derived suppressor cells and M2 macrophages. High
ILT3 expression is associated with poor survival. Moreover,
fibronectin has been shown to be upregulated in multiple cancers
and associated with tumor progression. For tumors in which both
ILT3 and fibronectin are upregulated, the ILT3-fibronectin
signaling pathway may act as a "stromal checkpoint" to repress
myeloid cell function and inhibit anti-tumor immunity. By
inhibiting ILT3's interaction with fibronectin and its other
ligands, we believe NGM831 has the potential to mobilize a
patient's own immune system to fight tumors by shifting myeloid
cells from a suppressive state to a stimulatory state and promoting
anti-tumor activity. Our scientists have made discoveries related
to this pathway, including the discovery of fibronectin as ILT3’s
functional ligand, as described in a publication in
Cancer Immunology Research,
a journal of the American Association for Cancer Research, in
2021.
Clinical Development of NGM831
In 2022, we initiated an open-label Phase 1/1b clinical trial to
evaluate NGM831 as a monotherapy and in combination with
pembrolizumab for the treatment of patients with advanced or
metastatic solid tumors. A Phase 1, Part 1a cohort evaluating
NGM831 as a monotherapy was initiated in the first quarter of 2022
and is ongoing. In addition, a Phase 1, Part 1b cohort evaluating
NGM831 in combination with pembrolizumab was initiated in the third
quarter of 2022 and is ongoing. We expect to enroll up to
approximately 80 patients in these two cohorts.
NGM831 Patent Portfolio
As of December 31, 2022, we did not own or have a license to
any issued patent that covers NGM831. However, NGM831 and related
compositions-of-matter and methods of use are disclosed in pending
U.S. and international patent applications we have filed. Any
patent that may issue from these or related applications or any
related applications we file is expected to expire no earlier than
2040, including any patent issued in the United States, if any, not
including any patent term adjustments and any patent term
extensions.
NGM831 Competition
We are aware of only one other antibody being pursued clinically
for the treatment of solid tumors that is intended to block the
interaction of Immunoglobulin-like transcript 3, or ILT3, with
fibronectin, as well as other cognate ligands, which is
Immune-Onc's Phase 1 asset, IO-202. However, there are other
programs that target ILT3 in the clinic. Merck, Immune-Onc and
Carbiogene Therapeutics Co. Ltd., or Carbiogene, all have clinical
stage anti-ILT3 programs. Merck’s anti-ILT3 program, MK-0482, is
currently in Phase 2 development. Carbiogene’s ILT3 program is in
Phase 1 development for acute myeloid leukemia. We are aware of
four additional preclinical anti-ILT3 candidates in development:
Biond has BND-35, Jounce has JTX-1484, and Immune-Onc has both an
ILT3 CAR-T and an ILT3 bispecific under development.
NGM438: LAIR1 Antagonist Antibody
Overview of NGM438
NGM438 is an antagonist antibody that is designed to inhibit
leukocyte-associated immunoglobulin-like receptor 1, or LAIR1, and
thereby promote anti-tumor immune responses. NGM438 has the
potential to potently block the binding of all collagens to LAIR1,
including tumor-derived collagens. Collagens produced by the tumor
stroma, meaning the non-malignant, non-immune components of the
tumor, are believed to bind LAIR1 to create an immuno-suppressive
TME. The interaction of collagens from the tumor stroma with LAIR1
on immune cells represents a "stromal checkpoint" that restrains
anti-tumor immune responses. Reinvigoration of these
collagen-suppressed immune cells by blocking the binding of
collagens to LAIR1 may address a key resistance mechanism that
limits tumor responses to current immunotherapies.
Clinical Development of NGM438
In 2022, we initiated an open-label, Phase 1/1b clinical trial to
evaluate NGM438 as a monotherapy and in combination with
pembrolizumab for the treatment of patients with advanced or
metastatic solid tumors. A Phase 1, Part 1a cohort evaluating
NGM438 as a monotherapy commenced in the second quarter of 2022 and
is ongoing. In addition, a Phase 1, Part 1b cohort evaluating
NGM438 in combination with pembrolizumab commenced in the fourth
quarter of 2022 and is ongoing. We expect to enroll up to
approximately 80 patients in these two cohorts.
NGM438 Patent Portfolio
As of December 31, 2022, we did not own or have a license to any
issued patent that covers NGM438. However, NGM438 and related
compositions-of-matter and methods of use are disclosed in pending
U.S. and international patent applications we have filed. Any
patent that may issue from these applications or any related
applications we file is expected to expire no earlier than 2041,
including any patent issued in the United States, if any, not
including any patent term adjustments and any patent term
extensions.
NGM438 Competition
We are aware of only two other anti-LAIR1 antibodies currently in
development, Immune-Onc’s preclinical-stage asset, IO-106, and
NextCure, Inc.'s, or NextCure's, NC525. NextCure also has a Phase 1
product candidate in the clinic, NC410, a LAIR2 fusion protein
designed to mimic the natural decoy effects of LAIR2, which binds
to collagens and blocks the activity of LAIR1.
NGM120: The Potential of GDF15/GFRAL Inhibition to Treat Cancer and
Cancer-Related Cachexia
Our scientists have made several discoveries related to growth
differentiation factor 15, or GDF15, including identifying its
cognate receptor glial cell-derived neurotrophic factor receptor
alpha-like, or GFRAL. GFRAL is expressed in a specific region of
the hindbrain, partially outside the blood brain barrier. Our
preclinical research suggests the central role of the GDF15/GFRAL
pathway in promoting tumor-associated appetite suppression,
metabolic regulation and immune modulation.
In vivo
screening of human genes shows that GDF15 expression leads to an
outsized effect on weight loss and, in animal models, elevated
serum levels of GDF15 are a regulator of immune function,
metabolism and feeding. In addition, elevated serum levels of GDF15
have been shown to be associated with cachexia, a disorder that
causes extreme weight loss and muscle wasting. Evidence has shown
that serum levels of GDF15 are elevated in patients across a number
of tumor types and are associated with a worse prognosis in
prostate, colorectal, esophageal and ovarian cancers.
As a result of our identification of GFRAL, we developed novel
insights into the mechanism of action of GDF15 and the structure
and function of the GDF15/GFRAL interaction.
Overview of NGM120
NGM120 is an antagonist antibody that binds to GFRAL and is
designed to block the effects of elevated serum levels of GDF15. We
designed NGM120 as a potent, humanized monoclonal antibody
inhibitor of GFRAL
with the potential for once-monthly or less frequent dosing.
Preclinical studies suggest that NGM120 may reduce tumor growth and
improve survival in syngeneic orthotopic pancreatic tumor models in
mice.
Although NGM120 was originally researched and developed under a
collaboration agreement with funding from Merck, we have had the
sole right, at our sole discretion, to independently research,
develop and commercialize NGM120, at our sole expense, since March
2022, subject to the payment to Merck of low single-digit royalties
on commercial sales of any resulting products. See “Licensing and
Collaboration Arrangements—Merck Collaboration.”
Clinical Development of NGM120
We are currently conducting a Phase 1/2 clinical trial to assess
NGM120’s effect on cancer and cancer-related cachexia in patients
with select advanced solid tumors, metastatic pancreatic cancer and
metastatic castration-resistant prostate cancer, or mCRPC. The
trial includes:
•a
Phase 1a cohort evaluating NGM120 as a monotherapy in patients with
select advanced solid tumors,
•a
Phase 1b cohort evaluating NGM120 in combination with gemcitabine
and Nab-paclitaxel in patients with metastatic pancreatic
cancer,
•an
additional Phase 1b cohort testing NGM120 in combination with one
or more lines of hormone therapies in patients with mCRPC,
and
•a
Phase 2 cohort evaluating NGM120 in combination with gemcitabine
and Nab-paclitaxel as first-line treatment in patients with
metastatic pancreatic cancer (referred to as the PINNACLES
trial).
In August 2022, we initiated the Phase 1b cohort testing NGM120 in
combination with one or more lines of hormone therapies in patients
with mCRPC.
In September 2022, at the European Society for Medical Oncology, or
ESMO, Annual Congress, we reported updated preliminary findings for
a subgroup of patients with advanced prostate cancer from the Phase
1a cohort evaluating NGM120 as a monotherapy in patients with
select advanced solid tumors. The updated preliminary results
reported at ESMO demonstrated that NGM120 was well tolerated with
no dose-limiting toxicities and provided encouraging signals of
anti-cancer activity in patients with advanced prostate
cancer.
In September 2022, at the American Association for Cancer Research,
or AACR, Special Conference: Pancreatic Cancer, we reported updated
preliminary findings from the Phase 1b cohort evaluating NGM120 in
combination with gemcitabine and Nab-paclitaxel in patients with
metastatic pancreatic cancer. The updated preliminary results
reported at AACR demonstrated that NGM120 was well tolerated with
no dose-limiting toxicities and provided encouraging signals of
anti-cancer activity in patients with metastatic pancreatic
cancer.
NGM120 Patent Portfolio
As of December 31, 2022, we owned two issued patents in the United
States, as well as six issued foreign patents covering NGM120 and
related compositions-of-matter and methods of use. We also own
pending patent applications covering similar subject matter in the
United States and multiple jurisdictions outside of the United
States. The issued patents are expected to expire in 2037, not
including any patent term adjustments and any patent term
extensions.
NGM120 Competition
We are not aware of any publicly disclosed program other than
NGM120 that targets GFRAL. There are three Phase 1 programs we are
aware of that target GDF15: AVEO Pharmaceuticals, Inc.’s AV-380 is
in a Phase 1 trial in healthy volunteers, Pfizer’s monoclonal
antibody PF-06946860 is in Phase 1 trials in solid tumors assessing
various cachexia-related measures and anti-tumor effects and
CatalYm GmbH, or CatalYm, has initiated a Phase 1 clinical trial of
visugromab (formerly known as CTL-002) in Europe to explore the
treatment of cancer in solid tumors, and initial results from this
trial were presented in September 2022. AstraZeneca also has a
preclinical program, AZD8853, an antibody targeting GDF15, and
CatalYm has an additional discovery program targeting the GDF15
pathway.
The current standard of care for first-line metastatic pancreatic
cancer is chemotherapy with gemcitabine and Nab-paclitaxel or a
combination chemotherapy regimen referred to as FOLFIRINOX. No new
treatments have been FDA-approved for this population since
Abraxane® (paclitaxel protein bound), or Nab-paclitaxel, in 2013
and several programs have failed in Phase 3 development in recent
years. We are aware of three programs in Phase 3 trials in
combination with chemotherapy in first-line metastatic pancreatic
cancer: Novartis’ NIS793, a monoclonal antibody targeting
transforming growth factor beta, or TGFβ, FibroGen Inc.’s
pamrevlumab targeting connective tissue growth factor, and Novocure
GmbH’s Tumor Treating Fields device. Over 50 therapies are in Phase
1 and
Phase 2 trials for pancreatic cancer, spanning multiple mechanisms
of action, including immune checkpoint inhibitors, cancer vaccines,
tyrosine kinase inhibitors and chemokine receptor
antagonists.
Additional Programs Currently Without Significant Resource
Allocation
Due to the need to conserve capital and prioritize focused
execution, the remainder of our pipeline includes programs whose
further development is primarily dependent on our ability to secure
potential future BD Arrangements. These programs are in therapeutic
areas where clinical development is relatively resource intensive
and can have long timelines to generate proof-of-concept data. As a
result, we are actively seeking, or intend to seek, BD Arrangements
with third-party partners possessing sufficient resources and
relevant domain expertise in the relevant therapeutic area in order
to further clinical development of these programs. In the absence
of such BD Arrangements for these programs, we are unlikely to be
able to advance their development unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development. These programs are set forth
below:

C3 = component 3; NASH = non-alcoholic steatohepatitis; FGF19 =
fibroblast growth factor 19; FGFR1c = fibroblast growth factor
receptor 1c; KLB = beta-klotho; F2/3/4 = stage 2/3/4 liver
fibrosis; ILT3 = immunoglobulin-like transcript 3; CD3 = cluster of
differentiation 3; AML = acute myeloid leukemia
Therapeutic Area: Retinal Diseases
Geographic Atrophy Disease Overview
Geographic atrophy, or GA, is an advanced form of age-related, dry
macular degeneration characterized by progressive retinal
degeneration associated with irreversible loss of vision and is a
major cause of blindness for elderly patients. GA afflicts over one
million patients in the United States and approximately five
million patients worldwide. One in six people with GA becomes
legally blind within six years of diagnosis. The decline in visual
function experienced by patients with GA is typically bilateral and
directly related to the progressive loss of retinal photoreceptors,
retinal pigment epithelium, or RPE, and choriocapillaris in the
macular, or central, region of the retina. GA disease progression,
and the patient’s accompanying visual decline, can have significant
consequences for the patient, which can include the inability to
drive, read and perform activities of daily living, a reduction in
quality of life and increased likelihood of accidents or injuries
and loss of independence. Dysregulated activation of the complement
system, a key component of the immune system, including complement
C3, has been implicated in the onset and progression of
GA.
NGM621: A Potential Treatment for Geographic Atrophy
NGM621 is a humanized Immunoglobulin 1, or IgG1, monoclonal
antibody administered via intravitreal, or IVT, injection. NGM621
was engineered to potently bind to, and be a long-acting inhibitor
of, complement C3 with the treatment goal of reducing the rate of
disease progression in patients with geographic atrophy, or GA,
secondary to age-related macular degeneration, or AMD.
In October 2022, we announced topline results from the Phase 2
CATALINA clinical trial, which evaluated the efficacy and safety of
NGM621 when given to patients with GA every four weeks or every
eight weeks via IVT injections compared to sham control. The trial
did not meet its primary endpoint of a statistically significant
reduction in the rate of change in GA lesion area growth using
slope analysis over 52 weeks of treatment with NGM621 versus sham.
NGM621 demonstrated a favorable safety profile, with no evidence of
increased choroidal
neovascularization in NGM621-treated patients compared to sham. In
addition, there were no serious adverse events deemed by an
investigator to be treatment-related.
In November 2022, we presented additional findings from the
CATALINA trial at The Retina Society Annual Scientific Meeting. One
of the post-hoc analyses presented at the Retina Society meeting
involved the evaluation of a sub-population of patients least
likely to be impacted by fundus autofluorescence, or FAF, grading
methodology limitations: those in the middle two quartiles of a
quartile analysis based on baseline lesion area. The patients in
this sub-group had baseline GA lesions measuring 4.17 – 9.64
mm2
as compared to study inclusion criteria of baseline GA area between
≥2.5 mm2
and ≤17.5 mm2.
In this analysis, NGM621 demonstrated a reduction in the rate of
change in GA lesion area (slope) of 21.9% (Q4W) (n=55) and 16.8%
(Q8W) (n=52), compared to sham (n=53). Using MMRM analysis, a mixed
effects model for repeated measures, to evaluate the change from
baseline in GA area at weeks 24 and 52 for this subgroup, the
reduction in GA growth (change from baseline vs sham) at 52 weeks
was 20.6% (Q4W) and 16.6.% (Q8W).
Merck had a one-time option to license NGM621 and its related
compounds upon completion of the CATALINA trial. In December 2022,
Merck notified us that it would not exercise its option to license
NGM621 and its related compounds, nor would Merck exercise the
related ophthalmology bundle option; accordingly, these options
expired unexercised in January 2023 and the program is now
wholly-owned by us. Further development of NGM621 is primarily
dependent on our ability to secure potential future BD Arrangements
and, in the absence of such BD Arrangements, we are unlikely to be
able to advance development of NGM621 unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development.
NGM621 Patent Portfolio
As of December 31, 2022, we owned one issued United States patent
covering NGM621, and the product and related compositions-of-matter
and methods of use are disclosed and claimed in other patent
applications pending in the United States and in multiple
jurisdictions outside of the United States. The current patent and
any patent that may issue from any of the pending applications
would be expected to expire no earlier than 2039, not including any
patent term adjustments and any patent term
extensions.
Geographic Atrophy Competition
Current Treatments
There is currently only one medicine approved by the FDA and none
approved by the EMA for the treatment of GA. Patients with GA have
very limited options other than SYFOVRE™ (pegcetacoplan injection)
approved by the FDA in February 2023 for the treatment of GA
secondary to AMD. Patients are observed by their ophthalmologist or
retina specialist for the purposes of documenting disease
worsening, through imaging and visual acuity testing, and to
monitor for any conversion to wet age-related macular degeneration,
or wet AMD (which is treatable with anti-VEGFs). Some patients with
GA take AREDS formula vitamins which have been shown to reduce the
risk of progression to advanced forms of AMD; however, results from
the AREDS trials have shown that there is no benefit to reducing
the rate of existing GA progression. As their vision declines,
patients with GA can receive visual rehabilitation and instruction
on adaptive tools, like magnifiers, to help manage their disability
as well as possible.
Treatments in Development
Given the large market opportunity in GA, there are multiple
programs in clinical development for GA. The landscape can be
subdivided into either agents targeting the complement pathway or
agents targeting other pathways implicated in AMD pathogenesis and
different modes of action. Most treatment approaches for GA have
focused on reducing the rate of GA lesion area progression, as
assessed by retinal imaging. For the complement-targeted
approaches, some therapeutics focus on inhibiting key points in the
complement pathway with targeted inhibitors, while others are
replacing regulatory proteins that modulate the complement cascade
activity. Additionally, the product administration approaches vary
and include oral pills, subcutaneous injections, IVT injections and
surgical approaches like gene therapy. GA is a chronic, progressive
disease and, currently, many believe that slowing the progression
of disease requires treatment periods of at least 12 months to show
a meaningful treatment benefit relative to sham
control.
Multiple complement inhibition therapies are under clinical
evaluation in patients with GA, and one has received regulatory
approval from the FDA. In February 2023, Apellis Pharmaceuticals,
Inc., or Apellis, announced that the FDA approved SYFOVRE™
(pegcetacoplan injection) for the treatment of GA secondary to AMD.
With reference to other therapies currently in clinical
development, Iveric bio, Inc.’s, or Iveric's, avacincaptad pegol, a
PEGylated aptamer inhibitor of complement C5, completed a Phase 2/3
clinical trial that demonstrated statistically significant
reductions in the rate of GA lesion area growth in the avacincaptad
pegol arm versus the sham arm. In
February 2023, Iveric announced that the FDA had accepted its NDA
of avacincaptad pegol. Other agents in development targeting the
complement pathway include: Ionis Pharmaceuticals, Inc.’s
IONIS-FB-LRx, a factor B inhibitor in Phase 2 development; Hemera
Biosciences, LLC’s HMR59, a gene therapy in development that
produces CD59 to inhibit the complement membrane attack complex
formation; Gemini Therapeutics, Inc.’s complement factor H
replacement agent in Phase 2 development, GEM103; and Gyroscope
Therapeutics Holdings plc’s gene therapy GT-005, replacing
complement factor I in patients with genetically defined GA in
Phase 2 development; and Alexion Pharmaceuticals, Inc.’s ALXN2040
and Annexon, Inc.'s ANX007, both in Phase 2
development.
There are multiple product candidates in development that target
other pathways implicated in AMD pathogenesis, including visual
cycle modulators (for example, ALK001 in Phase 3 development by
Alkeus Pharmaceuticals, Inc.), an NLRP3 inflammasome-targeting
molecule, Xiflam, in Phase 2 development by InflammX Therapeutics,
and others with undeclared targets (for example, EG-301 moving into
Phase 2 development in early 2023 by Evergreen Therapeutics).
Additionally, there are stem cell products being developed with the
potential to replace RPE cells in late-stage GA and with the intent
of preserving or improving visual function (for example, OpRegen in
development by Lineage Cell Therapeutics, Inc.; CPCB-RPE1 in
development by Regenerative Patch Technologies LLC; and ASP7217 in
development by Astellas Pharma Inc.).
Therapeutic Area: Liver and Metabolic Diseases
We have spent more than a decade discovering and developing a
portfolio of clinical-stage drug candidates that target various
forms of cardio-metabolic and liver diseases, most specifically
nonalcoholic steatohepatitis, or NASH. We have identified multiple
hormonal pathways of interest and our drug candidates stem from
novel insights we have made in the regulation of cardio-metabolic
processes and liver function.
NASH Disease Overview
NASH and metabolic diseases are among the largest unmet medical
needs globally and represent a leading cause of morbidity and
mortality and a significant burden for patients and healthcare
systems. They also represent areas of underinvestment by the
pharmaceutical industry, driven in part by the biological
complexity of the diseases and the substantial costs necessary to
develop new therapeutics. Metabolic syndrome is exhibited by
approximately 35% of adults in the United States and comprises a
constellation of co-morbid conditions, including type 2 diabetes,
obesity, high blood pressure, poorly regulated lipids and
non-alcoholic fatty liver disease, or NAFLD, a precursor to NASH.
NAFLD is characterized by abnormal amounts of fat in the liver, a
condition known as steatosis. This abnormal fat in the liver
contributes to the progression in certain NAFLD patients to NASH by
developing a necroinflammatory state in the liver that ultimately
drives scarring, also known as fibrosis, and, for many, progresses
to cirrhosis, liver cancer and liver failure.
The estimated global prevalence of NAFLD and NASH has risen rapidly
in parallel with the dramatic rise in obesity and diabetes. In the
United States alone, the prevalence of NASH was estimated to total
19.3 million cases in 2020 and is expected to reach 27 million
cases in the United States by 2030, with similar trends occurring
globally. Patients with NASH with F2, F3 or F4 fibrosis were
believed to encompass approximately 8.3 million patients in the
United States in 2020 and that number is expected to grow to 14.1
million by 2030. The population of cirrhotic patients with NASH in
the United States is expected to reach 3.5 million in
2030.
In addition to living with the burden of illness, NASH with
advanced fibrosis can be very expensive for patients, their
families and society. Advanced liver fibrosis is generally
considered fibrosis stages F3 and F4. The annual economic burden
associated with NAFLD and NASH in the United States was estimated
to be over $100 billion in 2016. If a patient progresses through
the earlier stages of fibrosis to F4 fibrosis, or cirrhosis, there
is an increased occurrence of negative liver-related outcomes,
including a more than 60% risk of cirrhosis-related complications
such as ascites, jaundice, hepatic encephalopathy, variceal bleeds,
liver cancer or liver transplant. The median survival for a
cirrhotic NASH patient is approximately seven years.
Our NASH Product Candidates
Aldafermin
Aldafermin is an engineered analog of human hormone fibroblast
growth factor 19, or FGF19, that is administered through a
once-daily subcutaneous injection. Aldafermin is wholly-owned by
us. Further development of aldafermin is primarily dependent on our
ability to secure potential future BD Arrangements and, in the
absence of such BD Arrangements, we are unlikely to be able to
advance development of aldafermin unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development.
Clinical Development of Aldafermin
To date, aldafermin has been dosed in over 700 patients and healthy
volunteers across multiple liver and metabolic diseases, including
more than 300 patients with NASH. In May 2021, we announced that
the Phase 2b ALPINE 2/3 trial of aldafermin in patients with NASH
and liver fibrosis stage 2 or 3, or F2 or F3, did not meet its
primary endpoint evaluating a dose response at week 24 on liver
fibrosis improvement by >1 stage with no worsening of NASH. As a
result, we decided to suspend further development of aldafermin in
patients with F2/F3 NASH, allowing for the reallocation of
resources to advancing our other programs.
Aldafermin remains in Phase 2b development for the treatment of
patients with compensated cirrhosis due to NASH (liver fibrosis
stage 4, or F4, by the NASH Clinical Research Network
classification). The Phase 2b ALPINE 4 clinical trial, which is
fully enrolled, is designed to evaluate the treatment effect of
aldafermin over 48 weeks in a population of patients with NASH with
F4 liver fibrosis and well-compensated cirrhosis. We initiated the
ALPINE 4 trial in February 2020 and completed enrollment of 160
patients across 80 sites in the United States, Europe, Hong Kong
and Australia in January 2022. The objective of the trial is to
evaluate whether fibrosis regression can be achieved in compensated
cirrhotic patients with NASH, for whom liver mortality rates are
high and liver transplant is the only option. The primary endpoint
for the trial is the Enhanced Liver Fibrosis, or ELF, test, a
reproducible, quantitative non-invasive liver prognostic test that
evaluates liver fibrosis and correlates to liver-related outcomes.
The ELF test is a composite blood test measuring the presence of
three biomarkers associated with liver matrix metabolism. Liver
biopsy data will also be measured and reported as a secondary
endpoint upon completion of the trial. We expect to report topline
data from the ALPINE 4 trial in the second quarter of
2023.
Aldafermin has been generally well tolerated in clinical trials to
date. In patients with NASH receiving various doses of aldafermin
(between 0.3 mg and 6 mg) in our completed Phase 2 trials, the most
common reported adverse events occurring in more than 10% of
patients included diarrhea, headache, abdominal distension, nausea,
fatigue, vomiting, constipation, frequent bowel movements,
injection site bruising, urinary tract infection, nasopharyngitis,
abdominal pain, injection site reaction, vitamin D deficiency,
injection site symptoms (such as pruritus, erythema or swelling),
cough, fecal color discoloration, cholesterol and low-density
lipoprotein cholesterol increase, with the majority of adverse
events classified as mild or moderate. SAEs included one case of
acute pancreatitis, as well as pleurisy, vertigo, headache,
hypertension, cardiac arrest, chest pain, pneumonia, kidney mass,
rectal bleeding and liver biopsy complication, none of which were
considered related to study drug.
In patients with NASH and stage 2 or 3 liver fibrosis receiving
various doses of aldafermin (between 0.3 mg and 3 mg) in the
completed Phase 2b ALPINE 2/3 trial, results showed that the most
common reported adverse events occurring in more than 10% of
patients included diarrhea, nausea, headache, upper abdominal pain,
injection site erythema, constipation and sinusitis with the
majority of adverse events classified as mild or moderate. SAEs
included osteoarthritis, uterine cancer, suicide attempt, small
bowel obstruction, cholecystitis, cardiac hypertrophy and obesity,
none of which were considered related to study drug.
Aldafermin Patent Portfolio
As of December 31, 2022, we owned 27 issued patents in the United
States, as well as issued patents in more than 40 foreign
countries, including various member states of the European Patent
Office, or EPO, covering aldafermin, related compositions-of-matter
and methods of use. We also own patent applications covering
similar subject matter in the United States and multiple foreign
jurisdictions including Europe. The earliest issued patents in the
United States are expected to expire in 2032, not including any
patent term adjustments and any patent term
extensions.
MK-3655 (NGM313): An Insulin Sensitizer for the Treatment of
NASH
MK-3655, also known as NGM313, is an agonistic antibody discovered
by us that selectively activates fibroblast growth factor receptor
1c-beta-klotho, or FGFR1c/KLB, which regulates insulin sensitivity,
blood glucose and liver fat and is administered every four weeks
through a subcutaneous injection. We believe that MK-3655 has the
potential to be a treatment for those patients with NASH with early
to moderate fibrosis with or without type 2 diabetes.
In November 2018, Merck exercised its option for a license to
conduct research upon, develop and commercialize MK-3655 and other
FGFR1c/KLB agonists. As described below, in January 2023, Merck
provided us with the required 90-days' notice of partial
termination of our collaboration with Merck as it relates to
MK-3655 and its related compounds. As a result, in late April 2023,
the license rights granted to Merck in 2018 with respect to MK-3655
will revert to us and the program will become wholly-owned by us.
Further development of MK-3655, once the termination is effective,
is primarily dependent on our ability to secure potential future BD
Arrangements and, in the absence of such BD Arrangements, we are
unlikely to be able to advance development of MK-3655 unless
our
portfolio prioritization changes and we have access to the
necessary capital to fund such development. See “Licensing and
Collaboration Arrangements—Merck Collaboration.”
Clinical Development of MK-3655
At the end of 2020, Merck initiated a Phase 2b clinical trial of
MK-3655 for the treatment of patients with NASH with F2 or F3
fibrosis. The trial was a multi-center, double-blind,
placebo-controlled trial administering 50 mg, 100 mg and 300 mg
doses of MK-3655 every four weeks compared to placebo for 52 weeks.
The primary objective of the Phase 2b trial was NASH resolution
without worsening of fibrosis at 52 weeks. In January 2023, we
announced that Merck notified us of its decision to terminate the
Phase 2b trial based on the results of an interim analysis of
safety and reduction in liver fat at Week 24. Although it was not
the primary endpoint of the trial, the percent reduction from
baseline in liver fat for MK-3655, while greater than placebo
across multiple dose arms, did not reach Merck’s threshold for
continuing the trial through to completion. The trial was not
discontinued for safety concerns.
In the Phase 1 and Phase 1b clinical trials we conducted, MK-3655
was generally well tolerated and data has shown the agent is
capable of reducing liver fat content and improving metabolic
biomarkers in obese, insulin resistant subjects with NAFLD after a
single dose. In the Phase 1 trial, there were two SAEs reported in
the MK-3655 treatment group, lower gastrointestinal, or GI,
hemorrhage due to hemorrhoids and cholecystitis, both of which were
deemed by the investigators to be unrelated to treatment with
MK-3655. The majority of adverse events were mild to moderate in
severity, and treatment-related events with the greatest proportion
of subjects were GI disorders, injection site reactions, upper
respiratory tract infections, headache and increased appetite. In
the Phase 1b trial, all adverse events observed during the course
of the study were deemed mild, with increased appetite (12%) and
injection site reaction (12%) being the only adverse events
reported in at least 10% of MK-3655-treated subjects.
MK-3655 Patent Portfolio
As of December 31, 2022, we owned three issued patents in the
United States, which were licensed to Merck in connection with
Merck's exercise of its license option for MK-3655, as well as
pending patent applications in the United States and granted
patents and pending patent applications in multiple jurisdictions
outside of the United States covering MK-3655, related
compositions-of-matter and methods of use. The earliest issued
patents in the United States are expected to expire in 2035, not
including any patent term adjustments and any patent term
extensions. Once the partial termination of our collaboration with
Merck as it relates to MK-3655 and its related compounds becomes
effective, the license rights to these patents will revert to
us.
NASH Competition
Current Treatments
Currently, there are no therapeutic agents approved by the FDA or
the EMA for the treatment of NASH. Weight loss through diet and
lifestyle management is currently considered the first-line
treatment strategy for NASH and is associated with improvement in
liver histology and a reduction in cardiovascular and metabolic
complications. However, fewer than 10% of patients are successful
in achieving or maintaining at least a 10% total body weight loss
that is sufficient to improve fibrosis and, therefore, require
other interventions. In cases of morbid obesity, gastric bypass
surgery has been successful in resolving NASH in a majority of
patients; however, the effect on fibrosis improvement was less
substantial and the risk of complications and expense of the
surgery limit more widespread use.
In the absence of approved products, some physicians utilize agents
approved for other indications, including Vitamin E and
pioglitazone; however, the evidence of their effect on NASH is
modest and/or they have safety issues that limit acceptance. Given
the increasing disease burden and lack of approved treatment
options, the development of novel pharmacologic therapies to treat
NASH is critical.
Treatments in Development
Certain NASH drug development candidates are focused on the
metabolic components of the disease, such as insulin resistance and
lipotoxicity, that are associated with the inception and early
stages of the disease pathology. Metabolically-oriented mechanism
of action classes that have product candidates with histological
proof-of-concept data include: Madrigal Therapeutic, Inc.’s, or
Madrigal's, resmetirom and Viking Therapeutic Inc.’s VK2809, both
thyroid hormone receptor β-selective (THRβ) agonists; Novo Nordisk
AS’s glucagon-like peptide (GLP)-1 agonist, semaglutide; the
stearyl-CoA desaturase inhibitor aramchol from Galmed
Pharmaceuticals Ltd.; Inventiva SA’s pan-peroxisome
proliferator-activated receptors (PPAR) agonist, lanifibranor;
Akero Therapeutics, Inc.’s efruxifermin and 89 Bio Inc.'s
BIO89-100, both analogs of fibroblast growth factor 21 (FGF21);
and
Genentech/Roche’s BFKB8488A, an FGFR1c/KLB bi-specific agonistic
antibody. In December 2022, Madrigal announced positive topline
results from the pivotal Phase 3 MAESTRO-NASH biopsy clinical trial
of resmetirom. MAESTRO-NASH, a registrational Phase 3 trial,
achieved both liver histological improvement endpoints that FDA
proposed as reasonably likely to predict clinical benefit to
support accelerated approval for the treatment of NASH with liver
fibrosis.
Product candidates targeting various mechanisms with possible
anti-inflammatory and anti-fibrotic effects are also in clinical
testing for NASH. These classes of compounds have shown mixed
results in meaningfully improving the fibrosis score of patients.
Where fibrosis improvements have been shown, results have either
been transient or not accompanied by significant improvements in
other histological measures of the disease, which may reflect the
difficulty in treating the disease without removing the underlying
insult of lipotoxicity or the challenge of impinging on the complex
process of hepatocellular death and fibrosis from collagen
deposition by intervention through a single pathway. Members of the
“anti-inflammatory” or “anti-fibrotic” mechanism of action classes
with compounds that have histological proof-of-concept data include
farnesoid X receptor, or FXR, agonists, such as Intercept
Pharmaceuticals, Inc.’s, or Intercept’s, obeticholic acid. A new
drug application, or NDA, for obeticholic acid was filed with the
FDA by Intercept in September 2019 and received a complete response
letter in June 2020. In December 2021, Intercept withdrew its
marketing authorization application from the EMA. In December 2022,
Intercept resubmitted an NDA with the FDA and in January 2023,
Intercept announced that the FDA had accepted its NDA with a
Prescription Drug User Fee Act, or PDUFA, target action date
of June 22, 2023.
An ongoing consideration in NASH clinical development is pursuing
combination treatments in an attempt to combine agents with less
than optimal activity on their own to achieve a more clinically
meaningful result. Combinations currently being evaluated in
proof-of-concept trials include: metabolic/anti-fibrotic
combinations such as semaglutide/cilofexor/firsocostat and
tropifexor/licogliflozin (FXR agonist/SGLT-2, both from Novartis
AG) and anti-inflammatory/anti-fibrotic duos such as
cenicriviroc/tropifexor.
Therapeutic Area: Hematologic Oncology
Hematologic Cancer Disease Overview
Hematologic cancer, also referred to as blood cancer, refers to
various forms of cancer that lead to uncontrolled growth or
dysregulation of blood cells or blood-forming tissues. Examples of
hematologic cancer include leukemia, lymphoma and multiple
myeloma.
NGM936: ILT3xCD3 Bispecific T Cell Engager
Overview of NGM936
NGM936 is a bispecific T cell engager therapeutic candidate for the
treatment of hematologic malignancies that targets ILT3 and cluster
of differentiation 3, or CD3. NGM936 is designed to direct T cell
mediated killing of ILT3-positive cancer cells while sparing normal
hematopoietic stem cells, or HSCs, and minimizing CD3-driven
cytokine release. ILT3, a myeloid-cell restricted receptor, has
enriched expression in myelomonocytic leukemia, monocytic leukemia
and leukemia stem cells but is not expressed on healthy HSCs. The
expression profile of ILT3 may make it a potential target for the
treatment of monocytic acute myeloid leukemia, or AML, and multiple
myeloma.
Preclinical Development of NGM936
NGM936 has been evaluated in preclinical studies, where it has
demonstrated
in vitro
the ability to potently kill ILT3+ AML cells, kill ILT3+ multiple
myeloma cells and preserve healthy bone marrow cells. Further
development of NGM936 is primarily dependent on our ability to
secure potential future BD Arrangements and, in the absence of such
BD Arrangements, we are unlikely to be able to advance development
of NGM936 unless our portfolio prioritization changes and we have
access to the necessary capital to fund such
development.
NGM936 Patent Portfolio
As of December 31, 2022, we did not own or have a license to any
issued patent that covers NGM936. However, NGM936 and related
compositions-of-matter and methods of use are disclosed in pending
U.S. provisional patent applications we have filed. Any patent that
may issue from these applications or any related applications we
file is expected to expire no earlier than 2043, including any
patent issued in the United States, if any, not including any
patent term adjustments and any patent term
extensions.
NGM936 Competition
We are not aware of any publicly disclosed program other than
NGM936 that targets ILT3 and CD3 using a bispecific T cell engager.
Immune-Onc has a bispecific antibody, IO-312, in preclinical
development which targets ILT3 and is being pursued for cancer. The
identity of the target of the second arm of IO-312 has not been
disclosed.
Manufacturing
We do not own, and have no plans to establish, any manufacturing
facilities. We currently use third-party contract development and
manufacturing organizations or contract manufacturing
organizations, which we refer to collectively as CMOs, to
manufacture and supply all of the raw materials, drug substances
and drug products for our R&D programs, including all the
clinical trial materials used in the clinical trials of our
clinical-stage product candidates. We have established
relationships with several CMOs, including Lonza Ltd and
Biotechpharma UAB. The activities of our CMOs are overseen by an
experienced group of employees and third-party
consultants.
We plan to continue to rely on CMOs to manufacture commercial
quantities of any products for which we successfully obtain
regulatory approval, as well as to provide packaging, storage and
distribution of any approved products. We have not entered into
long-term clinical or commercial supply agreements with any of our
CMOs. In addition, each of our product candidates relies on a
single contract manufacturer for supplies of its drug substance and
drug product.
Competition
The biopharmaceutical industry is characterized by intense
competition and rapid innovation. Although we believe that we hold
a strong position in research in certain areas of cancer, retinal
diseases and liver and metabolic diseases, our competitors may be
able to develop other compounds or drugs that are able to achieve
similar or better results. Our competitors include multinational
pharmaceutical companies, specialized biotechnology companies,
universities and other research institutions. Smaller or
earlier-stage companies also may prove to be significant
competitors, particularly through collaboration or partnering
arrangements with large, established companies. We believe the key
competitive factors that will affect the development and commercial
success of our product candidates are their efficacy, safety and
tolerability profile, and reliability.
There are many pharmaceutical companies, biotechnology companies,
public and private universities and research organizations actively
engaged in the R&D of products that may be competitive to our
products. A number of pharmaceutical companies, including AbbVie,
Allergan, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers
Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Johnson & Johnson,
Merck, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi and Takeda, as
well as large and small biotechnology companies such as 89Bio,
Akero, Albireo, Alentis, Amgen, Apellis, Ascletis, Axcella, AVEO,
Biond, Bird Rock, Can-Fite, CatalYm GmbH, Cirius, Enanta, Galectin,
Galmed, Genfit, Gilead, Glympse, Immune-Onc, ImmunOS, Immuron,
Intercept, Inventiva, Iveric, Jounce, Madrigal, MannKind,
MediciNova, Mirum, Nalpropion, NextCure, North Sea, Promethera,
Salix, Scholar Rock, Seal Rock, Terns, Tiziana, Tizona, Viking and
Vivus, are pursuing the development or marketing of pharmaceuticals
that target the same diseases that we are targeting. It is probable
that the number of companies seeking to develop products and
therapies for the treatment of cancer, retinal diseases and liver
and metabolic diseases will increase.
For example, in February 2023, Apellis announced that the FDA
approved SYFOVRE™ (pegcetacoplan injection) for the treatment of GA
secondary to AMD.
And in February 2023, Iveric announced that the FDA accepted
Iveric's NDA of avacincaptad pegol for the treatment of GA. Many of
these and other existing or potential competitors have
substantially greater financial, technical, human and other
resources than we have and may be better equipped to develop,
manufacture and market technologically superior products. In
addition, many of these competitors have significantly greater
experience than we have in undertaking preclinical studies and
human clinical trials of new pharmaceutical products and in
obtaining regulatory approvals of human therapeutic products.
Accordingly, our competitors may succeed in obtaining FDA approval
for superior products or for other products that would compete with
our product candidates. In addition, other technologies or products
may be developed that have an entirely different approach or means
of accomplishing the intended purposes of our products, which might
render our technology and products noncompetitive or
obsolete.
For more information regarding the competition that our disclosed
product candidates face, or may face, see the discussion of
specific competition for each product candidate see “—Our Pipeline
Programs.”
Intellectual Property
Our intellectual property is critical to our business and our
success depends, in part, on our ability to obtain and maintain
intellectual property protection for our product candidates,
technology and know-how, to defend and
enforce our intellectual property rights, in particular, our patent
rights, to preserve the confidentiality of our trade secrets and to
operate without infringing the proprietary rights of
others.
We seek to protect the proprietary technology that we believe is
important to our business through a variety of methods, including
seeking and maintaining patents and patent applications intended to
cover our product candidates, their compositions-of-matter, their
methods of use and the processes for their manufacture and any
other aspects of inventions that are commercially important to the
success of our business. We seek to obtain domestic and
international patent protection and, in addition to filing and
prosecuting patent applications in the United States, we may file
counterpart patent applications in additional countries where we
believe such foreign filing is likely to be
beneficial.
As of December 31, 2022, our patent portfolio includes over 600
patents and applications, including over 50 issued U.S. patents and
over 30 pending U.S. patent applications covering our product
candidates, certain aspects of our proprietary technology, and
related inventions and improvements. Our patent portfolio also
includes over 500 patents and patent applications in jurisdictions
outside of the United States that, in many cases, are counterparts
to our U.S. patents and patent applications. For more information
regarding the patents and patent applications relating to eight of
our disclosed product candidates, see the discussion of
intellectual property protection for each product candidate in
“—Our Pipeline Programs.” The patent landscape surrounding our
product candidates is crowded, and we do not know if our pending
patent applications will be issued with the claims we are seeking
or if our issued patents will withstand challenges from third
parties.
Not all patent applications result in the issuance of patents.
Patent applications in the United States and certain other
jurisdictions are maintained in secrecy for 18 months or
potentially longer, so public disclosure of discoveries via the
publication of patent applications or in the scientific literature
is often delayed. As a result, we cannot be certain of the priority
of inventions covered by our patent applications and may be subject
to claims of priority from third parties or the United States
Patent and Trademark Office, or USPTO, against which we will need
to defend ourselves.
In addition, the scope of claims that may be allowed in any granted
patent may be significantly reduced from the coverage claimed in
the initial patent application. Further, the scope of the claims in
an issued patent may be reinterpreted and, in some cases, narrowed
or even cancelled after issuance by courts upon review. In
addition, many jurisdictions allow third parties to challenge
issued patents in administrative proceedings that may result in
further narrowing or cancellation of patent claims. As a result,
even issued patents may not provide sufficient protection from
competitors.
When patents are issued, the term of each individual patent will
depend on the legal term for patents in the countries in which it
is granted. In most countries, including the United States, the
patent term is 20 years from the earliest claimed filing date of a
non-provisional patent application in the applicable country. The
actual term of any patent that may issue from the above-described
patent applications claiming one of our product candidates could be
longer than described above due to patent term adjustment or patent
term extension, if available, or shorter if we are required to file
terminal disclaimers.
Any changes we make to the composition, formulation, method of
delivery or other attributes of our current and future product
candidates to cause them to have what we view as more advantageous
properties may not be covered by our existing patents and patent
applications, and we may be required to file new applications
and/or seek other forms of protection.
Even if patents are issued, if a third party engages in activities
covered by valid claims of our patents, we may be required to
engage in enforcement actions in the courts to enforce our patents.
Not all enforcement proceedings are successful. We also must take
care not to infringe the valid patents of third parties.
Third-party patent rights that purport to cover our product
candidates or their discovery, use or manufacture may require us to
challenge their validity in court or administrative proceedings and
prevail in such challenges, to alter our development or commercial
strategy or our product candidates or their uses and manufacture,
to obtain licenses to such patents and/or to stop certain
activities altogether. We hold various licenses with third parties
to their intellectual property, including those with Horizon
Discovery Ltd. and, as described below, Lonza Sales AG, or Lonza,
for the use of their cell lines. The patent positions of
biotechnology companies like ours are generally uncertain and
involve complex legal, scientific and factual questions. We may not
obtain or maintain adequate patent protection for any of our
programs and product candidates.
In addition to patent protection, we also rely on trademark
registration, trade secrets, know-how, other proprietary
information and continuing scientific innovation to develop and
maintain our competitive position. We seek to maintain the
confidentiality of proprietary information to protect aspects of
our business that are not amenable to, or that we do not consider
appropriate for, patent protection. As a part of these efforts, it
is our policy
to require our employees, consultants, outside scientific
collaborators, sponsored researchers and other advisors to execute
confidentiality agreements upon the commencement of their
respective relationships with us. These agreements provide that all
confidential information concerning our business or financial
affairs developed or made known to the individual during the course
of the individual’s relationship with us is to be kept confidential
and not disclosed to third parties except in specific
circumstances. Our agreements with employees also provide that all
inventions conceived by the employee in the course of employment
with us or from the employee’s use of our confidential information
are our exclusive property. Although we take these and other steps
to safeguard our proprietary information and trade secrets, these
agreements may be breached or third parties may independently
develop substantially equivalent proprietary information and
techniques or otherwise gain access to our trade secrets or
disclose our technology. Thus, we may not be able to meaningfully
protect our proprietary information that is not otherwise protected
by patent.
