UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-K
CURRENT REPORT
PURSUANT TO SECTION 13 OR 15(D)
OF THE SECURITIES EXCHANGE ACT OF 1934
Date of Report (Date of earliest event reported): March 9, 2021
Marinus Pharmaceuticals, Inc.
(Exact name of registrant as specified in its charter)
Delaware | 001-36576 | 20-0198082 | ||
(State or other jurisdiction
of
incorporation) |
(Commission File Number) |
(IRS Employer Identification
No.) |
5
Radnor Corporate Center, Suite
500
100 Matsonford Rd Radnor, PA |
19087 | |
(Address of principal executive offices) | (Zip Code) |
Registrant’s telephone number, including area code: (484) 801-4670
(Former name or former address, if changed since last report.) |
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
¨ | Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) |
¨ | Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) |
¨ | Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) |
¨ | Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) |
Securities registered pursuant to Section 12(b) of the Act:
Title of each class |
Trading Symbol(s) |
Name of each exchange on which registered |
||
Common Stock, par value $0.001 | MRNS | Nasdaq Global Market |
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).
Emerging growth company ¨
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. ¨
Item 2.02. Results of Operations and Financial Condition.
Marinus Pharmaceuticals, Inc. (the “Company”) issued a press release on March 9, 2021 announcing its financial results for the year ended December 31, 2020 and providing an update on its clinical development activities. A copy of the press release is being furnished as Exhibit 99.1 to this Current Report on Form 8-K and is incorporated by reference to this Item 2.02.
The information furnished pursuant to this Item 2.02 shall not be deemed to be “filed” for purposes of Section 18 of the Securities Exchange Act of 1934 (the “Exchange Act”) or otherwise subject to the liabilities of that section, nor shall it be deemed to be incorporated by reference into any of the Company’s filings with the Securities and Exchange Commission under the Exchange Act or the Securities Act of 1933, whether made before or after the date hereof, regardless of any general incorporation language in such a filing, except as expressly set forth by specific reference in such a filing. Except as required by law, we undertake no duty or obligation to publicly update or revise the information so furnished.
Item 8.01. Other Events.
On March 9, 2021, the Company posted an updated corporate investor presentation on its website at www.marinuspharma.com. A copy of the corporate investor presentation is filed as Exhibit 99.2 to this Current Report on Form 8-K and is incorporated by reference to this Item 8.01.
Item 9.01. | Financial Statements and Exhibits. |
(d) Exhibits
Exhibit No. |
Description | |
99.1 | Press Release, dated March 9, 2021, of Marinus Pharmaceuticals, Inc. | |
99.2 | Corporate investor presentation, dated March 9, 2021. | |
104 | The cover page from this Current Report on Form 8-K, formatted in Inline XBRL. |
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
MARINUS PHARMACEUTICALS, INC. | |
Date: March 9, 2021 | /s/ Edward Smith |
Edward Smith | |
Vice President, Chief Financial Officer and Treasurer |
Exhibit 99.1
Marinus Pharmaceuticals Provides Business Update and Reports Fourth Quarter 2020 Financial Results
· | PCDH19 related epilepsy (PCDH19-RE) Phase 2 Violet Study Proof-of-Concept Trial (n=21) shows a median 61.5% reduction in seizure frequency for ganaxolone compared to 24.0% for placebo (p=0.17) | |
· | Interim efficacy and safety evaluation of the CALM Study (open label Phase 2 trial) designed to evaluate the preliminary efficacy and safety of adjunctive ganaxolone treatment in tuberous sclerosis complex (TSC), supports advancing to Phase 3 | |
· | CALM Study (in TSC) will complete enrollment this week with top line data expected in Q3 2021 | |
· | Remain on track to submit NDA for use of ganaxolone in CDKL5 deficiency disorder (CDD) in mid-2021 | |
· | Site initiations and enrollment of patients continues in Phase 3 clinical trial of IV ganaxolone (RAISE trial) for the treatment of refractory status epilepticus (RSE). Top line data on track for 1H 2022 | |
· | Raised gross proceeds of $70 million in an underwritten public offering in December | |
· | Edward F. Smith, Chief Financial Officer, will be leaving the company to pursue other career opportunities; J&J veteran, Steven Pfanstiel, will join the company as new CFO |
RADNOR, Pa.--(BUSINESS WIRE)-- Marinus Pharmaceuticals, Inc. (Nasdaq: MRNS), a pharmaceutical company dedicated to the development of innovative therapeutics to treat rare seizure disorders, today provided an update on its clinical and regulatory development activities and reported its financial results for the fourth quarter and fiscal year ended December 31, 2020.
“Although 2020 was extremely challenging for so many, we finished the year achieving several important milestones, which has provided momentum into 2021,” said Scott Braunstein, M.D., Chief Executive Officer of Marinus Pharmaceuticals. “We remain on track to submit a new drug application to the FDA for use of ganaxolone in CDKL5 Deficiency Disorder, continue active enrollment in our Phase 3 RSE trial, while advancing and expanding our oral programs. In the second half of 2021 our attention will continue to be focused on enrolling our Phase 3 trials in RSE and TSC, advancing our commercialization preparations for ganaxolone’s potential launch in CDKL5 deficiency disorder, and expanding our novel formulation development work. We are also looking to expand our oral and IV franchises into new target therapeutic indications with significant unmet medical need and a strong scientific rationale for the use of ganaxolone.”
“Based on the progress to date, as well as our analysis of all prior studies in a number of epilepsy indications, we believe that the oral formulation of ganaxolone has the potential to become an important drug in a variety of rare, pediatric seizure disorders, a tremendous complement to our expanding IV franchise,” Dr. Braunstein said.
Dr. Braunstein added, “In December, we raised $70 million, ending the year with $140 million of cash on hand, which provides financial support for our ongoing clinical trials, commercial planning and portfolio development. We continue to add talent throughout the organization, including in our commercial, clinical, legal, regulatory, and operations areas. Our focus remains on realizing ganaxolone’s potential to help those suffering from rare seizure disorders.”
Pipeline Update:
PCDH19 