See “Risk Factors—Risks Related to Our Intellectual Property” for
information regarding the risks related to our intellectual
property.
Licensing and Collaboration Arrangements
Merck Collaboration
In 2015, we entered into a research collaboration, product
development and license agreement with Merck, which, together with
amendments made prior to June 30, 2021, is referred to as the
Original Collaboration Agreement, covering the discovery,
development and commercialization of novel therapies across a range
of therapeutic areas, including a broad, multi-year drug discovery
and early development program financially supported by Merck, but
scientifically directed by us with input from Merck. The original
research phase of the collaboration was for five years and was
extended by Merck for an additional two years through March
2022.
On June 30, 2021, we entered into an amended and restated research
collaboration, product development and license agreement with
Merck, or the Amended Collaboration Agreement, replacing the
Original Collaboration Agreement and extending the research phase
of the collaboration, but with a narrower scope than in the
Original Collaboration Agreement. Under the Amended Collaboration
Agreement, the collaboration was focused primarily on the
identification, research and development of collaboration compounds
directed to targets of interest to Merck in the fields of
ophthalmology and cardiovascular or metabolic, or CVM, disease,
including heart failure. The collaboration scope also included
certain laboratory testing and other activities on compounds that
are directed to one of up to two undisclosed targets outside of the
fields of ophthalmology and CVM disease, or the Lab Programs.
Currently, the only ongoing research activities funded under the
Amended Collaboration Agreement are certain CVM-related activities
and remaining activities under the Lab Programs, or the Remaining
Research Programs. The ophthalmology compounds in the collaboration
under the Amended Collaboration Agreement initially included NGM621
(and its related compounds) and compounds directed against two
other undisclosed ophthalmology targets (and their related
compounds). Merck had a one-time option to license NGM621 and its
related compounds upon completion of the Phase 2 CATALINA trial. In
December 2022, Merck notified us that it would not exercise its
option to license NGM621 and its related compounds, nor would Merck
exercise the related ophthalmology bundle option; accordingly,
these options expired unexercised in January 2023 and the programs
are now wholly-owned by us. Further, Merck did not elect for us to
continue to conduct R&D on any compounds from our other
ophthalmology programs that were subject to the collaboration,
which are preclinical and directed to undisclosed targets. Such an
election would have resulted in an extended or tail period in which
Merck would continue to fund our R&D of such ophthalmology
compounds. Because Merck did not exercise its ophthalmology license
options or make such a tail period election, we do not have any
funding from Merck to pursue such ophthalmology
programs.
For the period that started on January 1, 2023 and ends on March
31, 2024, we expect to receive funding of approximately $13.0
million in the aggregate from Merck for ongoing activities under
the Remaining Research Programs and for certain costs and
reimbursements related to the NGM621 program. Funding from Merck
after December 31, 2023 is expected to be minimal. The research
phase for the CVM-related programs under the Amended Collaboration
Agreement will continue through March 31, 2024, unless the parties
mutually agree to extend the research phase through March 31, 2026,
in which case Merck would provide up to a total of $20.0 million in
R&D funding during the additional two years of the CVM program
research phase. New CVM-related programs may be added to the
collaboration if recommended by us and selected by Merck, although
we do not expect any new CVM-related programs to be added. The
research phase for the Lab Programs was scheduled to end no later
than December 31, 2022, although certain limited activities
continue and will be wrapped up in 2023.
In January 2023, we announced that Merck notified us of its
decision to terminate the Phase 2b trial of MK-3655 in patients
with NASH and liver fibrosis stage 2 or 3 and Merck subsequently
provided us with the required
90-days' notice of partial termination of the Amended Collaboration
Agreement as it relates to MK-3655 and its related compounds. As a
result, in late April 2023, the license rights granted to Merck in
2018 with respect to MK-3655 will revert to us and the program will
become wholly-owned by us. Further development of MK-3655, once the
termination is effective, is primarily dependent on our ability to
secure potential future BD Arrangements and, in the absence of such
BD Arrangements, we are unlikely to be able to advance development
of MK-3655 unless our portfolio prioritization changes and we have
access to the necessary capital to fund such
development.
During the three-month period before the end of the research phase
for the CVM-related programs, Merck has the right to review the
product candidates from each applicable program and to elect to
have R&D activities continue under the collaboration for an
additional period, referred to as a Tail Period. If Merck makes
such an election, then the applicable Tail Period will begin at the
end of the research phase for the applicable program and will end
on the earlier of achievement of the License Option exercise point
or three years, except that in certain circumstances a Tail Period
may continue beyond three years if the License Option exercise
point has not been achieved by such time. All R&D work on
CVM-related programs during the applicable Tail Period, if any,
will be conducted by Merck or its third-party contractors at
Merck’s expense. Each Lab Program will enter a Tail Period if Merck
elects to continue work on it after we complete specified
laboratory and other activities.
Under the Amended Collaboration Agreement, Merck retains License
Options to obtain an exclusive, worldwide license, on specified
terms, to each collaboration compound (and its related compounds)
that remains within the scope of the continuing collaboration under
the Remaining Research Programs. Merck generally has a one-time
right to exercise its License Option for any product candidate when
we or Merck achieve the specified License Option exercise point.
The License Option exercise point for a collaboration compound from
the CVM-related programs or the Lab Programs will be the
designation by Merck of such collaboration compound as a research
program development candidate that Merck intends to progress into
preclinical development. Upon Merck’s exercise of a License Option
for any CVM-related program or Lab Program, Merck will pay us an
option exercise fee of $6.0 million and we will be eligible to
receive a milestone payment of $10.0 million if Merck subsequently
completes a proof-of-concept trial for a product candidate from
such program.
If Merck exercises its License Option to a product candidate and
its related compounds, referred to as a Licensed Program, we will
have the option to receive milestones and royalty payments or, in
certain cases, prior to Merck initiating any Phase 3 clinical trial
of such licensed compound, to co-fund development and participate
in a global cost and profit share arrangement of up to 50%, with an
additional option to co-detail any such licensed compound in the
United States. If we do not elect to exercise our cost and profit
share option for a particular licensed compound, we are eligible to
receive an aggregate of up to $469.0 million in milestone payments
upon the achievement of specific clinical development and
regulatory events, commercial milestone payments of up to $125.0
million and royalties from low-double digit to mid-teen percentages
of worldwide net sales of such licensed compound.
Merck will be responsible, at its own cost, for all development and
commercialization of product candidates from each Licensed Program,
subject to our options to cost and profit share worldwide, and to
co-detail those compounds in the United States as described above.
If Merck does not exercise its License Option with respect to a
particular candidate and its related compounds within the
applicable time period, in most instances we retain all rights to
research, develop and commercialize that candidate and those
compounds on a worldwide basis, either alone or in partnership with
a third party, subject to the payment to Merck of low single-digit
royalties on commercial sales of any resulting
products.
Under the Amended Collaboration Agreement, we also granted Merck a
worldwide, exclusive right to conduct R&D on, and to
manufacture, use and commercialize, small molecule compounds
identified or developed by Merck that have specified activity
against any target that we are researching or developing under the
research phase of the collaboration. Merck’s research license for
its own small molecule program will become non-exclusive if Merck
does not exercise its option to a product candidate against a
target at its option exercise point, but Merck will retain an
exclusive license to any small molecule compounds that it has
already identified and developed. Merck has sole responsibility for
R&D of any of these small molecule compounds, at its own cost.
We are eligible to receive milestone and royalty payments on small
molecule compounds that are developed by Merck under such a license
from us.
In addition to the options and exclusive licenses that we granted
or are obligated to grant to Merck, we have the following
exclusivity obligations to Merck under the Amended Collaboration
Agreement. During the applicable research phase and Tail Period, if
any, for the CVM-related programs and Lab Programs, we may not
directly or indirectly research, develop, manufacture or
commercialize, outside of our collaboration with Merck, any product
with specified activity against any target that is being researched
or developed under the applicable programs and, if Merck exercises
its License Option for a program, we may not directly or indirectly
research, develop,
manufacture or commercialize any product with specified activity
against the target that is the subject of that Licensed Program for
so long as Merck’s license to it remains in effect. In addition, we
are prohibited from directly or indirectly researching, developing
or commercializing any product for the treatment of heart failure
with preserved ejection fraction, or HFpEF, during the research
phase for the CVM-related programs.
After the research phase, Merck may terminate the overall Amended
Collaboration Agreement for convenience upon written notice.
Subject to certain limitations, Merck may partially terminate the
Amended Collaboration Agreement for convenience as it relates to
any Licensed Program or any of its rights to research and develop
small molecule compounds.
Either we or Merck may terminate the Amended Collaboration
Agreement with respect to a specific Licensed Program or any
particular licensed small molecule compound if the other party is
in material breach of its obligations regarding that specific
program and fails to cure the breach within the specified cure
period. If Merck terminates a Licensed Program as a result of our
uncured material breach, then we would lose our option to
participate in a global cost and profit share if not yet exercised
as of the time of termination and lose our co-detailing option
(whether or not exercised as of that time) for candidates arising
from the relevant Licensed Program. If Merck terminates a licensed
small molecule compound program for our uncured material breach, we
would continue to receive the full amount of milestones and
royalties we were otherwise eligible for with respect to the
relevant small molecule compounds.
Lonza License
In October 2014, we entered into a Multi-Product License Agreement,
or the Lonza License, with Lonza under which we obtained a
worldwide, non-exclusive license to use Lonza’s glutamine
synthetase gene expression system, known as GS Xceed™, to
manufacture and commercialize our proprietary
products.
Pursuant to the Lonza License, we paid Lonza an upfront fee of
£250,000. Upon the initiation of the first Phase 2 clinical trial,
the first Phase 3 clinical trial and the first commercial sale of
any product manufactured using GS Xceed™, we are required to pay
Lonza one-time milestone payments of £100,000, £100,000 and
£150,000, respectively. We paid a one-time milestone payment to
Lonza of £100,000 for each of the Phase 2 trial initiations for
MK-3655, NGM621 and NGM120. We are also required to pay low
single-digit royalties to Lonza based on net sales of any product
manufactured using GS Xceed™. Our royalty obligation to Lonza
continues on a product-by-product basis until the later of the
expiration of the last-to-expire licensed patent or ten years after
the first commercial sale of the product. We are also required to
pay an annual license fee to Lonza of up to £300,000 per product if
a party other than Lonza, we, our affiliates or our strategic
partners (including Merck or any potential future partners)
manufactures certain product candidates for commercial activities.
We are currently required to pay this fee for MK-3655 and NGM120.
In accordance with the Lonza License, for certain additional
product candidates, we are instead required to pay an annual
license fee to Lonza of £25,000 per product candidate prior to the
initiation of clinical development, and following the initiation of
clinical development, £100,000, £150,000 or £300,000 annually per
product candidate, respectively, if such product candidate is in a
Phase 1, Phase 2 and Phase 3 clinical trial. We were required to
pay this fee for NGM621 prior to Merck's decision not to exercise
its option to license NGM621 and its related compounds in January
2023.
The Lonza License continues until the expiration of the royalty
term. We have the right to terminate the Lonza License upon written
notice to Lonza. Each party may terminate the Lonza License for the
other party’s uncured material breach or bankruptcy. In addition,
Lonza may terminate the Lonza License if we participate in the
opposition or challenge of any Lonza patent or patent application
licensed to us under the Lonza License.
Government Regulation
Product Approval in the United States
The FDA and other regulatory health authorities at federal, state
and local levels, as well as in foreign countries, extensively
regulate, among other things, the research, development, testing,
manufacture, quality control, import, export, safety,
effectiveness, labeling, packaging, storage, distribution, record
keeping, approval, advertising, promotion, marketing, post-approval
monitoring and post-approval reporting of biologics, such as those
we are developing. We, along with third-party contractors, will be
required to navigate the various preclinical, clinical and
commercial approval requirements of the governing regulatory
agencies and health authorities of the countries in which we wish
to conduct studies or seek approval or licensure of our product
candidates.
The process of obtaining regulatory approvals and the subsequent
compliance with appropriate federal, state, and local statutes and
regulations requires the expenditure of substantial time and
financial resources. Failure
to comply with the applicable U.S. requirements at any time during
the product development process, approval process or following
approval may subject an applicant to administrative actions or
judicial sanctions. These actions and sanctions could include,
among other actions, the FDA’s refusal to approve pending
applications, withdrawal of an approval, license revocation, a
clinical hold, untitled or warning letters, voluntary or mandatory
product recalls or market withdrawals, product seizures, total or
partial suspension of production or distribution, injunctions,
fines, refusals of government contracts, restitution, disgorgement
and civil or criminal fines or penalties. Any agency or judicial
enforcement action could have a material adverse effect on our
business, the market acceptance of our products and our
reputation.
Preclinical and Clinical Development
Prior to beginning the first clinical trial with a product
candidate, a sponsor must submit an IND to the FDA. An IND is a
request for authorization from the FDA to administer an IND product
to humans. The central focus of an IND submission is on the general
investigational plan and the protocol(s) for clinical studies. The
IND also includes results of animal and
in vitro
studies assessing the toxicology, pharmacology, pharmacokinetics
and pharmacodynamic characteristics of the product; chemistry,
manufacturing and controls information; and any available human
data or literature to support the use of the investigational
product. An IND must become effective before human clinical trials
may begin. The IND automatically becomes effective 30 days after
receipt by the FDA, unless the FDA, within the 30-day time period,
raises concerns or questions regarding safety or conduct of the
proposed clinical trial. In such a case, the IND may be placed on
clinical hold and the IND sponsor and the FDA must resolve any
outstanding concerns or questions before the clinical trial can
begin. Submission of an IND therefore may or may not result in FDA
authorization to begin a clinical trial.
Clinical trials involve the administration of the investigational
product to human subjects under the supervision of qualified
investigators in accordance with current Good Clinical Practices,
or cGCPs, which include the requirement that all research subjects
provide their informed consent for their participation in any
clinical study. Clinical trials are conducted under protocols
detailing, among other things, the objectives of the study, the
parameters to be used in monitoring safety and the effectiveness
criteria to be evaluated. A separate submission to the existing IND
must be made for each successive clinical trial conducted during
product development and for any subsequent protocol amendments.
Furthermore, an institutional review board, or IRB, for each site
proposing to conduct the clinical trial must review and approve the
plan for any clinical trial and its informed consent form before
the clinical trial begins at that site and must monitor the study
until completed.
The FDA, an IRB or the sponsor may suspend a clinical trial at any
time on various grounds, including a finding that the subjects are
being exposed to an unacceptable health risk or that the trial is
unlikely to meet its stated objectives. Some trials also include
oversight by an independent group of qualified experts organized by
the clinical study sponsor, known as a data safety monitoring board
or committee, which provides authorization for whether a trial may
move forward at designated checkpoints based on access to certain
data from the trial and may halt the clinical trial if it
determines that there is an unacceptable safety risk for subjects
or other grounds, such as no demonstration of efficacy. There are
also requirements governing the reporting of ongoing clinical
studies and clinical study results to public
registries.
For purposes of biologics license application, BLA, approval, human
clinical trials are typically conducted in three sequential phases
that may overlap.
•Phase
1—The
investigational product is initially introduced into healthy human
subjects or patients with the target disease or condition. These
studies are designed to test the safety, dosage tolerance,
absorption, metabolism and distribution of the investigational
product in humans, the side effects associated with increasing
doses and, if possible, to gain early evidence on
effectiveness.
•Phase
2—The
investigational product is administered to a limited patient
population with a specified disease or condition to evaluate the
preliminary efficacy, optimal dosages and dosing schedule and to
identify possible adverse side effects and safety risks. Multiple
Phase 2 clinical trials may be conducted to obtain information
prior to beginning larger and more expensive Phase 3 clinical
trials.
•Phase
3—The
investigational product is administered to an expanded patient
population to further evaluate dosage, to provide statistically
significant evidence of clinical efficacy and to further test for
safety, generally at multiple geographically dispersed clinical
trial sites. These clinical trials are intended to establish the
overall risk/benefit ratio of the investigational product and to
provide an adequate basis for product approval.
In some cases, the FDA may require, or companies may voluntarily
pursue, additional clinical trials after a product is approved to
gain more information about the product. These are called Phase 4
studies and may be made a condition to approval of the BLA.
Concurrent with clinical trials, companies may complete additional
animal
studies and develop additional information about the biological
characteristics of the product candidate and must finalize a
process for manufacturing the product in commercial quantities in
accordance with current Good Manufacturing Practices, or cGMP,
requirements. The manufacturing process must be capable of
consistently producing quality batches of the product candidate
and, among other things, for biologics, must develop methods for
testing the identity, strength, quality, purity and potency of the
product. Additionally, appropriate packaging must be selected and
tested and stability studies must be conducted to demonstrate that
the product candidate does not undergo unacceptable deterioration
over its shelf life.
BLA Submission and Review
Assuming successful completion of all required testing in
accordance with all applicable regulatory requirements, the results
of product development, nonclinical studies and clinical trials are
submitted to the FDA as part of a BLA requesting approval to market
the product for one or more indications. The submission of a BLA
requires payment of a substantial application user fee to FDA,
unless a waiver or exemption applies.
Once a BLA has been submitted, the FDA generally makes a decision
on the acceptance of the application for filing within 60 days of
receipt. The FDA’s goal is to review standard applications within
ten months after it accepts the application for filing, or, if the
application qualifies for priority review, six months after the FDA
accepts the application for filing. In both standard and priority
reviews, the review process is often significantly extended by FDA
requests for additional information or clarification. The FDA
reviews a BLA to determine, among other things, whether a product
is safe, pure and potent and the facility in which it is
manufactured, processed, packed or held meets standards designed to
assure the product’s continued safety, purity and potency. The FDA
may convene an advisory committee to provide clinical insight on
application review questions. Before approving a BLA, the FDA will
typically inspect the facility or facilities where the product is
manufactured. The FDA will not approve an application unless it
determines that the manufacturing processes and facilities are in
compliance with cGMP requirements and adequate to assure consistent
production of the product within required specifications.
Additionally, before approving a BLA, the FDA will typically
inspect one or more clinical sites to assure compliance with cGCPs.
If the FDA determines that the application, manufacturing process
or manufacturing facilities are not acceptable, it will outline the
deficiencies in the submission and often will request additional
testing or information.
The FDA may issue an approval letter or a Complete Response letter.
An approval letter authorizes commercial marketing of the product
with specific prescribing information for specific indications. A
Complete Response letter will describe all of the deficiencies that
the FDA has identified in the BLA. In issuing the Complete Response
letter, the FDA may recommend actions that the applicant might take
to place the BLA in condition for approval, including requests for
additional information or clarification, completion of other
significant and time-consuming requirements related to clinical
trials, and/or conduct of additional preclinical studies or
manufacturing activities. Even if such data and information are
submitted, the FDA may determine that the BLA does not satisfy the
criteria for approval. FDA approval of a BLA must be obtained
before a biologic may be marketed in the United States. The FDA may
delay or refuse approval of a BLA, require additional testing or
information and/or require post-marketing testing and surveillance
to monitor safety or efficacy of a product.
If regulatory approval of a product is granted, such approval will
be granted for particular indications and may entail limitations on
the indicated uses for which such product may be marketed. For
example, the FDA may approve the BLA with a Risk Evaluation and
Mitigation Strategy, or REMS, to ensure the benefits of the product
outweigh its risks. A REMS is a safety strategy to manage a known
or potential serious risk associated with a product and to enable
patients to have continued access to such medicines by managing
their safe use, and could include medication guides, physician
communication plans or elements to assure safe use, such as
restricted distribution methods, patient registries and other risk
minimization tools. The FDA also may condition approval on, among
other things, changes to proposed labeling or the development of
adequate controls and specifications. Once approved, the FDA may
withdraw the product approval if compliance with pre- and
post-marketing requirements is not maintained or if problems occur
after the product reaches the marketplace. The FDA may require one
or more Phase 4 post-marketing studies and surveillance to further
assess and monitor the product’s safety and effectiveness after
commercialization and may limit further marketing of the product
based on the results of these post-marketing studies.
Expedited Programs
A sponsor may seek to develop and obtain approval of its product
candidates under programs designed to accelerate the FDA review and
approval of marketing applications for new drugs and biologics that
meet certain criteria, such as the Fast Track program, priority
review, accelerated approval, breakthrough therapy designation and
Real-Time Oncology Review, or RTOR, Program.
Fast Track Designation
The FDA Fast Track program is intended to facilitate development
and expedite review of new drugs and biologics that are intended to
treat a serious or life-threatening disease or condition and that
demonstrate potential to address an unmet medical need. For a Fast
Track-designated product, there may be more frequent meetings and
communication with the FDA, and early and frequent communication
between the FDA and sponsor is encouraged throughout the entire
development and review process. The FDA may consider sections of a
BLA for review on a rolling basis if certain conditions are
satisfied, including an agreement with the FDA on the proposed
schedule for submission of portions of the application and the
payment of applicable user fees before the FDA may initiate a
review. The product may also be eligible for priority review and
accelerated approval. The sponsor can request the FDA to designate
the product for Fast Track status any time before receiving BLA
approval, but ideally no later than the pre-BLA
meeting.
Priority Review
Generally, the FDA follows a two-tiered system of review times,
standard review and priority review. For a product that receives
priority review designation, the FDA has the goal of taking action
on the marketing application within six months of the 60-day filing
date, compared to ten months under standard review. However, the
FDA does not always meet its PDUFA goal dates for standard and
priority BLAs, and the review process is often extended by FDA
requests for additional information or clarification. A priority
review designation is applicable for products that, if approved,
would be significant improvements in the safety or effectiveness of
the treatment, diagnosis, or prevention of serious conditions when
compared to marketed products. The FDA decides on the review
designation for every application; however, an applicant may
expressly request priority review. The FDA informs the applicant of
a priority review designation within 60 days of the receipt of the
original marketing application. If criteria are not met for
priority review, the application is subject to the standard FDA
review period of ten months after FDA accepts the application for
filing. Priority review designation does not change the scientific
or medical standard for approval, or the quality of evidence
necessary to support approval.
Accelerated Approval
In addition, the FDA may base accelerated approval for drugs and
biologics for serious conditions that fill an unmet medical need on
whether the drug or biologic has an effect on a surrogate or an
intermediate clinical endpoint. A surrogate endpoint used for
accelerated approval is a marker, such as a laboratory measurement,
radiographic image, physical sign or other measure that is thought
to predict clinical benefit but is not itself a measure of clinical
benefit. Likewise, an intermediate clinical endpoint is a measure
of a therapeutic effect that is considered reasonably likely to
predict the clinical benefit of a product, such as an effect on
irreversible morbidity and mortality, or IMM. The FDA bases its
decision on whether to accept the proposed surrogate or
intermediate clinical endpoint on the scientific support for that
endpoint. As a condition of accelerated approval, the FDA will
generally require the sponsor to perform and provide regular
updates to the agency on adequate and well-controlled
post-marketing clinical studies to verify and describe the
anticipated effect on IMM or other clinical benefit. Where
confirmatory trials verify clinical benefit, the FDA will generally
terminate the requirement. Approval of a product may be withdrawn
or the labeled indication of the product changed, if trials fail to
verify clinical benefit or do not demonstrate sufficient clinical
benefit to justify the risks associated with the product, for
example, if the product shows a significantly smaller magnitude or
duration of benefit than was anticipated based on the observed
effect on the surrogate endpoint. In addition, the FDA currently
requires as a condition for accelerated approval the pre-approval
of promotional materials, which could adversely impact the timing
of the commercial launch of the product.
Breakthrough Therapy Designation
Additionally, a drug or biologic may be eligible for designation as
a breakthrough therapy if the product is intended, alone or in
combination with one or more other drugs or biologics, to treat a
serious or life-threatening condition and preliminary clinical
evidence indicates that the product may demonstrate substantial
improvement over currently approved therapies on one or more
clinically significant endpoints, such as substantial treatment
effects observed early in clinical development. If the FDA
designates a breakthrough therapy, it may take actions appropriate
to expedite the development and review of the application, which
may include holding meetings with the sponsor and the review team
throughout the development of the therapy; providing timely advice
to, and interactive communication with, the sponsor regarding the
development of the drug to ensure that the development program to
gather the nonclinical and clinical data necessary for approval is
as efficient as practicable; involving senior managers and
experienced review staff, as appropriate, in a collaborative,
cross-disciplinary review; assigning a cross-disciplinary project
lead for the FDA review team to facilitate an efficient review of
the development program and to serve as a scientific liaison
between the review team and the sponsor; and considering
alternative clinical trial designs when scientifically appropriate,
which may result in smaller trials or more efficient trials that
require less
time to complete and may minimize the number of patients exposed to
a potentially less efficacious treatment. Breakthrough therapy
designation comes with all of the benefits of Fast Track
designation, which means that the sponsor may file sections of the
BLA for review on a rolling basis if certain conditions are
satisfied, including an agreement with the FDA on the proposed
schedule for submission of portions of the application and the
payment of applicable user fees before the FDA may initiate a
review.
Real-Time Oncology Review (RTOR) Program
The RTOR program is for oncology product candidates that are likely
to demonstrate substantial improvements over available therapy,
which may include drugs previously granted breakthrough therapy
designation for the same or other indications and candidates
meeting other criteria for other expedited programs, such as Fast
Track and priority review. Submissions for RTOR consideration
should also have straightforward study designs and endpoints that
can be easily interpreted (such as overall survival or progression
free survival). Acceptance into the RTOR program does not guarantee
or influence approvability of the application, which is subject to
the usual benefit-risk evaluation by FDA reviewers, but the program
allows FDA to review data earlier, before an applicant formally
submits a complete application. The RTOR program does not affect
FDA’s PDUFA timelines.
Even if a product qualifies for one or more of these programs, the
FDA may later decide that the product no longer meets the
conditions for qualification or the time period for FDA review or
approval may not be shortened. Furthermore, Fast Track designation,
priority review, accelerated approval, breakthrough therapy
designation and RTOR program acceptance do not change the standards
for product approval.
Orphan Drug Designation
Under the Orphan Drug Act, the FDA may grant orphan designation to
a drug or biologic intended to treat a rare disease or condition,
which is a disease or condition that affects fewer than 200,000
individuals in the United States, or more than 200,000 individuals
in the United States for which there is no reasonable expectation
that the cost of developing and making available in the United
States a drug or biologic for this type of disease or condition
will be recovered from sales in the United States for that drug or
biologic. Orphan drug designation must be requested before
submitting a BLA. After the FDA grants orphan drug designation, the
generic identity of the therapeutic agent and its potential orphan
use are disclosed publicly by the FDA. The orphan drug designation
does not convey any advantage in, or shorten the duration of, the
regulatory review or approval process.
If a product that has orphan drug designation subsequently receives
the first FDA approval for the disease for which it has such
designation, the product is entitled to orphan drug exclusive
approval (or exclusivity), which means that the FDA may not approve
any other applications, including a full BLA, to market the same
biologic for the same indication for seven years, except in limited
circumstances, such as a showing of clinical superiority to the
product with orphan drug exclusivity by means of greater
effectiveness, greater safety or providing a major contribution to
patient care or in instances of drug supply issues. Orphan drug
exclusivity does not prevent FDA from approving a different drug or
biologic for the same disease or condition, or the same drug or
biologic for a different disease or condition. Among the other
benefits of orphan drug designation are tax credits for certain
research and a waiver of the BLA application fee.
A designated orphan drug may not receive orphan drug exclusivity if
it is approved for a use that is broader than the indication for
which it received orphan designation. In addition, exclusive
marketing rights in the United States may be lost if the FDA later
determines that the request for designation was materially
defective or if the manufacturer is unable to assure sufficient
quantities of the product to meet the needs of patients with the
rare disease or condition.
Pediatric Information and Pediatric Exclusivity
Under the Pediatric Research Equity Act, or PREA, certain BLAs and
certain supplements to a BLA must contain data to assess the safety
and efficacy of the drug for the claimed indications in all
relevant pediatric subpopulations and to support dosing and
administration for each pediatric subpopulation for which the
product is safe and effective. The FDA may grant deferrals for
submission of pediatric data or full or partial waivers. A sponsor
who is planning to submit a marketing application for a drug that
includes a new active ingredient, new indication, new dosage form,
new dosing regimen or new route of administration must submit an
initial Pediatric Study Plan, or PSP. The initial PSP must include
an outline of the pediatric study or studies that the sponsor plans
to conduct, including study objectives and design, age groups,
relevant endpoints and statistical approach, or a justification for
not including such detailed information, and any request for a
deferral of pediatric assessments or a full or partial waiver of
the requirement to provide data from pediatric studies along with
supporting information. The FDA and the sponsor must reach an
agreement on the PSP. A sponsor can submit amendments to an
agreed-upon initial PSP at
any time if changes to the pediatric plan need to be considered
based on data collected from preclinical studies, early phase
clinical trials and/or other clinical development
programs.
A drug or biologic product can also obtain pediatric market
exclusivity in the United States. Pediatric exclusivity, if
granted, adds six months to existing exclusivity periods and patent
terms. This six-month exclusivity, which runs from the end of other
exclusivity protection or patent term, may be granted based on the
voluntary completion of a pediatric study in accordance with an
FDA-issued “Written Request” for such a study.
Post-Approval Requirements
Any products manufactured or distributed pursuant to FDA approvals
are subject to pervasive and continuing regulation by the FDA,
including, among other things, requirements relating to
record-keeping, reporting of adverse experiences, periodic
reporting, product sampling and distribution and advertising and
promotion of the product. After approval, most changes to the
approved product, such as adding new indications or other labeling
claims, are subject to prior FDA review and approval. There also
are continuing user fee requirements, under which FDA assesses an
annual program fee for each product identified in an approved
BLA.
FDA regulations require that products be manufactured in specific
approved facilities and in accordance with cGMP regulations. We
rely, and expect to continue to rely, on third parties for the
production of clinical and commercial quantities of our products in
accordance with cGMP regulations. These manufacturers must comply
with FDA regulations that require, among other things, quality
control and quality assurance, the maintenance of records and
documentation and the obligation to investigate and correct any
deviations from cGMP. FDA regulations also impose reporting
requirements upon sponsors and their third-party manufacturers.
Manufacturers and other entities involved in the manufacture and
distribution of approved biologics are required to register their
establishments with the FDA and certain state agencies and are
subject to periodic unannounced inspections by the FDA and certain
state agencies for compliance with cGMP requirements and other
laws, which impose certain procedural and documentation
requirements upon sponsors and their third-party manufacturers. The
discovery of violative conditions, including failure to conform to
cGMP regulations, could result in enforcement actions, and the
discovery of problems with a product after approval may result in
restrictions on a product, manufacturer or holder of an approved
BLA, including recall. Biologic manufacturers and their
subcontractors are required to register their establishments with
the FDA and certain state agencies and are subject to periodic
unannounced inspections by the FDA and certain state agencies for
compliance with cGMP, which impose certain procedural and
documentation requirements upon sponsors and their third-party
manufacturers. Changes to the manufacturing process are strictly
regulated, and, depending on the significance of the change, may
require prior FDA approval before being implemented. FDA
regulations also require investigation and correction of any
deviations from cGMP and impose reporting requirements upon
sponsors and their third-party manufacturers.
The FDA may also place other conditions on approvals including the
requirement for a REMS, to assure the safe use of the product. If
the FDA concludes a REMS is needed, the sponsor of the BLA must
submit a proposed REMS. The FDA will not approve the BLA without an
approved REMS, if required. A REMS could include medication guides,
physician communication plans or elements to assure safe use, such
as restricted distribution methods, patient registries and other
risk minimization tools. Any of these limitations on approval or
marketing could restrict the commercial promotion, distribution,
prescription or dispensing of products. Product approvals may be
withdrawn for non-compliance with regulatory standards or if
problems occur following initial marketing. The FDA may withdraw
approval if compliance with regulatory requirements and standards
is not maintained or if problems occur after the product reaches
the market. Later discovery of previously unknown problems with a
product, including adverse events of unanticipated severity or
frequency, or with manufacturing processes, or failure to comply
with regulatory requirements, may result in: revisions to the
approved labeling to add new safety information; imposition of
post-market studies or clinical studies to assess new safety risks;
or imposition of distribution restrictions or other restrictions
under a REMS program. Other potential consequences include, among
other things:
•restrictions
on the marketing or manufacturing of a product, complete withdrawal
of the product from the market or product recalls;
•fines,
warning letters or holds on post-approval clinical
studies;
•refusal
of the FDA to approve pending applications or supplements to
approved applications, or suspension or revocation of existing
product approvals;
•product
seizure or detention, or refusal of the FDA to permit the import or
export of products; or
•injunctions
or the imposition of civil or criminal penalties.
The FDA closely regulates the marketing, labeling, advertising and
promotion of biologics. A company can make only those claims
relating to safety and efficacy, purity and potency that are
approved by the FDA and in
accordance with the provisions of the approved label. The FDA and
other agencies actively enforce the laws and regulations
prohibiting the promotion of off-label uses and misbranding.
Failure to comply with these requirements can result in, among
other things, adverse publicity, warning letters, corrective
actions, including corrective advertising, and potential civil and
criminal penalties, including monetary penalties. Physicians may
prescribe legally available products for uses that are not
described in the product’s labeling and that differ from those
tested and approved by the FDA. Such off-label uses are common
across medical specialties. Physicians may believe that such
off-label uses are the best treatment for many patients in varied
circumstances. The FDA does not regulate the behavior of physicians
in their choice of treatments. The FDA does, however, restrict
manufacturer’s communications on the subject of off-label use of
their products, and a company that is found to have improperly
promoted off-label uses may be subject to significant liability,
including investigation by federal and state authorities.
Prescription drug promotional materials must be submitted to the
FDA in conjunction with their first use or first publication (or
thirty days in advance of their first use if approved via the
accelerated approval pathway). Further, if there are any
modifications to the drug or biologic, including changes in
indications, labeling or manufacturing processes or facilities, the
applicant may be required to submit and obtain FDA approval of a
new BLA or BLA supplement, which may require the development of
additional data or preclinical studies and clinical
trials.
Other U.S. Healthcare Laws and Compliance Requirements
In the United States, our current and future operations are subject
to regulation by various federal, state and local authorities. For
example, our clinical research, sales, marketing and
scientific/educational grant programs may have to comply with the
anti-fraud and abuse provisions of the Social Security Act, the
federal Anti-Kickback Statute, the false claims laws, the privacy
and security provisions of the Health Insurance Portability and
Accountability Act, or HIPAA, and similar state laws, each as
amended, as applicable.
The federal Anti-Kickback Statute prohibits, among other things,
any person or entity, from knowingly and willfully offering,
paying, soliciting or receiving any remuneration, directly or
indirectly, overtly or covertly, in cash or in kind, to induce or
in return for purchasing, leasing, ordering or arranging for the
purchase, lease or order of any item or service reimbursable, in
whole or in part, under Medicare, Medicaid or other federal
healthcare programs. The term remuneration has been interpreted
broadly to include anything of value. There are a number of
statutory exceptions and regulatory safe harbors protecting some
common activities from prosecution. The exceptions and safe harbors
are drawn narrowly and practices that involve remuneration that may
be alleged to be intended to induce prescribing, purchasing or
recommending may be subject to scrutiny if they do not qualify for
an exception or safe harbor. Failure to meet all of the
requirements of a particular applicable statutory exception or
regulatory safe harbor does not make the conduct per se illegal
under the Anti-Kickback Statute. Instead, the legality of the
arrangement will be evaluated on a case-by-case basis based on a
cumulative review of all of its facts and circumstances. Our
practices may not in all cases meet all of the criteria for
protection under a statutory exception or regulatory safe
harbor.
Additionally, the intent standard under the Anti-Kickback Statute
was amended by the Patient Protection and Affordable Care Act, as
amended by the Health Care and Education Reconciliation Act,
collectively referred to as the ACA, to impose a stricter standard
such that a person or entity no longer needs to have actual
knowledge of the statute or specific intent to violate it in order
to have committed a violation. In addition, the ACA codified case
law 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 federal False Claims Act,
or FCA.
The federal false claims and civil monetary penalty laws, including
the FCA, which imposes significant penalties and can be enforced by
private citizens through civil
qui tam
actions, prohibit any person or entity from, among other things,
knowingly presenting, or causing to be presented, a false or
fraudulent claim for payment to, or approval by, the federal
government, including federal healthcare programs, such as Medicare
and Medicaid, knowingly making, using or causing to be made or used
a false record or statement material to a false or fraudulent claim
to the federal government, or knowingly making a false statement to
improperly avoid, decrease or conceal an obligation to pay money to
the federal government. A claim includes “any request or demand”
for money or property presented to the U.S.
government.
HIPAA created additional federal criminal statutes that prohibit,
among other things, knowingly and willfully executing, or
attempting to execute, a scheme to defraud or to obtain, by means
of false or fraudulent pretenses, representations or promises, any
money or property owned by, or under the control or custody of, any
healthcare benefit program, including private third-party payors,
willfully obstructing a criminal investigation of a healthcare
offense and knowingly and willfully falsifying, concealing or
covering up by trick, scheme or device, a material fact or making
any materially false, fictitious or fraudulent statement in
connection with the delivery of or payment for healthcare benefits,
items or services. Like the Anti-Kickback Statute, the ACA amended
the intent standard for
certain healthcare fraud statutes under HIPAA such that a person or
entity no longer needs to have actual knowledge of the statute or
specific intent to violate it in order to have committed a
violation.
Also, many states have similar, and typically more prohibitive,
fraud and abuse statutes or regulations that apply to items and
services reimbursed under Medicaid and other state programs, or, in
several states, apply regardless of the payor.
HIPAA, as amended by the Health Information Technology for Economic
and Clinical Health Act, or HITECH, and its implementing
regulations, imposes requirements on covered entities (including
certain health care providers, health plans and health care
clearinghouses, business associates and their covered
subcontractors) relating to the privacy, security and transmission
of individually identifiable health information. HIPAA may be
enforced by several federal agencies as well as state attorneys
general. In addition, many state laws govern the privacy and
security of health information in specified circumstances, many of
which differ from each other in significant ways, are often not
pre-empted by HIPAA and may have a more prohibitive effect than
HIPAA, thus complicating compliance efforts.
Our physician-administered products, once approved, may be eligible
for coverage under Medicare through Medicare Part B. As a condition
of receiving Medicare Part B reimbursement for a manufacturer’s
eligible drugs, the manufacturer is required to participate in
other government healthcare programs, including the Medicaid Drug
Rebate Program and the 340B Drug Pricing Program, and would be
subject to those requirements as well.
In addition, many pharmaceutical manufacturers must calculate and
report certain price reporting metrics to the government, such as
average sales price and best price. Penalties may apply in some
cases when such metrics are not submitted accurately and timely.
Further, these prices for drugs may be reduced by mandatory
discounts or rebates required by government healthcare programs or
private payors and by any future relaxation of laws that presently
restrict imports of drugs from countries where they may be sold at
lower prices than in the United States.
Additionally, the federal Physician Payments Sunshine Act, or the
Sunshine Act, as amended, and its implementing regulations, require
that certain manufacturers of drugs, devices, biological and
medical supplies for which payment is available under Medicare,
Medicaid or the Children’s Health Insurance Program (with certain
exceptions) report annually to CMS information related to certain
payments or other transfers of value made or distributed to
physicians (defined to include doctors, dentists, optometrists,
podiatrists and chiropractors), other health care professionals
(such as physician assistants and nurse practitioners) and teaching
hospitals, as well as information regarding ownership and
investment interests held by physicians and their immediate family
members.
In addition, many states also govern the reporting of such payments
or other transfers of value, many of which differ from each other
in significant ways, are often not pre-empted and may have a more
prohibitive effect than the Sunshine Act, thus further complicating
compliance efforts.
In order to distribute products commercially, we must comply with
state laws that require the registration of manufacturers and
wholesale distributors of drug and biological products in a state,
including, in certain states, manufacturers and distributors who
ship products into the state even if such manufacturers or
distributors have no place of business within the state. Some
states also impose requirements on manufacturers and distributors
to establish the pedigree of product in the chain of distribution,
including some states that require manufacturers and others to
adopt new technology capable of tracking and tracing product as it
moves through the distribution chain. Several states have enacted
legislation requiring pharmaceutical and biotechnology companies to
establish marketing compliance programs, file periodic reports with
the state, make periodic public disclosures on sales, marketing,
pricing, clinical trials and other activities and/or register their
sales representatives, as well as to prohibit pharmacies and other
healthcare entities from providing certain physician prescribing
data to pharmaceutical and biotechnology companies for use in sales
and marketing, and to prohibit certain other sales and marketing
practices. All of our activities are potentially subject to federal
and state consumer protection and unfair competition
laws.
The scope and enforcement of each of these laws is uncertain and
subject to rapid change in the current environment of healthcare
reform, especially in light of the lack of applicable precedent and
regulations. Ensuring business arrangements with third parties
comply with applicable healthcare laws and regulations is a costly
endeavor. If our operations are found to be in violation of any of
the federal and state healthcare laws described above or any other
current or future governmental regulations that apply to us, we may
be subject to penalties, including without limitation, civil,
criminal and/or administrative penalties, damages, fines,
disgorgement, individual imprisonment, exclusion from participation
in government programs, such as Medicare and Medicaid, injunctions,
private
qui tam
actions brought by individual whistleblowers in the name of the
government, refusal to allow us to enter into government contracts,
contractual damages, reputational harm, administrative burdens,
diminished profits and future earnings, 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, and the curtailment or
restructuring of our operations, any of which could adversely
affect our ability to operate our business and our results of
operations.
The Foreign Corrupt Practices Act
The Foreign Corrupt Practices Act, or FCPA, prohibits any U.S.
individual or business from paying, offering or authorizing payment
or offering of anything of value, directly or indirectly, to any
foreign official, political party or candidate for the purpose of
influencing any act or decision of the foreign entity in order to
assist the individual or business in obtaining or retaining
business. The FCPA also obligates companies whose securities are
listed in the United States to comply with accounting provisions
requiring us to maintain books and records that accurately and
fairly reflect all transactions of the corporation, including
international subsidiaries, and to devise and maintain an adequate
system of internal accounting controls for international
operations.
Environmental, Health and Safety Regulation
In addition to the foregoing, state and federal laws regarding safe
working conditions, environmental protection and hazardous
substances, including the Occupational Safety and Health Act, the
Resource Conservancy and Recovery Act and the Toxic Substances
Control Act, affect our business. These and other laws govern our
use, handling and disposal of various biological, chemical and
radioactive substances used in, and wastes generated by, our
operations. We may incur significant costs to comply with such laws
and regulations now or in the future. If our operations result in
contamination of the environment or expose individuals to hazardous
substances, we could be liable for damages and governmental fines.
We believe that we are in material compliance with applicable
environmental laws and regulations and that continued compliance
therewith will not have a material adverse effect on our business.
We cannot predict, however, how changes in these laws and
regulations may affect our future operations.
European Union Development of Medicinal Products
In the European Economic Area, or EEA, which consists of the 27
Member States of the European Union, or the EU and the EU Member
States, as well as Norway, Iceland and Liechtenstein, medicinal
products can only be commercialized after a marketing
authorization, or MA, has been granted by a competent regulatory
authority. This is similar to the approach in the United States.
The various phases of preclinical and clinical research in the EEA
are currently regulated by Clinical Trials Regulation (EU) No
536/2014, which went into effect on January 31, 2022. The
regulation, which is directly applicable in all EEA countries,
overhauls the current system of approvals for clinical trials in
the EU in an effort to simplify and streamline the approval of
clinical trials in the EU.
European Union Review of Marketing Authorization and
Approval
Depending on the type of product and its intended therapeutic
indication, related MAs may be granted either by the European
Commission at the EU level or by the competent authorities of the
EEA countries. An EU MA is issued by the European Commission
through the Centralized Procedure, based on the opinion of the
Committee for Medicinal Products for Human Use, or CHMP, of the
EMA, and is valid throughout the entire territory of the EEA. The
Centralized Procedure is mandatory for certain types of products,
such as biotechnology medicinal products, orphan medicinal
products, advanced-therapy medicines such as gene-therapy, somatic
cell-therapy or tissue-engineered medicines and medicinal products
containing a new active substance indicated for the treatment of
HIV, AIDS, cancer, neurodegenerative disorders, diabetes,
autoimmune and other immune dysfunctions and viral diseases. The
Centralized Procedure is optional, subject to the approval of the
EMA, for products containing a new active substance not yet
authorized in the EEA, or for products that constitute a
significant therapeutic, scientific or technical innovation or
which are in the interest of public health in the EU.
National MAs, which are issued by the competent authorities of the
EEA countries, and only cover their respective territory, are
available for products not falling within the mandatory scope of
the Centralized Procedure. Where a product has already been
authorized for marketing in an EEA country, that National MA can be
recognized in another EEA country through the Mutual Recognition
Procedure. If the product has not received a National MA in any EEA
country at the time of application for authorization, it can be
approved simultaneously in various EEA countries through the
Decentralized Procedure. Under the Decentralized Procedure, an
identical dossier is submitted to the competent authorities of each
of the EEA countries in which the MA is sought, one of which is
selected by the applicant as the Reference Member State, or RMS.
The competent authority of the RMS prepares a draft assessment
report, a draft Summary of Product Characteristics, or SmPC, the
document that provides information to physicians concerning the
safe and effective use of the product, and a draft of the labeling
and package leaflet, which are sent to the other EEA countries,
referred to as the Concerned Member States, or CMSs, for their
approval. If the CMSs raise no objections to the assessment, SmPC,
labeling or packaging proposed by the
RMS, the product is subsequently granted a National MA in the RMS
and the Concerned Member States. The RMS or CMSs may only raise
objections to authorization that are based on a potential serious
risk to public health.
In the EEA, a MA, whether granted through the Centralized,
Decentralized or Mutual Recognition Procedures, may be granted only
to an MA applicant that is established within the EEA.
In principle, an MA has an initial validity of five years. The MA
may be renewed after five years on the basis of a re-evaluation of
the risk-benefit balance by the EMA or by the competent authority
of the EEA country in which the original MA was granted. The
European Commission or the competent authorities of the EEA country
may decide, on justified grounds relating to pharmacovigilance, to
require one additional five-year period for the MA before it is
definitively renewed. Once subsequently definitively renewed, the
MA is valid for an unlimited period. Any MA that is not followed by
the actual placing of the medicinal product on the EEA market (in
case of Centralized Procedure approvals), or on the market of the
authorizing EEA country if applicable, within three years after
authorization ceases to be valid (the so-called sunset
clause).
Innovative products that target an unmet medical need and are
expected to be of major public health interest may be eligible for
a number of expedited development and review programs, such as the
Priority Medicines, or PRIME, scheme, which provides incentives
similar to the breakthrough therapy designation in the United
States. In the EEA, a conditional MA may be granted by the European
Commission through the Centralized Procedure in cases where all the
required safety and efficacy data are not yet available. The
conditional MA is subject to conditions to be fulfilled concerning
generation of missing data or ensuring increased safety measures.
It is valid for one year and must be renewed annually until all
related conditions have been fulfilled. After this, the conditional
MA is converted to a normal MA. An MA may also be granted “under
exceptional circumstances” by the European Commission through the
Centralized Procedure where the MA applicant can show that it is
unable to provide comprehensive data on the efficacy and safety of
the medicinal product under normal conditions of use even after the
product has been authorized and subject to specific procedures
after being introduced. These circumstances may arise in particular
when the intended therapeutic indications are very rare and, based
on the state of scientific knowledge at that time, it is not
possible to provide comprehensive information, or when generating
data may be contrary to generally accepted ethical
principles.
Data and Market Exclusivity
The EU legislation governing the grant of marketing authorizations
for medicinal products also provides opportunities for data and
market exclusivity related to MAs in certain circumstances. Upon
grant of an MA, innovative medicinal products generally benefit
from eight years of data exclusivity and ten years of market
exclusivity. Data exclusivity, if granted, prevents regulatory
authorities in the EEA from referencing the innovator’s data to
assess a biosimilar application for eight years from the date of
authorization of the innovative product, after which a biosimilar
application for MA can be submitted, and the innovator’s data may
be referenced. The market exclusivity period prevents a successful
biosimilar applicant from commercializing its product in the EEA
until ten years have elapsed from the initial MA of the innovator
product in the EEA. The overall ten-year period may, occasionally,
be extended for a further year to a maximum of eleven years if,
during the first eight years of those ten years, the MA holder
obtains an authorization for one or more new therapeutic
indications which, during the scientific evaluation prior to their
authorization, are held to bring a significant clinical benefit in
comparison with existing therapies. There is, however, no guarantee
that our products will be considered by European regulatory
authorities to be a new biological entity. In such circumstances,
our products, even if granted MA, may not qualify for data and
market exclusivity.
Pediatric Development
Regulation (EC) No 1901/2006 provides that all applicants for MA
for new medicinal products have to include the results of trials
conducted in the pediatric population in compliance with a
pediatric investigation plan, or PIP, agreed to with the EMA’s
Pediatric Committee, or PDCO. The PDCO can grant a deferral of the
obligation to implement some or all of the measures provided in the
PIP until there are sufficient data to demonstrate the efficacy and
safety of the product in adults. The obligation to provide
pediatric clinical trial data can be waived entirely by the PDCO
when these data are not needed or appropriate because the product
is likely to be ineffective or unsafe in children, the disease or
condition for which the product is intended occurs only in adult
populations, or when the product does not represent a significant
therapeutic benefit over existing treatments for pediatric
patients. Once the MA is obtained in all EEA countries and study
results in compliance with the PIP are included in the product
information, even when those results are negative, the product may
be eligible for a six-month extension to certain patent protections
or, in the case of orphan medicinal products, a two-year extension
of orphan market exclusivity.
Post-Approval Requirements
Similar to the United States, both MA holders and manufacturers of
medicinal products are subject to comprehensive regulatory
oversight by the EMA, the European Commission and/or the competent
regulatory authorities of the individual EEA countries and regional
authorities within those countries. Legislation adopted at the EU
level, such as Directives, may be implemented differently by
individual EEA countries. Examples of post-approval requirements
include the obligation on the holder of an MA to comply with a
range of regulatory requirements applicable to the manufacturing,
marketing, promotion and sale of medicinal products, establish and
maintain a pharmacovigilance system and appoint an individual
qualified person for pharmacovigilance who is responsible for
oversight of that system. Key obligations include expedited
reporting of suspected serious adverse reactions and submission of
periodic safety update reports, or PSURs. All new applicants for MA
must include a risk management plan, or RMP, describing the risk
management system that the company will put in place and
documenting measures to prevent or minimize the risks associated
with the product. The regulatory authorities may also impose
risk-minimization measures or post-authorization obligations as a
condition of the MA, which may include additional safety
monitoring, more frequent submission of PSURs or the conduct of
additional clinical trials or post-authorization safety
studies.
Marketing of Medicinal Products in the EEA
In the EEA, the advertising and promotion of medicinal products are
subject to both EU law and the national law of individual EEA
countries governing promotion of medicinal products, interactions
with physicians and other healthcare professionals, misleading and
comparative advertising and unfair commercial practices. Although
general requirements for advertising and promotion of medicinal
products are established at the EU level, the details are governed
by rules developed in individual EEA countries and can differ from
one country to another. Examples of regulatory obligations include
the requirement that promotional materials and advertising in
relation to medicinal products comply with the product’s SmPC as
approved by the competent authorities in connection with an MA.
Promotional activity that does not comply with the SmPC is
considered off-label and is prohibited in the EU.
Direct-to-consumer advertising of prescription medicinal products
is also prohibited in the EU.
Marketed products in the EEA are subject to substantial continuing
regulation. This includes, among other things, requirements
relating to record-keeping, reporting of adverse experiences,
periodic reporting, product sampling and distribution and
advertising and promotion of the product. For example, much like
the Anti-Kickback Statute prohibition in the United States, the
provision of benefits or advantages to physicians to induce or
encourage the prescription, recommendation, endorsement, purchase,
supply, order or use of medicinal products is also prohibited in
the EEA. The provision of benefits or advantages to physicians is
governed by national laws, including anti-bribery laws, industry
codes or professional codes of conduct and related national
implementing laws. Payments made to physicians in certain EEA
countries must also be publicly disclosed, and agreements with
physicians are often the subject of prior notification and approval
by the physician’s employer, his or her competent professional
organization and/or the regulatory authorities of the individual
EEA countries. Failure to comply with these requirements could
result in reputational risk, public reprimands, administrative
penalties, fines or imprisonment.
Regulation in the United Kingdom Following Brexit
The withdrawal of the UK from the EU, commonly referred to as
“Brexit,” took effect on January 31, 2020. Pursuant to the formal
withdrawal arrangements agreed between the UK and the EU, the UK
was subject to a transition period that ended December 31, 2020,
during which EU rules continued to apply. A Trade and Cooperation
Agreement, or the TCA, that outlines the trading relationship
between the UK and the EU entered into force provisionally in
January 2021, and permanently since May 2021. The TCA primarily
focuses on ensuring free trade between the EU and the UK in
relation to goods, including medicinal products. Although the body
of the TCA includes general terms which apply to medicinal
products, greater detail on sector-specific issues is provided in
an Annex. Under the TCA, Great Britain (England, Scotland and
Wales) is be treated as a third country, except that Northern
Ireland will, with regard to EU regulations on free movement of
goods, continue to follow the EU regulatory rules. As part of the
TCA, the EU and the UK will mutually recognize cGMP inspections and
accept official cGMP documents. The UK has unilaterally agreed to
accept EU batch testing and batch release. However, the EU
continues to apply EU laws that require batch testing and batch
release to take place in the EU. This means that medicinal products
that are tested and released in the UK must be retested and
re-released when entering the EU market for commercial use. The TCA
also encourages, although it does not oblige, the parties to
consult one another on proposals to introduce significant changes
to technical regulations or inspection procedures.
With respect to MAs, Great Britain has a separate regulatory
submission and approval process and a national MA implemented
through its regulator, the Medicines and Healthcare products
Regulatory Agency, or
MHRAs, with certain exceptions for Northern Ireland. Companies
established in the UK can no longer use the Centralized Procedure
for approval by the European Commission to obtain an MA to market
products in the UK and instead must follow one of the UK national
authorization procedures. Until the end of 2023, the MHRA may rely
on a decision made by the European Commission on the approval of a
new Centralized Procedure MA when deciding on an application for a
Great Britain MA. Thereafter, a new international recognition
process, which will take into consideration decisions made by the
EMA and certain other regulatory authorities, is anticipated to be
in place. The MHRA has also established its own decentralized or
mutual recognition procedures enabling MAs approved in EU Member
States through decentralized and mutual recognition procedures to
be recognized in the United Kingdom or Great Britain. It is
currently unclear to what extent the UK will seek to align its
regulations with the EU in the future.
The data exclusivity periods in the UK are currently in line with
those in the EU, but the TCA provides that the periods for both
data and market exclusivity are to be determined by domestic law,
so there could be divergence in the future.
Privacy and Data Security Laws and Compliance
Obligations
In the ordinary course of our business, we may process personal or
sensitive data. Accordingly, we are, or may become, subject to
numerous obligations, including U.S. federal, state and local, as
well as foreign, data privacy and security laws, regulations,
guidance and industry standards, and other legal obligations
related to privacy and data security. The regulatory framework with
respect to data privacy and security is stringent and constantly
evolving. For example, in addition to laws such as HIPAA that
govern the processing of health information, we are or may become
subject to numerous other data privacy and security laws and legal
obligations, which may include laws such as the Federal Trade
Commission Act, the California Consumer Privacy Act of 2018, or
CCPA, the California Privacy Rights Act of 2020, or CPRA, and
similar laws enacted or proposed in other states in the United
States, the EU’s General Data Protection Regulation 2016/679, or EU
GDPR, and the EU GDPR as it forms part of UK law by virtue of
section 3 of the European Union (Withdrawal) Act 2018, or UK GDPR.
Additionally, we are, or may become, subject to various U.S.
federal and state consumer protection laws which require us to
publish statements that accurately and fairly describe how we
handle personal data and choices individuals may have about the way
we handle their personal data.
These laws and obligations impose on subject entities extensive,
costly and complex compliance obligations, which may conflict or be
inconsistent with one another, and violations may result in
significant fines, penalties and other adverse consequences. The
CCPA and EU GDPR are examples of the increasingly stringent and
evolving regulatory frameworks related to personal data processing
that may increase our compliance obligations and exposure for any
noncompliance. For example, the CCPA imposes obligations on covered
businesses to provide specific disclosures related to a business’s
collecting, using and disclosing personal data and to respond to
certain requests from California residents related to their
personal data. Also, the CCPA provides for civil penalties and a
private right of action for data breaches which may include an
award of statutory damages. In addition, the CPRA, effective
January 1, 2023, expanded the CCPA to, among other things, give
California residents the ability to limit use of certain sensitive
personal data, establish restrictions on personal data retention,
expand the types of data breaches that are subject to the CCPA’s
private right of action and establish a new California Privacy
Protection Agency to implement and enforce the new
law.
Foreign data privacy and security laws (including but not limited
to the EU GDPR and UK GDPR) impose significant and complex
compliance obligations on entities that are subject to those laws.
As one example, the EU GDPR applies to any company established in
the EEA and to companies established outside the EEA that process
personal data in connection with the offering of goods or services
to data subjects in the EEA or the monitoring of the behavior of
data subjects in the EEA. These obligations may include limiting
personal data processing to only what is necessary for specified,
explicit and legitimate purposes; requiring a legal basis for
personal data processing; requiring the appointment of a data
protection officer in certain circumstances; increasing
transparency obligations to data subjects; requiring data
protection impact assessments in certain circumstances; limiting
the collection and retention of personal data; increasing rights
for data subjects; formalizing a heightened and codified standard
of data subject consents; requiring the implementation and
maintenance of technical and organizational safeguards for personal
data; mandating notice of certain personal data breaches to the
relevant supervisory authorities and affected individuals; and
mandating the appointment of representatives in the EU in certain
circumstances. See “Risk Factors—Risks Related to Our Business and
Industry” for additional information about the privacy and data
security risks we may face, including in relation to the laws and
regulations to which we are or may become subject.
Rest of the World Regulation
For other countries outside of the EU, United Kingdom and the
United States, such as countries in Eastern Europe, Latin America
or Asia, the requirements governing the conduct of clinical trials,
product licensing, pricing and reimbursement vary from country to
country. Additionally, clinical trials must be conducted in
accordance with cGCP requirements and the applicable regulatory
requirements and the ethical principles that have their origin in
the Declaration of Helsinki. Failure to comply with applicable
foreign laws and regulatory requirements may result in, among other
things, fines, suspension or withdrawal of regulatory approvals,
product recalls, seizure of products and operating
restrictions.
Additional Laws and Regulations Governing International
Operations
If we further expand our operations outside of the United States,
we must dedicate additional resources to comply with numerous laws
and regulations in each jurisdiction in which we plan to operate.
The FCPA prohibits any U.S. individual or business from paying,
offering, authorizing payment or offering of anything of value,
directly or indirectly, to any foreign official, political party or
candidate for the purpose of influencing any act or decision of the
foreign entity in order to assist the individual or business in
obtaining or retaining business. The FCPA also obligates companies
whose securities are listed in the United States to comply with
certain accounting provisions requiring the company to maintain
books and records that accurately and fairly reflect all
transactions of the corporation, including international
subsidiaries, and to devise and maintain an adequate system of
internal accounting controls for international operations.
Likewise, the UK Bribery Act of 2010 applies to companies that
carry on all or part of their business in the UK, and prohibits
bribing another person or being bribed, bribing a foreign public
official with the intent to influence and obtain or retain business
or an advantage, and failure by a commercial party to prevent
bribery, including where the prohibited conduct or its effects
occurred entirely outside the UK.
Compliance with the FCPA and anti-corruption and anti-bribery laws
in other countries is expensive and difficult, particularly in
countries in which corruption is a recognized problem. In addition,
the FCPA presents particular challenges in the pharmaceutical
industry because, in many countries, hospitals are operated by the
government and doctors and other hospital employees are considered
foreign officials. Certain payments to hospitals in connection with
clinical trials and other work have been deemed to be improper
payments to government officials and have led to FCPA enforcement
actions.
Various laws, regulations and executive orders also restrict the
use and dissemination outside of the United States, or the sharing
with certain non-U.S. nationals, of information classified for
national security purposes, as well as certain products and
technical data relating to those products. If we expand our
presence outside of the United States, it will require us to
dedicate additional resources to comply with these laws, and these
laws may preclude us from developing, manufacturing or selling
certain products and product candidates outside of the United
States, which could limit our growth potential and increase our
development costs.
The failure to comply with laws governing international business
practices may result in substantial civil and criminal penalties
and suspension or debarment from government contracting. The U.S.
Securities and Exchange Commission, or SEC, also may suspend or bar
issuers from trading securities on U.S. exchanges for violations of
the FCPA’s accounting provisions.
Coverage, Pricing and Reimbursement
In the United States and in foreign markets, sales of any products
for which we receive regulatory approval for commercial sale will
depend, in part, on the extent to which third-party payors provide
coverage and establish adequate reimbursement levels for such
products. In the United States, third-party payors include federal
and state healthcare programs, private managed care providers,
health insurers and other organizations. Adequate coverage and
reimbursement from governmental healthcare programs, such as
Medicare and Medicaid in the United States, and commercial payors
are critical to new product acceptance.
Coverage and reimbursement by a third-party payor may depend upon a
number of factors, including the third-party payor’s determination
that use of a therapeutic is:
•a
covered benefit under its health plan;
•safe,
effective and medically necessary;
•appropriate
for the specific patient;
•cost-effective;
and
•neither
experimental nor investigational.
Coverage may also be more limited than the purposes for which the
product is approved by the FDA or comparable foreign regulatory
authorities. Reimbursement may impact the demand for, or the price
of, any product for which we obtain regulatory
approval.
Third-party payors are increasingly challenging the price,
examining the medical necessity and reviewing the
cost-effectiveness of medical products, therapies and services, in
addition to questioning their safety and efficacy. Obtaining
reimbursement for our products may be particularly difficult
because of the higher prices often associated with branded drugs
and drugs administered under the supervision of a physician. We may
need to conduct expensive pharmacoeconomic studies in order to
demonstrate the medical necessity and cost-effectiveness of our
products. Obtaining coverage and reimbursement approval of a
product from a government or other third-party payor is a
time-consuming and costly process that could require us to provide
to each payor supporting scientific, clinical and
cost-effectiveness data for the use of our product on a
payor-by-payor basis, with no assurance that coverage and adequate
reimbursement will be obtained. A payor’s decision to provide
coverage for a product does not imply that an adequate
reimbursement rate will be approved. Adequate third-party
reimbursement may not be available to enable us to maintain price
levels sufficient to realize an appropriate return on our
investment in product development. If reimbursement is not
available or is available only at limited levels, we may not be
able to successfully commercialize any product candidate that we
successfully develop.
Different pricing and reimbursement schemes exist in other
countries. In the EU, governments influence the price of
pharmaceutical products through their pricing and reimbursement
rules and control of national health care systems that fund a large
part of the cost of those products to consumers. Some jurisdictions
operate positive and negative list systems under which products may
only be marketed once a reimbursement price has been agreed. To
obtain reimbursement or pricing approval, some of these countries
may require the completion of clinical trials that compare the cost
effectiveness of a particular product candidate to currently
available therapies. Other member states allow companies to fix
their own prices for medicines but monitor and control company
profits. The downward pressure on health care costs has become
intense. As a result, increasingly high barriers are being erected
to the entry of new products. In addition, in some countries,
cross-border imports from low-priced markets exert a commercial
pressure on pricing within a country.
The marketability of any product candidates for which we receive
regulatory approval for commercial sale may suffer if the
government and third-party payors fail to provide adequate coverage
and reimbursement. In addition, emphasis on managed care, the
increasing influence of health maintenance organizations and
additional legislative changes in the United States have increased,
and we expect will continue to increase, the pressure on healthcare
pricing. The downward pressure on the rise in healthcare costs in
general, particularly prescription medicines, medical devices and
surgical procedures and other treatments, has become very intense.
Coverage policies and third-party reimbursement rates may change at
any time. Even if favorable coverage and reimbursement status is
attained for one or more products for which we receive regulatory
approval, less favorable coverage policies and reimbursement rates
may be implemented in the future.
Before products become available to patients in the EEA, they are
generally subject to decisions on pricing and reimbursement by the
applicable authorities in a Member State. Key criteria to determine
the reimbursement status and pricing of a product may include the
product’s therapeutic value, medical need, safety and cost
effectiveness. Obtaining pricing and reimbursement approval of a
product from a government is a time-consuming and costly process,
and significant uncertainty exists as to the pricing and
reimbursement status of any product candidates for which we may
seek marketing approval in the EEA. Our ability to commercialize
any such products successfully in the EEA will depend, in part, on
the outcome of these decisions.
In many EU Member States periodically review their reimbursement
procedures for medicinal products, which could have an adverse
impact on reimbursement status. We expect that legislators,
policymakers and healthcare insurance funds in the EU Member States
will continue to propose and implement cost-containing measures,
such as lower maximum prices, lower or lack of reimbursement
coverage and incentives to use cheaper, usually generic, products
as an alternative to branded products, and/or branded products
available through parallel import to keep healthcare costs down.
Moreover, in order to obtain reimbursement for our products in some
European countries, including some EU Member States, we may be
required to compile additional data comparing the
cost-effectiveness of our products to other available therapies.
Health Technology Assessment, or HTA, of medicinal products is
becoming an increasingly common part of the pricing and
reimbursement procedures in some EU Member States, including those
representing the larger markets. The HTA process, which is
currently governed by national laws in each EU Member State, is the
procedure to assess therapeutic, economic and societal impact of a
given medicinal product in the national healthcare systems of the
individual country. The outcome of an HTA will often influence the
pricing and reimbursement status granted to these medicinal
products by the competent authorities of individual EU Member
States. The extent to which pricing and reimbursement decisions are
influenced
by the HTA of the specific medicinal product currently varies
between EU Member States. In 2021 the European Union Parliament
adopted the HTA regulation which, when it enters into application
in 2025, will be intended to harmonize the clinical benefit
assessment of HTA across the European Union. If we are unable to
maintain favorable pricing and reimbursement status in EU Member
States for product candidates that we may successfully develop and
for which we may obtain regulatory approval, any anticipated
revenue from and growth prospects for those products in the
European Union could be negatively affected.
Legislators, policymakers and healthcare insurance funds in the EU
and the UK may continue to propose and implement cost-containing
measures to keep healthcare costs down; particularly due to the
financial strain that the COVID-19 pandemic has placed on national
healthcare systems. These measures could include limitations on the
prices we would be able to charge for product candidates that we
may successfully develop and for which we may obtain regulatory
approval or the level of reimbursement available for these products
from governmental authorities or third-party payors. Further, an
increasing number of EU and other foreign countries use prices for
medicinal products established in other countries as “reference
prices” to help determine the price of the product in their own
territory. Consequently, a downward trend in prices of medicinal
products in some countries could contribute to similar downward
trends elsewhere.
Healthcare Reform
In the United States and some foreign jurisdictions, there have
been, and continue to be, several legislative and regulatory
changes and proposed changes regarding the healthcare system that
could prevent or delay marketing approval of product candidates,
restrict or regulate post-approval activities and affect the
ability to profitably sell product candidates for which marketing
approval is obtained. Among policy makers and payors in the United
States and elsewhere, there is significant interest in promoting
changes in healthcare systems with the stated goals of containing
healthcare costs, improving quality and/or expanding access. In the
United States, the pharmaceutical industry has been a particular
focus of these efforts and has been significantly affected by major
legislative initiatives.
The ultimate content, timing or effect of any healthcare reform
legislation on the U.S. healthcare industry is unclear. For
example, on August 16, 2022, President Biden signed the Inflation
Reduction Act of 2022, or the IRA, into law, which among other
things, (1) directs the U.S. Department of Health and Human
Services, or HHS, to negotiate the price of certain single-source
drugs and biologics covered under Medicare and (2) imposes rebates
under Medicare Part B and Medicare Part D to penalize price
increases that outpace inflation. These provisions will take effect
progressively starting in fiscal year 2023, although they may be
subject to legal challenges. It is currently unclear how the IRA
will be implemented but is likely to have a significant impact on
the pharmaceutical industry.
Further, in March 2010, the ACA was signed into law and has
substantially changed healthcare financing and delivery by both
governmental and private insurers. Among the ACA provisions of
importance to the pharmaceutical and biotechnology industries are
those governing enrollment in federal healthcare programs, a new
methodology by which rebates owed by manufacturers under the
Medicaid Drug Rebate Program are calculated for drugs that are
inhaled, infused, instilled, implanted or injected and annual fees
based on pharmaceutical companies’ share of sales to federal
healthcare programs.
There have been legal and political challenges to certain aspects
of the ACA. For example, former President Trump signed several
executive orders and other directives designed to delay, circumvent
or loosen certain requirements mandated by the ACA. On June 17,
2021, the U.S. Supreme Court dismissed a challenge on procedural
grounds that argued the ACA is unconstitutional in its entirety
because the “individual mandate” was repealed by Congress. However,
the ACA may be subject to judicial or Congressional challenges in
the future. Additionally, on January 28, 2021, President Biden
issued an executive order instructing certain governmental agencies
to review and reconsider their existing policies and rules that
limit access to healthcare, including among others, reexamining
Medicaid demonstration projects and waiver programs that include
work requirements, and policies that create unnecessary barriers to
obtaining access to health insurance coverage through Medicaid or
the ACA. The IRA, among other things, extends enhanced subsidies
for individuals purchasing health insurance coverage in ACA
marketplaces through plan year 2025 and eliminates the “donut hole”
under the Medicare Part D program beginning in 2025 by
significantly lowering the beneficiary maximum out-of-pocket cost
through a newly established manufacturer discount
program.
We anticipate that the ACA, if substantially maintained in its
current form, will continue to result in additional downward
pressure on coverage and the price that we receive for any approved
product, and could seriously harm our business. Any reduction in
reimbursement from Medicare and other government programs may
result in a similar reduction in payments from private payors. The
implementation of cost containment measures or other
healthcare reforms may prevent us from being able to generate
revenue, attain profitability or commercialize our
products.
Further legislation or regulation could be passed that could harm
our business, financial condition and results of operations. Other
legislative changes have been proposed and adopted since the ACA
was enacted. Aggregate reductions to Medicare payments to providers
of up to 2% per fiscal year, which went into effect beginning on
April 1, 2013, will stay in effect through 2031 unless additional
Congressional action is taken. Under current legislation. the
actual reduction in Medicare payments will vary from 1% in 2022 to
up to 4% in later years.
Additionally, there has been increasing legislative and enforcement
interest in the United States with respect to specialty drug
pricing practices. Specifically, there have been several U.S.
Congressional inquiries, presidential executive orders and proposed
and enacted federal legislation designed to, among other things,
bring more transparency to drug pricing, reduce the cost of
prescription drugs under Medicare, review the relationship between
pricing and manufacturer-patient programs and reform government
program reimbursement methodologies for drugs. For example, in July
2021, the Biden administration released an executive order,
“Promoting Competition in the American Economy,” with multiple
provisions aimed at prescription drugs. In response to President
Biden’s executive order, on September 9, 2021, the United States
Department of Health and Human Services, or HHS, released a
Comprehensive Plan for Addressing High Drug Prices that outlines
principles for drug pricing reform and sets out a variety of
potential legislative policies that Congress could pursue as well
as potential administrative actions HHS can take to advance these
principles. Further, the Biden administration released an
additional executive order on October 14, 2022, directing HHS to
submit a report on how the Center for Medicare and Medicaid
Innovation can be further leveraged to test new models for lowering
drug costs for Medicare and Medicaid beneficiaries. It is unclear
whether this executive order or similar policy initiatives will be
implemented in the future. Individual states in the United States
have also become increasingly active in passing legislation and
implementing regulations designed to control pharmaceutical product
pricing, including price or patient reimbursement constraints,
discounts, restrictions on certain product access and marketing
cost disclosure and transparency measures, and, in some cases,
designed to encourage importation from other countries and bulk
purchasing.
Human Capital
Our team of talented scientists and industry professionals is the
foundation of our company and fuels our historical and prospective
achievements for patients. We consider the intellectual capital of
our employees to be an essential driver of our business and key to
our future opportunities. As of December 31, 2022, we had 239
employees, of which approximately 155 (65%) were engaged in R&D
activities, 89 hold Ph.D. and/or M.D. degrees and an additional 52
hold a masters or other post-graduate degree. Every NGM team member
plays a vital role in furthering our goals and impacting our
progress towards fully realizing our mission to develop
transformative therapies for patients.
To succeed in our mission, we must attract, recruit, retain,
develop and motivate qualified clinical, nonclinical, scientific,
manufacturing, regulatory, management and other personnel needed to
support our business and operations. We recruit for talent in the
biotechnology and pharmaceutical industry in the San Francisco Bay
Area, which is in one of the most competitive and highest cost
labor markets in the United States and periodically experiences
higher turnover rates than other industries. For example, in 2022,
we continued to experience a challenging recruiting environment
with relative high rates of employees leaving the company to pursue
other opportunities, particularly in the first three quarters of
the year. This turnover was mitigated by a robust recruiting
effort, including extensive efforts to source and interview a
talented and diverse pipeline of candidates. We maintain a
comprehensive dashboard of measurements, including recruitment
productivity, diversity, equity and inclusion metrics, employee
engagement scores, total rewards benchmarking, participation rates
and satisfaction scores for internal training, turnover rates and
exit interview results, to guide our human capital management
efforts.
We believe that we can best address competitive challenges by
enhancing the reputation of NGM as a great place to work, which
includes nurturing our workplace culture, providing competitive
compensation and benefits programs and supporting employee career
development and related management training. To that end, we
continue to invest resources and energy into being an employer of
choice – attracting and engaging individuals who are innovative,
curious, driven, diligent, collaborative and of the highest
integrity and ethics. Some of our key efforts in this area and
management of our human capital assets generally are described
here.
Compensation and Benefits
Our compensation philosophy is to provide pay and benefits that are
competitive in the biotechnology and pharmaceutical industry where
we compete for talent. We monitor our compensation programs closely
and review them throughout the year to provide what we consider a
very competitive mix of compensation and health,
welfare
and retirement benefits for all our employees. Our compensation
package for all employees includes market-competitive base
salaries, eligibility for annual performance bonuses and equity
grants. Our benefits programs include company-sponsored medical,
dental and vision health care coverage, life and AD&D
insurance, a 401(k) plan with a matching employer contribution,
paid time off and family leave and an employee stock purchase plan,
among others benefits. Every year, we undertake a detailed review
of our compensation by position and level and make adjustments
necessary to ensure that we continue to provide competitive
compensation. Our hiring practices and annual compensation reviews
are designed to ensure fairness in pay equity across gender and
ethnicity among similar roles and responsibilities throughout our
organization, after accounting for legitimate business factors that
can explain differences, such as performance, time at grade level,
education and tenure. In conjunction with the California’s Pay
Transparency law (SB 1162), beginning January 1, 2023, we will
publish pay ranges in all job postings and we are proactively
providing existing employees with the salary range for their
positions. In addition, our efforts extend beyond pay equity to
include fairness in gender and ethnic representation at all levels
in the organization.
Diversity, Equity and Inclusion
Our goal is to have a diverse, equitable and inclusive workforce –
not just because it is the right thing to do, but because we
believe this is key to our long-term success. As of December 31,
2022, NGM employed 136 women (57%) and 103 men (43%), and 59% of
our employees self-identify as non-white, including 10% that are
from traditionally underrepresented groups. Our leadership,
including employees at or above the vice president level and
members of our board of directors, includes 43% women and 22% who
self-identify as non-white. To champion our efforts in this area, a
cross-functional team of employees continues to drive our
diversity, equity and inclusion initiatives that have focused on
awareness and understanding; diverse candidate pipelines; community
outreach; advocacy and career advancement; and business impact. Our
efforts, which began in 2020 with a focus on anti-Black racism,
have included mandatory unconscious bias and discrimination
training, an employee-led diversity page on our intranet updated
monthly with fresh content, voluntary participation in a program to
encourage allyship, guest speaker programs on Diversity, Equity
& Inclusion, or DEI, topics, and conducting a survey to
understand employee sentiment around race-related issues to
establish a baseline for tracking future progress. We implemented
an internship program targeted to students from underrepresented
minorities and adopted specific quantitative efforts to provide the
company with a diverse candidate pipeline and more diverse
interview panels. In addition to internal efforts, our research
employees volunteer to teach elementary school students various
topics in biology.
In 2022, we engaged an external consultant with expertise in DEI to
help conduct an assessment to understand where improvements could
be made in our culture to drive equitable outcomes and foster an
inclusive environment, with a particular focus on women scientists.
The assessment included cross-organizational interviews, focus
group discussions, a detailed review of our policies, programs and
business norms, an all-employee inclusion survey and a review of
organizational diversity metrics to determine what are the barriers
to success and advancement of women and underrepresented groups.
The project identified three areas of action that are being shared
across the company, and we plan to begin to implement the
recommendations in 2023. In addition, we supported an employee-led
effort to develop our first employee resource group, N-GAGE (NGM
Gathers to Advance Gender Equity). Since its inception, N-GAGE has
supported the DEI assessment, created community spaces for
engagement and discussions on current topics disproportionately
affecting women, and incubated a company-wide mentorship and
professional enrichment program starting with speed-mentoring
events and guest speakers with a planned roll-out in
2023.
Communication and Engagement
We believe that part of what sets NGM apart from other companies is
our culture and, in particular, our focus on providing timely and
transparent communications and creating a strong sense of belonging
and inclusiveness. In 2022, after nearly two years of the COVID-19
pandemic, we were able to reinstate many of the traditions and
celebrations that contribute to what makes NGM a special place to
work: monthly themed happy hours; weekly group lunch programs,
often with employee-led lunch-and-learns with scientific and other
updates of interest; quarterly all-hands' meetings; regular coffee
chats or other gatherings for small groups with our CEO and other
members of senior management; and events including a summer family
picnic, Thanksgiving potluck and holiday white elephant party,
among many others.
We survey our employees each year to measure their level of
engagement at NGM. Our employee engagement scores have remained
relatively steady over the past three years, despite the challenges
we faced through the COVID-19 pandemic and disappointing clinical
trial readouts. These surveys provide rich feedback each year that
helps us to continue to grow our culture and make NGM a great place
to work.
Health, Wellness and Safety
In addition to specific support relating to health and safety
during the COVID-19 pandemic, we continue other activities that
continue to promote our employees' whole health and wellness,
including an on-site gym, external support from our employee
assistance program and mental wellness and health advocacy
services.
None of our employees is subject to a collective bargaining
agreement or represented by a trade or labor union. We consider our
relations with our employees to be good.
Corporate and Available Information
We were incorporated in Delaware in December 2007 and commenced
operations in 2008. Our principal executive offices are located at
333 Oyster Point Blvd., South San Francisco, CA 94080-7014, and our
telephone number is (650) 243-5555. Our website address is
http://www.ngmbio.com.
We file or furnish electronically with the U.S. Securities and
Exchange Commission, or the SEC, annual reports on Form 10-K,
quarterly reports on Form 10-Q, current reports on Form 8-K and
amendments to those reports filed or furnished pursuant to Section
13(a) or 15(d) of the Exchange Act. We make copies of these reports
available free of charge through the “SEC Filings” tab on the
“Investors & Media” page of our website as soon as reasonably
practicable after we file or furnish them with the
SEC.
Information contained on or accessible through our website is not
incorporated into, and does not form a part of, this Annual Report
or any other report or document we file with the SEC, and any
references to our website are intended to be inactive textual
references only.
Item 1A. Risk Factors.
An investment in our common stock involves a high degree of risk.
You should carefully consider the risks and uncertainties described
below before deciding whether to make an investment decision with
respect to our common stock. You should also refer to the other
information contained in this Annual Report on Form 10-K, including
in Part II, Item 7, “Management’s Discussion and Analysis of
Financial Condition and Results of Operations” and in our
consolidated financial statements and related notes, as well as our
other filings with the U.S. Securities and Exchange Commission, or
SEC. Our business, financial condition, results of operations,
stock price and prospects could be materially and adversely
affected by any of these risks or uncertainties. In any such case,
the trading price of our common stock could decline, and you could
lose all or part of your investment. We caution you that the risks,
uncertainties and other factors referred to below and elsewhere in
this Annual Report on Form 10-K may not contain all of the risks,
uncertainties and other factors that may affect our future results
and operations. Additional risks and uncertainties not presently
known to us or that we currently deem immaterial may also impair
our business operations and the market price of our common stock.
Moreover, new risks will emerge from time to time. It is not
possible for our management to predict all risks.
Risks Related to Our Financial Condition and Capital
Needs
We have incurred net losses every year since our inception and have
no source of product revenue. We expect to continue to incur
significant operating losses and may never become
profitable.
We have no products approved for commercial sale and have not
generated any revenue from product sales to date. As a result, we
are not profitable and have incurred losses in each year since
commencing operations. Our net losses were $162.7 million, $120.3
million and $102.5 million for the years ended December 31,
2022, 2021 and 2020, respectively. As of December 31, 2022, we
had an accumulated deficit of $581.6 million.
We expect to continue to incur significant research and
development, or R&D, and other expenses related to our ongoing
operations for the foreseeable future, particularly to fund R&D
of, and seek regulatory approvals for, our product candidates. We
incurred substantial net operating losses in 2022 and expect to
continue to incur significant operating losses in 2023 and over the
next several years as our research, development, manufacturing,
preclinical studies, clinical trial and related activities
increase. We expect our accumulated deficit will also increase in
future periods. The size of our future net losses will depend, in
part, on the amount of our expenses and our ability to generate
revenue. All of our revenue from recent periods has been provided
under our collaboration with Merck Sharp & Dohme LLC, or Merck,
under the amended and restated research collaboration, product
development and license agreement we entered into with Merck on
June 30, 2021, or the Amended Collaboration Agreement. That revenue
will be substantially lower in 2023 than in 2022 and prior years
and minimal thereafter. See the risk factor titled
“All of our revenue for recent periods has been received from a
single collaboration partner, and that revenue will be
substantially lower going forward as compared to historical
periods.”
Our prior losses and expected future losses have had and will
continue to have an adverse effect on our stockholders’ equity and
working capital.
In addition, we will not be able to generate product revenue unless
and until one of our product candidates successfully completes
clinical trials, receives regulatory approval and is successfully
commercialized. As our product candidates are in Phase 2 trials or
in earlier stages of development, we do not expect to receive
product revenue from our product candidates for a number of years,
if ever.
Our ability to generate any product revenue from our current or
future product candidates also depends on a number of additional
factors, including our ability or the ability of any potential
future third-party partner to:
•successfully
complete research and clinical development of current and future
product candidates and obtain regulatory approval for those product
candidates;
•establish
and maintain supply and manufacturing relationships with third
parties, and ensure adequate, scaled up and legally compliant
manufacturing of bulk drug substances and drug products to maintain
sufficient supply;
•launch
and commercialize any product candidates for which marketing
approval is obtained, if any, and, if launched independently by us
without a partner, successfully establish a sales force and
marketing and distribution infrastructure;
•demonstrate
the necessary safety data (and, if accelerated approval is
obtained, verify the clinical benefit) post-approval to ensure
continued regulatory approval;
•obtain
coverage and adequate product reimbursement from third-party
payors, including government payors, for any approved
products;
•achieve
market acceptance for any approved products;
•establish,
maintain, protect and enforce our intellectual property rights;
and
•attract,
hire and retain qualified personnel.
Because of the numerous risks and uncertainties associated with
pharmaceutical product development, including that our product
candidates may not advance through development or be approved for
commercial sale, we are unable to predict if or when we will
generate product revenue or achieve or maintain
profitability.
Even if we successfully complete development and regulatory
processes for any product candidates that we take forward, we
anticipate incurring significant costs associated with launching
and commercializing any products. If we fail to become profitable
or do not sustain profitability on a continuing basis, we may be
unable to continue our operations at planned levels and be forced
to reduce or cease our operations.
All of our revenue for recent periods has been received from a
single collaboration partner, and that revenue will be
substantially lower going forward as compared to historical
periods.
We do not have any committed external source of funds, other than
pursuant to our collaboration with Merck, which has provided us
with substantial financial support since 2015. However, as
described under “Management’s Discussion and Analysis of Financial
Condition and Results of Operations—Overview of Our
Business—Licensing and Collaboration Updates” in Part II, Item 7 of
this Annual Report on Form 10-K, in 2023 the R&D funding we
receive from Merck under the collaboration will be substantially
lower on an annual basis than the research funding previously
provided by Merck. In this regard, for the period that started on
January 1, 2023 and ends on March 31, 2024, we expect to receive
funding of approximately $13.0 million in the aggregate from Merck
for the ongoing activities under the Amended Collaboration
Agreement and for certain costs and reimbursements related to the
NGM621 program. Funding from Merck after December 31, 2023 is
expected to be minimal.
In any event, we need to devote a substantial amount of our own
financial resources to our R&D programs, particularly with
respect to our wholly-owned programs that now include all of our
ophthalmology programs and, as described below, once Merck's
termination of its license with respect to MK-3655 is effective,
MK-3655 (NGM313). In addition, our funding requirements would
increase for any preclinical programs that remain within the scope
of the collaboration in the event Merck does not elect to license
these programs and we decide to continue them, in the event Merck
elects to terminate its license to any program it licenses and we
decide to continue it or in the event we opt to co-develop any
Merck-licensed programs. For example, as a result of Merck’s
decision not to exercise its option to license NGM621 and its
related compounds, as described below, NGM621 and its related
compounds are now wholly-owned by us. Further development of NGM621
is primarily dependent on our ability to secure potential future
collaboration, out licensing, partnering or other business
development arrangements, or BD Arrangements, with third-party
partners and, in the absence of such BD Arrangements, we are
unlikely to be able to advance development of NGM621 unless our
portfolio prioritization changes and we have access to the
necessary capital to fund such development. In addition, as a
result of Merck's decision to terminate its license to MK-3655 and
its related compounds, once the termination is effective, the
license rights granted to Merck in 2018 with respect to MK-3655
will revert to us and the program will become wholly-owned by us.
Further development of MK-3655, once the termination is effective,
is also primarily dependent on our ability to secure potential
future BD Arrangements and, in the absence of such BD Arrangements,
we are unlikely to be able to advance development of MK-3655 unless
our portfolio prioritization changes and we have access to the
necessary capital to fund such development.
Other than our Amended Collaboration Agreement with Merck, which is
limited in scope and duration, and may be unilaterally terminated
by Merck under certain circumstances, we are not party to any
agreements that could provide us with future revenue. Accordingly,
we will need to raise significant additional capital and we will
need to enter into additional partnering arrangements in order to
proceed with development through regulatory approval and
commercialization of our current and potential future product
candidates. Neither may be possible and, as a result, if adequate
funds are not available when we need them, we may need to
significantly delay, scale back or discontinue development of or
abandon some or all of our product candidates or scale back or
discontinue discovery efforts, which could have a material adverse
effect on our business, operating results and prospects, or we may
be required to cease operations altogether.
We will need significant additional capital to proceed with
development and commercialization of our current and potential
future product candidates and our other operations. We may not be
able to access sufficient capital on acceptable terms, if at all,
and, as a result, we may be required to delay, scale back or
discontinue development of such product candidates or other
operations.
As an R&D company, our operations have consumed substantial
amounts of cash since inception, and we will require substantial
additional capital to finance our operations and pursue our
strategy, both in the short and the long term, and the amount of
funding we will need depends on many factors,
including:
•the
initiation, progress, timing, delays, costs and results of
preclinical studies and clinical trials for our current and future
product candidates;
•the
outcome, timing and cost of seeking and obtaining regulatory
approvals from the United States Food and Drug Administration, or
FDA, and comparable foreign health authorities, including the
potential for such authorities to require that we perform more
studies than those that we currently expect or to change their
requirements on studies that had previously been agreed
to;
•the
cost to establish, maintain, expand, enforce and defend the scope
of our intellectual property portfolio, including the amount and
timing of any payments we may be required to make, or that we may
receive, in connection with licensing, preparing, filing,
prosecuting, defending and enforcing any patents or other
intellectual property rights;
•the
cost and timing of selecting, auditing and potentially validating a
manufacturing site for later-stage clinical and commercial-scale
manufacturing;
•the
effect of products that may compete with our product candidates or
other market developments;
•market
acceptance of any approved product candidates, including product
pricing and product reimbursement by third-party
payors;
•whether
Merck exercises its option to license any preclinical candidates
that remain within the scope of the collaboration at the license
option point as specified in the Amended Collaboration Agreement
for each such candidate;
•whether
Merck terminates the research phase of the collaboration under
pre-specified circumstances set forth in the Amended Collaboration
Agreement or terminates a program that it has licensed, such as its
decision to terminate its license for MK-3655 and its related
compounds;
•the
cost of potentially acquiring, licensing or investing in additional
businesses, products, product candidates and technologies;
and
•the
cost of establishing sales, marketing and distribution capabilities
for any of our product candidates for which we may receive
regulatory approval and that we determine to commercialize
ourselves or in collaboration with partners.
We believe that our existing cash, cash equivalents and short-term
marketable securities will be sufficient to fund our operations for
at least the twelve months from the date of filing of this Annual
Report on Form 10-K. Moreover, based on our current development
plans and related assumptions, we believe our current cash position
is sufficient to fund our key solid tumor oncology programs through
generation of proof-of-concept data. We have based these estimates
on plans and assumptions that may prove to be insufficient or
inaccurate (for example, with respect to anticipated costs, timing
or success of certain activities), and we could utilize our
available capital resources sooner than we currently expect. In
addition, our forecast of the period of time through which our
financial resources will be adequate to support our operations is a
forward-looking statement that involves risks and uncertainties,
and actual results could vary materially as a result of a number of
factors, including the factors discussed elsewhere in this “Risk
Factors” section.
We plan to finance our future cash needs through public or private
equity or debt offerings, including under the Open Market Sale
AgreementSM,
or the Sales Agreement, we entered into with Jefferies LLC in June
2020, BD Arrangements or a combination of these potential financing
sources. Additional capital may not be available in sufficient
amounts, on reasonable terms or when we need it, if at all. While
the long-term economic impact of either the COVID-19 pandemic or
the conflict between Russia and Ukraine is difficult to assess or
predict, each of these events has caused significant disruptions to
the global financial markets and contributed to a general global
economic slowdown. Furthermore, inflation rates, particularly in
the United States and the U.K., have increased recently to levels
not seen in decades. Increased inflation may result in increased
operating costs (including labor costs) and may affect our
operating budgets. In addition, the U.S. Federal Reserve has
raised, and is expected to further raise, interest rates in
response to concerns about inflation. Increases in interest rates,
especially if coupled with reduced government spending and
volatility in financial markets, may further increase economic
uncertainty
and heighten these risks. If the financial market disruptions and
economic slowdown deepen or persist, we may not be able to access
additional capital on favorable terms, or at all, which could in
the future negatively affect our financial condition and our
ability to pursue our business strategy.
If adequate funds are not available from public or private equity
or debt offerings on acceptable terms when needed, in order to
continue the development of product candidates outside of the scope
of the collaboration with Merck we may need to:
•seek
strategic alliances for R&D programs when we otherwise would
not, at an earlier stage than we would otherwise desire or on terms
less favorable than might otherwise be available; or
•enter
into BD Arrangements that could require us to relinquish, or
license, on potentially unfavorable terms, our rights to
intellectual property, product candidates or products that we
otherwise would develop or seek to commercialize
ourselves.
In this regard, due to the need to conserve capital and prioritize
focused execution, we are actively seeking, or intend to seek, BD
Arrangements with third-party partners with sufficient resources
and relevant domain expertise in order to further the clinical
development, if any, of NGM621, aldafermin, NGM936 and, once
termination of Merck's license is effective, MK-3655. Further
development of these programs, which are in therapeutic areas where
clinical development is relatively resource intensive and can have
long timelines to generate proof-of-concept data, is primarily
dependent on our ability to secure potential future BD
Arrangements. However, we may not be able to enter into such BD
Arrangements on acceptable terms, if at all. We face significant
competition in seeking appropriate partners. Whether we reach a
definitive agreement for a BD Arrangement will depend, among other
things, upon the potential partner’s evaluation of the subject
product candidate and its market opportunity, our assessment of the
partner’s resources and expertise and the terms and conditions of
the potential BD Arrangement. In the absence of such BD
Arrangements for these programs, we are unlikely to be able to
advance their development unless our portfolio prioritization
changes and we have access to the necessary capital to fund such
development.
We are also restricted under our existing Amended Collaboration
Agreement with Merck, and may be restricted under future BD
Arrangements, from entering into additional agreements on certain
terms with potential partners. For example, under the current terms
of the Amended Collaboration Agreement, we may not directly or
indirectly research, develop, manufacture or commercialize, except
pursuant to the Amended Collaboration Agreement, any medicine or
product candidate that modulates a target then subject to the
collaboration with specified activity. In addition, under the
Amended Collaboration Agreement, we are prohibited from, directly
or indirectly, researching, developing or commercializing any
product for the treatment of heart failure with preserved ejection
fraction, or HFpEF, during the research phase for the CVM-related
programs.
We may not be able to raise adequate additional capital or
negotiate potential future BD Arrangements on a timely basis, on
acceptable terms or at all. If we are unable to do so, we may need
to significantly delay, scale back or discontinue development of or
abandon some or all of our product candidates, or scale back or
discontinue discovery research efforts, which could have a material
adverse effect on our business, operating results and prospects, or
we may be required to cease operations altogether.
Raising additional capital may cause dilution to our existing
stockholders, lead to restrictions on our operations or require us
to relinquish rights to our product candidates or intellectual
property.
If we raise additional funds by issuing equity securities, our
stockholders may experience dilution. Debt financing, if available,
may involve restrictive covenants. Any debt financing or additional
equity that we raise may contain terms that are not favorable to us
or our stockholders. Our ability to raise capital may be adversely
impacted by the trading prices of our common stock following the
announcement in October 2022 that the CATALINA trial did not meet
its primary endpoint. Furthermore, any securities that we may issue
may have rights senior to those of our common stock and could
contain covenants or protective rights that would lead to
restrictions on our operations and potentially impair our
competitiveness, such as limitations on our ability to incur
additional debt, limitations on our ability to acquire, sell or
license intellectual property rights and other operating
restrictions that could adversely impact our ability to conduct our
business.
Risks Related to Our Dependence on Third Parties
Funding from Merck under the collaboration after December 31, 2023
is expected to be minimal, and we may never realize the anticipated
benefits to us of the collaboration.
As described in more detail under “Business—Licensing and
Collaboration Arrangements—Merck Collaboration” in Part I, Item 1
of this Annual Report on Form 10-K and under “Management’s
Discussion and Analysis of Financial Condition and Results of
Operations—Overview of Our Business—Business Development and Merck
Collaboration Updates” in Part II, Item 7 of this Annual Report on
Form 10-K, our continuing Merck collaboration involves a complex
allocation of rights, provides for certain limited R&D funding
and, for remaining collaboration preclinical candidates for which
Merck exercises its license option, if any, provides us with either
milestone payments based on the achievement of specified clinical
development, regulatory and commercial milestones and royalty-based
revenue if certain product candidates are successfully
commercialized or a cost and profit share arrangement with the
possibility that we would provide sales representatives to
co-detail the product candidates that Merck elects to advance in
the United States.
The level of R&D funding we expect to receive from Merck will
be limited and substantially lower on an annual basis than the
funding previously provided by Merck. In this regard, for the
period that started on January 1, 2023 and ends on March 31, 2024,
we expect to receive funding of approximately $13.0 million in the
aggregate from Merck for the ongoing activities under the Amended
Collaboration Agreement and for certain costs and reimbursements
related to the NGM621 program. Funding from Merck after December
31, 2023 is expected to be minimal.
In addition, in January 2023, we announced that Merck notified us
of its decision to terminate the Phase 2b trial of MK-3655 in
patients with nonalcoholic steatohepatitis, or NASH, and liver
fibrosis stage 2 or 3, or F2/F3, and Merck subsequently provided us
with the required 90-days' notice of partial termination of the
Amended Collaboration Agreement as it relates to MK-3655 and its
related compounds. As a result, in late April 2023, the license
rights granted to Merck in 2018 with respect to MK-3655 will revert
to us and the program will become wholly-owned by us. Further
development of MK-3655, once the termination is effective, is
primarily dependent on our ability to secure potential future BD
Arrangements and, in the absence of such BD Arrangements, we are
unlikely to be able to advance development of MK-3655 unless our
portfolio prioritization changes and we have access to the
necessary capital to fund such development.
Similarly, in October 2022, we announced that our Phase 2 CATALINA
trial evaluating NGM621 in patients with geographic atrophy, or GA,
secondary to age-related macular degeneration, or AMD, did not meet
its primary endpoint and, in December 2022, Merck notified us that
it would not exercise its option to license NGM621 and its related
compounds or the related ophthalmology bundle option and, as a
result, those options expired unexercised in January 2023. Further,
Merck did not elect for us to continue to conduct R&D on any
compounds from our other ophthalmology programs that were subject
to the collaboration, which are preclinical and directed to
undisclosed targets. Such an election would have resulted in an
extended or tail period in which Merck would continue to fund our
R&D of such ophthalmology compounds. Because Merck did not make
such an election, we do not have any funding from Merck to pursue
such ophthalmology programs after we complete certain wind down
activities related to NGM621, and if we choose to develop these
programs further, we will be responsible for funding them. As a
result, while our ophthalmology programs, including NGM621, are now
wholly-owned by us, further development of those programs is
primarily dependent on our ability to secure potential future BD
Arrangements and, in the absence of such BD Arrangements, we are
unlikely to be able to advance development of NGM621 or the
preclinical ophthalmology programs unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development.
We do not know whether Merck will elect to exercise its option to
license any CVM-related preclinical candidates that remain subject
to the collaboration. Accordingly, the anticipated benefits to us
of the collaboration with Merck may never be realized and it
possible that the Amended Collaboration Agreement will be
terminated without Merck exercising its option to license any other
programs or product candidates.
Moreover, under the Amended Collaboration Agreement, Merck has the
unilateral right to terminate all or part of the agreement at
certain times and under certain circumstances. Merck also may
unilaterally terminate its R&D funding for programs that remain
within the scope of the collaboration if we are acquired by a third
party or in the event of an uncured material breach by us. Subject
to certain limitations, Merck may partially terminate the Amended
Collaboration Agreement for convenience as it relates to any future
licensed program, as they did with respect to MK-3655 in January
2023 (effective in late April 2023) and with respect to our growth
differentiation factor 15, or GDF15, agonist program, which
included product candidates NGM395 and NGM386, in 2019. Merck may
also unilaterally terminate the Amended Collaboration Agreement as
it relates to its rights to research and develop
small molecule compounds. It may also unilaterally terminate the
Amended Collaboration Agreement with respect to a specific licensed
program in the event of an uncured material breach by us. If Merck
terminates a program as a result of our uncured material breach,
then we would lose our option to participate in a global cost and
profit share arrangement if not yet exercised as of the time of
termination and lose our co-detailing option (whether or not
exercised as of that time) for the relevant licensed
program.
If Merck terminates funding or terminates the Amended Collaboration
Agreement, it could delay or preclude our ability to further our
CVM-related research programs, which could materially and adversely
affect our business. In addition, in the event that Merck decides
to take over any CVM-related preclinical candidates that remain
within the scope of the collaboration for development during any
tail period, or exercises its license option for any such
preclinical candidate, we could be subject to disputes with Merck
with respect to their obligation to use commercially reasonable
efforts with respect to the development and commercialization of
the affected product candidate, and we could otherwise be subject
to disputes with Merck over the scope of the parties’ respective
rights under the Amended Collaboration Agreement, any of which
could delay or preclude the development or commercialization of the
affected product candidate and involve us in costly and
time-consuming arbitration and litigation, which could divert
management attention and resources and otherwise negatively affect
our business and operations.
We may depend in the future on BD Arrangements with third-party
partners for the development and commercialization of our product
candidates and for revenue. If we are unable to secure those BD
Arrangements on beneficial terms, if at all, or if any such future
arrangements are not successful, we may not be able to capitalize
on the market potential of our product candidates or continue their
development.
Pursuing BD arrangements has been and is expected to continue to be
a key component of our strategy, and we are actively seeking, or
intend to seek, BD Arrangements with third-party partners to
progress, in whole or in part, the development of one or more of
our product candidates. While we may opportunistically consider BD
Arrangements to advance development of our key solid tumor oncology
programs, the further development of other programs in our
pipeline, including NGM621, aldafermin, NGM936 and, once
termination of Merck's license is effective, MK-3655, is primarily
dependent on our ability to secure potential future BD Arrangements
for these programs. Due to the need to conserve capital and
prioritize focused execution and unless our portfolio
prioritization changes, if we are unable to secure BD Arrangements
for these programs on beneficial terms, if at all, we are unlikely
to be able to advance their development unless our portfolio
prioritization changes and may discontinue or abandon any or all of
these programs altogether, in which case we will not realize any
return on our investments in these programs. Even if we are
successful in entering into any BD Arrangements with third-party
partners for our programs, we will likely have limited control over
the amount and timing of resources that our partners dedicate to
the development or commercialization of the applicable product
candidates. Our ability to generate revenue from any such
arrangement will depend on the specific financial terms we reach
with any partner, as well as each of our partners’ abilities to
successfully perform the functions assigned to them in such
arrangement towards developing, seeking regulatory approval for and
commercializing our product candidates.
BD Arrangements involving our product candidates pose risks to us,
including the following:
•Partners
have significant discretion in determining the efforts and
resources that they will apply to these arrangements. For example,
under the terms of the collaboration with Merck, if Merck exercises
its option to acquire an exclusive license for any CVM-related
preclinical candidate that remains within the scope of the
collaboration, our ability to influence the resources Merck devotes
to such candidate are substantially reduced until such time, if
any, that we exercise our right to participate in a cost and profit
share arrangement. Even after we exercise that right to participate
in a cost and profit share arrangement, our ability to influence
Merck will be limited.
•Partners
might opt not to pursue development and commercialization of our
product candidates or not to continue or renew development or
commercialization programs based on clinical trial results, changes
in the partner’s strategic focus or available funding or external
factors, such as an acquisition that diverts resources or creates
competing priorities. For example, in June 2021, we and Merck
entered into the Amended Collaboration Agreement that covers a
narrower scope, focused primarily on ophthalmology- and CVM-related
therapeutic areas, than had been covered under the original
collaboration agreement we entered into with Merck in 2015. In
addition, under the terms of the Amended Collaboration Agreement,
it is possible for Merck to unilaterally terminate and any other
future licensed program, if any, (whether or not we have exercised
our cost and profit share option) upon prior written notice, such
as it did for NGM386 and NGM395 in 2019 and most recently in its
notice of termination for MK-3655 (effective late April 2023),
without triggering a termination of the remainder of the Amended
Collaboration Agreement. Moreover, Merck might also opt not to
designate any collaboration preclinical candidates for further
development
during the tail period following the end of the research phase or
exercise any of its options to acquire a license to a product
candidate, as it did with respect to the preclinical ophthalmology
product candidates.
•Partners
may delay clinical trials, provide insufficient funding for a
clinical trial program, request the suspension or termination of a
clinical trial or abandon a product candidate, repeat or conduct
new clinical trials or require a new formulation of a product
candidate for clinical testing.
•Partners
could independently develop, or develop with third parties,
products that compete directly or indirectly with our product
candidates if the partners believe that competitive products are
more likely to be successfully developed or can be commercialized
under terms that are more economically attractive than
ours.
•A
partner with marketing and distribution rights might not commit
sufficient resources to the marketing and distribution of our
product candidates.
•Partners
might not properly maintain or defend our intellectual property
rights or may use our proprietary information in such a way as to
invite litigation that could jeopardize or invalidate our
proprietary information or expose us to potential
litigation.
•Disputes
may arise between the partners and us that result in the delay or
termination of the research, development or commercialization of
our product candidates or that result in costly litigation or
arbitration that diverts management attention and
resources.
•We
may lose certain valuable rights under circumstances identified in
our BD Arrangements, including, in the case of our collaboration
with Merck, if we undergo a change in control.
•BD
Arrangements might be terminated and, if terminated, may result in
a need for additional capital to pursue further development or
commercialization of the applicable product
candidates.
•BD
Arrangements might not lead to development or commercialization of
product candidates in the most efficient manner, or at all. If a
present or future partner of ours were to be involved in a business
combination, the continued pursuit and emphasis on our product
development or commercialization program under such arrangement
could be delayed, diminished or terminated.
We may not be able to obtain and maintain the relationships with
third parties that are necessary to develop, commercialize and
manufacture some or all of our product candidates.
In addition to our dependence on any potential future partners, we
expect to depend on other third parties, including contract
research organizations, or CROs, clinical data management
organizations, clinical investigators, contract manufacturing
organizations/contract development and manufacturing organizations,
or CMOs, and other third-party partners and service providers to
support our discovery efforts, to formulate product candidates, to
conduct our clinical trials and certain aspects of our research and
preclinical studies, to manufacture clinical and commercial-scale
quantities of our drug substances and drug products and to market,
sell and distribute any products we successfully develop and for
which we obtain regulatory approval. Any problems we experience
with any of these third parties could delay our research efforts or
the development, manufacturing or commercialization of our product
candidates or any future products, which could harm our results of
operations. For more information, see the risk factors
titled
“We rely completely on CMOs for the manufacture of our product
candidates, and we are subject to many manufacturing risks, any of
which could substantially increase our costs and limit supply of
our product candidates and any future products"
and
“We have no experience in sales, marketing and distribution and may
have to enter into agreements with third parties to perform these
functions, which could prevent us from successfully commercializing
our product candidates.”
We cannot guarantee that we or, as applicable, any of our partners
will be able to successfully negotiate agreements for, and maintain
relationships with, third-party partners and service providers on
favorable terms, if at all. If we or any of our partners are unable
to obtain and maintain these agreements, we may not be able to
clinically develop, formulate, manufacture, obtain regulatory
approvals for or commercialize our product candidates, which will,
in turn, adversely affect our business. If we or any of our
partners need to enter into alternative arrangements, it would
delay our product development and, if applicable, commercialization
activities and such alternative arrangements may not be available
on terms acceptable to us.
We expect to continue to expend substantial management time and
effort to enter into relationships with third parties and, if we
successfully enter into such relationships, to manage these
relationships. In addition, our reliance on these third parties for
R&D activities reduces our control over these activities but
does not relieve us of our responsibilities. For example, we remain
responsible for ensuring that each of our clinical trials is
conducted in accordance with the general investigational plan and
protocols for the trial. However, we cannot control the amount or
timing of resources our partners will devote to our R&D
programs, product candidates or potential product
candidates, and we cannot guarantee that these parties will fulfill
their obligations to us under these arrangements in a timely
fashion, if at all. If these third parties do not successfully
carry out their contractual duties, meet expected deadlines or
conduct our clinical trials or other R&D activities in
accordance with regulatory requirements, we will not be able to
obtain, or may be delayed in obtaining, marketing approvals for our
product candidates and will not be able to, or may be delayed in
our efforts to, successfully commercialize any approved products.
In addition, we base our expense accruals related to clinical
trials on our estimates of the services received and efforts
expended pursuant to contracts with multiple research institutions
and CROs that conduct and manage clinical trials on our behalf and,
if their estimates are not accurate, it could negatively affect the
accuracy of our financial statements.
Any agreements we have or may enter into with third-party partners
and service providers may give rise to disputes regarding the
rights and obligations of the parties. Disagreements could develop
over contract interpretation, rights to ownership or use of
intellectual property, the scope and direction of R&D, the
approach for regulatory approvals or commercialization strategy. We
are conducting research programs in a range of therapeutic areas,
and our pursuit of these opportunities could result in conflicts
with the other parties to these agreements that may be developing
or selling pharmaceuticals or conducting other activities in these
same therapeutic areas. Any disputes or commercial conflicts could
lead to the termination of our agreements, delay progress of our
product development programs, compromise our ability to renew
agreements or obtain future agreements, lead to the loss of
intellectual property rights, result in increased financial
obligations for us or result in costly and time-consuming
arbitration or litigation.
In addition, we are less knowledgeable about the reputation and
quality of third-party contractors in countries outside of the
United States where we conduct discovery research or preclinical
and clinical development and manufacturing of our product
candidates and, therefore, we may not choose the best parties for
these relationships.
We rely completely on CMOs for the manufacture of our product
candidates, and we are subject to many manufacturing risks, any of
which could substantially increase our costs and limit supply of
our product candidates and any future products.
We have limited process development capabilities and require the
services of third-party CMOs to provide additional process
development and manufacturing capabilities. We do not have, and we
do not currently plan to acquire or develop, the facilities or
capabilities to manufacture bulk drug substance or filled drug
product for use in clinical trials or commercialization. As a
result, we rely completely on CMOs, which entails risks to which we
would not be subject if we manufactured product candidates or
products ourselves, including risks related to reliance on third
parties for availability of drug product to use in our clinical
trials and for regulatory compliance and quality assurance with
respect to such drug product, the possibility of breach of the
manufacturing agreement by third parties because of factors beyond
our control (including a failure to manufacture our product
candidates or any products we may eventually commercialize in
accordance with our specifications) and the possibility of
termination or nonrenewal of agreements by third parties, based on
their own business priorities, at a time that is costly or damaging
to us.
Our product candidates are biologics, and the manufacture of
biologic products is complex, highly regulated and requires
significant expertise and capital investment, including the
development of advanced manufacturing techniques and process
controls. As a result, the manufacture of our product candidates is
subject to many risks, including the following, some of which we
have experienced:
•product
loss or other negative consequences due to contamination, equipment
failure, improper installation or operation of equipment, vendor or
operator error, shortages of qualified personnel or improper
delivery or storage conditions;
•difficulties
with production costs and yields, quality control, product
stability and quality assurance testing, including challenges
related to bioanalytical method development and the qualification
and implementation of those methods for release testing, which can
delay availability of clinical trial materials;
•the
negative consequences of failure to comply with strictly enforced
federal, state and foreign regulations;
•minor
deviations from normal manufacturing processes, which have in the
past and may in the future result in reduced production yields,
product defects and other supply disruptions;
•the
presence of microbial, viral or other contaminants discovered in
our product candidates or in the manufacturing facilities in which
they are made, which can necessitate closure of facilities for an
extended period of time to investigate and eliminate the
contamination;
•the
negative consequences of our CMOs’ failure to qualify upon an audit
by regulatory authorities, by us or by our partners;
•our
CMOs’ changing strategies and business priorities, which can affect
the availability of facilities where we intend to manufacture our
product candidates; and
•our
CMOs’ manufacturing facilities being adversely affected by labor,
raw material and component shortages, turnover of qualified staff
or financial difficulties of their owners or operators, including
as a result of the effects of the ongoing COVID-19 pandemic, or by
natural disasters, power failures, local political unrest or other
factors.
We cannot ensure that issues relating to the manufacture or testing
of our product candidates, such as those described above, will not
occur or continue to occur in the future and if we or our CMOs
experience any such issues there could be a shortage of drug
substance or drug product for use in our clinical trials, which
could delay clinical and regulatory timelines significantly and
have an adverse effect on our business.
In addition, to date our product candidates have been manufactured
by CMOs solely for preclinical studies and relatively small
clinical trials. We intend to continue to use CMOs for these
purposes, and also for the supply of larger quantities that may be
required to conduct accelerated or expanded early clinical trials
or larger, later clinical trials and for commercialization if we
advance any of our product candidates through regulatory approval
and to commercialization. These manufacturers may not have
sufficient manufacturing capacity and may not be able to scale up
the production of drug substance or drug product in the quantities
we need and at the level of quality required in a timely or
effective manner, or at all. In particular, there is increased
competition in the biotechnology industry for CMO manufacturing
slots and other capabilities generally, which has had, and may
continue to have, a negative impact on the availability of
manufacturing capacity and therefore our ability to supply clinical
trial materials for planned, ongoing or expanded clinical
trials.
The transfer of our small-scale manufacturing processes to CMOs for
scale up and validation and any later scale up and validation of
the manufacturing process in the CMOs’ facilities to manufacture
larger quantities, involve difficult and complex processes. We may
not be successful in transferring our production system to a CMO,
either because it is unable to implement the process successfully
in its facilities or for other reasons. Later scale-up activities
are also difficult and costly and entail risks such as process
reproducibility, stability, consistency and other technical
challenges. If we are unable to adequately validate or scale up the
manufacturing processes for our product candidates, we would need
to undertake a transfer to another third party and repeat the
manufacturing validation process, which can be expensive and
time-consuming and could delay the initiation or completion of our
clinical trials.
Similarly, we or our CMOs may make changes to our product
candidates’ manufacturing processes at various points in product
development for many reasons, including scaling up, facility fit,
raw material or component availability, decreasing costs or timing
of production, improving processing robustness and reliability,
decreasing processing times or others. Such changes require further
validation and may have unintended consequences, which could
include causing our product candidates to perform differently when
administered in clinical trials and affecting clinical trial
results. In some circumstances, we may be required to perform
comparability or other studies to demonstrate that the product used
in earlier clinical trials or at earlier stages of a trial are
comparable to the product we intend to use in later trials or later
stages of an ongoing trial. These efforts are expensive and there
is no assurance that they will be successful, which could impact
our ability to continue or initiate clinical trials in a timely
manner, or at all.
Any future adverse developments affecting manufacturing operations
or the scale up or validation of manufacturing processes for our
product candidates may result in shipment delays, lot failures,
clinical trial delays or discontinuations, or, if we are
commercializing products, inventory shortages, product withdrawals
or recalls or other interruptions in supply. We may also have to
record inventory write-offs and incur other charges and expenses
for drug substance or drug product that fails to meet
specifications or cannot be used before its expiration date. In
addition, for out of specification materials, we may need to
undertake costly remediation efforts or manufacture new batches at
considerable cost and time delays or, in the longer run, seek more
expensive manufacturing alternatives.
We also have a single source of supply for most of our product
candidates, including the drug substances used in manufacturing
them. Single sourcing minimizes our leverage with our CMOs, who may
take advantage of our reliance on them to increase the pricing of
their manufacturing services or require us to change our intended
manufacturing plans based on their strategies and priorities.
Single sourcing also imposes a risk of interruption or delays in
supply in the event of manufacturing, quality or compliance
difficulties and/or other difficulties in timely supplying us with
materials. For example, our investigational new drug application,
or IND, submissions for NGM438 and NGM831 were delayed due to
challenges at one of our CMOs, primarily related to analytical
method qualification and release testing for those product
candidates. It is possible that we could experience further
supply-related delays that would adversely affect our ability to
commence first-in-human testing of product candidates
on
our anticipated timing. Moreover, we do not currently have
arrangements in place for redundant supply for drug substance or
drug product. If one of our suppliers fails or refuses to supply us
for any reason or we otherwise choose to engage a new supplier for
one or more of our product candidates, including a second source
supplier to mitigate the risks of single-source supply, it would
take a significant amount of time and cost to implement and execute
the necessary technology transfer to, and qualification of, a new
supplier. The FDA or comparable foreign health authority must
approve manufacturers of drug substance and drug product. If there
are any delays in qualifying new suppliers or facilities or a new
supplier is unable to meet the requirements of the FDA or
comparable foreign health authority for approval, there could be a
shortage of drug substance or drug product for use in clinical
trials with respect to the affected product
candidates.
Our product candidates use certain raw materials for their
production, such as reagents that support cell growth, purification
materials and testing and manufacturing supplies. Some of these
materials only have a single supplier and are purchased as
necessary without a long-term supply agreement in place. In
addition, our drug products may require the use of syringe or other
components, some of which have been the subject of shortages
amplified by the COVID-19 pandemic due to their use in, among other
things, COVID-19 vaccine production. If our CMOs are required to
obtain an alternative source of certain raw materials and
components, additional testing, validation activities and
regulatory approvals may be required, which may negatively impact
manufacturing and other development timelines. For example, one of
our CMOs experienced shortages of the specific cell culture media
used to manufacture one of our products due to global supply chain
challenges and, while we have been successful in obtaining a
replacement product, these types of substitutions may require
additional and unplanned testing, qualification or validation
activities. Any significant delay in the acquisition or decrease in
the availability of these materials, components or other items, or
failure to successfully qualify or validate alternative materials
or components, could considerably delay the manufacture of our
product candidates, which could adversely impact the timing or
completion of any ongoing and planned trials or the timing of
regulatory approvals, if any, of our product
candidates.
In addition, our CMOs’ facilities and operations have been
adversely affected by labor, raw material and component shortages,
high turnover of staff and difficulties in hiring trained and
qualified replacement staff and the operations of our CMOs may be
requisitioned, diverted or allocated by U.S. or foreign government
orders such as under emergency, disaster and civil defense
declarations in connection with the COVID-19 pandemic or otherwise.
For a discussion of how the COVID-19 pandemic has affected or may
affect drug or related component supplies for our clinical trials,
refer to the risk factor titled
“Our business could be materially and adversely affected in the
future by the effects of disease outbreaks, epidemics and
pandemics, including the COVID-19 pandemic.”
Changes in economic conditions, supply chain constraints, labor,
raw material and component shortages and steps taken by governments
and central banks, particularly in response to the COVID-19
pandemic as well as other stimulus and spending programs, could
also lead to higher inflation than previously experienced or
expected, which could, in turn, lead to an increase in
costs.
Our product candidates other than NGM621 and aldafermin are
currently solely manufactured at a facility in Lithuania. Following
Russia's invasion of Ukraine in February 2022, the response from
the United States and its allies has included both significant
sanctions and NATO's deployment of additional military forces to
Eastern Europe, including to Lithuania. The ongoing conflict
between Russia and Ukraine and the retaliatory measures taken or
that may be taken by the United States, NATO and others, including
significant sanctions against Russia, create global security
concerns and regional instability, including due to the possibility
of expanded regional or global conflict, and are likely to have
short-term and likely longer-term negative impacts on regional and
global economies, any or all of which could disrupt our supply
chain and adversely affect our ability to conduct ongoing and
future clinical trials of our product candidates and our ability to
raise capital on favorable terms.
Any further delays or interruptions in the supply of clinical trial
material could delay the completion or initiation of our clinical
trials, increase the costs associated with maintaining clinical
trial programs and, depending upon the period of delay, require us
to commence new clinical trials at additional expense, terminate
ongoing clinical trials or abandon planned clinical trials or
expansions or accelerations of clinical trials
completely.
We have no experience in sales, marketing and distribution and may
have to enter into agreements with third parties to perform these
functions, which could prevent us from successfully commercializing
our product candidates.
We currently have no sales, marketing or distribution capabilities.
To commercialize our product candidates outside of the Merck
collaboration, or to commercialize products subject to the Merck
collaboration for which we may in the future exercise our
co-detailing rights in the United States, if any, or for which
Merck decides not to exercise its license option, we must either
develop our own sales, marketing and distribution capabilities or
make
arrangements with third parties to perform these services for us.
If we exercise our co-detailing rights in the United States with
respect to the Merck collaboration, we will be responsible for the
costs of fielding such a sales force, subject to partial offset
pursuant to the formula by which profits are allocated, and the
risks of attracting, retaining, motivating and ensuring the
compliance of such a sales force with the various requirements of
the Merck collaboration and applicable law. If we decide to market
any of our products on our own, we will have to commit significant
resources to developing a marketing and sales force and supporting
distribution capabilities. If we decide to enter into arrangements
with third parties for performance of these services, we may find
that they are not available on terms acceptable to us, or at all.
If we are not able to establish and maintain successful
arrangements with third parties or build our own sales and
marketing infrastructure, we may not be able to commercialize our
product candidates, which would adversely affect our business,
operating results and prospects.
Risks Related to Our Business and Industry
Our product candidates must undergo rigorous clinical trials before
seeking regulatory approvals, and clinical trials may be delayed,
suspended or terminated at any time for many reasons, any of which
could delay or prevent regulatory approval and, if approval is
granted, commercialization of our product candidates.
All of our product candidates are subject to rigorous and extensive
clinical trials before we can seek regulatory approval from the FDA
and comparable foreign health authorities such as the European
Commission. Clinical trials may be delayed, suspended or terminated
at any time for reasons including but not limited to:
•ongoing
discussions with the FDA or comparable foreign health authorities
regarding the scope or design of our clinical trials;
•delays
in obtaining, or the inability to obtain, required approvals from
IRBs and ethics committees or other governing entities at clinical
trial sites selected for participation in our clinical
trials;
•delays
in patient enrollment and other key trial activities, including as
a result of the effects of the ongoing COVID-19 pandemic and of the
significant competition for recruiting patients with cancer in
clinical trials;
•delays
in reaching agreement on acceptable terms with prospective CROs and
the failure of CROs, testing laboratories and other third parties
to satisfy their contractual duties to us or meet expected
deadlines;
•deviations
from the trial protocol by clinical trial sites and investigators,
or failures to conduct the trial in accordance with regulatory
requirements;
•lower
than anticipated retention rates of participants in clinical
trials, including patients dropping out due to side effects,
disease progression or concerns about the COVID-19
pandemic;
•failure
of enrolled patients to complete treatment or to return for
post-treatment follow-up;
•for
clinical trials in selected patient populations, delays in
identification and auditing of central or other laboratories and
the transfer and validation of assays or tests to be used to
identify selected patients and test any patient
samples;
•implementation
of new, or changes to, guidance or interpretations from the FDA or
comparable foreign health authorities with respect to approval
pathways for product candidates we are pursuing;
•the
need to repeat clinical trials as a result of inconclusive or
negative results, poorly executed testing or changes in required
endpoints;
•insufficient
supply or deficient quality of drug substance, drug product or
other clinical trial material necessary to conduct our clinical
trials, as well as delays in the testing, validation, manufacturing
and delivery to clinical trial sites of such material;
•withdrawal
of clinical trial sites or investigators from our clinical trials
for any reason, including as a result of changing standards of care
or the ineligibility of a site to participate in our clinical
trials;
•unfavorable
FDA or comparable foreign health authority inspection or review of
a clinical trial site or records of any clinical or preclinical
investigation;
•drug-related
adverse effects or tolerability issues experienced by participants
in our clinical trials;
•changes
in government regulations or administrative actions;
•lack
of adequate funding to continue the clinical trials;
•our
ability to hire and retain key R&D personnel; or
•the
placement of a clinical hold on a trial by the FDA or comparable
foreign health authorities.
We cannot guarantee that we will be able to successfully accomplish
required regulatory and/or manufacturing activities or all of the
other activities necessary to initiate and complete clinical trials
in a timely fashion, if at all. As a result, our preclinical
studies and clinical trials may be extended, delayed or terminated,
and we may be unable to obtain regulatory approvals or successfully
commercialize our products. In addition, we have only limited
experience in conducting late-stage clinical trials required to
obtain regulatory approval. In any event, we do not know whether
any of our clinical trials will begin as planned, will need to be
restructured or will be completed on schedule, or at
all.
Our product development costs will increase if we continue to
experience delays in clinical testing. Significant clinical trial
delays could also shorten any periods during which we may have the
exclusive right to commercialize our product candidates or allow
our competitors to bring products to market before we do, which
would impair our ability to successfully commercialize our product
candidates and may harm our business, results of operations and
prospects. Our or our partners’ inability to timely complete
clinical development could result in additional costs to us or
impair our ability to generate product revenue or development,
regulatory, commercialization and sales milestone payments and
royalties on product sales.
If clinical trials of our product candidates fail to produce
positive results or to demonstrate safety and efficacy to the
satisfaction of the FDA or comparable health authorities or
sufficient to demonstrate differentiation from other approved
therapies or therapies in development, we may incur additional
costs or experience delays in completing, or ultimately be unable
to complete, the development and commercialization of our product
candidates.
Our product candidates are in early stages of development, with our
most advanced product candidates only in Phase 2 development.
Before obtaining marketing approval from health authorities for the
sale of our product candidates, we or our partners must conduct
extensive preclinical studies and clinical trials to demonstrate
the safety and efficacy of the product candidates in humans.
Preclinical studies and clinical trials are expensive, take several
years to complete and may not yield results that support further
clinical development or product approvals. The design of a clinical
trial can determine whether its results will support approval of a
product, and flaws in the design of a clinical trial may not become
apparent until the clinical trial is well advanced. Because we have
limited experience designing clinical trials, we may be unable to
design and execute a clinical trial to support regulatory
approval.
In addition, there is a high failure rate for drugs and biologic
products proceeding through clinical trials and failure can occur
at any stage of testing. For example, despite the results of
preclinical and Phase 1 studies of NGM621, our Phase 2 CATALINA
clinical trial evaluating NGM621 in patients with GA secondary to
AMD did not meet its primary endpoint. Since Merck did not elect to
exercise its option to license NGM621 and its related compounds,
further development of NGM621 is primarily dependent on our ability
to secure potential future BD Arrangements and, in the absence of
such BD Arrangements, we are unlikely to be able to advance
development of NGM621 unless our portfolio prioritization changes
and we have access to the necessary capital to fund such
development.
Similarly, our Phase 2b ALPINE 2/3 trial evaluating aldafermin in
patients with F2/F3 NASH did not meet its primary endpoint and, as
a result, we decided to suspend further development of aldafermin
in patients with F2/F3 NASH, allowing for the reallocation of
resources to advancing our other programs. While we continued, and
have completed, enrollment in our Phase 2b ALPINE 4 clinical trial
of aldafermin in patients with compensated cirrhosis due to NASH
(liver fibrosis stage 4, or F4, by the NASH Clinical Research
Network classification), we updated the design of the ALPINE 4
trial, elevating the Enhanced Liver Fibrosis, or ELF, test, a
reproducible, quantitative non-invasive liver prognostic test that
evaluates liver fibrosis and correlates to liver-related outcomes,
to be the primary endpoint for the trial. The ELF test is a
composite blood test measuring the presence of three biomarkers
associated with liver matrix metabolism. Liver biopsy data will
also be measured and reported as a secondary endpoint upon
completion of the trial. For more information, refer to the risk
factor titled “Aldafermin
is, and MK-3655 was, being developed, for the treatment of NASH, an
indication for which there are no approved products. This makes it
difficult to predict the timing, cost and potential success of
their continued clinical development, if any, and regulatory
approval for the treatment of NASH, or
otherwise.”
Further, we expect that certain of our current product candidates
will, and future product candidates may, require chronic
administration. The need for chronic administration increases the
risk that participants in our clinical trials will fail to comply
with our dosing regimens. If participants fail to comply, we may
not be able to generate clinical data in our trials acceptable to
the FDA or comparable foreign health authorities. The need for
chronic administration also increases the risk that our clinical
drug development programs may not uncover all possible adverse
events that patients who take our products may eventually
experience. The number of patients exposed to
treatment with, and the average exposure time to, our product
candidates in clinical development programs may be inadequate to
detect rare adverse events or chance findings that may only be
detected once our products are administered to more patients and
for longer periods of time.
We may also not be successful in generating clinical data
sufficient to differentiate our product candidates from other
products in the same therapeutic area. If our competitors' products
are, or are perceived to be, more effective, more convenient, less
costly or safer than our products, or we are unable to demonstrate
differentiation in any of those factors, we may not be able to
achieve a competitive position in the market. For more information,
refer to the risk factor titled “We
face substantial competition, which may result in others
discovering, developing or commercializing products before or more
successfully than us."
In addition, data obtained from preclinical and clinical activities
are subject to varying interpretations, which may delay, limit or
prevent regulatory approval. In any event, it is impossible to
predict when or if any of our product candidates will prove safe
and effective in humans or will receive regulatory approval. If we
are unable to successfully discover, develop or enable our partners
to develop drugs that regulatory authorities deem effective and
safe in humans, we will not have a viable business.
Success in preclinical studies or earlier-stage clinical trials may
not be indicative of results in future clinical
trials.
To date, the data supporting our drug discovery and development
programs are derived from laboratory and preclinical studies and
earlier-stage clinical trials. Owing in part to the complexity of
biological pathways, when used to treat human patients, our product
candidates might not demonstrate the biochemical and
pharmacological properties we anticipate based on laboratory
studies or earlier-stage clinical trials, and they may interact
with human biological systems or other drugs in unforeseen,
ineffective or harmful ways. Success in preclinical studies and
earlier-stage clinical trials does not ensure that later clinical
trials will generate the same results or otherwise provide adequate
data to demonstrate the effectiveness and safety of our product
candidates. In this regard, the data supporting our drug discovery
and development programs are derived from laboratory and
preclinical studies, and future clinical trials in humans may show
that one or more of our product candidates are not safe and
effective, in which event we may need to abandon development of
such product candidates. In fact, many companies in the
pharmaceutical and biotechnology industries have suffered
significant setbacks in late-stage clinical trials even after
achieving promising results in preclinical studies and
earlier-stage clinical trials. Similarly, preliminary data and
interim results from clinical trials may not be predictive of final
results. For example, despite the results of preclinical and Phase
1 studies of NGM621, our Phase 2 CATALINA clinical trial evaluating
NGM621 in patients with GA secondary to AMD did not meet its
primary endpoint. Similarly, in spite of the results we had
obtained in our Phase 1 trials of aldafermin and in our first Phase
2 trial, in May 2021, we announced that our Phase 2b ALPINE 2/3
trial evaluating aldafermin in patients with F2/F3 NASH did not
meet its primary endpoint. For more information, refer to the risk
factor titled “If
clinical trials of our product candidates fail to produce positive
results or to demonstrate safety and efficacy to the satisfaction
of the FDA or comparable health authorities or sufficient to
demonstrate differentiation from other approved therapies or
therapies in development, we may incur additional costs or
experience delays in completing, or ultimately be unable to
complete, the development and commercialization of our product
candidates."
There can be no assurance that any clinical testing of our product
candidates will be successful or will otherwise be supportive of
continued development and/or regulatory approvals of such product
candidates.
In addition, some of our earlier-stage clinical trials involve
small patient populations, sometimes at single sites, and the
results of these clinical trials may be subject to substantial
variability and may not be indicative of either future interim
results or final results. As a general matter, there is also a
substantial risk that Phase 3 trials with larger numbers of
patients and/or longer durations of therapy will fail to replicate
efficacy and safety results observed in earlier clinical
trials.
Our product candidates may cause undesirable side effects or
adverse events or have other properties or safety risks, which
could delay or prevent continued clinical development or their
regulatory approval or limit the commercial profile of any approved
label.
Adverse events, undesirable side effects or similar safety issues
caused by our product candidates could cause us or health
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 health
authorities. Additional clinical trials may be required to further
evaluate the safety profile of our product candidates. Patients in
certain of our ongoing or planned clinical trials, particularly
patients with cancer or with NASH with more advanced fibrosis,
often enter our trials with significant comorbidities or advanced
life-threatening illness and/or are treated in the
trial
with our product candidate in combination with other medications,
including, in cancer patients, chemotherapy or other approved
cancer treatments. As a result, patients in our clinical trials can
be expected to experience some adverse events, including death, or
side effects that are not or may not be related to treatment with
our product candidates. Nonetheless, the occurrence of adverse
events or side effects, whether or not related to our product
candidates, could impact the success of our clinical
trials.
Patients experienced, and we reported, serious adverse events, or
SAEs, in the treatment arms of our completed trials of MK-3655,
NGM621 and aldafermin. We expect that patients in our clinical
trials, including those that are sham- or placebo-controlled with
some patients not receiving study drug, will continue to experience
adverse events and SAEs and we will continue to monitor those SAEs
for any signals of concern regarding the safety and tolerability of
our product candidates. For example, cancer patients enrolled in
our ongoing clinical trials of NGM120, NGM707, NGM831 and NGM438,
many of whom are suffering from advanced life-threatening illness,
have experienced, and we expect will continue to experience, SAEs
and other adverse events, which may or may not be drug-related. If
patients in any of our clinical trials experience a high or
unacceptable severity and prevalence of side effects, including
particularly SAEs, it could affect patient recruitment or the
ability of enrolled patients to complete their treatment in a
clinical trial, it may result in a regulatory authority putting a
clinical hold on the clinical trial or it may result in failure to
obtain regulatory approval for our product candidates or product
liability claims.
In addition, significant increases in serum levels of low-density
lipoprotein cholesterol, or LDL-C, were observed in clinical trials
of aldafermin in patients with NASH and type 2 diabetes. Serum
levels of LDL-C were brought back to baseline levels with
concomitant statin use in patients with NASH; however, the impact
of these drug-induced changes in LDL-C are unknown. Generally,
sustained and prolonged LDL-C elevations in untreated patients are
associated with cardiovascular disease through atherosclerotic
plaque development. While data from our completed Phase 2b ALPINE
2/3 clinical trial and earlier trials of aldafermin demonstrated
the ability of concomitant statin use to mitigate the serum LDL-C
elevations driven by aldafermin activity, aldafermin’s impact on
LDL-C may negatively impact market acceptance of an approved
aldafermin product.
Our product candidates are protein or antibody therapeutics.
Protein and antibody therapeutics can sometimes induce host immune
responses that can cause the production of anti-drug antibodies, or
ADAs. In some cases, ADAs have no effect. In other cases, ADAs may
neutralize the effectiveness of the product candidate, can require
that higher doses be used to obtain a therapeutic effect or can
cross react with substances naturally occurring in a subject’s
body, which can cause unintended effects, including potential
impacts on efficacy and adverse events. Some patients treated with
aldafermin in our completed clinical trials have developed ADAs
against aldafermin and, in some cases, those antibodies were
neutralizing or appeared to cross react with the patient’s
naturally occurring FGF19. We developed an assay to measure the
presence of ADAs against aldafermin for our ongoing NASH program,
which we are using to test patient samples and which will need to
be evaluated by regulatory agencies. The presence of ADAs was also
observed in our Phase 1 MK-3655 trial. If we are required to
undertake substantial additional testing as a result of the
detection of ADAs in subjects using aldafermin, MK-3655 or any
other product candidate, the costs of our clinical trials may
increase. If we determine that ADAs are causing safety or efficacy
concerns when using any of our product candidates, we may need to
delay or halt clinical trials of our product candidates and the
affected product candidates may never obtain regulatory approval.
We cannot provide assurance that the detection of ADAs will not be
higher than we have observed historically or that observed rates
will not later be found to limit drug exposure or cause adverse
safety events, or that the detection of ADAs will not otherwise
result in the non-approvability of any of our product
candidates.
NGM621 had been delivered to clinical sites in vials and then
administered to patients using commercially available single-use
syringes. The manufacturer of a commercially available single-use
syringe widely used by ophthalmologists for intravitreal, or IVT,
injections, including investigators in the Phase 2 CATALINA trial,
issued a notice that such single-use syringes should not be used
for ocular medications due to an increased potential for adverse
eye conditions. While we have not experienced any safety concerns
in our completed NGM621 clinical trials relating to syringe use, we
communicated with the FDA and our study investigators regarding
this issue and this issue could preclude or delay any efforts to
partner our NGM621 program.
Future results of our trials could reveal a high and unacceptable
severity and prevalence of side effects, SAEs, ADAs, safety issues
or other negative or otherwise unexpected characteristics. The
occurrence of those issues could affect patient recruitment or the
ability of enrolled patients to complete their treatment in a
clinical trial, result in failure to obtain regulatory approval for
our product candidates or product liability claims or impact market
acceptance of our products. Any of these occurrences could
materially and adversely affect our business, financial condition
and prospects.
Aldafermin is, and MK-3655 was, being developed for the treatment
of NASH, an indication for which there are no approved products.
This makes it difficult to predict the timing, cost and potential
success of their continued clinical development, if any, and
regulatory approval for the treatment of NASH, or
otherwise.
We are developing aldafermin, and MK-3655 was in development by
Merck, for the treatment of NASH, an indication for which there are
no approved products. Implementation of new, or changes to,
guidance or interpretations from the FDA or comparable foreign
health authorities with respect to approval pathways, such as draft
guidance documents from the FDA for the development of products for
the treatment of NASH that issued in 2018 and 2019 and from the
European Medicines Agency, or EMA, that issued in 2018, may impact
the path for regulatory approval for NASH therapies. Further, as we
and other companies advance clinical trials for potential NASH
therapies, we expect that the path for regulatory approval for NASH
therapies may continue to evolve as companies refine their
regulatory approval strategies and interact with health
authorities. Such evolution may impact our future clinical trial
designs, including trial size and endpoints, in ways that we cannot
currently predict. We updated the design of the ALPINE 4 trial of
aldafermin, elevating the ELF test to be the primary endpoint for
the trial. Neither the ELF test, nor any other surrogate biomarker
endpoints, are currently endorsed by the FDA or EMA as sufficient
for granting regulatory approval of products being developed for
the treatment of compensated cirrhosis due to NASH (stage F4) and
therefore may not be able to be used as a primary endpoint in
potential future Phase 3 trials to support regulatory approval for
aldafermin.
In addition, certain of our competitors have experienced regulatory
setbacks for NASH therapies following communications from the FDA.
We currently do not know the impact, if any, that these setbacks
could have on the path for regulatory approval for NASH therapies
generally or for aldafermin and MK-3655 in particular. If the
clinical trials for aldafermin and MK-3655 are not designed in a
manner that, even if successful, support regulatory approval due to
shifting approval pathways or for other reasons, those product
candidates may be delayed in obtaining approval or may never be
approved, which could have a material adverse effect on our
business, operating results and prospects. Moreover, the above
factors could make it difficult or preclude altogether our ability
to secure potential future partners necessary to further the
development of aldafermin and MK-3655 in NASH or
otherwise.
As a result of the above, the future development of aldafermin and
MK-3655 in patients with NASH is substantially uncertain and could
be discontinued altogether, in which case, we will not receive any
return on our investments in these programs.
Aldafermin is a modified version of a human hormone that has been
associated with liver cancer in rodent testing.
The IND application we filed for aldafermin in February 2014 for
type 2 diabetes was placed on clinical hold by the FDA Division of
Metabolism and Endocrinology Products pending receipt of additional
information relating to the potential risk of proliferative effects
of aldafermin in the livers of non-human primates and mice based on
concerns relating to the observation that human FGF19 can induce
hepatocellular proliferation in rodents. We withdrew this IND in
January 2015, as we determined that we would not further study
aldafermin in type 2 diabetes after we analyzed the results of the
Phase 2 clinical trial of aldafermin in type 2 diabetes and made
the determination to pursue NASH and other liver indications. To
date, the FDA Division of Hepatology and Nutrition, which is
responsible for the NASH indication, has not requested any
additional information regarding the potential for aldafermin to
induce hepatocellular proliferation. We have received feedback from
the FDA Carcinogenicity Assessment Committee that our preclinical
data through six-month chronic toxicology studies in mice and
monkeys support a single species, two-year carcinogenicity
assessment in rats. The human hormone and the rodent ortholog for
FGF19 share a sequence identity of approximately 50%, which means
that the results of these studies of aldafermin in rats are not
necessarily predictive of the potential risk of carcinogenicity in
humans. To our knowledge, neither FGF19 nor any variant thereof
other than aldafermin has ever been tested in humans. Concerns
about the association between FGF19 and liver cancer could have an
adverse effect on our ability to develop and commercialize
aldafermin.
We may not successfully identify new product candidates to expand
our development pipeline.
The success of our business over the longer term depends upon our
ability to identify and validate new potential protein and antibody
therapeutics. Research programs to identify new product candidates
require substantial technical, financial and human resources, and
our research methodology may not successfully identify medically
relevant protein or antibody therapeutics to be developed as
product candidates. In addition, our drug discovery efforts often
identify and select novel, untested proteins in the particular
disease indication we are pursuing, which we may fail to validate
after further research work. Moreover, our research efforts may
initially show promise in discovering potential new protein and
antibody therapeutics yet fail to yield product candidates for
clinical
development for multiple reasons. For example, potential product
candidates may, on further study, be shown to have inadequate
efficacy, harmful side effects, suboptimal drug profiles or other
characteristics suggesting that they are unlikely to be
commercially viable products. Our inability to successfully
identify additional new product candidates to advance into clinical
trials could have a material adverse effect on our business,
operating results and prospects.
We may fail to select or capitalize on the most scientifically,
clinically and commercially promising or profitable product
candidates.
We have limited technical, managerial and financial resources to
determine which of our product candidates should proceed to initial
clinical trials, later-stage clinical development and potential
commercialization. We may make incorrect determinations in
allocating resources among these product candidates. Our decisions
to allocate our R&D, management and financial resources toward
particular product candidates or therapeutic areas may not lead to
the development of viable commercial products and may divert
resources from better opportunities. For example, our key pipeline
programs in active development include product candidates in solid
tumor oncology, and we are focusing most of our execution efforts
and resources on these programs, intending to mainly advance them
in generation of proof-of-concept data internally. However, our
focus on the solid tumor oncology therapeutic area may be
unsuccessful and may never lead to the development of viable
commercial products. Similarly, our decisions to delay or terminate
drug development programs, such as our decision to suspend
development activities related to multiple metabolic disease
product candidates and for aldafermin in patients with F2/F3 NASH
to concentrate our resources elsewhere, also may be incorrect and
could cause us to miss valuable opportunities.
Under the terms of our Amended Collaboration Agreement with Merck,
we have the right, exercisable during a specified period prior to
the commencement of Phase 3 clinical testing of the applicable
product candidate, to convert our economic participation from a
milestones and net sales royalty arrangement into a cost and profit
share arrangement. If we exercise the cost and profit share right,
we have the ability to participate in a co-detailing relationship
in the United States. Due to the limited exercise period, we may
have to choose whether a product candidate will be subject to a
cost and profit share arrangement before we have as much
information as we would like, including whether and when such
program may receive FDA approval of the applicable biologics
license application, or BLA. As a result of such incomplete
information or due to incorrect analysis by us, we may select a
cost and profit share program that later proves to have less
commercial potential than an alternative, or none at all, or may
pass on a cost and profit share program that proves commercially
successful.
We must attract and retain highly skilled employees in order to
succeed. If we are not able to retain our current senior management
team, especially our Chief Scientific Officer, Dr. Jin-Long Chen,
or to continue to attract and retain qualified scientific,
technical and business personnel, our business will
suffer.
To succeed, we must recruit, retain, manage and motivate qualified
clinical, scientific, technical and management personnel and we
face significant competition for experienced personnel. If we do
not succeed in attracting and retaining qualified personnel,
particularly at the management level, it could adversely affect our
ability to execute our business plan and harm our operating
results. An important element of our strategy is to take advantage
of the R&D and other expertise of our current management. The
loss of any one of our executive officers, including, in
particular, Dr. Jin-Long Chen, our Chief Scientific Officer, could
result in a significant loss in the knowledge and experience that
we, as an organization, possess and could cause significant delays,
or outright failure, in the development and further
commercialization of our product candidates.
There is intense competition for qualified personnel, including
management, in the technical fields in which we operate,
particularly in the oncology field, and we may not be able to
attract and retain qualified personnel necessary for the successful
research, development and future commercialization, if any, of our
product candidates. We recruit for talent in the biotechnology and
pharmaceutical industry in the San Francisco Bay Area, which is one
of the most competitive and highest cost labor market in the United
States and periodically experiences higher turnover rates than
other industries. For example, in 2022, we continued to experience
a challenging recruiting environment with relatively high rates of
employees leaving the company to pursue other opportunities,
particularly in the first three quarters of the year.
Many of the other pharmaceutical companies that we compete against
for qualified personnel have greater financial and other resources,
different risk profiles and a longer history in the industry than
we do. They also may provide more diverse opportunities and better
chances for career advancement. Some of these characteristics may
be more appealing to high-quality candidates than what we have to
offer. The labor market tightened significantly after the beginning
of the ongoing COVID-19 pandemic. During the first couple of years
of the COVID-19 pandemic, we experienced employee attrition at
rates higher than we experienced historically, which may recur and
could have
a negative impact on our productivity. If we are unable to attract
and retain high-quality personnel, the rate and success with which
we can discover and develop product candidates and our business
will be limited.
We face substantial competition, which may result in others
discovering, developing or commercializing products before or more
successfully than us.
The biopharmaceutical industry is intensely competitive and subject
to rapid and significant technological change. Our competitors
include multinational pharmaceutical companies, specialized
biotechnology companies and universities and other research
institutions. A number of pharmaceutical and biotechnology
companies are pursuing the development or marketing of
pharmaceuticals that seek to treat the same diseases that we are
pursuing with our most advanced product candidates, particularly in
the oncology field. Some of these pharmaceuticals in development
are active, or seek to be active, against the same targets that our
product candidates are engineered to effect, including the targets
that are the focus of our immuno-oncology candidates, ILT2, ILT3,
ILT4 and LAIR1. It is probable that the number of companies seeking
to develop products and therapies for the treatment of cancer,
retinal diseases and liver and metabolic diseases will increase.
Many of our competitors have substantially greater financial,
technical, human and other resources than we do and may be better
equipped to develop, manufacture and market technologically
superior products. In addition, many of these competitors have
significantly greater experience than we have in undertaking
preclinical studies and human clinical trials of new pharmaceutical
products and in obtaining regulatory approvals of human therapeutic
products. Accordingly, our competitors may succeed in obtaining FDA
approval and approval or marketing authorization from comparable
health authorities such as the European Commission for superior
products or for other products that would compete with our product
candidates. Many of our competitors have established distribution
channels and commercial infrastructure to support the
commercialization of their products, whereas we have no such
channel or capabilities. In addition, many competitors have greater
name recognition and more extensive collaboration or partnering
relationships. Smaller and earlier-stage companies may also prove
to be significant competitors, particularly through collaboration
or partnering arrangements with large, established
companies.
Our competitors may obtain regulatory approval of their products
more rapidly than us or may obtain patent protection or other
intellectual property rights that limit our ability to develop or
commercialize our product candidates. Our competitors may also
develop drugs that are more effective, more convenient, more widely
used and less costly or have a better safety profile than our
products and these competitors may also be more successful than us
in manufacturing and marketing their products. If we are unable to
compete effectively against these companies, then we may not be
able to commercialize our product candidates or achieve a
competitive position in the market. These companies also compete
with us in recruiting and retaining qualified scientific,
management and commercial personnel, establishing clinical trial
sites and patient registration for clinical trials, as well as in
acquiring technologies complementary to, or necessary for, our
programs.
Although we believe there are no FDA- or European
Commission-approved therapies that specifically target the
signaling pathways that our current product candidates are designed
to modulate or inhibit, there are numerous currently approved
therapies for treating the same diseases or indications (other than
NASH or GA) for which our product candidates may be useful and many
of these currently approved therapies act through mechanisms
similar to our product candidates. Many of these approved drugs are
well-established therapies or products and are widely accepted by
physicians, patients and third-party payors. Some of these drugs
are branded and subject to patent protection, and others are
available on a generic basis. Insurers and other third-party payors
may also encourage the use of generic products or specific branded
products. We expect that if our product candidates are approved,
they will be priced at a significant premium over competitive
generic products, including branded generic products. This may make
it difficult for us to differentiate our products from currently
approved therapies, which may adversely impact our business
strategy. In addition, many companies are developing new
therapeutics, and we cannot predict what the standard of care will
be as our product candidates progress through clinical development.
For more information regarding the competition that our most
advanced product candidates face, or may face, see the discussion
of specific competition for each product candidate in “Business-Our
Pipeline Programs” in this Annual Report on Form 10-K.
In February 2023, Apellis Pharmaceuticals, Inc., or Apellis,
announced that the FDA approved SYFOVRE™ (pegcetacoplan injection)
for the treatment of GA secondary to AMD. Apellis' regulatory
approval for pegcetacoplan injection may affect future late-stage
clinical trial designs, if any, and require added clinical
development expense. Iveric bio, Inc.’s, or Iveric's, avacincaptad
pegol, a PEGylated aptamer inhibitor of complement C5, completed a
Phase 2/3 clinical trial that demonstrated statistically
significant reductions in the rate of GA lesion area growth in the
avacincaptad pegol arm versus the sham arm. In February 2023,
Iveric announced that the FDA had accepted its NDA for avacincaptad
pegol. Even if we are successful in securing a future BD
Arrangement for the NGM621 program, which may not occur in a timely
manner or at all, and our partner obtains regulatory approval of
NGM621,
which is substantially uncertain given the failure to meet the
primary endpoint in the CATALINA trial, NGM621 may not be able to
compete effectively against pegcetacoplan and avacincaptad pegol,
which could adversely affect our future revenues and business
prospects in the event we are able to successfully partner the
program.
Our product candidates may not achieve adequate market acceptance
among physicians, patients, healthcare payors and others in the
medical community necessary for commercial success.
Demonstrating the safety and efficacy of our product candidates and
obtaining regulatory approvals will not guarantee future revenue.
Even if our product candidates receive regulatory approval, they
may not gain adequate market acceptance among physicians, patients,
healthcare payors and others in the medical community. The degree
of market acceptance of any of our approved product candidates will
depend on a number of factors, including:
•the
efficacy and safety profile of the product candidate as
demonstrated in clinical trials;
•the
timing of market introduction of the product candidate, as well as
competitive products;
•the
clinical indications for which the product candidate is
approved;
•acceptance
of the product candidate as a safe and effective treatment by
physicians and patients;
•the
actual and perceived advantages of the product candidate over
alternative treatments, including any similar generic
treatments;
•the
viewpoints of influential physicians with respect to the product
candidate;
•the
inclusion or exclusion of the product candidate from treatment
guidelines established by various physician groups;
•the
cost of treatment relative to alternative treatments;
•our
pricing and the availability of coverage and adequate reimbursement
by third parties and government authorities as described in the
risk factor titled “Even
if we obtain approval to market our products, these products may
become subject to unfavorable pricing regulations, reimbursement
practices from third-party payors or healthcare reform initiatives
in the United States and abroad, which could harm our
business”;
•the
relative convenience and ease of administration;
•the
frequency and severity of adverse events;
•the
effectiveness of sales and marketing efforts; and
•any
unfavorable publicity relating to the product
candidate.
For example, aldafermin is currently administered via a once-daily
subcutaneous injection, which may negatively impact market
acceptance of an approved aldafermin product, if any. In addition,
refer to the risk factor titled “Our
product candidates may cause undesirable side effects or adverse
events or have other properties or safety risks, which could delay
or prevent continued clinical development or their regulatory
approval or limit the commercial profile of any approved
label."
If any product candidate is approved but does not achieve an
adequate level of acceptance by such parties, we may not generate
or derive sufficient revenue from that product candidate and may
not become or remain profitable.
Even if we obtain approval to market our products, these products
may become subject to unfavorable pricing regulations,
reimbursement practices from third-party payors or healthcare
reform initiatives in the United States and abroad, which could
harm our business.
The regulations that govern marketing approvals, pricing and
reimbursement for new drug products vary widely from country to
country. Current and future legislation may significantly change
the approval requirements in ways that could involve additional
costs and cause delays in obtaining approvals. In many regions,
including the European Union, or EU, Japan and Canada, the pricing
of prescription drugs is controlled by the government and some
countries require approval of the sale price of a drug before it
can be marketed. In many countries, the pricing review period
begins after regulatory approval for the product is granted.
Regulatory agencies in those countries could determine that the
pricing for our products should be based on prices of other
commercially available drugs for the same disease, rather than
allowing us to market our products at a premium as new drugs. As a
result, we might obtain marketing approval for a product in a
particular country, but then be subject to price regulations that
delay or limit our commercial launch of the product, possibly for
lengthy time periods, which could negatively impact the revenue we
generate from the sale of the product in that particular country.
In some foreign markets, prescription pharmaceutical pricing
remains subject to continuing governmental control even after
initial approval is granted. Adverse pricing limitations may hinder
our ability to recoup our investment in one or more product
candidates, even if our product candidates obtain marketing
approval.
Our commercial success also depends on coverage and adequate
reimbursement of our product candidates by third-party payors,
including government payors, private health insurers, health
maintenance organizations and other organizations, which may be
difficult or time-consuming to obtain, may be limited in scope and
may not be obtained in all jurisdictions in which we may seek to
market our products. Governments and private insurers closely
examine medical products to determine whether they should be
covered by reimbursement and, if so, the level of reimbursement
that will apply. Government authorities and other third-party
payors have attempted to control costs by limiting coverage and the
amount of reimbursement for particular drugs. Increasingly,
third-party payors are requiring that drug companies provide them
with predetermined discounts from list prices and are challenging
the prices charged for drug products. We cannot be sure that
coverage and reimbursement will be available for any product that
we or our partners commercialize and, if reimbursement is
available, what the level of reimbursement will be. Coverage and
reimbursement may impact the demand for, or the price of, any
product candidate for which we or our partners obtain regulatory
approval. If coverage and reimbursement are not available or
reimbursement is available only to limited levels, we and our
partners may not be able to successfully commercialize any product
candidate for which marketing approval is obtained.
There may be significant delays in obtaining coverage and
reimbursement for newly approved drugs, and coverage may be more
limited than the purposes for which the drug is approved by the FDA
or comparable foreign health authorities. Moreover, eligibility for
coverage and reimbursement does not imply that a drug will be paid
for in all cases or at a rate that covers our costs, including
costs of research, development, manufacture, sale and distribution.
Interim reimbursement levels for new drugs, if applicable, may also
not be sufficient to cover our costs and may only be temporary.
Reimbursement rates may vary according to the use of the drug and
the clinical setting in which it is used, may be based on
reimbursement levels already set for lower cost drugs and may be
incorporated into existing payments for other services. Net prices
for drugs may be reduced by mandatory discounts or rebates required
by government healthcare programs or private payors and by any
future relaxation of laws that presently restrict imports of drugs
from countries where they may be sold at lower prices than in the
United States. Our inability to promptly obtain coverage and
profitable reimbursement rates from both government-funded and
private payors for any approved products that we develop could have
a material adverse effect on our operating results, our ability to
raise capital needed to commercialize products and our overall
financial condition.
The advancement of healthcare reform may negatively impact our
ability to profitably sell our product candidates, if
approved.
Third-party payors, whether domestic or foreign, or governmental or
commercial, are developing increasingly sophisticated methods of
controlling healthcare costs. The United States and many foreign
jurisdictions have enacted or proposed legislative and regulatory
changes affecting the healthcare system that could prevent or delay
marketing approval of our product candidates, restrict or regulate
post-approval activities and affect our ability to profitably sell
any product for which we obtain marketing approval.
For example, on August 16, 2022, President Biden signed the
Inflation Reduction Act of 2022, or the IRA, into law, which among
other things, (1) directs the U.S. Department of Health and Human
Services, or HHS, to negotiate the price of certain single-source
drugs and biologics covered under Medicare and (2) imposes rebates
under Medicare Part B and Medicare Part D to penalize price
increases that outpace inflation. These provisions will take effect
progressively starting in fiscal year 2023, although they may be
subject to legal challenges. It is currently unclear how the IRA
will be implemented but is likely to have a significant impact on
the pharmaceutical industry. Further, in March 2010, the Patient
Protection and Affordable Care Act, as amended by the Health Care
and Education Reconciliation Act, collectively referred to as the
ACA, was enacted, which includes measures that have significantly
changed the way health care is financed by both governmental and
private insurers. There have been executive, judicial and
congressional challenges to certain aspects of the ACA. While
Congress has not passed comprehensive legislation repealing the
ACA, such legislation may be reintroduced. Members of Congress have
introduced legislation to modify or replace certain provisions of
the ACA. It is unclear how these efforts to repeal and/or replace
the ACA will impact the ACA and our business. For example, the Tax
Cuts and Jobs Act, or the 2017 Tax Act, repealed the tax-based
shared responsibility payment imposed by the ACA on certain
individuals who fail to maintain qualifying health coverage that is
commonly referred to as the “individual mandate.” On June 17, 2021,
the U.S. Supreme Court dismissed a challenge on procedural grounds
that argued the ACA is unconstitutional in its entirety because the
“individual mandate” was repealed by Congress. Prior to the United
States Supreme Court ruling, on January 28, 2021, President Biden
issued an executive order that initiated a special enrollment
period for purposes of obtaining health insurance coverage through
the ACA marketplace. The executive order also instructed certain
governmental agencies to review and reconsider their existing
policies and rules that limit access to healthcare, including among
others, reexamining Medicaid demonstration projects and waiver
programs that include work requirements, and policies that create
unnecessary barriers to obtaining access to health insurance
coverage
through Medicaid or the ACA. The IRA also, among other things,
extends enhanced subsidies for individuals purchasing health
insurance coverage in ACA marketplaces through plan year 2025 and
eliminates the “donut hole” under the Medicare Part D program
beginning in 2025 by significantly lowering the beneficiary maximum
out-of-pocket cost through a newly established manufacturer
discount program. It is possible that the ACA and IRA may be
subject to judicial or Congressional challenges in the future. It
is unclear how any additional healthcare reform measures may impact
the ACA or IRA, increase the pressure on drug pricing or limit the
availability of coverage and adequate reimbursement for our product
candidates, which would adversely affect our business.
There has also been increasing executive, legislative and
enforcement interest in the United States with respect to drug
pricing practices. There have been U.S. congressional inquiries,
presidential executive orders and proposed and enacted legislation
designed to, among other things, bring more transparency to drug
pricing, reduce the cost of prescription drugs under Medicare,
review the relationship between pricing and manufacturer patient
programs and reform government program reimbursement methodologies
for drugs. For example, in an executive order, the administration
of President Biden expressed its intent to pursue certain policy
initiatives to reduce drug prices and, in response, HHS released a
Comprehensive Plan for Addressing High Drug Prices that outlines
principles for drug pricing reform and sets out a variety of
potential legislative policies that Congress could pursue to lower
drug prices. Further, the Biden administration released an
additional executive order on October 14, 2022, directing HHS to
submit a report on how the Center for Medicare and Medicaid
Innovation can be further leveraged to test new models for lowering
drug costs for Medicare and Medicaid beneficiaries. It is unclear
whether this executive order or similar policy initiatives will be
implemented in the future. We expect that the healthcare reform
measures that have been adopted and may be adopted in the future
may result in more rigorous coverage criteria and additional
downward pressure on the price that we receive for any approved
product and could seriously harm our future revenues. Any reduction
in reimbursement from Medicare or other government programs may
result in a similar reduction in payments from private payors. The
implementation of cost containment measures or other healthcare
reforms may prevent us from being able to generate revenue, attain
profitability or commercialize our products.
There have been, and likely will continue to be, legislative and
regulatory proposals at the foreign, federal and state levels
directed at broadening the availability of healthcare and
containing or lowering the cost of healthcare. Such reforms could
have an adverse effect on anticipated revenue from product
candidates that we may successfully develop and for which we may
obtain regulatory approval and may affect our overall financial
condition and ability to develop product candidates.
In many countries outside the United States, government-sponsored
healthcare systems are the primary payors for drugs. With
increasing budgetary constraints and/or difficulty in understanding
the value of medicines, governments and payors in many countries
are applying a variety of measures to exert downward price pressure
and we expect that legislators, policy makers and healthcare
insurance funds in the EU Member States will continue to propose
and implement cost cutting measures. These measures include
mandatory price controls, price referencing, therapeutic-reference
pricing, increases in mandates, incentives for generic substitution
and biosimilar usage, government-mandated price cuts, limitations
on coverage of target population and introduction of volume
caps.
Many countries implement health technology assessment, or HTA,
procedures that use formal economic metrics such as
cost-effectiveness to determine prices, coverage and reimbursement
of new therapies. These assessments are increasingly implemented in
established and emerging markets. In the EU, the newly-adopted
Regulation (EU) 2021/2282 on Health Technology Assessment, or HTA
Regulation, which will become effective in January 2025, will allow
EU member states to use common HTA tools, methodologies and
procedures to conduct joint clinical assessments and joint
scientific consultations whereby HTA authorities may provide advice
to health technology developers. Each EU member state will,
however, remain exclusively competent for assessing the relative
effectiveness of health technologies and making pricing and
reimbursement decisions. Given that the extent to which pricing and
reimbursement decisions are influenced by the HTA process currently
varies between EU member states, it is possible that our products
may be subject to favorable pricing and reimbursement status only
in certain EU countries. If we are unable to maintain favorable
pricing and reimbursement status in EU member states that represent
significant markets, including following periodic review, our
anticipated revenue from and growth prospects for our products in
the EU could be negatively affected. Moreover, in order to obtain
reimbursement for our products in some EU member states, we may be
required to compile additional data comparing the
cost-effectiveness of our products to other available therapies.
Efforts to generate additional data for the HTA process will
involve additional expenses which may substantially increase the
cost of commercializing and marketing our products in certain EU
member states.
We expect that countries will continue taking aggressive actions to
seek to reduce expenditures on drugs. Similarly, fiscal constraints
may also affect the extent to which countries are willing to
approve new and innovative therapies and/or allow access to new
technologies.
We cannot predict the likelihood, nature or extent of healthcare
reform initiatives that may arise from future legislation or
administrative action. If we or any third parties we may engage are
slow or unable to adapt to changes in existing requirements or the
adoption of new requirements or policies, or if we or such third
parties are not able to maintain regulatory compliance, our product
candidates may lose any regulatory approval that may have been
obtained and we may not achieve or sustain
profitability.
Our international operations may expose us to business, regulatory,
political, operational, financial, pricing and reimbursement risks
associated with doing business outside of the United
States.
Our business is subject to risks associated with conducting
business internationally. Some of our suppliers and clinical trial
sites are located outside of the United States. Furthermore, if we,
Merck or any future partner succeeds in developing any of our
product candidates, we intend to market them in the EU and other
jurisdictions in addition to the United States. If approved, we,
Merck or any future partner may hire sales representatives and
conduct physician and patient association outreach activities
outside of the United States. Doing business internationally
involves a number of challenges and risks, including but not
limited to:
•multiple,
conflicting and changing laws and regulations, such as privacy and
data protection regulations, tax laws, export and import
restrictions, employment laws, regulatory requirements and other
governmental approvals, permits and licenses;
•failure
by us to obtain and maintain regulatory approvals for the use of
our products in various countries;
•rejection
or qualification of foreign clinical trial data by the competent
authorities of other countries;
•delays
or interruptions in the supply of clinical trial material resulting
from any events affecting raw material or component supply or
manufacturing capabilities abroad, including those that may result
from the ongoing COVID-19 pandemic;
•additional
potentially relevant third-party patent rights;
•complexities
and difficulties in obtaining, maintaining, protecting and
enforcing our intellectual property;
•difficulties
in staffing and managing foreign operations;
•complexities
associated with managing multiple payor reimbursement regimes,
government payors or patient self-pay systems;
•limits
on our ability to penetrate international markets;
•financial
risks, such as longer payment cycles, difficulty collecting
accounts receivable, the impact of inflation and local and regional
financial crises on demand and payment for our products and
exposure to foreign currency exchange rate
fluctuations;
•natural
disasters, political, geopolitical and economic instability,
including wars such as the conflict between Russia and Ukraine,
terrorism and political unrest, disease outbreaks, epidemics and
pandemics, including COVID-19 and related shelter-in-place orders,
travel, social distancing and quarantine policies, boycotts,
curtailment of trade and other business restrictions;
and
•regulatory
and compliance risks that relate to anti-corruption compliance and
record-keeping that may fall within the purview of the U.S. Foreign
Corrupt Practices Act, its accounting provisions or its
anti-bribery provisions or provisions of anti-corruption or
anti-bribery laws in other countries.
Any of these factors could harm our ongoing international clinical
operations and supply chain, as well as any future international
expansion and operations and, consequently, our business, financial
condition, prospects and results of operations.
Product liability lawsuits against us could cause us to incur
substantial liabilities and to limit commercialization of any
products that we may develop.
We face an inherent risk of product liability exposure related to
the testing of our product candidates in human clinical trials and
will face an even greater risk if we or our partner commercializes
any resulting products. Product liability claims may be brought
against us by subjects enrolled in our clinical trials, patients,
healthcare providers or others using, administering or selling our
products. If we cannot successfully defend ourselves against claims
that our product candidates or products that we may develop caused
injuries, we could incur substantial liabilities. Regardless of
merit or eventual outcome, liability claims may result
in:
•decreased
demand for any product candidates or products that we may
develop;
•termination
of clinical trial sites or entire trial programs;
•injury
to our reputation and significant negative media
attention;
•withdrawal
of clinical trial participants;
•significant
costs to defend the related litigation;
•substantial
monetary awards to trial subjects or patients;
•loss
of revenue;
•diversion
of management and scientific resources from our business
operations; and
•the
inability to commercialize any products that we may
develop.
Our clinical trial liability insurance coverage may not adequately
cover all liabilities that we may incur. We may not be able to
maintain insurance coverage at a reasonable cost or in an amount
adequate to satisfy any liability that may arise. Our inability to
obtain product liability insurance at an acceptable cost or to
otherwise protect against potential product liability claims could
prevent or delay the commercialization of any products or product
candidates that we develop. We intend to expand our insurance
coverage for products to include the sale of commercial products if
we obtain marketing approval for our product candidates in
development, but we may be unable to obtain commercially reasonable
product liability insurance for any products approved for
marketing. Large judgments have been awarded in class action
lawsuits based on drugs that had unanticipated side effects. If we
are sued for any injury caused by our products, product candidates
or processes, our liability could exceed our product liability
insurance coverage and our total assets. Claims against us,
regardless of their merit or potential outcome, may also generate
negative publicity or hurt our ability to obtain physician
endorsement of our products or expand our business.
Our relationships with healthcare providers, customers and
third-party payors will be subject to applicable anti-kickback,
fraud and abuse, transparency and other healthcare laws and
regulations, which, if violated, could expose us to criminal
sanctions, civil penalties, contractual damages, reputational harm,
administrative burdens and diminished profits and future
earnings.
Healthcare providers, including physicians, and third-party payors
will play a primary role in the recommendation and prescription of
any product candidates for which we or our partner obtains
marketing approval. Our arrangements with healthcare providers,
third-party payors and customers may expose us to broadly
applicable fraud and abuse and other healthcare laws and
regulations that may constrain the business or financial
arrangements and relationships through which we research, market,
sell and distribute our products for which we or our partner obtain
marketing approval. Restrictions under applicable federal and state
healthcare laws and regulations, include the
following:
•the
federal Anti-Kickback Statute prohibits persons from, among other
things, knowingly and willfully soliciting, offering, receiving or
providing remuneration, directly or indirectly, in cash or in kind,
to induce or reward, or in return for, the referral of an
individual for the furnishing or arranging for the furnishing, or
the purchase, lease or order, or arranging for or recommending
purchase, lease or order, of any good or service for which payment
may be made under a federal healthcare program, such as Medicare
and Medicaid;
•the
federal False Claims Act, or FCA, imposes criminal and civil
penalties, including through civil whistleblower or
qui tam
actions, against individuals or entities for knowingly presenting,
or causing to be presented, to the federal government, claims for
payment that are false or fraudulent or making a false statement to
avoid, decrease or conceal an obligation to pay money to the
federal government;
•the
federal Health Insurance Portability and Accountability Act, or
HIPAA, imposes criminal liability for knowingly and willfully
executing a scheme to defraud any healthcare benefit program,
knowingly and willfully embezzling or stealing from a healthcare
benefit program, willfully obstructing a criminal investigation of
a healthcare offense or knowingly and willfully making false
statements relating to healthcare matters;
•HIPAA,
as amended by the Health Information Technology for Economic and
Clinical Health Act of 2009 and its implementing regulations, or
HITECH, also imposes obligations on certain covered entity
healthcare providers, health plans and healthcare clearinghouses,
and their business associates that perform certain services
involving the use or disclosure of individually identifiable health
information as well as their covered subcontractors, including
mandatory contractual terms, with respect to safeguarding the
privacy, security, processing and transmission of individually
identifiable health information;
•the
federal Physician Payments Sunshine Act, as amended, and its
implementing regulations, requires manufacturers of drugs, devices,
biologics and medical supplies for which payment is available under
Medicare, Medicaid or the Children’s Health Insurance Program (with
certain exceptions) to report annually to the HHS information
related to “payments or other transfers of value” made to
physicians (defined to include doctors, dentists, optometrists,
podiatrists and chiropractors), other health care professionals
(such as physician assistants and nurse practitioners) and teaching
hospitals, as well as information regarding ownership and
investment interests held by physicians and their immediate family
members; and
•analogous
state and foreign laws and regulations, such as state anti-kickback
and false claims laws, which may apply to sales or marketing
arrangements and claims involving healthcare items or services
reimbursed by non-governmental third-party payors, including
private insurers; state and foreign laws that require
pharmaceutical companies to comply with the pharmaceutical
industry’s voluntary compliance guidelines and the relevant
compliance guidance promulgated by the federal government or
otherwise restrict payments that may be made to healthcare
providers; state and local laws requiring the registration of
pharmaceutical sales representatives; state and foreign laws that
require drug manufacturers to report information related to
payments and other transfers of value to physicians and other
healthcare providers, marketing expenditures or pricing; and state
and foreign laws that govern the privacy and security and other
processing of health information in certain circumstances, many of
which differ from each other in significant ways and often are not
preempted by HIPAA, thus complicating compliance
efforts.
Efforts to ensure that our business arrangements with third parties
will comply with applicable healthcare laws and regulations will
involve substantial costs. It is possible that governmental
authorities will conclude that our business practices may not
comply with current or future statutes, regulations or case law
interpreting applicable fraud and abuse or other healthcare laws
and regulations. If our operations are found to be in violation of
any of these laws or any other governmental regulations that may
apply to us, we may be subject to significant civil, criminal and
administrative penalties, damages, fines, additional regulatory
oversight, litigation, imprisonment, exclusion from government
funded healthcare programs, such as Medicare and Medicaid, and the
curtailment or restructuring of our operations. If any of the
physicians or other healthcare providers or entities with whom we
expect to do business is found not to be in compliance with
applicable laws, that person or entity may be subject to criminal,
civil or administrative sanctions, including exclusions from
government funded healthcare programs.
Outside the United States, interactions between pharmaceutical
companies and health care professionals are also governed by strict
laws, such as national anti-bribery laws of EU member states,
national sunshine rules, regulations, industry self-regulation
codes of conduct and physicians’ codes of professional conduct.
Failure to comply with these requirements could result in
reputational risk, public reprimands, administrative penalties,
fines or imprisonment.
Our business could be materially and adversely affected in the
future by the effects of disease outbreaks, epidemics and
pandemics, including the COVID-19 pandemic.
Disease outbreaks, epidemics and pandemics, such as the COVID-19
pandemic, in regions where we have concentrations of clinical trial
sites or other business operations could adversely affect our
business, including by causing significant disruptions in our
operations and/or in the operations of third-party manufacturers
and CROs upon whom we rely. Disease outbreaks, epidemics and
pandemics have negative impacts on our ability to initiate new
clinical trial sites, to enroll new patients and to maintain
existing patients who are participating in our clinical trials,
which may include increased clinical trial costs, longer timelines
and delay in our ability to obtain regulatory approvals of our
product candidates, if at all. For example, our ability to attract
additional clinical trial sites and principal investigators to
conduct our clinical trials and to conduct the necessary clinical
trial site initiation procedures was impacted by COVID-19
quarantines, shelter-in-place and similar restrictions imposed by
federal, state and local governments. In addition, during the
COVID-19 pandemic, we experienced, from time to time, a slower pace
of clinical site initiation and clinical trial enrollment and a
higher subject dropout rate than originally anticipated in certain
of our clinical trials, which we believe may have been due to
factors such as the vulnerability of our studied patient
populations, site staff shortages, clinical trial site suspensions,
reallocation of medical resources and the challenges of working
remotely due to shelter-in-place and similar government orders and
guidelines, among other factors.
General supply chain issues may be exacerbated during disease
outbreaks, epidemics and pandemics and may also impact the ability
of our clinical trial sites to obtain basic medical supplies used
in our trials in a timely fashion, if at all. For example, in 2022
we were made aware of a shortage of tubes required for taking blood
samples, requiring the use of tubes of a different size from those
specified in one of our protocols. In addition, our CMOs’
facilities and operations have been adversely affected by labor,
raw material and component shortages, high
turnover of staff and difficulties in hiring trained and qualified
replacement staff during the COVID-19 pandemic. These difficulties
have resulted in some delays in early development timelines and we
could experience more significant disruptions to our supply chain
and operations as a result of disease outbreaks, epidemics or
pandemics in the future. If our CMOs are required to obtain an
alternative source of certain raw materials and components, for
example, additional testing, validation activities and regulatory
approvals may be required which can also have a negative impact on
timelines. Any associated delays in the manufacturing and supply of
drug substance and drug product for our clinical trials could
adversely affect our ability to conduct ongoing and future clinical
trials of our product candidates on our anticipated development
timelines. Likewise, the operations of our third-party
manufacturers may be requisitioned, diverted or allocated by U.S.
or foreign government orders such as under emergency, disaster and
civil defense declarations in connection with the COVID-19 pandemic
or otherwise. For example, early in the COVID-19 pandemic, our
aldafermin drug product CMO advised us that it could be required
under orders of the U.S. government to allocate manufacturing
capacity to the manufacture or distribution of COVID-19 vaccines.
If any of our CMOs or raw materials or components suppliers become
subject to acts or orders of U.S. or foreign government entities to
allocate or prioritize manufacturing capacity, raw materials or
components to the manufacture or distribution of vaccines or
medical supplies needed to test or treat patients in a disease
outbreak, epidemic or pandemic, this could delay our clinical
trials, perhaps substantially, which could materially and adversely
affect our business.
Moreover, COVID-19 continues to evolve, and the extent to which
COVID-19 may impact our business, results of operations and
financial position will depend on future developments, which are
highly uncertain and cannot be predicted with confidence, such as
the emergence, infectiousness and severity of new variants, travel
restrictions, quarantines and social distancing in the United
States and other countries, business closures or business
disruptions, global supply challenges, and the effectiveness of
actions in the United States and other countries to contain and
treat the disease. New health epidemics or pandemics may emerge
that result in similar or more severe disruptions to our business.
To the extent the effects of the continuing COVID-19 pandemic, or
any future disease outbreak, epidemic or pandemic, adversely
affects our business and results of operations, it also may have
the effect of heightening many of the other risks and uncertainties
described elsewhere in this ‘‘Risk Factors’’ section.
Risks Related to Regulatory Approvals
The regulatory approval processes of the FDA and comparable foreign
health authorities are lengthy and inherently unpredictable. Our
inability to obtain regulatory approval for our product candidates
would substantially harm our business.
Currently, none of our product candidates has received regulatory
approval and we do not expect our product candidates to be
commercially available for several years, if at all. The time
required to obtain approval from the FDA and comparable foreign
health authorities is unpredictable but typically takes many years
following the commencement of preclinical studies and clinical
trials and depends upon numerous factors, including the substantial
discretion of the health authorities. In addition, approval
policies, regulations or the type and amount of preclinical and
clinical data necessary to gain approval may change during the
course of a product candidate’s development and may vary among
jurisdictions. It is possible that none of our existing or future
product candidates will ever obtain regulatory
approval.
Our product candidates could fail to receive regulatory approval
from the FDA or a comparable foreign health authority for many
reasons, including:
•disagreement
with the design or implementation of our clinical
trials;
•failure
to demonstrate that a product candidate is safe and effective for
its proposed indication;
•failure
of results of clinical trials to meet the level of statistical
significance required for approval;
•failure
to demonstrate that a product candidate’s clinical and other
benefits outweigh its safety risks;
•disagreement
with our interpretation of data from preclinical studies or
clinical trials;
•the
insufficiency of data collected from clinical trials to support the
submission and filing of a BLA or other submission or to obtain
regulatory approval;
•failure
to obtain approval of the manufacturing processes or facilities of
third-party manufacturers with whom we contract for clinical and
commercial supplies;
•unfavorable
quality review or audit/inspection findings; or
•changes
in the approval policies or regulations that render our preclinical
and clinical data insufficient for approval.
The FDA or a comparable foreign health authority may require more
information, including additional preclinical or clinical data, to
support approval, which may delay or prevent approval and
commercialization, or we may decide to abandon the development
program for other reasons. If we obtain approval, regulatory
authorities may approve any of our product candidates for fewer or
more limited indications than we request, may grant accelerated
approval or conditional marketing authorization based on a
surrogate endpoint and contingent on the successful outcome of
costly post-marketing confirmatory clinical trials or 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.
The FDA has a Fast Track program that is intended to expedite or
facilitate the process for reviewing new drug products that meet
certain criteria. Specifically, new drugs are eligible for Fast
Track designation if they are intended to treat a serious or
life-threatening disease or condition and demonstrate the potential
to address unmet medical needs for the disease or condition, and
the FDA may grant accelerated approval based on a surrogate
endpoint reasonably likely to predict clinical benefit. However,
Fast Track designation does not guarantee, or in any way change the
standards for, full product approval.
Many agents in development for NASH have, or are expected to, opt
for an accelerated approval pathway and rely on surrogate endpoints
for initial approval. If we or a future partner seek accelerated
approval for one of our product candidates based on a surrogate
endpoint, the FDA may not accept such endpoint, may require
additional studies or analysis or may not approve our product
candidate on an accelerated basis, or at all. For example, in June
2020, Intercept Pharmaceuticals, Inc., or Intercept, announced that
it had received a complete response letter regarding its new drug
application, or NDA, for obeticholic acid for the treatment of
NASH, in which the FDA indicated that it had determined that the
predicted benefit of obeticholic acid based on a surrogate
histopathologic endpoint was uncertain and did not sufficiently
outweigh the potential risks to support accelerated approval for
the treatment of patients with liver fibrosis due to NASH. The FDA
recommended that Intercept submit additional post-interim analysis
efficacy and safety data from its ongoing Phase 3 study in support
of potential accelerated approval and that the long-term outcomes
phase of the study should continue. In addition, if full approval
is granted for another product in the same indication for which we
are seeking accelerated approval for one of our product candidates,
the accelerated approval pathway may no longer be available to us
or a future partner for our product candidate.
In the EU, innovative products that target an unmet medical need
and are expected to be of major public health interest may be
eligible for a number of expedited development and review programs,
such as the Priority Medicines, or PRIME, scheme, which provides
incentives similar to the breakthrough therapy designation in the
United States.
Sponsors that benefit from PRIME designation are potentially
eligible for accelerated assessment of their marketing
authorization applications, although this is not guaranteed. If a
product for which PRIME designation was granted is the subject of
an accelerated assessment, the product may be placed on the market
in the EU before our product candidate with a similar therapeutic
indication.
Our failure to obtain health authority approval in foreign
jurisdictions would prevent us from marketing our product
candidates outside the United States.
If we or our partners succeed in developing any products, we intend
to market them in the EU and other foreign jurisdictions in
addition to the United States. In order to market and sell our
products in other jurisdictions, we must obtain separate marketing
approvals and comply with numerous and varying regulatory
requirements. The approval procedure varies among countries and can
involve additional testing. The time required to obtain approval
may differ substantially from that required to obtain FDA approval.
The regulatory approval process outside the United States generally
includes all of the risks associated with obtaining FDA approval.
In addition, in many countries outside the United States, we must
secure product pricing and reimbursement approvals before health
authorities will approve the product for sale in that country.
Obtaining foreign regulatory approvals and compliance with foreign
regulatory requirements could result in significant delays,
difficulties and costs for us and could delay or prevent the
introduction of our products in certain countries. Further,
clinical trials conducted in one country may not be accepted by
health authorities in other countries and regulatory approval in
one country does not ensure approval in any other country, while a
failure or delay in obtaining regulatory approval in one country
may have a negative effect on the regulatory approval process in
others. If we fail to obtain approval of any of our product
candidates by health authorities in another country, we will be
unable to commercialize our product in that country, and the
commercial prospects of that product candidate and our business
prospects could decline.
Even if our product candidates receive regulatory approval, they
may still face future development and regulatory
difficulties.
Even if we obtain regulatory approval for a product candidate, it
would be subject to ongoing requirements by the FDA and comparable
foreign health authorities governing the manufacture, quality
control, further development, labeling, packaging, storage,
distribution, safety surveillance, import, export, advertising,
promotion, recordkeeping and reporting of safety and other
post-market information. The FDA and comparable foreign health
authorities will continue to closely monitor the safety profile of
any product even after approval. If the FDA or comparable foreign
health authorities become aware of new safety information after
approval of any of our product candidates, they may require
labeling changes or establishment of a Risk Evaluation and
Mitigation Strategy, or REMS, or similar strategy, impose
significant restrictions on a product’s indicated uses or marketing
or impose ongoing requirements for potentially costly post-approval
studies or post-market surveillance. Failure to comply with any
related obligations may result in the suspension or withdrawal of
an obtained approval and in civil and/or criminal penalties.
Receipt of approval for narrower indications than sought,
restrictions on marketing through a REMS or similar strategy
imposed in an EU member state or other foreign country, or
significant labeling restrictions or requirements in an approved
label such as a boxed warning, could have a negative impact on our
ability to recoup our R&D costs and to successfully
commercialize that product, any of which could materially and
adversely affect our business, financial condition, results of
operations and growth prospects. In any event, if we are unable to
comply with our post-marketing obligations imposed as part of the
marketing approvals in the United States, the EU, or other
countries, our approval may be varied, suspended or revoked,
product supply may be delayed and our sales of our products could
be materially adversely affected.
In addition, manufacturers of drug substance and drug products and
their facilities are subject to continual review and periodic
inspections by the FDA and comparable foreign health authorities
for compliance with current Good Manufacturing Practices, or cGMP,
regulations. If we or a regulatory agency discover previously
unknown problems with a product, such as adverse events of
unanticipated severity or frequency, or problems with the facility
where the product is manufactured, a regulatory agency 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. If we or the manufacturing
facilities for our product candidates fail to comply with
applicable regulatory requirements, or if our product candidates
are found to cause undesirable or unacceptable side effects, a
regulatory agency may:
•issue
safety alerts, Dear Healthcare Provider letters, press releases or
other communications containing warnings about such
product;
•mandate
modifications to promotional materials or require us to provide
corrective information to healthcare practitioners;
•require
that we conduct and complete post-marketing studies;
•require
us to enter into a consent decree, which can include imposition of
various fines, reimbursements for inspection costs, required due
dates for specific actions and penalties for
noncompliance;
•seek
an injunction or impose civil or criminal penalties or monetary
fines;
•suspend
marketing of, withdraw regulatory approval of or initiate a recall
of such product;
•suspend
any ongoing clinical trials;
•refuse
to approve pending applications or supplements to applications
filed by us;
•suspend
or impose restrictions on operations, including costly new
manufacturing requirements; or
•seize
or detain products or refuse to permit the import or export of
products.
The occurrence of any event or penalty described above may inhibit
our ability to commercialize our products and generate
revenue.
Advertising and promotion of any product candidate that obtains
approval in the United States will be heavily scrutinized by the
FDA, Department of Justice, HHS, Office of Inspector General, state
attorneys general, members of Congress and the public. Violations,
including promotion of our products for unapproved (or off-label)
uses, are subject to enforcement letters, inquiries and
investigations and civil and criminal sanctions by the government.
Additionally, comparable foreign health authorities, public
prosecutors, industry associations, healthcare professionals and
other members of the public will heavily scrutinize advertising and
promotion of any product candidate outside of the United
States.
In the United States, engaging in the impermissible promotion of
our products for off-label uses can subject us to false claims
litigation under federal and state statutes, which can lead to
civil and criminal penalties and fines
and agreements that materially restrict the manner in which a
company promotes or distributes drug products. These false claims
statutes include the federal FCA, which allows any individual to
bring a lawsuit against a pharmaceutical company on behalf of the
federal government alleging submission of false or fraudulent
claims, or causing to present such false or fraudulent claims, for
payment by a federal program such as Medicare or Medicaid. If the
government prevails in the lawsuit, the individual will share in
any fines or settlement funds. Since 2004, these FCA lawsuits
against pharmaceutical companies have increased significantly in
volume and breadth, leading to several substantial civil and
criminal settlements regarding certain sales practices promoting
off-label drug uses involving fines in excess of $1 billion. This
growth in litigation has increased the risk that a pharmaceutical
company will have to defend a false claim action, pay settlement
fines or restitution, agree to comply with burdensome reporting and
compliance obligations and be excluded from Medicare, Medicaid and
other federal and state healthcare programs. If we do not lawfully
promote our approved products, we may become subject to such
litigation and, if we do not successfully defend against such
actions, those actions may have a material adverse effect on our
business, financial condition and results of
operations.
The FDA’s policies may change, and additional government
regulations may be enacted that could prevent, limit or delay
regulatory approval of our product candidates. If we are slow or
unable to adapt to changes in existing requirements or the adoption
of new requirements or policies, or if we are not able to maintain
regulatory compliance, we may lose any marketing approval that we
may have obtained, which would adversely affect our business,
prospects and ability to achieve or sustain
profitability.
In the EU, the advertising and promotion of medicinal products are
subject to both EU and EU member state laws governing promotion of
medicinal products, interactions with physicians and other
healthcare professionals, misleading and comparative advertising
and unfair commercial practices. Although general requirements for
advertising and promotion of medicinal products are established
under EU directives, the details are governed by regulations in
each member state and can differ from one country to another. For
example, applicable laws require that promotional materials and
advertising in relation to medicinal products comply with the
product’s Summary of Product Characteristics, or SmPC, as approved
by the competent authorities in connection with a marketing
authorization. The SmPC is the document that provides information
to physicians concerning the safe and effective use of the product.
Promotional activity that does not comply with the SmPC is
considered off-label and is prohibited in the EU.
Direct-to-consumer advertising of prescription medicinal products
is also prohibited in the EU.
Failure to comply with EU, EU member state, and other country laws
that apply to the conduct of clinical trials, manufacturing
approval, marketing authorization of medicinal products and
marketing of such products, both before and after grant of a
marketing authorization, or with other applicable regulatory
requirements, may result in administrative, civil or criminal
penalties. These penalties could include delays or refusal to
authorize the conduct of clinical trials, or to grant marketing
authorization, product withdrawals and recalls, product seizures,
suspension, withdrawal or variation of the marketing authorization,
total or partial suspension of production, distribution,
manufacturing or clinical trials, operating restrictions,
injunctions, suspension of licenses, fines and criminal penalties.
In addition, legislation adopted at the EU level may be implemented
differently by individual member states. These regulations, and
their differing implementations in member states, increase our
legal and financial compliance costs and may make some activities
more time-consuming and expensive.
Even if we are able to obtain regulatory approvals for any of our
product candidates, if they exhibit harmful side effects after
approval, our regulatory approvals could be revoked or otherwise
negatively impacted.
Even if we receive regulatory approval for any of our product
candidates, we will have tested them in only a small number of
patients during our clinical trials. If an application for
marketing is approved for any of our product candidates and more
patients begin to use our product, new risks and side effects
associated with our products may be discovered. As a result, health
authorities may revoke their approvals. If aldafermin is approved
by the FDA based on a surrogate endpoint pursuant to accelerated
approval regulations (Subpart E regulations), we will be required
to conduct additional clinical trials establishing clinical benefit
on the ultimate outcome of NASH. Additionally, we may be required
to conduct additional clinical trials, make changes in labeling of
our product, reformulate our product or make changes and obtain new
approvals for our and our suppliers’ manufacturing facilities for
our product candidates. Equivalent obligations could be imposed by
the foreign health authorities. We might have to withdraw or recall
our products from the marketplace. We may also experience a
significant drop in the potential sales of our product if and when
regulatory approvals for such product are obtained, experience harm
to our reputation in the marketplace or become subject to lawsuits,
including class actions. Any of these results could decrease or
prevent any sales of our approved product or substantially increase
the costs and expenses of commercializing and marketing our
product.
Risks Related to Our Intellectual Property
Our success depends in significant part upon our ability to obtain
and maintain intellectual property protection for our products and
technologies.
Our success depends in significant part on our ability and the
ability of our current or future licensors, licensees, partners or
collaborators to establish and maintain adequate intellectual
property covering the product candidates that we plan to develop.
In addition to taking other steps designed to protect our
intellectual property, we have applied for, and intend to continue
applying for, patents with claims covering our technologies,
processes and product candidates when and where we deem it
appropriate to do so. However, the patent prosecution process is
expensive and time-consuming, and we and our current or future
licensors, licensees, partners or collaborators may not be able to
prepare, file and prosecute all necessary or desirable patent
applications at a reasonable cost or in a timely manner. It is also
possible that we or our current or future licensors, licensees,
partners or collaborators will fail to identify patentable aspects
of inventions made in the course of development and
commercialization activities before it is too late to obtain patent
protection for them. Pending and future patent applications filed
by us or our current or future licensors’, licensees’, partners' or
collaborators’ may not result in patents being issued that protect
our technology or product candidates, or products resulting
therefrom, in whole or in part, or that effectively prevent others
from commercializing competitive technologies and
products.
We have filed numerous patent applications both in the United
States and in certain foreign jurisdictions to obtain patent rights
to our inventions, with claims directed to compositions-of-matter,
methods of use, formulations, combination therapy and other
technologies relating to our product candidates. There can be no
assurance that any of these patent applications will issue as
patents or, for those applications that do mature into patents,
whether the claims of the patents will exclude others from making,
using or selling our product or product candidates, or products or
product candidates that are substantially similar to ours. In
countries where we have not and do not seek patent protection,
third parties may be able to manufacture and sell products that are
substantially similar or identical to our products or product
candidates without our permission, and we may not be able to stop
them from doing so.
Similar to other biotechnology companies, our patent position is
generally highly uncertain and involves complex legal and factual
questions. In this regard, we cannot be certain that we or our
current or future licensors, licensees, partners or collaborators
were the first to make an invention, or the first inventors to file
a patent application claiming an invention in our owned or licensed
patents or pending patent applications. In addition, even if
patents are issued, given the amount of time required for the
development, testing and regulatory review of our product
candidates, any patents protecting such candidates might expire
before or shortly after the resulting products are commercialized.
Moreover, the laws and regulations governing patents could change
in unpredictable ways that could weaken the ability of us and our
current or future licensors, licensees, partners or collaborators
to obtain new patents or to enforce existing patents and patents we
may obtain in the future. In any event, the issuance, scope,
validity, enforceability and commercial value of our patent rights
and those of our current or future licensors, licensees, partners
or collaborators are highly uncertain and may not effectively
prevent others from commercializing competitive technologies and
products.
In some circumstances, we may not have the right to control the
preparation, filing and prosecution of patent applications, or to
maintain or enforce the patents, covering technology that we
license from or license to third parties and may be reliant on our
current or future licensors, licensees, partners or collaborators
to perform these activities, which means that these patent
applications may not be prosecuted, and these patents may not be
enforced, in a manner consistent with the best interests of our
business. If our current or future licensors, licensees, partners
or collaborators fail to establish, maintain, protect or enforce
such patents and other intellectual property rights, such rights
may be reduced or eliminated. If our current or future licensors,
licensees, partners or collaborators are not fully cooperative or
disagree with us as to the prosecution, maintenance or enforcement
of any patent rights, such patent rights could be
compromised.
In addition, the legal protection afforded to inventors and owners
of intellectual property in countries outside of the United States
may not be as broad or effective as that in the United States and
we may be unable to acquire and enforce intellectual property
rights outside the United States to the same extent as in the
United States, if at all. Accordingly, our efforts, and those of
our licensors, licensees, partners or collaborators, to enforce
intellectual property rights around the world may be inadequate to
obtain a significant commercial advantage from the intellectual
property that we own or license.
We own one issued United States patent that covers our NGM621
product candidate, although the product and related
compositions-of-matter and methods of use are disclosed and claimed
in other pending U.S. non-provisional and/or national stage
applications in particular foreign countries. We do not currently
own or have a
license to any issued patents that cover our NGM707, NGM831 and
NGM438 product candidates, although these product candidates are
disclosed and claimed in our pending U.S. non-provisional and
international applications. The patent landscape surrounding all of
our product candidates is crowded, and there can be no assurance
that we will be able to secure patent protection that would
adequately cover such product candidates, that we will obtain
sufficiently broad claims to be able to prevent others from selling
competing products or that we will be able to protect and maintain
any patent protection that we initially secure.
Any changes we make to our product candidates to cause them to have
what we view as more advantageous properties may not be covered by
our existing patents and patent applications, and we may be
required to file new patent applications and/or seek other forms of
protection for any such altered product candidates. The patent
landscape surrounding the technology underlying our product
candidates is crowded, and there can be no assurance that we would
be able to secure patent protection that would adequately cover an
alternative to any of our product candidates.
We may be unable to obtain intellectual property rights or
technologies necessary to develop and commercialize our product
candidates.
Several third parties are actively researching and seeking and
obtaining patent protection in the fields of cancer, retinal
diseases, CVM-related diseases, including heart failure, and liver
and metabolic diseases, and there are issued third-party patents
and published third-party patent applications in these fields. The
patent landscape around our product candidates is complex, and we
are aware of several third-party patents and patent applications
containing claims directed to compositions-of-matter, methods of
use and related subject matter, some of which pertain, at least in
part, to subject matter that might be relevant to our product
candidates. However, we may not be aware of all third-party
intellectual property rights potentially relating to our product
candidates and technologies.
Depending on what patent claims ultimately issue and how courts
construe the issued patent claims, as well as the ultimate
formulation and method of use of our product candidates, we may
need to obtain a license to practice the technology claimed in such
patents. There can be no assurance that such licenses will be
available on commercially reasonable terms, or at all. If we are
unable to successfully obtain rights to required third-party
intellectual property rights or maintain the existing rights to
third-party intellectual property rights we have, we might be
unable to develop and commercialize one or more of our product
candidates, which could have a material adverse effect on our
business, financial condition, results of operations and
prospects.
We could lose the ability to continue the development and
commercialization of our products or product candidates if we
breach any license agreement related to those products or product
candidates.
Our commercial success depends upon our ability, and the ability of
our current and future licensors, licensees, partners and
collaborators, to develop, manufacture, market and sell our
products and product candidates and use our proprietary
technologies without infringing the proprietary rights of third
parties. A third party may hold intellectual property rights,
including patent rights that are important or necessary to the
development of our products. As a result, we are a party to a
number of technology and patent licenses that are important to our
business, and we expect to enter into additional licenses in the
future. If we fail to comply with the obligations under these
agreements, including payment and diligence obligations, our
licensors may have the right to terminate these agreements. In the
event of a termination of these agreements, we may not be able to
develop, manufacture, market or sell any product that is covered by
these agreements or to engage in any other activities necessary to
our business that require the freedom-to-operate afforded by the
agreements, or we may face other penalties under the agreements.
For example, we are party to license agreements with multiple
vendors, including our licenses with Horizon Discovery Ltd. and
Lonza Sales AG, under which we license cell lines and other
technology used to produce multiple product candidates, including
some that are currently subject to our collaboration with Merck. We
require prior consent from some of these vendors to grant
sub-licenses under these agreements. Therefore, these vendors may
be able to prevent us from granting sub-licenses to third parties,
which could affect our ability or Merck’s ability to use certain
desired manufacturers in order to manufacture our product
candidates. In the event of a termination of our license
agreements, our ability or Merck’s ability to manufacture or
develop any product candidates covered by these agreements may be
limited or halted unless we can develop or obtain the rights to
technology necessary to produce these product
candidates.
Any of the foregoing could materially adversely affect the value of
the product or product candidate being developed under any such
agreement. Termination of these agreements or reduction or
elimination of our rights under these agreements may result in our
having to negotiate new or amended agreements, which may not be
available to us on equally favorable terms, or at all, or cause us
to lose our rights under these agreements, including our rights to
intellectual property or technology important to our development
programs.
We may become involved in lawsuits or other proceedings to protect
or enforce our intellectual property, which could be expensive,
time-consuming and unsuccessful and have a material adverse effect
on the success of our business.
Third parties may infringe patents or misappropriate or otherwise
violate intellectual property rights owned or controlled by us or
our current or future licensors, licensees, partners or
collaborators. In the future, it may be necessary to initiate legal
proceedings to enforce or defend these intellectual property
rights, to protect trade secrets or to determine the validity or
scope of intellectual property rights that are owned or controlled
by us or our current or future licensors, licensees, partners or
collaborators. Litigation could result in substantial costs and
diversion of management resources, which could harm our business
and financial results.
If we or our current or future licensors, licensees, partners or
collaborators initiated legal proceedings against a third party to
enforce a patent covering a product candidate, the defendant could
counterclaim that such patent is invalid or unenforceable. In
patent litigation in the United States, defendant counterclaims
alleging invalidity 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
United States Patent and Trademark Office, or USPTO, or made a
misleading statement during prosecution. In an infringement or
declaratory judgment proceeding, a court may decide that a patent
owned by or licensed to us or our current or future licensors,
licensees, partners or collaborators is invalid or unenforceable,
or may refuse to stop the other party from using the technology at
issue on the grounds that the patent does not cover the technology
in question. An adverse result in any litigation proceeding could
put one or more of the patents at risk of being invalidated,
narrowed, held unenforceable or interpreted in such a manner that
would not preclude third parties from entering the market with
competing products.
Third parties may initiate legal proceedings against us or our
current or future licensors, licensees, partners or collaborators
to challenge the validity or scope of intellectual property rights
we own or control. For example, generic or biosimilar drug
manufacturers or other competitors or third parties may challenge
the scope, validity or enforceability of patents owned or
controlled by us or our current or future licensors, licensees,
partners or collaborators. These proceedings can be expensive and
time-consuming, and many of our adversaries may have the ability to
dedicate substantially greater resources to prosecuting these legal
actions than us. Accordingly, despite our efforts, we or our
current or future licensors, licensees, partners or collaborators
may not be able to prevent third parties from infringing upon or
misappropriating intellectual property rights we own, control or
have rights to, particularly in countries where the laws may not
protect those rights as fully as in the United States.
There is a risk that some of our confidential information could be
compromised by disclosure during litigation because of the
substantial amount of discovery required. Additionally, many
foreign jurisdictions have rules of discovery that are different
than those in the United States and that may make defending or
enforcing our patents extremely difficult. There also could be
public announcements of the results of hearings, motions or other
interim proceedings or 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.
Third-party pre-issuance submission of prior art to the USPTO,
opposition, derivation, revocation, reexamination,
inter partes
review or interference proceedings, or other pre-issuance or
post-grant proceedings, as well as other patent office proceedings
or litigation in the United States or other jurisdictions brought
by third parties against patents or patent applications owned or
controlled by us or our current or future licensors, licensees,
partners or collaborators, may be necessary to determine the
inventorship, priority, patentability or validity of these patents
or patent applications. An unfavorable outcome could leave our
technology or product candidates without patent protection and
allow third parties to commercialize our technology or product
candidates without payment to us. Additionally, potential
licensees, partners or collaborators could be dissuaded from
collaborating with us to license, develop or commercialize current
or future product candidates if the breadth or strength of
protection provided by our patents and patent applications is
threatened. Even if we successfully defend such litigation or
proceeding, we may incur substantial costs and it may distract our
management and other employees.
Third parties may initiate legal proceedings against us alleging
that we infringe their intellectual property rights or we may
initiate legal proceedings against third parties to challenge the
validity or scope of the third-party intellectual property rights,
the outcome of which would be uncertain and could have a material
adverse effect on the success of our business.
Third parties may initiate legal proceedings against us or our
current or future licensors, licensees, partners or collaborators
alleging that we infringe their intellectual property rights.
Alternatively, we may initiate legal proceedings to challenge the
validity or scope of intellectual property rights controlled by
third parties, including in
oppositions, interferences, revocations, reexaminations,
inter partes
review or derivation proceedings before the USPTO or its
counterparts in other jurisdictions. In this regard, we are aware
of several third-party patents and patent applications containing
claims directed to compositions-of-matter, methods of use and
related subject matter, some of which pertain, at least in part, to
subject matter that might be relevant to our product candidates.
These proceedings can be expensive and time-consuming, and many of
our adversaries may have the ability to dedicate substantially
greater resources to prosecuting these legal actions than
us.
In addition, we may be subject to claims that we or our employees
have used or disclosed confidential information or intellectual
property, including trade secrets or other proprietary information,
of any such employee’s former employer, or that third parties have
an interest in our patents as an inventor or co-inventor. Likewise,
we and our current or future licensors, licensees, partners or
collaborators may be subject to claims that former employees,
partners, collaborators or other third parties have an interest in
our owned or in-licensed patents, trade secrets or other
intellectual property as an inventor or co-inventor. Litigation may
be necessary to defend against these claims.
Even if we believe third-party intellectual property claims are
without merit, there is no assurance that a court would find in our
favor on questions of infringement, validity, enforceability or
priority. In order to successfully challenge the validity of any
such U.S. patent in federal court, we would need to overcome a
presumption of validity in favor of the granted third-party patent.
This is a high burden, requiring us to present clear and convincing
evidence as to the invalidity of any such U.S. patent
claim.
An unfavorable outcome in any such proceeding could require us and
our current or future licensors, licensees, partners or
collaborators to cease using the related technology or developing
or commercializing the product or product candidate, or to attempt
to license rights to it from the prevailing party, which may not be
available on commercially reasonable terms, or at all.
Additionally, we could be found liable for monetary damages,
including treble damages and attorneys’ fees, if we are found to
have willfully infringed a patent. A finding of infringement could
prevent us from commercializing our product candidates or force us
to cease some of our business operations, which could materially
harm our business.
We may not be able to protect our intellectual property rights
throughout the world.
Filing, prosecuting and defending patents in all countries
throughout the world would be prohibitively expensive, and our
intellectual property rights in some countries outside the United
States can be less extensive than those in the United States. In
addition, the laws of some foreign countries do not protect
intellectual property rights to the same extent as federal and
state laws in the United States, even in jurisdictions where we do
pursue patent protection. Consequently, we may not be able to
prevent third parties from practicing our or our licensors’
inventions in all countries outside the United States, even in
jurisdictions where we or our licensors do pursue patent
protection. Competitors may use our technologies in jurisdictions
where we have not obtained patent protection to develop their own
competing products and, further, may export otherwise infringing
products to territories where we have patent protection, but
enforcement is not as strong as that in the United
States.
Many countries have compulsory licensing laws under which a patent
owner may be compelled to grant licenses to third parties. In
addition, many countries limit the enforceability of patents
against government agencies or government contractors. In these
countries, the patent owner may have limited remedies, which could
materially diminish the value of such patent. If we are forced to
grant a license to third parties with respect to any patents
relevant to our business, our competitive position may be impaired,
and our business, financial condition, results of operations and
prospects may be adversely affected.
In Europe, expected by the end of 2023, European applications will
soon have the option, upon grant of a patent, of becoming a Unitary
Patent which will be subject to the jurisdiction of the Unitary
Patent Court, or the UPC. This will be a significant change in
European patent practice. As the UPC is a new court system, there
is no precedent for the court, increasing the uncertainty of any
litigation. It is our initial belief that the UPC, while offering a
cheaper streamlined process, has potential disadvantages to patent
holders, such as making a single European patent vulnerable in all
jurisdictions when challenged in a single
jurisdiction.
Risks Related to Ownership of Our Common Stock
The market price of our common stock has been and may continue to
be volatile, and you could lose all or part of your
investment.
The market price for our common stock has fluctuated significantly
from time to time, for example, varying between a high of $32.12 on
March 17, 2021 and a low of $2.92 on October 17, 2022. The trading
price of our common stock has been and may continue to be highly
volatile and subject to wide fluctuations in response
to
various factors, some of which we cannot control. In addition to
the factors discussed in this “Risk Factors” section, these factors
include:
•results
of clinical trials of our product candidates or those of our
competitors;
•our
ability to raise adequate capital through public or private equity
or debt offerings or negotiate potential future BD
Arrangements;
•the
success of competitive products or technologies, including
disclosure of data by our competitors;
•regulatory
actions with respect to our product candidates or our competitors’
product candidates or products;
•timeline
delays in our clinical trials, including delays resulting from the
effects of the ongoing global COVID-19 pandemic or
otherwise;
•actual
or anticipated changes in our growth rate relative to our
competitors;
•announcements
by us or our competitors or partners of significant acquisitions,
strategic collaborations, joint ventures or capital
commitments;
•regulatory,
legal or payor developments in the United States and other
countries;
•developments
or disputes concerning patent applications, issued patents or other
proprietary rights;
•the
recruitment or departure of key personnel;
•the
level of expenses related to any of our product candidates or
clinical development programs;
•the
results of our efforts to in-license or acquire additional product
candidates or products;
•actual
or anticipated changes in estimates as to financial results,
development timelines or recommendations by securities
analysts;
•variations
in our financial results or those of companies that are perceived
to be similar to us;
•fluctuations
in the valuation of companies perceived by investors to be
comparable to us;
•share
price and volume fluctuations attributable to inconsistent trading
volume levels of our shares;
•announcement
or expectation of additional financing efforts;
•purchases
or sales of our common stock by us, our insiders or our other
stockholders;
•changes
in the structure of healthcare payment systems;
•market
conditions in the pharmaceutical and biotechnology sectors;
and
•general
economic, industry and market conditions.
In addition, the stock market in general, and The Nasdaq Global
Select Market and biotechnology companies in particular, have
experienced extreme price and volume fluctuations that have often
been unrelated or disproportionate to the operating performance of
these companies, including in connection with the ongoing COVID-19
pandemic and the conflict between Russia and Ukraine, which has
resulted in decreased stock prices for many companies
notwithstanding the lack of a fundamental change in their
underlying business models or prospects. Broad market and industry
factors, including worsening economic conditions and other adverse
effects or developments relating to the effects of the ongoing
COVID-19 pandemic, macroeconomic factors including inflation and
rising interest rates, and geopolitical instability, including
instability resulting from the conflict between Russia and Ukraine
and the related sanctions imposed against Russia, may negatively
affect the market price of our common stock, regardless of our
actual operating performance. The realization of any of the above
risks or any of a broad range of other risks, including those
described elsewhere in this “Risk Factors” section, could have a
dramatic and material adverse impact on the market price of our
common stock.
Because of volatility in our trading price and trading volume, we
may incur significant costs from class action securities
litigation.
Holders of stock in companies that have a volatile stock price
frequently bring securities class action litigation against the
company that issued the stock. We may be the target of this type of
litigation in the future. If any of our stockholders were to bring
a lawsuit of this type against us, even if the lawsuit is without
merit, we could incur substantial costs defending the lawsuit and
the time and attention of our management could be diverted from
other business concerns, either of which could seriously harm our
business. Refer to the risk factor titled “An
active trading market for our common stock may not be sustained and
sales of a substantial number of shares of our common stock in the
public market could cause our stock price to
fall.”
Our principal stockholders, including entities affiliated with The
Column Group, Merck and management, own a substantial percentage of
our stock and collectively will be able to exert significant
control over matters subject to stockholder approval.
Our executive officers, directors, significant stockholders,
including entities affiliated with The Column Group and Merck, and
their respective affiliates, beneficially own a substantial amount
of our voting stock. These stockholders collectively may be able to
determine all matters requiring stockholder approval. For example,
these stockholders collectively may be able to control elections of
directors, amendments of our organizational documents or approval
of any merger, sale of assets or other major corporate transaction.
The interests of this group of stockholders may not always coincide
with your interests or the interests of other stockholders. In
addition, if any of our significant stockholders decide to sell a
meaningful amount of their ownership position and there is not
sufficient demand in the market for our common stock, our stock
price could fall.
An active trading market for our common stock may not be sustained
and sales of a substantial number of shares of our common stock in
the public market could cause our stock price to fall.
Our common stock is currently listed on The Nasdaq Global Select
Market under the symbol “NGM” and trades on that market. We cannot
ensure that an active trading market for our common stock will be
sustained. Accordingly, we cannot ensure the liquidity of any
trading market, your ability to sell your shares of our common
stock when desired or the prices that you may obtain for your
shares.
For the trading days during the nine months ended September 30,
2022, the average daily trading volume for our common stock on The
Nasdaq Global Select Market was only 376,739 shares. As a result,
sales of a substantial number of shares of our common stock in the
public market, including pursuant to the Sales Agreement or by any
of our large stockholders, or even the perception in the market
that we or the holders of a large number of shares intend to sell
shares, could reduce the market price of our common stock. In
addition, as a result of the low trading volume of our common
stock, the trading of relatively small quantities of shares by our
stockholders could disproportionately influence the market price of
our common stock in either direction. The price for our shares
could, for example, decline significantly in the event that a large
number of shares of our common stock are sold on the market without
commensurate demand, as compared to an issuer with a higher trading
volume that could better absorb those sales without an adverse
impact on its stock price. Moreover, certain holders of our common
stock have rights, subject to certain conditions, to require us to
file registration statements covering their shares or to include
their shares in registration statements that we may file for
ourselves or other stockholders.
We do not intend to pay dividends on our common stock so any
returns will be limited to the value of our stock.
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 appreciation of their stock, if any.
Some provisions of our charter documents, Delaware law and our
agreement with Merck may have anti-takeover effects or could
otherwise discourage an acquisition of us by others, even if an
acquisition would benefit our stockholders, and may prevent
attempts by our stockholders to replace or remove our current
management.
Provisions in our amended and restated certificate of incorporation
and amended and restated bylaws, as well as provisions of Delaware
law, could make it more difficult for a third party to acquire us
or increase the cost of acquiring us, even if doing so would
benefit our stockholders, or to remove our current management.
These provisions include:
•a
board of directors divided into three classes serving staggered
three-year terms, such that not all members of the board will be
elected at one time;
•authorizing
the issuance of “blank check” preferred stock, the terms of which
we may establish and shares of which we may issue without
stockholder approval;
•prohibiting
cumulative voting in the election of directors, which would
otherwise allow for less than a majority of stockholders to elect
director candidates;
•prohibiting
stockholder action by written consent, thereby requiring all
stockholder actions to be taken at a meeting of our
stockholders;
•eliminating
the ability of stockholders to call a special meeting of
stockholders; and
•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.
These provisions may frustrate or prevent any attempts by our
stockholders to replace or remove our current management by making
it more difficult for stockholders to replace members of our board
of directors, who are responsible for appointing the members of our
management. Because we are incorporated in Delaware, we are
governed by the provisions of Section 203 of the Delaware General
Corporation Law which may discourage, delay or prevent someone from
acquiring us or merging with us whether or not it is desired by or
beneficial to our stockholders. In addition, Section 203 of the
Delaware General Corporation Law prohibits a publicly-held Delaware
corporation from engaging in a business combination with an
interested stockholder, which is generally a person that together
with its affiliates owns, or within the last three years has owned,
15% of our voting stock, for a period of three years after the date
of the transaction in which the person became an interested
stockholder, unless the business combination is approved in a
prescribed manner.
Certain provisions in our agreement with Merck may also deter a
change of control. For example, under the Amended Collaboration
Agreement, a change of control gives Merck the right to terminate
the research phase of the collaboration as well as additional
rights if our acquirer is a qualifying large pharmaceutical company
or has a research, development or commercialization program that
competes with a program licensed by Merck, if any.
Any provision of our amended and restated certificate of
incorporation, amended and restated bylaws, Delaware law or our
agreement with Merck that has the effect of delaying or deterring a
change in control could limit the opportunity for our stockholders
to receive a premium for their shares of our common stock, and
could also affect the price that some investors are willing to pay
for our common stock.
Our amended and restated certificate of incorporation provides that
the Court of Chancery of the State of Delaware and the federal
district courts of the United States will be the exclusive forum
for substantially all disputes between us and our stockholders,
which could limit our stockholders’ ability to obtain a favorable
judicial forum for disputes with us or our directors, officers or
employees.
Our amended and restated certificate of incorporation provides that
the Court of Chancery of the State of Delaware is the exclusive
forum for the following types of actions or proceedings under
Delaware statutory or common law: any derivative action or
proceeding brought on our behalf; any action asserting a breach of
a fiduciary duty owed by any director, officer or other employee to
us or our stockholders; any action asserting a claim against us or
any director or officer or other employee arising pursuant to the
Delaware General Corporation Law, our amended and restated
certificate of incorporation or our amended and restated bylaws;
any action with respect to the validity of our amended and restated
certificate of incorporation or amended and restated bylaws; any
action as to which the Delaware General Corporation Law confers
jurisdiction to the Court of Chancery of the State of Delaware; or
any action asserting a claim against us or any director or officer
or other employee that is governed by the internal affairs
doctrine. This provision would not apply to suits brought to
enforce a duty or liability created by the Securities and Exchange
Act of 1934, as amended, or the Exchange Act, or any other claim
for which the federal courts have exclusive jurisdiction.
Furthermore, Section 22 of the Securities Act of 1933, as amended,
or the Securities Act, creates concurrent jurisdiction for federal
and state courts over all such Securities Act actions. Accordingly,
both state and federal courts have jurisdiction to entertain such
claims. To prevent having to litigate claims in multiple
jurisdictions and the threat of inconsistent or contrary rulings by
different courts, among other considerations, our amended and
restated certificate of incorporation further provides that the
federal district courts of the United States will be the exclusive
forum for resolving any complaint asserting a cause of action
arising under the Securities Act. While the Delaware courts have
determined that such choice of forum provisions are facially valid,
a stockholder may nevertheless seek to bring a claim in a venue
other than those designated in the exclusive forum provisions. In
such instance, we would expect to vigorously assert the validity
and enforceability of the exclusive forum provisions of our amended
and restated certificate of incorporation. This may require
significant additional costs associated with resolving such action
in other jurisdictions and there can be no assurance that the
provisions will be enforced by a court in those other
jurisdictions.
These exclusive forum provisions may limit a stockholder’s ability
to bring a claim in a judicial forum that it finds favorable for
disputes with us or our directors, officers or other employees,
which may discourage lawsuits against us and our directors,
officers and other employees. If a court were to find either
exclusive-forum provision in our amended and restated certificate
of incorporation to be inapplicable or unenforceable in an action,
we may incur further significant additional costs associated with
resolving the dispute in other jurisdictions, all of which could
seriously harm our business.
General Risk Factors
We, our CROs, our CMOs, our current and potential future partners
and other third parties we rely on or partner with could experience
a cybersecurity incident that could harm our business.
We collect, store and transmit proprietary, confidential and
sensitive information, including personal information (such as
health-related data), in the course of our business. Our technology
systems and the information and data processed and stored in our
technology systems or otherwise by us or on our behalf, and the
technology systems of, and data accessed on our behalf by, our
research collaborators, partners, CROs, CMOs, contractors,
consultants and other third parties on which we depend to operate
our business, may be vulnerable to security breaches, loss, damage,
corruption, unauthorized access, use or disclosure or
misappropriation. Such incidents may result from the actions of a
wide variety of actors, including traditional hackers, our
personnel or the personnel of the third parties we work with,
sophisticated nation-states and nation-state-supported actors.
During times of war and other major conflicts, we, the third
parties upon which we rely, and our customers may be vulnerable to
a heightened risk of these attacks, including retaliatory
cyber-attacks, that could materially disrupt our systems and
operations, supply chain, and ability to produce, sell and
distribute our goods and services. Threats we and third parties on
which we rely may face are constantly evolving and include (without
limitation) malware, viruses, software vulnerabilities and bugs,
software or hardware failure, hacking, denial of service attacks,
social engineering (including phishing), ransomware, inside
threats, credential stuffing or other cyberattacks,
telecommunications failures, earthquakes, fires, floods and similar
threats. Threats such as ransomware attacks, for example, are
becoming increasingly prevalent and severe. Extortion payments may
alleviate the negative impact of a ransomware attack, but we may be
unwilling or unable to make such payments due to, for example,
applicable laws or regulations prohibiting such payments.
Supply-chain attacks have also increased in frequency and severity,
and we cannot guarantee that third parties’ infrastructure in our
supply chain or our third-party partners’ supply chains have not
been compromised. Our ability to monitor third parties on whom we
rely to operate our business is limited, and these third parties
may be subject to, and may expose us to, cyberattacks and other
security incidents.
We may, under certain data privacy and security obligations, be
required to, or we may choose to, expend significant resources or
modify our business activities (including our clinical trial
activities) in an effort to protect against security incidents.
While we have developed systems and processes designed to protect
the integrity, confidentiality and security of the confidential and
personal information under our control, we cannot assure you that
any security measures that we or our third-party service providers
implement will be effective in preventing cybersecurity incidents.
There are many different cyber-crime and hacking techniques, and as
such techniques continue to evolve, we may be unable to anticipate
attempted security breaches, identify them before our information
is exploited or react in a timely manner.
Certain functional areas of our workforce work remotely on a full-
or part-time basis outside of our corporate network security
protection boundaries or otherwise utilize network connections,
computers and devices outside of our premises or network, which
imposes additional risks to our business, including increased risk
of industrial espionage, phishing and other cybersecurity attacks,
and unauthorized dissemination of proprietary or confidential
information, including personal information, any of which could
have a material adverse effect on our business.
Despite our efforts to strengthen security and authentication
measures, we have not always been able in the past, and may be
unable in the future, to detect vulnerabilities in our information
technology systems. We have experienced an overall increase in
cybersecurity incidents since 2020, none of which, to date, have
caused material disruption to our business, or to our knowledge,
involved a material security breach. For example, in December 2020,
we detected that an attacker had gained access to a single system
on our network and unsuccessfully attempted to use that access to
stage a broader attack against us. We or the third parties we rely
on or partner with could experience a material system failure,
security breach or other cybersecurity incident, including any
related to or in connection with any of the aforementioned threats,
in the future, which could interrupt our operations, disrupt our
development programs and have a material adverse effect on our
business, financial condition and results of operations. For
example, the loss or corruption 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 rely on third parties
for the manufacture of our product candidates, to analyze clinical
trial samples and to conduct clinical trials, and cybersecurity
incidents experienced by these third parties could have a material
adverse effect on our business. Security breaches and other
cybersecurity incidents affecting us or the third parties we rely
on or partner with could also result in substantial remediation
costs and expose us to litigation (including class claims),
regulatory enforcement action (for example, investigations, fines,
penalties, audits and inspections), additional reporting
requirements and/or oversight, fines, penalties, indemnification
obligations, negative publicity, reputational harm, monetary fund
diversions, interruptions in our operations (including availability
of data), financial loss and other liabilities and harms.
Additionally, such incidents may trigger data privacy
and
security obligations requiring us to notify relevant stakeholders.
These disclosures are costly, and the disclosures or the failure to
comply with such requirements could lead to adverse
consequences.
Our contracts may not contain limitations of liability, and even
where they do, there can be no assurance that limitations of
liability in our contracts are sufficient to protect us from claims
related to our data privacy and security obligations. Additionally,
we cannot be certain that our insurance coverage will be adequate
for data security liabilities actually incurred, will continue to
be available to us on economically and commercially reasonable
terms, or at all, or that any insurer will not deny coverage as to
any future claim. The successful assertion of one or more large
claims against us that exceed available insurance coverage, or the
occurrence of changes in our insurance policies, including premium
increases or the imposition of large deductible or co-insurance
requirements, could adversely affect our reputation, business,
financial condition and results of operations.
The withdrawal of the United Kingdom from the EU, commonly referred
to as Brexit, could increase our cost of doing business, reduce our
gross margins or otherwise negatively impact our business and our
financial results.
The United Kingdom’s, or UK, withdrawal from the EU on January 31,
2020, commonly referred to as Brexit, has created significant
uncertainty concerning the future relationship between the UK and
the EU. The Medicines and Healthcare products Regulatory Agency, or
MHRA, is now the UK’s standalone regulator.
On December 24, 2020, the EU and UK reached an agreement in
principle on the framework for their future relationship, the
EU-U.K. Trade and Cooperation Agreement, or the TCA. The TCA
primarily focuses on ensuring free trade between the EU and the UK
in relation to goods, including medicinal products. Although the
body of the TCA includes general terms which apply to medicinal
products, greater detail on sector-specific issues is provided in
an Annex to the TCA.
Among the changes that are now applied are that Great Britain
(England, Scotland and Wales) are treated as a third country.
Northern Ireland, with regard to EU regulations, continues to
follow many aspects of EU regulatory rules. As part of the TCA, the
EU and the UK recognize GMP inspections carried out by the other
party and accept official GMP documents issued by the other party.
The TCA also encourages, although it does not oblige, the parties
to consult one another on proposals to introduce significant
changes to technical regulations or inspection procedures. Among
the areas of absence of mutual recognition are batch testing and
batch release. The eventual adoption of the Retained EU Law
(Revocation and Reform) Bill that is currently going through the UK
adoption procedure may, however, result in substantial change to
the extent to which EU laws influence these and other actions in
the UK.
After running a public consultation which ended in December 2022,
the UK government unilaterally agreed to permanently accept EU
batch testing and batch release. However, it is not certain whether
the UK will continue this approach, particularly following adoption
of the current Retained EU Law (Revocation and Reform) Bill. If the
UK were to adopt an approach whereby re-testing and/or re-release
in the UK would be required, this could result in increased costs.
Furthermore, the EU continues to apply EU laws that require batch
testing and batch release to take place in the EU territory. This
means that medicinal products that are tested and released in the
UK must be retested and re-released when entering the EU market for
commercial use. As regards marketing authorizations, Great Britain
has a separate regulatory submission process, approval process and
a national marketing authorization. Northern Ireland, however,
continues to be covered by the marketing authorizations granted by
the European Commission.
The UK regulatory framework in relation to clinical trials is
derived from existing EU legislation (as implemented into UK law,
through secondary legislation) and, as such, it falls within the
scope of the Retained EU Law (Revocation and Reform) Bill as
currently drafted. Adoption of the Retained EU Law (Revocation and
Reform) Bill as currently drafted would result in the regulatory
framework governing clinical trials in the UK being revoked unless
Ministerial action were taken to retain or replace it. It is
currently unclear to what extent the UK will seek to align its
regulations with the EU following entry into application of the
Clinical Trials Regulation in the EU which occurred on January 31,
2022.
Since January 1, 2021, an applicant for a marketing authorization
granted by the European Commission in accordance with the
centralized procedure based on the opinion of the Committee for
Medicinal Products for Human Use, or CHMP, of the EMA can no longer
be established in the UK. Since this date, companies established in
the UK cannot use the centralized procedure and instead must follow
one of the UK national authorization procedures to obtain a
marketing authorization to market products in the UK. For an
initial two-year period from January 1, 2021, MHRA could rely on a
decision taken by the European Commission on the approval of a new
centralized procedure marketing authorization when determining an
application for a Great Britain marketing
authorization, or use the MHRA’s decentralized or mutual
recognition procedures which enable marketing authorizations
approved in EEA countries to be granted in Great Britain. Post
Brexit, the MHRA has been updating various aspects of the
regulatory regime for medicinal products in the UK. These include:
introducing the Innovative Licensing and Access Procedure to
accelerate the time to market and facilitate patient access for
innovative medicinal products; updates to the UK national approval
procedure, introducing a 150-day objective for assessing
applications for marketing authorizations in the UK, Great Britain
and Northern Ireland and a rolling review process for marketing
authorization applications (rather than a consolidated full dossier
submission). In September 2022, the MHRA extended the procedure
whereby it may rely on a decision taken by the European Commission
when determining an application for a Great Britain marketing
authorization until December 31, 2023.
Orphan designation in Great Britain following Brexit is, unlike in
the EU, not a pre-marketing authorization. Applications for orphan
designation are made at the same time as an application for a
marketing authorization. The criteria to be granted an orphan drug
designation are essentially identical to those in the EU but based
on the prevalence of the condition in Great Britain. It is
therefore possible that medical conditions that were or would have
been designated as orphan conditions in Great Britain prior to the
end of the Transition Period are or would no longer be and that
conditions that were not or would not have been designated as
orphan conditions in the EU will be designated as such in Great
Britain.
Since a significant part of the regulatory framework in the UK
applicable to our business and our product candidates is derived
from EU legislation, Brexit has the potential of materially
impacting the regulatory framework with respect to the development,
manufacture, approval, import and placement of our product
candidates on the market in the UK and the EU. The changes effected
by the TCA, as well as any future changes in the regulatory
framework governing medicinal products, including the adoption of
the Retain EU Law (Revocation and Reform) Bill, could increase the
costs and complexity of doing business in or with the UK, which
could adversely affect our business.
We are subject to rapidly changing and increasingly stringent
foreign and domestic laws and regulations relating to privacy, data
protection and information security. The restrictions imposed by
these requirements or our actual or perceived failure to comply
with them could harm our business.
We may collect, use, transfer or otherwise process proprietary,
confidential and sensitive information, including personal
information (including health-related data), which subjects us to
numerous evolving and complex data privacy and security
obligations, including various laws, regulations, guidance,
industry standards, external and internal privacy and security
policies, contracts and other obligations that govern the
processing of such information by us and on our behalf. Outside the
United States, an increasing number of laws, regulations, and
industry standards may govern data privacy and security. For
example, the European Union’s General Data Protection Regulation,
or EU GDPR, and the United Kingdom’s GDPR, or UK GDPR, impose
strict requirements for processing personal information. For
example, the EU GDPR, UK GDPR and other relevant laws that govern
patient confidentiality and storage of personal health data may
apply to our processing of personal information from clinical
trials participants and other individuals located in the European
Economic Area, or EEA, and/or the UK and, if any of our product
candidates are approved, we may seek to commercialize those
products in the EEA and/or the UK (as applicable). Companies that
violate the EU GDPR can face private litigation, prohibitions on
data processing, other administrative measures, reputational damage
and fines of up to the greater of 20 million Euros or 4% of their
worldwide annual revenue. The EU GDPR requires us to, among other
things: give detailed disclosures about how we collect, use and
share personal information; contractually commit to data protection
measures in our contracts with vendors; maintain adequate data
security measures; notify regulators and affected individuals of
certain data breaches; meet extensive privacy governance and
documentation requirements; and honor individuals’ data protection
rights, including their rights to access, correct and delete their
personal information. The UK has incorporated an amended version of
the EU GDPR into UK law, commonly referred to as the UK GDPR, which
is independent from, but at present materially aligned with, the EU
GDPR, which together with the UK Data Protection Act of 2018, or UK
DPA, covers the processing of personal information of UK residents.
Non-compliance with UK GDPR may result in substantially similar
adverse consequences to those in relation to the EU GDPR, including
monetary penalties of up to £17.5 million or 4% of worldwide
revenue, whichever is higher.
On June 28, 2021, the European Commission adopted an adequacy
decision permitting flows of personal data between the EU and the
UK to continue without additional requirements. The UK Government
also adopted a reciprocal adequacy decision in respect of EEA
member states permitting flows of personal data from the UK to the
EEA. However, the European Commission's UK adequacy decision will
automatically expire in June 2025 unless the European Commission
re-assesses and renews/extends that decision and remains under
review by the European Commission during this period. The entry
into force of the US-UK Data Access Agreement on October 3, 2022
may put at risk the European Commission’s adequacy decision granted
to the UK. If such adequacy decision were to be
withdrawn, personal data could not flow freely between the UK and
the EU and additional safeguards would need to be adopted, which
could result in additional costs for us.
The relationship between the UK and the EU in relation to certain
aspects of data protection laws remains unclear, and it is unclear
how UK data protection laws and regulations will develop in the
medium to longer term, and how data transfers to and from the UK
will be regulated in the long term. The UK’s Data Protection and
Digital Information Bill, or the Bill, was laid before the UK
Parliament on July 18, 2022, introducing reforms intended to update
and simplify the UK’s data protection framework, deviating from the
EU GDPR. However, the Bill’s progress through Parliament is
currently on pause following changes to the UK Government’s
leadership. The Bill is expected to re-enter the legislative
process in due course.
Certain jurisdictions have enacted data localization laws and laws
restricting cross-border transfers of personal information. In
particular, regulators and courts in the EEA and the UK have
significantly restricted the transfer of personal information to
the United States and other countries whose privacy laws it
believes are inadequate. Other jurisdictions may adopt similarly
stringent interpretations of their data localization and
cross-border data transfer laws. Although there are currently
various mechanisms that may be used to transfer personal
information from the EEA and UK to the United States in compliance
with law, such as the EEA’s standard contractual clauses and the
UK's international data transfer agreement, these mechanisms are
subject to legal challenges, and there is no assurance that we can
satisfy or rely on these measures to lawfully transfer personal
information to the United States.
We continue to monitor changes in data protection laws related to
the cross-border transfer of personal information; however,
uncertainty remains regarding any future regulations,
interpretations of existing law or guidance that may be issued,
particularly by the EU authorities. If we are unable to implement a
valid compliance solution for cross-border transfers of personal
information, or if the requirements for a legally-compliant
transfer are too onerous, we will face increased exposure to
significant adverse consequences, including substantial fines,
regulatory actions, as well as injunctions against the export and
processing of personal information from the EEA. Our inability to
import personal information from the EEA, UK or Switzerland or
other countries may also restrict or prohibit our clinical trial
activities in those countries; limit our ability to collaborate
with CROs, service providers, contractors and other companies
subject to laws restricting cross-border data transfers; require us
to increase our data processing capabilities in other countries at
significant expense and may otherwise negatively impact our
business operations. We may also become subject to new laws in the
EEA that regulate cybersecurity and non-personal data, such as data
collected through the internet of things. Depending on how these
laws are interpreted, we may have to make changes to our business
practices and products to comply with such
obligations.
Additionally, other countries have enacted or are considering
enacting similar cross-border data transfer restrictions and laws
requiring local data residency, which could increase the cost and
complexity of delivering our services and operating our
business.
Privacy and data security laws in the United States at the federal,
state and local level are increasingly complex and changing
rapidly. For example, at the federal level, HIPAA, as amended by
HITECH, imposes specific requirements relating to the privacy,
security and transmission of individually identifiable health
information. Additionally, at the state level, the privacy and data
protection landscape is changing rapidly. For example, the
California Consumer Privacy Act of 2018, or CCPA, took effect on
January 1, 2020. The CCPA gives California residents certain rights
similar to the individual rights given under the EU GDPR, including
the right to access and delete their personal information, opt-out
of certain personal information sharing and receive detailed
information about how their personal information is used. The CCPA
provides for civil penalties for violations, including statutory
fines for noncompliance and a limited private right of action in
connection with certain data breaches. In addition, the California
Privacy Rights Act of 2020, or CPRA, which becomes operative
January 1, 2023, will expand the CCPA’s requirements, including in
that it applies to personal information of business representatives
and employees and establishes a new regulatory agency to implement
and enforce the law. While the CCPA contains an exemption for
certain personal information processed in connection with clinical
trials, we may process other personal information that is subject
to the CCPA and forthcoming CPRA. Other states, such as Virginia
and Colorado, have also passed comprehensive privacy laws, and
similar laws are being considered in several other states, as well
as at the federal and local levels. The evolving patchwork of
differing state and federal privacy and data security laws
increases the cost and complexity of operating our business and
increase our exposure to liability.
We may also be bound by contractual obligations related to data
privacy and security, and our efforts to comply with such
obligations may not be successful. We may publish privacy policies,
marketing materials and other statements, such as compliance with
certain certifications or self-regulatory principles, regarding
data privacy and security. If these policies, materials or
statements are found to be deficient, lacking in transparency,
deceptive,
unfair or misrepresentative of our practices, we may be subject to
investigation, enforcement actions by regulators or other adverse
consequences.
Our obligations related to data privacy and security are quickly
changing in an increasingly stringent fashion. These obligations
may be subject to differing applications and interpretations, which
may be inconsistent or in conflict among jurisdictions. Preparing
for and complying with these obligations requires us to devote
significant resources (including, without limitation, financial and
time-related resources). These obligations may necessitate changes
to our information technologies, systems and practices and to those
of any third parties that process personal information on our
behalf. In addition, these obligations may require us to change
aspects of our business model. Although we endeavor to comply with
applicable data privacy and security obligations, we may at times
fail (or be perceived to have failed) to do so. Moreover, despite
our efforts, our personnel or third parties upon whom we rely may
fail to comply with such obligations, which could impact whether or
not we are in compliance.
If we (or third parties on which we rely) fail, or are perceived to
have failed, to address or comply with data privacy and security
obligations, we could face significant consequences, including
(without limitation): government enforcement actions (e.g.,
investigations, fines, penalties, audits, inspections and similar);
litigation (including class-related claims); additional reporting
requirements and/or oversight; bans on processing personal
information; orders to destroy or not use personal information; and
imprisonment of company officials. Any of these events could have a
material adverse effect on our reputation, business or financial
condition, including but not limited to: loss of customers;
interruptions or stoppages in our business operations (including
clinical trials); inability to process personal information or to
operate in certain jurisdictions; limited ability to develop or
commercialize our products; expenditure of time and resources to
defend any claim or inquiry; adverse publicity; or revision or
restructuring of our operations.
Our operations are vulnerable to interruption by fire, earthquake,
power loss, telecommunications failure, terrorist activity and
other events beyond our control, which could harm our
business.
Our facilities have experienced electrical blackouts as a result of
a shortage of available electrical power. Future blackouts, which
may be implemented by the local electricity provider in the face of
high winds and dry conditions, could disrupt our operations. Our
facility is located in a seismically active region. We have not
undertaken a systematic analysis of the potential consequences to
our business and financial results from a major earthquake, fire,
power loss, terrorist activity or other disasters and do not have a
comprehensive recovery plan for such disasters. In addition, we do
not carry sufficient insurance to compensate us for actual losses
from interruption of our business that may occur, and any losses or
damages incurred by us could harm our business. In addition, the
sole supplier of clinical drug substances for NGM120, NGM707,
NGM831, NGM438 and MK-3655 is located in Lithuania, a region that
has experienced political unrest. Refer to the risk factor titled
“We
rely completely on CMOs for the manufacture of our product
candidates and are subject to many manufacturing risks, any of
which could substantially increase our costs and limit supply of
our product candidates and any future products.”
If our operations or the operations of third parties providing
services to us are disrupted by any such occurrences, our business
and future prospects may be negatively affected.
We use and generate materials that may expose us to material
liability.
Our research programs involve the use of hazardous materials,
chemicals and radioactive and biological materials. We are subject
to foreign, federal, state and local environmental and health and
safety laws and regulations governing, among other matters, the
use, manufacture, handling, storage and disposal of hazardous
materials and waste products. We may incur significant costs to
comply with these current or future environmental and health and
safety laws and regulations. In addition, we cannot completely
eliminate the risk of contamination or injury from hazardous
materials and may incur material liability as a result of such
contamination or injury. In the event of an accident, an injured
party may seek to hold us liable for any damages that result. Any
liability could exceed the limits or fall outside the coverage of
our workers’ compensation, property and business interruption
insurance and we may not be able to maintain insurance on
acceptable terms, if at all. We currently carry no insurance
specifically covering environmental claims.
Our ability to use net operating loss carryforwards and certain
other tax attributes to offset taxable income could be
limited.
We plan to use our current year operating losses to offset taxable
income from any revenue generated from operations, including BD
Arrangements. To the extent that our taxable income exceeds any
current year operating losses, we plan to use our net operating
loss carryforwards to offset income that would otherwise be
taxable. Our federal net operating loss carryforwards generated in
tax years beginning before January 1, 2018 are only
permitted
to be carried forward for 20 years under applicable U.S. tax law.
Under the 2017 Tax Act, as modified by the Coronavirus Aid, Relief
and Economic Security Act, or the CARES Act, our federal net
operating losses generated in tax years beginning after December
31, 2017 may be carried forward indefinitely, but the ability to
deduct such federal net operating losses generated in tax years
beginning after December 31, 2020 is limited to 80% of taxable
income. It is uncertain if and to what extent various states will
conform to the 2017 Tax Act or the CARES Act.
In addition, under Sections 382 and 383 of the U.S. Internal
Revenue Code of 1986, as amended, or the Code, and corresponding
provisions of state law, if we experience an “ownership change,”
generally defined as a greater than 50% change, by value, in equity
ownership over a three-year period, our ability to use our
pre-change net operating loss carryforwards and certain other
pre-change tax attributes (such as R&D tax credits) to offset
our post-change income may be limited. Due to our initial public
offering and other shifts in our stock ownership, we have
experienced ownership changes in the past and may experience
ownership changes in the future as a result of subsequent shifts in
our stock ownership, some of which are outside our control. As a
result, our use of federal net operating loss carryforwards and
certain other tax attributes could be limited. State net operating
loss carryforwards may be similarly limited. In addition, at the
state level, there may be periods during which the use of net
operating losses is suspended or otherwise limited, which could
accelerate or permanently increase state taxes owed.
New tax laws or regulations, changes to existing tax laws or
regulations or changes in their application to us or our customers
may have a material adverse effect on our business, cash flows,
financial condition or results of operations.
New tax laws, statutes, rules, regulations, directives, decrees or
ordinances could be enacted at any time. Further, existing tax
laws, statutes, rules, regulations, directives, decrees or
ordinances could be interpreted, changed or modified. Any such
enactment, interpretation, change or modification could adversely
affect us, possibly with retroactive effect. For example, the
recently enacted IRA imposes, among other rules, a 15% minimum tax
on the book income of certain large corporations and a 1% excise
tax on certain corporate stock repurchases. In addition, for
certain research and experimental, or R&E, expenses incurred in
tax years beginning after December 31, 2021, the 2017 Tax Act
requires the capitalization and amortization of such expenses over
five years if incurred in the United States and fifteen years if
incurred outside the United States, rather than deducting such
expenses currently. Although there have been legislative proposals
to repeal or defer the capitalization requirement, there can be no
assurance that such requirement will be repealed, deferred or
otherwise modified. Changes in corporate tax rates, the realization
of net deferred tax assets relating to our operations, the taxation
of foreign earnings and the deductibility of expenses under the
2017 Tax Act, as amended by the CARES Act or any future tax reform
legislation could have a material impact on the value of our
deferred tax assets, result in significant one-time charges and
increase our future U.S. tax expense.
Future changes in financial accounting standards or practices may
cause adverse and unexpected revenue fluctuations and adversely
affect our reported results of operations.
Future changes in financial accounting standards may cause adverse,
unexpected revenue fluctuations and affect our reported financial
position or results of operations. Financial accounting standards
in the United States are constantly under review and new
pronouncements and varying interpretations of pronouncements have
occurred frequently in the past and are expected to occur again in
the future. As a result, we may be required to make changes in our
accounting policies. Those changes could affect our financial
condition and results of operations or the way in which such
financial condition and results of operations are reported.
Compliance with new accounting standards may also result in
additional expenses. As a result, we intend to invest all
reasonably necessary resources to comply with evolving standards,
and this investment may result in increased general and
administrative expenses and a diversion of management time and
attention from business activities to compliance
activities.
We continue to incur increased costs as a result of operating as a
public company, and our management devotes substantial time to
compliance initiatives. In addition, we are obligated to develop
and maintain proper and effective internal control over financial
reporting. In the future, we may not complete our analysis of our
internal control over financial reporting in a timely manner, or
our internal control over financial reporting may not be determined
to be effective, which may adversely affect investor confidence in
our company and, as a result, the value of our common
stock.
As a public company, we incur significant legal, accounting,
insurance and other expenses, and these expenses further increased
in connection with our loss of “emerging growth company” status as
of December 31, 2021. As a public company, we are subject to the
reporting requirements of the Exchange Act, the
Sarbanes-Oxley
Act of 2002, or the Sarbanes-Oxley Act, and the Dodd-Frank Act, as
well as rules adopted, and to be adopted, by the SEC and The Nasdaq
Global Select Market. Our management and other personnel devote a
substantial amount of time to these compliance initiatives.
Moreover, these rules and regulations increase our legal and
financial compliance costs and may make some activities more
time-consuming and costly. The increased costs will increase our
net loss. For example, these rules and regulations 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 sufficient coverage. We cannot predict or
estimate the amount or timing of additional costs we may incur in
the future to respond to these requirements. The impact of these
requirements could also make it more difficult for us to attract
and retain qualified persons to serve on our board of directors,
our board committees or as executive officers.
Specifically, in order to comply with the requirements of being a
public company, we need to undertake various actions, including
maintaining effective internal controls and procedures. The
Sarbanes-Oxley Act requires, among other things, that we maintain
effective disclosure controls and procedures and internal control
over financial reporting. We are continuing to develop and refine
our disclosure controls and other procedures that are designed to
ensure that information required to be disclosed by us in the
reports that we file with the SEC is recorded, processed,
summarized and reported within the time periods specified in the
SEC’s rules and forms, and that information required to be
disclosed in reports under the Exchange Act is accumulated and
communicated to our principal executive and financial officers. In
addition, we must perform system and process evaluation and testing
of our internal control over financial reporting to allow
management to report on the effectiveness of our internal control
over financial reporting, as required by Section 404(b) of the
Sarbanes-Oxley Act, and to allow our independent registered public
accounting firm to issue an attestation report on the effectiveness
of our internal control over financial reporting. Our compliance
with Section 404(b) of the Sarbanes-Oxley Act requires that we
incur substantial accounting expense and expend significant
management efforts. We currently do not have an internal audit
staff and outsource this function to a third party. We have hired
and will need to retain our current accounting and financial staff
who have the appropriate public company experience and technical
accounting knowledge. If we or our independent registered public
accounting firm identify deficiencies in our internal control over
financial reporting that are deemed to be material weaknesses,
investors may lose confidence in our operating results and the
price of our common stock could decline. In addition, if we are
unable to continue to meet these requirements, we may not be able
to remain listed on The Nasdaq Global Select Market.
Our ability to successfully implement our business plan and comply
with Section 404(b) of the Sarbanes-Oxley Act requires us to be
able to prepare timely and accurate financial statements. We expect
that we will need to continue to improve existing, and implement
new operational and financial systems, procedures and controls to
manage our business effectively. Any delay in the implementation
of, or disruption in the transition to, new or enhanced systems,
procedures or controls may cause our operations to suffer, and we
may be unable to conclude that our internal control over financial
reporting is effective and to obtain an attestation report from our
independent registered public accounting firm as required under
Section 404(b) of the Sarbanes-Oxley Act. This, in turn, could have
an adverse impact on the price for our common stock and could
adversely affect our ability to access the capital
markets.
Our disclosure controls and procedures may not prevent or detect
all errors or acts of fraud.
We designed our disclosure controls and procedures to reasonably
assure that information we must disclose in reports we file or
submit under the Exchange Act is accumulated and communicated to
management, and recorded, processed, summarized and reported within
the time periods specified in the rules and forms of the SEC. We
believe that any disclosure controls and procedures or internal
controls and procedures, no matter how well-conceived and operated,
can provide only reasonable, not absolute, assurance that the
objectives of the control system are met.
These inherent limitations include the realities that judgments in
decision-making can be faulty and breakdowns can occur because of
simple error or mistake. Additionally, controls can be circumvented
by the individual acts of some persons, by collusion of two or more
people or by an unauthorized override of the controls. Accordingly,
because of the inherent limitations in our control system,
misstatements due to error or fraud may occur and not be
detected.
If securities or industry analysts do not publish research, or
publish inaccurate or unfavorable research, about our business, our
stock price and trading volume could decline.
Our stock price and trading volume is heavily influenced by the way
analysts and investors interpret our clinical trial results, any BD
Arrangements we may enter into, our financial information and other
disclosures. If securities or industry analysts do not publish
research or reports about our business, delay publishing reports
about
our business or publish negative reports about our business,
regardless of accuracy, our stock price and trading volume could
decline.
Item 1B. Unresolved Staff
Comments.
None.
Item 2. Properties.
We lease and occupy approximately 122,000 square feet of office
space and facilities in South San Francisco, California. In
July 2022, we entered into an operating lease agreement, or the
2024 Lease Agreement, for our existing corporate office space and
facilities at 333 Oyster Point Boulevard, South San Francisco,
California, that we currently occupy pursuant to a sublease
agreement scheduled to expire on December 31, 2023. The initial
term of the 2024 Lease Agreement will commence on January 1, 2024
and expire on December 31, 2033.
Item 3. Legal Proceedings.
None.
Item 4. Mine Safety
Disclosures.
Not applicable.
PART II
Item 5. Market for Registrant’s Common
Equity, Related Stockholder Matters and Issuer Purchases of Equity
Securities.
Market Information
Our common stock has been listed on the Nasdaq Global Select Market
under the symbol “NGM” since April 4, 2019.
Holders of Record
As of the close of business on February 22, 2023, there were
38 stockholders of record of our common stock. The actual number of
stockholders is greater than the number of stockholders of record
and includes stockholders who are beneficial owners but whose
shares are held in street name by brokers and other nominees. This
number of stockholders of record also does not include stockholders
whose shares may be held in trust by other entities.
Performance Graph
The following stock performance graph compares the value of an
investment in (i) our common stock, (ii) the Nasdaq Composite Index
and (iii) the Nasdaq Biotechnology Index for the period from April
4, 2019 (the date our common stock commenced trading on the Nasdaq
Global Select Market) through December 31, 2022. The figures
represented below assume an investment of $100 in our common stock
at the closing price on April 4, 2019 and in the Nasdaq Composite
Index and Nasdaq Biotechnology Index on April 4, 2019 and the
reinvestment of dividends into shares of common stock. However, no
dividends have been declared on our common stock to date. The
comparisons in the table are required by the Securities and
Exchange Commission, or SEC, and are not intended to forecast or be
indicative of possible future performance of our common
stock.

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4/4/2019 |
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12/31/2019 |
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12/31/2020 |
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12/31/2021 |
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12/31/2022 |
NGM Biopharmaceuticals, Inc. |
$ |
100.00 |
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$ |
125.78 |
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$ |
206.09 |
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$ |
120.48 |
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$ |
34.15 |
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NASDAQ Composite Index |
100.00 |
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113.70 |
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163.31 |
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198.24 |
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132.63 |
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NASDAQ Biotechnology Index |
100.00 |
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106.66 |
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134.05 |
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133.20 |
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118.67 |
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The information under “Performance Graph” is not deemed to be
“soliciting material” or “filed” with the SEC or subject to
Regulation 14A or 14C, or to the liabilities of Section 18 of the
Securities Exchange Act of 1934, as amended, or the Exchange Act,
and is not to be incorporated by reference in any filing of NGM
under the Securities
Act of 1933, as amended, or the Securities Act, or the Exchange
Act, whether made before or after the date of this Annual Report on
Form 10-K and irrespective of any general incorporation language in
those filings.
Recent Sales of Unregistered Securities
During the year ended December 31, 2022, we did not issue or
sell any unregistered securities.
Issuer Purchases of Equity Securities
During the three-month period ended December 31, 2022, we did
not repurchase shares of our common stock.
Item 6. [Reserved]
Item 7. Management’s Discussion and Analysis
of Financial Condition and Results of Operations.
The following discussion and analysis of our financial condition
and results of operations should be read in conjunction with our
audited consolidated financial statements and related notes
appearing elsewhere in this Annual Report. This discussion and
analysis contains forward-looking statements based upon current
beliefs, plans and expectations that involve risks, uncertainties
and assumptions, such as statements regarding our plans,
objectives, expectations, intentions and projections. Our actual
results and the timing of events could differ materially from those
anticipated in these forward-looking statements as a result of
several factors that could impact our business, including those set
forth in the section titled “Risk Factors” under Part I, Item 1A in
this Annual Report on Form 10-K. In some cases, you can identify
forward-looking statements by terminology such as “anticipate,”
"aspire," “believe,” “continue,” “could,” “estimate,” “expect,”
“intend,” “may,” “plan,” “potentially,” “predict,” “should,” “will”
or the negative of these terms or other similar expressions. See
“Special Note Regarding Forward-Looking Statements” in this Annual
Report on Form 10-K.
In addition, statements that “we believe” and similar statements
reflect our beliefs and opinions on the relevant subject. These
statements are based upon information available to us as of the
date of this Annual Report on Form 10-K, and while we believe such
information forms a reasonable basis for such statements, such
information may be limited or incomplete, and our statements should
not be read to indicate we have conducted exhaustive inquiry into,
or review of, all potentially available relevant information. These
statements are inherently uncertain and investors are cautioned not
to unduly rely upon these statements.
Overview of Our Business
We are a biopharmaceutical company focused on discovering and
developing novel, potentially life-changing medicines based on
scientific understanding of key biological pathways underlying
grievous diseases with critical unmet or underserved patient need.
These diseases represent a significant burden for patients and
healthcare systems and, in some cases, are leading causes of
morbidity and mortality. Since the commencement of our operations
in 2008, we have generated a portfolio of product candidates
ranging from early discovery to Phase 2b development. Currently, we
have five programs in active clinical development. Our
biology-centric drug discovery approach is therapeutic area
agnostic and aims to seamlessly integrate interrogation of complex
disease-associated biology and protein engineering expertise to
unlock proprietary insights that are leveraged to generate
promising product candidates and enable their rapid advancement
into proof-of-concept studies. As explorers on the frontier of
life-changing science, we aspire to operate one of the most
productive research and development engines in the
biopharmaceutical industry. All therapeutic candidates in our
pipeline have been generated by our in-house discovery engine, led
by biology and motivated by patient need.
Our pipeline is currently divided into two categories with separate
approaches to development strategy and resource allocation in an
effort to enable more of the product candidates in our pipeline to
be advanced as effectively and efficiently as possible. To that
end, we are currently focusing most of our execution efforts and
resources on advancing our clinical-stage solid tumor oncology
programs to potentially rapid proof of concept. For our other
programs that are in therapeutic areas where clinical development
is relatively resource intensive and can have long timelines to
generate proof-of-concept data, due to the need to conserve capital
and prioritize focused execution, we are actively seeking, or
intend to seek, collaboration, out licensing, partnership or other
business development arrangements, or BD Arrangements, with
third-party partners with sufficient resources and relevant domain
expertise in order to further their development.
Pipeline Programs and Operational Updates
Key Programs in Active Development
Our pipeline includes four solid tumor oncology programs in active
ongoing clinical development. We are currently focusing most of our
execution efforts and resources on these key programs. We have
intentionally built our clinical capabilities primarily in areas
such as solid tumor oncology that offer development paths that are
relatively resource efficient and have the potential to generate
clinical proof-of-concept data more rapidly than certain other
indications, although we may in the future pursue development of
programs in other therapeutic areas. While we will
opportunistically consider BD Arrangements to advance development
of our key programs, we intend to invest our resources in their
development even in the absence of BD Arrangements.
•Solid
Tumor Oncology.
Our solid tumor oncology product candidates NGM707, NGM831, NGM438
and NGM120 and their related compounds are wholly-owned by
us.
•NGM707.
NGM707, the lead asset in our myeloid reprogramming and checkpoint
inhibition portfolio, is a dual antagonist monoclonal antibody that
is designed to improve patient immune responses to tumors by
inhibiting both Immunoglobulin-like transcript 2, or ILT2 (also
known as LILRB1), and Immunoglobulin-like transcript 4, or ILT4
(also known as LILRB2) receptors. We believe NGM707 has the
potential to reprogram ILT4- and ILT2-expressing myeloid cells to
shift them from a suppressive state that restricts anti-tumor
immunity to a stimulatory state that may promote anti-tumor
immunity. Blocking ILT2 also may reverse inhibition of
ILT2-expressing lymphoid cells to further stimulate anti-tumor
immune responses.
•We
are conducting an open-label Phase 1/2 clinical trial evaluating
NGM707 as a monotherapy and in combination with KEYTRUDA®
(pembrolizumab) for the treatment of patients with advanced or
metastatic solid tumors. We expect to enroll approximately 220
patients in this trial.
•A
Phase 1, Part 1a cohort evaluating NGM707 as a monotherapy was
initiated in the second quarter of 2021. A Phase 1, Part 1b cohort
evaluating NGM707 in combination with pembrolizumab was initiated
in the second quarter of 2022. Both cohorts are ongoing and will be
followed by Phase 2 expansion cohorts evaluating NGM707 in
combination with pembrolizumab in specific tumor
types.
•In
December 2022, we presented initial data from the Part 1a cohort at
the European Society for Medical Oncology Immuno-Oncology, or ESMO
I-O, Annual Congress. The data indicated that NGM707 was generally
well tolerated across all dose cohorts and demonstrated promising
early signals of anti-tumor activity. In the presentation, we
disclosed that of 24 response-evaluable patients as of November 23,
2022, best overall responses were a partial response in one
patient, stable disease in six patients and non-complete
response/non-progressive disease in one patient, and that potential
proof-of-mechanism (myeloid reprogramming) was observed in
peripheral blood and tumor biopsies.
•NGM831.
NGM831 is an antagonist antibody that is designed to block the
interaction of the Immunoglobulin-like transcript 3, or ILT3 (also
known as LILRB4) receptor,
with fibronectin, as well as other cognate ligands.
For tumors in which both ILT3 and fibronectin are upregulated, the
ILT3-fibronectin signaling pathway may act as a stromal checkpoint
to repress myeloid cell function and inhibit anti-tumor immunity.
By inhibiting ILT3's interaction with fibronectin and its other
ligands, we believe NGM831 has the potential to mobilize a
patient's own immune system to fight tumors by shifting myeloid
cells from a suppressive state to a stimulatory state and promoting
anti-tumor activity.
•In
the first quarter of 2022, we initiated an open-label Phase 1/1b
clinical trial to evaluate NGM831 as a monotherapy and in
combination with pembrolizumab for the treatment of patients with
advanced or metastatic solid tumors. A Phase 1, Part 1a cohort
evaluating NGM831 as a monotherapy was initiated in the first
quarter of 2022 and is ongoing. In addition, a Phase 1, Part 1b
cohort evaluating NGM831 in combination with pembrolizumab was
initiated in the third quarter of 2022 and is ongoing. We expect to
enroll up to approximately 80 patients in these two
cohorts.
•NGM438.
NGM438 is an antagonist antibody that is designed to inhibit
leukocyte-associated immunoglobulin-like receptor 1, or LAIR1, and
thereby promote anti-tumor immune responses. NGM438 has the
potential to potently block the binding of all collagens to LAIR1,
including tumor-derived collagens. Collagens produced by the tumor
stroma, meaning the non-malignant, non-
immune components of the tumor, are believed to bind LAIR1 to
create an immuno-suppressive tumor microenvironment. The
interaction of collagens from the tumor stroma with LAIR1 on immune
cells represents a “stromal checkpoint” that restrains anti-tumor
immune responses. Reinvigoration of these collagen-suppressed
immune cells by blocking the binding of collagens to LAIR1 may
address a key resistance mechanism that limits tumor responses to
current immunotherapies.
•In
the second quarter of 2022, we initiated an open-label, Phase 1/1b
clinical trial to evaluate NGM438 as a monotherapy and in
combination with pembrolizumab for the treatment of patients with
advanced or metastatic solid tumors. A Phase 1, Part 1a cohort
evaluating NGM438 as a monotherapy commenced in the second quarter
of 2022 and is ongoing. In addition, a Phase 1, Part 1b cohort
evaluating NGM438 in combination with pembrolizumab commenced in
the fourth quarter of 2022 and is ongoing. We expect to enroll up
to approximately 80 patients in these two cohorts.
•NGM120.
NGM120 is an antagonist antibody that binds to glial cell-derived
neurotrophic factor receptor alpha-like, or GFRAL, and is designed
to block the effects of elevated serum levels of growth
differentiation factor 15, or GDF15. We designed NGM120 as a
potent, humanized monoclonal antibody inhibitor of GFRAL with the
potential for once-monthly or less frequent dosing. Preclinical
studies suggest that NGM120 may reduce tumor growth and improve
survival in syngeneic orthotopic pancreatic tumor models in
mice.
•We
are currently conducting a Phase 1/2 clinical trial to assess
NGM120’s effect on cancer and cancer-related cachexia in patients
with select advanced solid tumors, metastatic pancreatic cancer and
metastatic castration-resistant prostate cancer, or
mCRPC.
The trial includes:
•a
Phase 1a cohort evaluating NGM120 as a monotherapy in patients with
select advanced solid tumors,
•a
Phase 1b cohort evaluating NGM120 in combination with gemcitabine
and Nab-paclitaxel in patients with metastatic pancreatic
cancer,
•an
additional Phase 1b cohort testing NGM120 in combination with one
or more lines of hormone therapies in patients with mCRPC,
and
•a
Phase 2 cohort evaluating NGM120 in combination with gemcitabine
and Nab-paclitaxel as first-line treatment in patients with
metastatic pancreatic cancer (referred to as the PINNACLES
trial).
•In
August 2022, we initiated the Phase 1b cohort testing NGM120 in
combination with one or more lines of hormone therapies in patients
with mCRPC.
•In
September 2022, at the European Society for Medical Oncology, or
ESMO, Annual Congress, we reported updated preliminary findings for
a subgroup of patients with advanced prostate cancer from
the
Phase 1a cohort evaluating NGM120 as a monotherapy in patients with
select advanced solid tumors. The updated preliminary results
reported at ESMO demonstrated that NGM120 was well tolerated with
no dose-limiting toxicities and provided encouraging signals of
anti-cancer activity in patients with advanced prostate
cancer.
•In
September 2022, at the American Association for Cancer Research, or
AACR, Special Conference: Pancreatic Cancer, we reported updated
preliminary findings from the Phase 1b cohort evaluating NGM120 in
combination with gemcitabine and Nab-paclitaxel in patients with
metastatic pancreatic cancer. The updated preliminary results
reported at AACR demonstrated that NGM120 was well tolerated with
no dose-limiting toxicities and provided encouraging signals of
anti-cancer activity in patients with metastatic pancreatic
cancer.
Additional Programs Currently Without Significant Resource
Allocation
Due to the need to conserve capital and prioritize focused
execution, the remainder of our pipeline includes programs whose
further development is primarily dependent on our ability to secure
potential future BD Arrangements. These programs are in therapeutic
areas where clinical development is relatively resource intensive
and can have long timelines to generate proof-of-concept data. As a
result, we are actively seeking, or intend to seek, BD Arrangements
with third-party partners possessing sufficient resources and
relevant domain expertise in the relevant therapeutic area in order
to further clinical development of these programs. In the absence
of such BD Arrangements for these programs, we are unlikely to be
able to advance their development unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development. These programs are set forth
below:
•Retinal
diseases.
•NGM621.
NGM621 is a humanized Immunoglobulin 1, or IgG1, monoclonal
antibody administered via intravitreal, or IVT, injection. NGM621
was engineered to potently bind to, and be a long-acting inhibitor
of, complement C3 with the treatment goal of reducing the rate of
disease progression in patients with geographic atrophy, or GA,
secondary to age-related macular degeneration, or AMD.
•In
October 2022, we announced topline results from the Phase 2
CATALINA clinical trial, which evaluated the efficacy and safety of
NGM621 when given to patients with GA every four weeks or every
eight weeks via IVT injections compared to sham control. The trial
did not meet its primary endpoint of a statistically significant
rate of change in GA lesion area using slope analysis over 52 weeks
of treatment with NGM621 versus sham. NGM621 demonstrated a
favorable safety profile, with no evidence of increased choroidal
neovascularization in NGM621-treated patients compared to sham. In
addition, there were no serious adverse events deemed
treatment-related by an investigator.
•In
November 2022, we presented additional findings from the CATALINA
trial at The Retina Society Annual Scientific Meeting and we intend
to continue to evaluate various pre-specified secondary endpoints
and post-hoc analyses relating to NGM621.
•Merck
had a one-time option to license NGM621 and its related compounds
upon completion of the CATALINA trial. In December 2022, Merck
notified us that it would not exercise its option to license NGM621
and its related compounds, nor would Merck exercise the related
ophthalmology bundle option; accordingly, these options expired
unexercised in January 2023 and these programs are now wholly-owned
by us.
•Further
development of NGM621 is primarily dependent on our ability to
secure potential future BD Arrangements and, in the absence of such
BD Arrangements, we are unlikely to be able to advance development
of NGM621 unless our portfolio prioritization changes and we have
access to the necessary capital to fund such
development.
•Liver
and metabolic diseases.
•Aldafermin.
Aldafermin is an engineered analog of human hormone fibroblast
growth factor 19, or FGF19, that is administered through a
once-daily subcutaneous injection. Aldafermin is wholly-owned by
us. Aldafermin remains in Phase 2b development for the treatment of
patients with compensated cirrhosis due to non-alcoholic
steatohepatitis, or NASH (liver fibrosis stage 4, or F4, by the
NASH Clinical Research Network classification). The Phase 2b ALPINE
4 clinical trial, which is fully enrolled, is designed to evaluate
the treatment effect of aldafermin over 48 weeks. The primary
endpoint for the trial is the Enhanced Liver Fibrosis, or ELF,
test, a reproducible, quantitative non-invasive liver prognostic
test that evaluates liver fibrosis and correlates to liver-related
outcomes. The ELF test is a composite blood test measuring the
presence of three biomarkers associated with liver matrix
metabolism. Liver biopsy data will also be measured and reported as
a secondary endpoint upon completion of the trial.
•Further
development of aldafermin is primarily dependent on our ability to
secure potential future BD Arrangements and, in the absence of such
BD Arrangements, we are unlikely to be able to advance development
of aldafermin unless our portfolio prioritization changes and we
have access to the necessary capital to fund such
development.
•Looking
forward:
We expect to report topline data from the Phase 2b ALPINE 4 trial
in the second quarter of 2023.
•MK-3655
(NGM313).
MK-3655 is an agonistic antibody discovered by us that selectively
activates fibroblast growth factor receptor 1c-beta-klotho, or
FGFR1c/KLB, which regulates insulin sensitivity, blood glucose and
liver fat and is administered every four weeks through a
subcutaneous injection. MK-3655 was licensed by Merck in November
2018.
•In
January 2023, we announced that Merck notified us of its decision
to terminate the Phase 2b trial of MK-3655 in patients with NASH
and liver fibrosis stage 2 or 3 based on the results of an interim
analysis of safety and reduction in liver fat at Week 24. Although
it was not the primary endpoint of the trial, the percent reduction
from baseline in liver fat for MK-3655,
while greater than placebo across multiple dose arms, did not reach
Merck’s threshold for continuing the trial. The trial was not
discontinued for safety concerns. Later in January 2023, Merck also
provided us with the required 90-days' notice of partial
termination of our collaboration with Merck as it relates to
MK-3655 and its related compounds. As a result, in late April 2023,
the license rights granted to Merck in 2018 with respect to MK-3655
will revert to us and the program will become wholly-owned by
us.
•Further
development of MK-3655 once termination of Merck's license is
effective is primarily dependent on our ability to secure potential
future BD Arrangements and, in the absence of such BD Arrangements,
we are unlikely to be able to advance development of MK-3655 unless
our portfolio prioritization changes and we have access to the
necessary capital to fund such development.
•Hematologic
cancer diseases.
•NGM936.
NGM936 is a bispecific T cell engager therapeutic candidate for the
treatment of hematologic malignancies that targets ILT3 and cluster
of differentiation 3, or CD3. NGM936 is designed to direct T cell
mediated killing of ILT3-positive cancer cells while sparing normal
hematopoietic stem cells, or HSCs, and minimizing CD3-driven
cytokine release. ILT3, a myeloid-cell restricted receptor, has
enriched expression in myelomonocytic leukemia, monocytic leukemia
and leukemia stem cells but is not expressed on healthy HSCs. This
expression profile of ILT3 may make it an effective target for the
treatment of monocytic acute myeloid leukemia, or AML, and multiple
myeloma.
•NGM936
has been evaluated in preclinical studies, where it has
demonstrated the ability to potently kill ILT3+ AML cells, kill
ILT3+ multiple myeloma cells and preserve healthy bone marrow
cells.
•Further
development of NGM936 is primarily dependent on our ability to
secure potential future BD Arrangements and, in the absence of such
BD Arrangements, we are unlikely to be able to advance development
of NGM936 unless our portfolio prioritization changes and we have
access to the necessary capital to fund such
development.
We have additional programs that are in various stages of
development ranging from functional validation to preclinical
development.
The success of each of our product candidates may be affected by
numerous factors, including preclinical data, clinical data,
competition, manufacturing capability, sales capability, any future
partners, the sufficiency of our cash resources, regulatory
matters, third-party payor matters and commercial viability. We do
not have any products approved for sale and do not anticipate
generating revenue from product sales for the foreseeable future,
if ever.
Business Development and Merck Collaboration Updates
Pursuing BD Arrangements has been and is expected to continue to be
a key component of our strategy. Given the breadth of opportunities
that have been, and may in the future be, produced by our discovery
engine, we are actively seeking, or intend to seek, BD Arrangements
with third-party partners to progress, in whole or in part, the
development of one or more of our product candidates. We believe
that this strategy, if successfully implemented, may enable more of
the programs in our pipeline, including those in active development
by us, to be advanced as effectively and efficiently as possible.
Further development of NGM621, aldafermin, NGM936 and, once
termination of Merck's license is effective, MK-3655, is primarily
dependent on our ability to secure potential future BD Arrangements
and, in the absence of such BD Arrangements, we are unlikely to be
able to advance development of those programs unless our portfolio
prioritization changes and we have access to the necessary capital
to fund such development.
Our collaboration with Merck, described in "Business — Licensing
and Collaboration Arrangements — Merck Collaboration" in Part I,
Item 1 of this Annual Report on Form 10-K and Note 5, “Research
Collaboration and License Agreements,” of the notes to audited
consolidated financial statements included in Part II, Item 8 of
this Annual Report on Form 10-K, historically provided us with
robust financial support that enabled us to broaden and accelerate
our research efforts and to develop more product candidates for
major indications than we likely could have advanced on our own. We
do not have any committed external source of funds, other than
pursuant to our collaboration with Merck under the amended and
restated research collaboration, product development and license
agreement we entered into with Merck on June 30, 2021, or the
Amended Collaboration Agreement. Currently, the only ongoing
activities funded under the Amended Collaboration Agreement are
ongoing cardiovascular or metabolic-, or CVM-, related activities
and remaining laboratory testing and other activities on compounds
that are
directed to one of up to two undisclosed targets outside of the
fields of ophthalmology and CVM disease, or the Lab Programs,
collectively referred to as the Remaining Research Programs. In
2023, the R&D funding we receive from Merck under the Amended
Collaboration Agreement will be limited and substantially lower on
an annual basis than the research funding previously provided by
Merck. In this regard, for the period that started on January 1,
2023 and ends on March 31, 2024, we expect to receive funding of
approximately $13.0 million in the aggregate from Merck for
activities under the Remaining Research Programs and for certain
costs and reimbursements related to the NGM621 program. Funding
from Merck after December 31, 2023 is expected to be minimal. The
research phase for the CVM-related programs under the Amended
Collaboration Agreement will continue through March 31, 2024,
unless the parties mutually agree to extend the research phase
through March 31, 2026, in which case Merck would provide up to a
total of $20.0 million in R&D funding during the additional two
years of the CVM program research phase.
In December 2022, Merck notified us that it would not exercise its
option to license NGM621 and its related compounds or the related
ophthalmology bundle option and, as a result, those options expired
unexercised in January 2023. Further, Merck did not elect for us to
continue to conduct R&D on any compounds from our other
ophthalmology programs that were subject to the collaboration,
which are preclinical and directed to undisclosed targets. Such an
election would have resulted in an extended or tail period in which
Merck would continue to fund our R&D of such ophthalmology
compounds. Because Merck did not make such an election, we do not
have any funding from Merck to pursue such ophthalmology programs.
Similarly, in January 2023, as described above, we announced that
Merck notified us of its decision to terminate the Phase 2b trial
of MK-3655. Later in January 2023, Merck provided us with the
required 90-days' notice of partial termination of the Amended
Collaboration Agreement as it relates to MK-3655 and its related
compounds. After the license rights granted to Merck with respect
to MK-3655 revert to us, we will be responsible for funding further
development of the program, if any.
Other Operational Updates
We do not own, and have no plans to establish, any manufacturing
facilities. All of our manufacturing activities are outsourced to
third-party contract development and manufacturing organizations or
third-party contract manufacturing organizations, which we refer to
collectively as CMOs, which are generally single-source suppliers
of the drug product or drug substance they are manufacturing for
us. We also utilize third-party contract research organizations, or
CROs, to carry out many of our clinical development activities. We
expect to be reliant on CMOs and CROs for these activities for the
foreseeable future. Significant portions of our research and
development, or R&D, resources are focused, and will continue
to be focused, on the manufacture and testing of clinical trial
materials. If our CROs and CMOs fail to satisfy their contractual
duties to us or meet expected deadlines or if our CMOs experience
difficulties in scaling production, higher than anticipated costs
or lower than anticipated yields, product loss due to
contamination, equipment failure, improper installation or
operation of equipment, vendor or operator error, turnover of
qualified staff or improper storage conditions, difficulties with
quality control, product stability or quality assurance testing, or
difficulties procuring raw materials or components as a result of
the ongoing COVID-19 pandemic or otherwise, our ongoing and planned
trials and possible acceleration or expansion of those trials may
be delayed, perhaps substantially, or abandoned, which could
materially and adversely affect our business. For example, while we
initiated the Phase 1/1b clinical trial of NGM831 in March
2022
and the Phase 1/1b clinical trial of NGM438 in May 2022, our
planned individual new drug application, or IND, submissions for
NGM831 and NGM438 were delayed due to challenges at one of our CMOs
with respect to the manufacture of those product candidates,
primarily related to analytical method qualification and release
testing. It is possible that we could experience further
supply-related delays that would create supply challenges and
possible timing delays for ongoing and planned clinical trials or
delay the commencement of first-in-human testing of future product
candidates. In addition, there is increased competition in the
biotechnology industry for CMO manufacturing slots and other
capabilities generally, which has had, and may continue to have, a
negative impact on the availability of manufacturing capacity and
therefore our ability to supply clinical trial materials for
planned, ongoing, accelerated or expanded clinical trials. Our
CMOs’ facilities and operations have also been adversely affected
by labor, raw material and component shortages, high turnover of
staff and difficulties in hiring trained and qualified replacement
staff. Changes in economic conditions, supply chain constraints,
labor, raw material and component shortages and steps taken by
governments and central banks, particularly in response to the
COVID-19 pandemic as well as other stimulus and spending programs,
could lead to higher inflation than previously experienced or
expected, which could, in turn, lead to an increase in costs. These
supply chain effects, increased competition and higher costs of
acquired goods and services may negatively impact our business
operations and our financial results.
In addition, all of our product candidates other than NGM621 and
aldafermin are currently manufactured solely at a facility in
Lithuania. Following Russia's invasion of Ukraine in February 2022,
NATO deployed additional military forces to Eastern Europe,
including to Lithuania. The ongoing conflict between Russia and
Ukraine and the
retaliatory measures taken or that may be taken by the United
States, NATO and others, including significant sanctions against
Russia, create global security concerns and regional instability,
including due to the possibility of expanded regional or global
conflict, and are likely to have short-term and likely longer-term
negative impacts on regional and global economies, any or all of
which could disrupt our supply chain and adversely affect our
ability to conduct ongoing and future clinical trials of our
product candidates and our ability to raise capital on favorable
terms.
In July 2022, we entered into an operating lease agreement, or the
2024 Lease Agreement, for our existing corporate office space and
facilities at 333 Oyster Point Blvd., South San Francisco,
California, which allows us to remain in our existing facilities
through December 31, 2033, subject to our compliance with the 2024
Lease Agreement. We also have an option to extend the 2024 Lease
Agreement for a period of either eight or ten years after the
initial ten-year term of January 1, 2024 to December 31,
2033.
We seek to allocate our capital efficiently and strategically and
fund our portfolio based on each program’s scientific and other
merits. Our discipline has been demonstrated by our decision not to
proceed with development activities on multiple potentially viable
product candidates for portfolio management and capital
conservation reasons to concentrate our resources and focus our
execution on our solid tumor oncology programs.
Given
the substantial decrease in research funding, we will now receive
from Merck as compared to historical periods commensurate with the
decreased collaboration scope described below, going forward we
will need to devote a substantial amount of our own financial
resources to fund our R&D programs, and we may need to delay or
suspend development activities on product candidates that we
consider promising unless and until we are able to raise sufficient
additional capital
and/or we will need to enter into additional BD Arrangements
in order to proceed with such development through to regulatory
approval.
Financial Highlights
Since inception, we have funded our operations primarily
through:
•fees
received from collaboration partners which since inception through
December 31, 2022 includes reimbursement of R&D expenses
of $533.0 million, and upfront cash licensing fees of $123.0
million, primarily from Merck, and a payment of $20.0 million from
Merck to license MK-3655 and related compounds;
•proceeds
from private placements of convertible preferred stock prior to our
initial public offering, or IPO, including approximately $106.0
million of our Series E convertible preferred stock purchased by
Merck;
•net
proceeds from our IPO in 2019 of approximately $107.8 million,
together with proceeds from the concurrent private placement of
shares of common stock to Merck of $65.9 million;
•net
proceeds of $134.6 million from the sale of 5,324,074 shares
of our common stock in January 2021 upon completion of an
underwritten public offering of our common stock, or the follow-on
offering, which included the full exercise by the underwriters of
their option to purchase additional shares; and
•net
proceeds of $71.5 million through December 31, 2022 from sales
of approximately 4.1 million shares of our common stock under an
Open Market Sale AgreementSM,
or the Sales Agreement, we entered into with Jefferies LLC, or
Jefferies, in June 2020.
At December 31, 2022, we had $271.5 million in cash, cash
equivalents and short-term marketable securities.
We have incurred net losses each year since our inception. As of
December 31, 2022, we had an accumulated deficit of
$581.6 million. Substantially all of our net losses have
resulted from costs incurred in connection with our R&D
programs and general and administrative, or G&A, costs
associated with our operations. Our net losses may fluctuate
significantly from quarter-to-quarter and year-to-year, depending
on the timing of our clinical trials and our expenses on other
R&D activities, and the amount of R&D funding we receive
from future BD Arrangements, if any. For further discussion of our
financial position and future sources of funding, see “Liquidity
and Capital Resources” below.
Financial Operations Overview
Related Party Revenue
Our revenue to date has been generated primarily from recognition
of license fees and R&D service funding pursuant to our
collaboration with Merck. Merck is also a significant stockholder
and, as such, collaboration revenue from Merck is referred to as
related party revenue.
Since the Company's inception through December 31, 2022, Merck
paid us $608.2 million pursuant to the terms of our
collaboration. Due to the nature of our collaboration with Merck
and the timing of related revenue recognition, our revenue has
fluctuated from period to period in the past and we expect that it
will continue to fluctuate in 2023 given the substantial decrease
in the level of funding we will receive from Merck in 2023. After
December 31, 2023, we expect funding, and revenue recognized, from
Merck to be minimal. As a result, we believe that period-to-period
comparisons of our revenue may not be meaningful and should not be
relied upon as being indicative of future performance.
We use the cost-based input method in accordance with Accounting
Standards Codification 606, or ASC 606, to calculate the
corresponding amount of revenue to recognize at each reporting
period. In applying the cost-based input measure of revenue
recognition, we measure actual costs incurred relative to budgeted
costs to fulfill our performance obligation. We apply considerable
judgment when we re-evaluate the estimate of expected costs to
satisfy the performance obligation each reporting period and make
adjustments for any significant changes. A significant change in
the estimate of expected costs under the Amended Collaboration
Agreement could have a material impact on revenue recognized
(including the possible reversal of previously recognized revenue)
at each reporting period.
In the past three years, our related party revenue was as follows
(in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
2022 |
|
2021 |
|
2020 |
Related party revenue |
$ |
55,333 |
|
|
$ |
77,882 |
|
|
$ |
87,368 |
|
Research and Development Expenses
R&D efforts include drug discovery and other research
activities and development activities relating to our product
candidates, such as manufacturing drug substance, drug product and
other clinical trial materials, conducting preclinical studies and
clinical trials and providing support for these operations. Our
R&D expenses consist of both internal and external costs. Our
internal costs include employee, consultant, facility and other
R&D operating expenses. Our external costs include fees paid to
CROs and other service providers in connection with our clinical
trials and preclinical studies, third-party license fees and CMO
costs related to manufacturing drug substance, drug product and
other clinical trial materials.
Our R&D efforts are extensive and costly. Our R&D expenses
related to the development of our product candidates consist
primarily of:
•fees
paid to our CROs in connection with our clinical trials and other
related clinical trial fees, when applicable;
•costs
related to acquiring and manufacturing drug substance, drug product
and clinical trial materials, and the costs of continued testing,
such as process validation testing and stability testing, of drug
substance and drug product;
•costs
related to toxicology testing and other research- and
preclinical-related studies;
•salaries
and related overhead expenses, which include stock-based
compensation and benefits, for personnel in R&D
functions;
•fees
paid to consultants for R&D activities;
•R&D
operating expenses, including facility costs and depreciation
expenses; and
•costs
related to compliance with regulatory requirements.
We need to devote a substantial amount of our own financial
resources to our wholly-owned development programs, primarily our
solid tumor oncology programs in active ongoing clinical
development. In addition, because Merck declined to exercise its
license to option NGM621, decided not to continue funding further
research on the other preclinical ophthalmology compounds and
provided notice of termination of its existing its license to
MK-3655 and in prior years other product candidates, our funding
requirements would increase even further if our
portfolio
prioritization changes and we decide to continue to develop those
programs on our own. As a result, further development of NGM621,
aldafermin, NGM936 and, once termination of Merck's license is
effective, MK-3655, is currently primarily dependent on our ability
to secure potential future BD Arrangements and, in the absence of
such BD Arrangements, we are unlikely to be able to advance
development of those programs unless our portfolio prioritization
changes and we have access to the necessary capital to fund such
development. For the foreseeable future, we anticipate a
significant portion of our financial resources, other than those
received from Merck which are dedicated to activities under the
Amended Collaboration Agreement, will be directed to activities
required to initiate and advance clinical trials of our solid tumor
oncology programs and complete the Phase 2b ALPINE 4 clinical trial
of aldafermin.
The successful development of our product candidates is highly
uncertain. At this time, we cannot reasonably estimate the nature,
timing or costs of the efforts that will be necessary to complete
the remainder of the development of our product candidates or if we
will be able to enter into BD Arrangements or otherwise raise
adequate additional capital to meet our funding requirements to
support such efforts, particularly outside of our key solid tumor
oncology programs. This is due to the numerous risks and
uncertainties associated with developing medicines, including the
uncertainty of:
•the
scope, rate of progress, results and expense of our ongoing, as
well as any future, clinical trials and other R&D-related
activities;
•the
impact and timing of any interactions with regulatory authorities,
including timing and receipt of regulatory approvals:
•our
ability to hire and retain key R&D personnel;
•manufacturing
scale-up challenges, production shortages or other supply
disruptions for clinical trial materials, including raw materials
and components;
•the
effects of the continuing COVID-19 pandemic on our employees,
patients, clinical trial sites and our CROs, CMOs and other service
providers;
•the
timely and quality performance of our CROs, CMOs and other service
providers;
•whether
Merck will elect to license, or to terminate its license, to any of
our preclinical programs remaining within the scope of the
collaboration and the timing of such election or
termination;
•the
effect of products that may compete with our product candidates or
other market developments; and
•our
ability to expand and enforce our intellectual property
portfolio.
A change in the outcome of any of the risks and uncertainties
associated with the development of a product candidate could mean a
significant change in the costs, as well as the timing, associated
with the development of that product candidate. For example, if the
FDA or a comparable foreign health authority were to require us to
conduct clinical trials beyond those that we currently anticipate
will be required for the completion of clinical development of a
product candidate, or if we experience significant delays in
enrollment in any of our clinical trials, we could be required to
expend significant additional financial resources and time on the
completion of clinical development. For additional discussion of
the risks and uncertainties associated with our R&D efforts,
see “Risk Factors—Risks Related to Our Business and Industry,”
“—Risks Related to Our Dependence on Third Parties,” “—Risks
Related to Regulatory Approvals” and "—Risks Related to Our
Intellectual Property” in Part I, Item 1A of this Annual Report on
Form 10-K.
General and Administrative Expenses
G&A expenses consist primarily of salaries and other related
costs, including stock-based compensation and benefits. Other
significant costs include legal fees relating to patent and
corporate matters, facility costs not otherwise included in R&D
expenses and fees for accounting and other consulting
services.
We anticipate that our G&A expenses in 2023 will remain
relatively consistent with 2022 in support of our narrowed R&D
activities. Beginning in 2024, our G&A expenses will include an
increase in operating lease expenses under the 2024 Lease
Agreement. Additionally, we anticipate continued costs associated
with being a public company, including expenses related to services
associated with maintaining compliance with Nasdaq listing rules
and related SEC requirements and costs related to insurance,
investor relations and compliance with Section 404 of the
Sarbanes-Oxley Act of 2002, or the Sarbanes-Oxley Act. In addition,
we may incur expenses associated with negotiating and entering into
BD Arrangements.
Results of Operations
Our results of operations were as follows (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
Change |
|
2022 |
|
2021 |
|
2020 |
|
2022 vs 2021 |
|
2021 vs 2020 |
Related party revenue |
$ |
55,333 |
|
|
$ |
77,882 |
|
|
$ |
87,368 |
|
|
$ |
(22,549) |
|
|
$ |
(9,486) |
|
Operating expenses: |
|
|
|
|
|
|
|
|
|
Research and development |
181,067 |
|
|
161,712 |
|
|
163,972 |
|
|
19,355 |
|
|
(2,260) |
|
General and administrative |
40,515 |
|
|
36,865 |
|
|
27,229 |
|
|
3,650 |
|
|
9,636 |
|
Total operating expenses |
221,582 |
|
|
198,577 |
|
|
191,201 |
|
|
23,005 |
|
|
7,376 |
|
Loss from operations |
(166,249) |
|
|
(120,695) |
|
|
(103,833) |
|
|
(45,554) |
|
|
(16,862) |
|
Interest income, net |
3,714 |
|
|
420 |
|
|
1,939 |
|
|
3,294 |
|
|
(1,519) |
|
Other expense, net |
(132) |
|
|
(60) |
|
|
(593) |
|
|
(72) |
|
|
533 |
|
Net loss |
$ |
(162,667) |
|
|
$ |
(120,335) |
|
|
$ |
(102,487) |
|
|
$ |
(42,332) |
|
|
$ |
(17,848) |
|
Related Party Revenue from Merck
Revenue decreased $22.5 million in the year ended
December 31, 2022 compared to the same period in 2021
primarily due to a decrease in R&D revenue under the Amended
Collaboration Agreement with Merck. Revenue in the year ended
December 31, 2022 includes $4.75 million in reimbursable
expenses by Merck related to a third-party manufacturer for
NGM621.
Revenue decreased $9.5 million in the year ended
December 31, 2021 compared to the same period in 2020
primarily due to a reduction in revenue of $4.6 million for an
amount we had recorded under the prior two-year extension of the
research phase that was no longer billable to Merck under the
Amended Collaboration Agreement as of June 30, 2021 and a $3.9
million decrease related to the recognition of the remaining
portion of an upfront payment in the first quarter of
2020.
Due to the nature of our collaboration with Merck and the timing of
related revenue recognition, our revenue has fluctuated from period
to period in the past and we expect that it will continue to
fluctuate in 2023 given the substantial decrease in the level of
funding we will receive from Merck in 2023. After December 31,
2023, we expect funding, and revenue recognized, from Merck to be
minimal.
Research and Development Expenses
Our R&D expenses by program were as follows (in
thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
2022 |
|
2021 |
|
2020 |
External R&D expenses: |
|
|
|
|
|
NGM707 (Anti-ILT2/ILT4 dual antagonist) |
$ |
24,333 |
|
|
$ |
5,521 |
|
|
$ |
4,817 |
|
NGM621 (C3 inhibitor) |
23,738 |
|
|
20,415 |
|
|
13,126 |
|
Aldafermin (FGF19 analog) |
13,665 |
|
|
31,766 |
|
|
50,553 |
|
NGM438 (LAIR1 antagonist) |
8,504 |
|
|
4,074 |
|
|
3,586 |
|
NGM120 (GFRAL antagonist) |
7,183 |
|
|
6,856 |
|
|
5,606 |
|
NGM831 (ILT3 antagonist) |
6,832 |
|
|
2,377 |
|
|
4,756 |
|
Other external R&D expenses |
1,186 |
|
|
1,437 |
|
|
4,822 |
|
Total external R&D expenses |
85,441 |
|
|
72,446 |
|
|
87,266 |
|
Personnel-related expenses |
62,151 |
|
|
56,209 |
|
|
43,811 |
|
Internal and unallocated R&D expenses (1) |
33,475 |
|
|
33,057 |
|
|
32,895 |
|
Total R&D expenses |
$ |
181,067 |
|
|
$ |
161,712 |
|
|
$ |
163,972 |
|
_________________
(1) Internal and unallocated R&D expenses consist primarily of
research supplies and consulting fees, which we deploy across
multiple R&D programs.
R&D expenses increased $19.4 million in the year ended
December 31, 2022 compared to the same period in 2021
primarily due to increases in external expenses, driven by our
ongoing clinical trials of NGM707, NGM831, NGM438 and NGM120, our
completed trial of NGM621, and personnel-related expenses including
an increase in share-based compensation expense of $3.6 million,
partially offset by a decrease in expenses for our manufacturing
activities and our clinical trials of aldafermin.
R&D expenses decreased $2.3 million in the year ended
December 31, 2021 compared to the same period in 2020
primarily due to a decrease in expenses for our manufacturing
activities and our clinical trials of aldafermin, partially offset
by an increase in personnel-related expenses, including an increase
in share-based compensation expense of $5.8 million, and an
increase in external expenses driven by our ongoing clinical trials
of NGM621, NGM120 and NGM707 and our preclinical studies of NGM438
and NGM831.
We expect our R&D expenses will decrease moderately in 2023
compared to 2022 as we suspend development activities related to
NGM621 and aldafermin and focus on the continued advancement of our
solid tumor oncology portfolio, including:
•NGM707:
continuing enrollment in the ongoing Phase 1/2 clinical
trial;
•NGM831:
continuing enrollment in the Phase 1/1b clinical
trial;
•NGM438:
continuing enrollment in the Phase 1/1b clinical trial,
and
•NGM120:
continuing enrollment in the Phase 2 PINNACLES portion of the Phase
1/2 clinical trial and the Phase 1b cohort of patients with
mCRPC.
General and Administrative Expenses
G&A expenses increased $3.7 million in the year ended
December 31, 2022 compared to the same period in 2021
primarily due to an increase in personnel-related expenses due to
increased headcount and an increase in share-based compensation
expense of $2.5 million.
G&A expenses increased $9.6 million in the year ended December
31, 2021 compared to the same period in 2020 primarily due to an
increase in personnel-related expenses due to increased headcount,
an increase in share-based compensation expense of $4.7 million and
a $2.5 million increase in fees paid to outside consultants,
lawyers and accountants.
We anticipate that our G&A expenses in 2023 will remain
relatively consistent compared to 2022 as we continue to support
our oncology program and operate as a public company.
Interest Income, net
Interest income, net increased $3.3 million in the year ended
December 31, 2022 compared to 2021 primarily due to higher
yielding investments.
Interest income, net decreased $1.5 million in the year ended
December 31, 2021 compared to 2020 primarily due to an increase in
unrealized losses in marketable securities, offset by an increase
in interest income due to an increase in our average cash
balance.
Liquidity and Capital Resources
Funding Requirements
We have no products approved for commercial sale, have not
generated any revenue from product sales to date and we are not and
may never be profitable. We have incurred losses in each year since
commencing operations, and we expect to incur significant operating
losses in 2023 and over the next several years. As of
December 31, 2022, we had an accumulated deficit of $581.6
million, and we expect our accumulated deficit will continue to
increase over time.
We have an active discovery research group and have spent
significant resources to fund R&D of multiple pipeline
programs. Our pipeline includes four key solid tumor oncology
programs, NGM707, NGM831, NGM438 and NGM120, in active ongoing
clinical development. We are currently focusing most of our
execution efforts and resources on these programs as our
substantial research, development, clinical trial and related
activities continue. While we will opportunistically consider BD
Arrangements to advance development of these key programs, we
intend to invest our resources in their development even in the
absence of BD Arrangements.
Due to the need to conserve capital and prioritize focused
execution, the remainder of our pipeline includes programs whose
further development is primarily dependent on our ability to secure
potential future BD Arrangements. We are actively seeking, or
intend to seek, BD Arrangements with third-party partners
possessing sufficient resources and relevant domain expertise in
the relevant therapeutic area in order to further clinical
development of these programs. In the absence of such BD
Arrangements for these programs, we are unlikely to be able to
advance their development unless our portfolio prioritization
changes and we have access to the necessary capital to fund such
development.
Prior to 2022, we received substantial R&D funding from our
collaboration with Merck. However, under the narrower scope of the
Amended Collaboration Agreement, R&D funding from Merck
beginning April 2022 was and is expected to be substantially lower
than the R&D funding previously provided by Merck. For the
period that started on January 1, 2023 and ends on March 31, 2024,
we expect to receive funding of approximately $13.0 million in the
aggregate from Merck for activities remaining under the Amended
Collaboration Agreement and for certain costs and reimbursements
related to the NGM621 program. Funding from Merck after December
31, 2023 is expected to be minimal.
Our cash requirements for fiscal year 2023 will continue to be
driven by our R&D and G&A expenses. In 2022 and 2021, our
R&D expenses were $181.1 million and $161.7 million,
respectively. In 2023, we expect our R&D expenses to decrease
moderately compared to 2022 as we suspend development activities
related to NGM621 and our other preclinical ophthalmology programs
and focus on the continued advancement of our solid tumor oncology
portfolio, as well as completion of development activities related
to ALPINE 4. In 2022 and 2021, our G&A expenses were $40.5
million and $36.9 million, respectively. In 2023, we expect our
G&A expenses will remain relatively consistent compared to 2022
in support of our narrowed R&D activities and expenses
associated with being a public company. Beginning in 2024, our
operating lease costs will increase pursuant to the 2024 Lease
Agreement we entered into in July 2022 for our current corporate
office space and facilities in South San Francisco, California. Our
current sublease will expire on December 31, 2023. The 2024 Lease
Agreement will commence on January 1, 2024 and expire on December
31, 2033. We will pay an initial monthly base rent of approximately
$0.9 million for the first year, which is subject to increase at an
annual rate of 3.5% each year thereafter, plus certain operating
and tax expenses.
We believe that our existing cash, cash equivalents and short-term
marketable securities will be sufficient to fund our operations for
at least twelve months from the date this Annual Report on Form
10-K is filed. Moreover, based on our current development plans and
related assumptions, we believe our current cash position is
sufficient to fund our key solid tumor oncology programs through
generation of proof-of-concept data. We have based these estimates
on plans and assumptions that may prove to be insufficient or
inaccurate (for example, with respect to anticipated costs, timing
or success of certain activities), and we could utilize our
available capital resources sooner than we currently expect. In
addition, our forecast of the period of time through which our
financial resources will be adequate to support our operations is a
forward-looking statement that involves risks and uncertainties,
and actual results could vary materially as a result of a number of
factors, including the factors discussed under “Risk Factors” in
Part I, Item 1A of this Annual Report on Form 10-K. Nonetheless, in
order to advance our current and potential future product
candidates through development and to regulatory approval and
commercialization, we will need to raise significant additional
capital and we will need to enter into BD Arrangements for one or
more of our wholly-owned programs and obtain funding or other
resources through such BD Arrangements. Neither may be possible
and, as a result, we may be required to delay, scale back or
discontinue development of such product candidates, which could
have a material adverse effect on our business, operating results
and prospects.
Sources of Liquidity
Cash and Investments
As of December 31, 2022, we had cash and cash equivalents of
$73.5 million and short-term marketable securities of
$198.0 million.
Merck Collaboration
The revenue we receive under the Amended Collaboration Agreement
with Merck is currently our only source of revenue. For the period
that started on January 1, 2023 and ends on March 31, 2024, we
expect to receive funding of approximately $13.0 million in the
aggregate from Merck for the ongoing CVM-related activities, the
remaining activities under the Lab Programs and for certain costs
and reimbursements related to the NGM621 program. See “Overview of
Our Business—Business Development and Merck Collaboration Updates”
above.
Other Sources of Capital
In June 2020, we entered into the Sales Agreement with Jefferies.
In accordance with the terms of the Sales Agreement, we may offer
and sell shares of our common stock having an aggregate offering
price of up to $150.0 million from time to time through Jefferies,
acting as our sales agent. As of December 31, 2022,
$76.2 million of our common stock remained available to be
sold under the Sales Agreement, subject to conditions specified in
the Sales Agreement.
We plan to finance our future cash needs through public or private
equity or debt offerings, including under the Sales Agreement, BD
Arrangements or a combination of these potential financing sources.
Additional capital may not be available in sufficient amounts, on
reasonable terms or when we need it, if at all.
Our ability to raise additional capital through public or private
equity or debt offerings may be adversely impacted by worsening
global economic conditions and the disruptions to, and volatility
in, the credit and financial markets in the United States and
worldwide, and in the biotechnology industry specifically. While
the long-term economic impact of either the COVID-19 pandemic or
the conflict between Russia and Ukraine is difficult to assess or
predict, each of these events has caused significant disruptions to
the global financial markets and contributed to a general global
economic slowdown. Furthermore, inflation rates across the globe
have increased to levels not seen in decades. Increased inflation
may result in increased operating costs (including labor costs) and
may affect our operating budgets. In addition, the U.S. Federal
Reserve has raised, and is expected to further raise, interest
rates in response to concerns about inflation. Increases in
interest rates, especially if coupled with reduced government
spending and volatility in financial markets, may further increase
economic uncertainty and heighten these risks. If the financial
market disruptions and economic slowdown deepen or persist, we may
not be able to access additional capital on favorable terms, or at
all, which could negatively affect our financial condition and our
ability to pursue our business strategy.
In addition, if we raise additional funds by issuing equity
securities, our stockholders may experience dilution. Debt
financing, if available, may involve restrictive covenants. Any
debt financing or additional equity that we raise may contain terms
that are not favorable to us or our stockholders. Furthermore, any
securities that we may issue may have rights senior to those of our
common stock and could contain covenants or protective rights that
would lead to restrictions on our operations and potentially impair
our competitiveness, such as limitations on our ability to incur
additional debt, limitations on our ability to acquire, sell or
license intellectual property rights and other operating
restrictions that could adversely impact our ability to conduct our
business.
While we may opportunistically consider BD Arrangements to advance
development of our key solid tumor oncology programs, we are
actively seeking, or intend to seek, BD Arrangements with
third-party partners to progress, in whole or in part, the
development of one or more of our other programs whose further
development is primarily dependent on our ability to secure
potential future BD Arrangements. We believe that this strategy, if
successfully implemented, may enable more of the product candidates
in our pipeline to be advanced as effectively and efficiently as
possible. If we are unable to secure BD Arrangements for NGM621 and
our preclinical ophthalmology programs, aldafermin, NGM936 and,
once termination of Merck's license is effective, MK-3655, we may
discontinue or abandon any or all of them altogether, in which case
we will not realize any return on our investments in these
programs. Even if we are successful in securing BD Arrangements for
these programs, we will likely have limited control over the amount
and timing of resources that our partners dedicate to the
development or commercialization of the applicable product
candidates. Our ability to generate revenue from any such BD
Arrangement will depend on the specific terms of the BD
Arrangement.
If we are unable to raise adequate additional capital through
public or private equity or debt offerings, BD Arrangements or
otherwise, on acceptable terms or at all, we may be delayed in or
prevented from pursuing our planned and any future development and
commercialization efforts, which will have a material adverse
effect on our business, operating results and
prospects.
Cash Flow Activity
The following table summarizes our cash flow activity for the
periods indicated (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Year Ended December 31, |
|
2022 |
|
2021 |
|
2020 |
Net cash provided by (used in): |
|
|
|
|
|
Operating activities |
$ |
(144,439) |
|
|
$ |
(73,229) |
|
|
$ |
(83,496) |
|
Investing activities |
14,322 |
|
|
(71,650) |
|
|
(50,998) |
|
Financing activities |
54,233 |
|
|
149,657 |
|
|
35,538 |
|
Net (decrease) increase in cash, cash equivalents and restricted
cash |
$ |
(75,884) |
|
|
$ |
4,778 |
|
|
$ |
(98,956) |
|
Operating Activities
Cash used in operating activities in 2022 was $144.4 million, which
consisted of a net loss of $162.7 million, adjusted for non-cash
charges of $39.0 million and a change in operating assets and
liabilities of $20.7 million. The non-cash charges consisted
primarily of stock-based compensation expense of $32.4 million,
depreciation expense of $4.0 million and noncash lease expense of
$1.9 million. The change in operating assets and liabilities was
mainly driven by decreases in contract liabilities of $17.4
million, operating lease liabilities of $5.1 million, prepaid
expenses and other current assets of $1.8 million and accrued
liabilities of $0.6 million, partially offset by increases in
accounts payable of $3.2 million and related party receivable of
$2.6 million.
Cash used in operating activities in 2021 was $73.2 million, which
consisted of a net loss of $120.3 million, adjusted for non-cash
charges of $42.9 million and a change in operating assets and
liabilities of $4.2 million. The non-cash charges consisted
primarily of stock-based compensation expense of $26.2 million,
depreciation expense of $6.1 million, a decrease in related party
contract assets due to the Amended Collaboration Agreement with
Merck of $4.6 million, amortization of a premium on marketable
securities of $3.5 million and noncash lease expense of $1.8
million. The change in operating assets and liabilities was mainly
driven by increases in contract liabilities of $17.8 million,
related party receivable of $4.6 million, prepaid expenses and
other current assets of $4.1 million and accrued liabilities of
$2.9 million, partially offset by decreases in operating lease
liabilities of $4.8 million, accounts payable of $4.4 million and
related party contract assets of $1.5 million.
Cash used in operating activities in 2020 was $83.5 million, which
consisted of a net loss of $102.5 million, adjusted for non-cash
charges of $22.3 million and net cash used in operating assets and
liabilities of $3.3 million. The non-cash charges consisted
primarily of stock-based compensation expense of $15.7 million and
depreciation expense of $6.6 million. The change in operating
assets and liabilities was mainly driven by increases in accrued
expenses of $6.2 million, prepaid expenses and other current assets
of $1.9 million, accounts payable of $0.9 million and a related
party contract asset of $6.1 million. These increases were offset
by a decrease in deferred rent of $2.8 million.
Investing Activities
Cash provided by investing activities in 2022 was $14.3 million,
which consisted primarily of $289.0 million in net proceeds on
maturity of marketable securities offset by purchases of marketable
securities of $272.9 million. Cash used in investing activities in
2021 was $71.7 million, which consisted of purchases of marketable
securities of $293.5 million primarily from the net proceeds of the
follow-on offering, partially offset by $223.5 million in net
proceeds on maturity of marketable securities. Cash used in
investing activities in 2020 was $51.0 million, which consisted of
purchases of marketable securities of $177.7 million and
purchases of property and equipment of $1.9 million partially
offset by net proceeds on maturity of marketable securities of
$128.5 million.
Financing Activities
Cash provided by financing activities in 2022 was $54.2 million,
which consisted of net proceeds of $49.4 million from the sale of
shares of our common stock under the Sales Agreement and proceeds
from our employee equity incentive and purchase plans of $4.8
million. Cash provided by financing activities in 2021 was $149.7
million, which consisted of net proceeds from the follow-on
offering of $134.6 million and proceeds from employee equity
incentive and purchase plans of $14.9 million. Cash provided by
financing activities in 2020 was $35.5 million and primarily
related to net proceeds from the sale of shares of our common stock
under the Sales Agreement of $21.9 million and proceeds from
employee equity incentive and purchase plans of $14.2
million.
Contractual Obligations
We have contractual obligations related to our lease liabilities.
In July 2022, we entered into the 2024 Lease Agreement for the
corporate office space and facilities in South San Francisco,
California that we currently occupy pursuant to a sublease
agreement scheduled to expire on December 31, 2023. The initial
term of the 2024 Lease Agreement will commence on January 1, 2024
and expire on December 31, 2033. Base rent during the initial
ten-year term of the 2024 Lease Agreement will total $124.1
million. See Note 6 to our consolidated financial statements
included in Part II, Item 8, “Financial Statements and
Supplementary Data,” of this Annual Report on Form 10-K for
information regarding our lease commitments.
We enter into agreements in the normal course of business with CROs
for clinical trials, CMOs and other vendors for preclinical
studies, supplies, manufacturing and other services and products
for operating purposes. These agreements are generally cancellable
at any time by us, upon prior written notice, and may or may not
include cancellation fees. Given that the amount and timing related
to such payments are uncertain, they are not considered to be
contractual obligations. Following Merck's decision to not exercise
its NGM621 option and our decision not to proceed with further
development of NGM621, we cancelled future Phase 3 manufacturing
activities for NGM621 and recorded approximately $3.0 million for
cancellation charges as of December 31, 2022. No other
termination or cancellation charges have been recorded as they were
not considered probable. Significant portions of our R&D
resources are focused, and will continue to be focused, on the
manufacture and testing of clinical trial materials. See "Funding
Requirements" above for information regarding our expected R&D
spend.
We are obligated to make future payments to third parties under
in-license agreements, including sublicense fees, low single-digit
royalties and payments that become due and payable on the
achievement of certain development and commercialization
milestones. As the amount and timing of sublicense fees and the
achievement and timing of these milestones are not probable and
estimable, such commitments have not been included on our
consolidated balance sheets and are not considered to be
contractual obligations. See "Business— Licensing and Collaboration
Arrangements" in Part I, Item 1 of this Annual Report on Form 10-K
for additional information regarding our current in-license
agreements.
Critical Accounting Policies and Estimates
Our management’s discussion and analysis of our financial condition
and results of operations is based on our consolidated financial
statements, which we have prepared in accordance with U.S.
generally accepted accounting principles, or U.S. GAAP. The
preparation of our consolidated financial statements requires us to
make estimates and assumptions that affect the reported amounts of
assets and liabilities and the disclosure of contingent assets and
liabilities at the date of our consolidated financial statements,
as well as revenue and expenses during the reported periods. We
evaluate these estimates and judgments on an ongoing basis. In
accordance with U.S. GAAP, we base our estimates on historical
experience and on various other factors that we believe are
reasonable under the circumstances, the results of which form the
basis for making judgments about the carrying value of assets and
liabilities that are not readily apparent from other sources.
Actual results may differ materially from these estimates under
different assumptions or conditions.
While our significant accounting policies are described in Note 2
to our consolidated financial statements included in Part II, Item
8, “Financial Statements and Supplementary Data,” of this Annual
Report on Form 10-K, we believe that the following critical
accounting policies are the most important policies in
understanding and evaluating our financial condition and results of
operations because they are complex and relate to the more
significant areas involving management’s judgment.
Revenue Recognition
ASC 606 requires an entity to recognize revenue upon the transfer
of goods or services to customers in an amount that reflects the
consideration to which the entity expects to be entitled in
exchange for those goods or services. We apply the following
five-step revenue recognition model outlined in ASC 606 to adhere
to this core principle: (1) identify the contract(s) with a
customer; (2) identify the performance obligations in the contract;
(3) determine the transaction price; (4) allocate the transaction
price to the performance obligations in the contract; and (5)
recognize revenue when (or as) the Company satisfies a performance
obligation.
All of our revenue to date has been generated from collaborations,
primarily the collaboration agreement with Merck. The terms of
these agreements generally require us to provide (i) license
options for our compounds, (ii) R&D services and (iii)
non-mandatory services in connection with participation in research
or steering committees. Payments received under these arrangements
may include non-refundable upfront license fees, partial or
complete
reimbursement of R&D costs, contingent consideration payments
based on the achievement of defined collaboration objectives and
royalties on sales of commercialized products.
We assess whether the promises in our arrangements, including any
options provided to the partner, are considered distinct
performance obligations that should be accounted for separately.
Judgment is required to determine whether the license to a compound
is distinct from R&D services or participation in research and
steering committees, as well as whether options create material
rights in the contract. In situations when a contract includes
distinct R&D services that are substantially the same and have
the same pattern of transfer to the customer over time, they are
recognized as a series of distinct services.
The transaction price in each arrangement is generally comprised of
a non-refundable upfront fee and unconstrained variable
consideration related to the performance of R&D services. The
unconstrained variable consideration amount included in the
transaction price represents an amount for which it is probable
that a significant reversal of cumulative revenue recognized will
not occur. We typically submit a budget for the R&D services to
our partner in advance of performing the services. The transaction
price is allocated to the identified performance obligations based
on the standalone selling price, or SSP, of each distinct
performance obligation. Judgment is required to determine the SSP.
In instances where the SSP is not directly observable, such as when
a license or service is not sold separately, the SSP is determined
using information that may include market conditions and other
observable inputs. We utilize judgment to assess the nature of our
performance obligations to determine whether they are satisfied
over time or at a point in time and, if over time, the appropriate
method of measuring progress toward completion. We re-evaluate
estimated costs to satisfy a performance obligation each reporting
period and make adjustments for any significant changes. In
applying the cost-based input method, we measure actual costs
incurred relative to budgeted costs to fulfill our performance
obligation. These budgeted costs consist of our employee full-time
equivalent hours plus allowable external (third-party) costs
incurred. Management applies considerable judgment in estimating
expected costs as such costs are key inputs when applying the
cost-based input method. We recognize revenue based on actual costs
incurred as a percentage of total budgeted costs as we complete a
performance obligation applied to the transaction price. A
significant change in the estimate of expected costs for the
remainder of a contract term could have a material impact on
revenue recognized (including the possible reversal of previously
recognized revenue) at each reporting period, as well as a related
impact on contract assets and liabilities.
Our collaboration or partnering agreements may include contingent
payments related to specified development and regulatory milestones
or contingent payments for royalties based on sales of a
commercialized product. Milestones can be achieved for such
activities in connection with progress in clinical trials,
regulatory filings in various geographical markets and marketing
approvals from health authorities. Sales-based royalties are
generally related to the volume of annual sales of a commercialized
product. At the inception of each agreement that includes such
payments, we evaluate whether the milestones are considered
probable of being achieved and estimate the amount to be included
in the transaction price by using the most likely amount method. If
it is probable that a significant revenue reversal would not occur,
the associated milestone value is included in the transaction
price. Milestone payments that are not within our or our partner’s
control, such as those related to regulatory approvals, are not
considered probable of being achieved until those approvals are
received. The transaction price is then allocated to each
performance obligation based on a relative SSP basis. At the end of
each subsequent reporting period, we re-evaluate the probability of
achievement of each such milestone and any related constraint and,
if necessary, adjust our estimate of the overall transaction price.
Pursuant to the guidance in ASC 606, sales-based royalties are not
included in the transaction price. Instead, royalties are
recognized at the later of when the performance obligation is
satisfied or partially satisfied, or when the sale that gives rise
to the royalty occurs.
Contract modifications, defined as changes in the scope or price
(or both) of a contract that are approved by the parties to the
contract, such as a contract amendment, exist when the parties to a
contract approve a modification that either creates new, or changes
existing, enforceable rights and obligations of the parties to the
contract. Depending on facts and circumstances, we account for a
contract modification as one of the following: (i) a separate
contract; (ii) a termination of the existing contract and a
creation of a new contract; or (iii) a combination of the preceding
treatments. A contract modification is accounted for as a separate
contract if the scope of the contract increases because of the
addition of promised services that are distinct and if the price of
the contract increases by an amount of consideration that reflects
our standalone selling prices of the additional promised services.
When a contract modification is not considered a separate contract
and the remaining services are distinct from the services
transferred on or before the date of the contract modification, we
account for the contract modification as a termination of the
existing contract and a creation of a new contract. When a contract
modification is not considered a separate contract and the
remaining services are not distinct, we account for the contract
modification as an add-on to the existing contract and as an
adjustment to revenue on a cumulative catch-up basis.
Accrued Research and Development Expenses
As part of the process of preparing these consolidated financial
statements, we are required to estimate and accrue expenses, the
largest of which are R&D expenses. This process
involves:
•identifying
services that have been performed on our behalf by third-party
vendors and estimating the level of service performed and the
associated cost incurred for the service when we have not yet been
invoiced or otherwise notified of actual cost;
•estimating
and accruing expenses in our consolidated financial statements as
of each balance sheet date based on facts and circumstances known
to us at the time; and
•periodically
confirming the accuracy of our estimates with selected service
providers and making adjustments, if necessary.
Examples of estimated R&D expenses that we accrue
include:
•fees
paid to CROs and other service providers in connection with
preclinical studies and clinical trials;
•fees
paid to investigative sites in connection with clinical
trials;
•fees
paid to CMOs in connection with the production of clinical trial
materials and to procure raw materials and components for
manufacture; and
•professional
service fees for consulting and other services.
We base our expense accruals related to clinical trials on our
estimates of the services received and efforts expended pursuant to
contracts with multiple research institutions and CROs that conduct
and manage clinical trials on our behalf. The financial terms of
these agreements vary from contract to contract and may result in
uneven payment flows. Payments under some of these contracts depend
on factors such as the successful enrollment of patients and the
completion of clinical study milestones. Our service providers
generally invoice us monthly in arrears for services performed. In
accruing service fees, we estimate the time period over which
services will be performed and the level of effort to be expended
in each period. If we do not identify costs that we have begun to
incur or if we underestimate or overestimate the level of services
performed or the costs of these services, our actual expenses could
differ from our estimates.
All of our clinical trials have been executed with support from
CROs and other vendors. We accrue costs for clinical trial
activities performed by CROs based upon the estimated amount of
work completed on each trial. For clinical trial expenses, the
significant factors used in estimating accruals include the number
of patients enrolled, the activities to be performed for each
patient, the number of active clinical sites and the duration for
which the patients will be enrolled in the trial. We monitor
patient enrollment levels and related activities to the extent
possible through internal reviews, correspondence with CROs and
review of contractual terms. We base our estimates on the best
information available at the time.
To date, we have not experienced significant changes in our
estimates of accrued R&D expenses after a reporting period.
However, due to the nature of estimates, we cannot assure that we
will not make changes to our estimates in the future as we become
aware of additional information about the status or conduct of our
clinical trials and other research activities.
Stock-Based Compensation
We account for stock-based compensation arrangements in accordance
with Topic 718, Compensation—Stock Compensation.
Stock-based compensation expense represents the grant-date fair
value of stock options granted under our 2008 Equity Incentive
Plan, or 2008 Plan, and our 2018 Amended and Restated Equity
Incentive Plan, or 2018 Plan, and rights to acquire stock granted
under our 2019 Employee Stock Purchase Plan, or ESPP, recognized
over the requisite service period of the awards (usually the
vesting period) on a straight-line basis, net of estimated
forfeitures.
We use the Black-Scholes option-pricing model to calculate the
grant-date fair value of stock-based compensation awards. The
Black-Scholes option-pricing model requires the use of subjective
assumptions, including stock price volatility, the expected term
that stock options will remain outstanding, risk-free interest
rates and expected dividends.
The expected volatility is based on the historical volatility of
our stock and the stock of similar entities within our industry
over periods commensurate with our expected term assumption. The
expected term of stock option grants represents the
weighted-average period the options are expected to remain
outstanding and is based on the “simplified” method where the
expected term is the midpoint between the vesting date and the end
of the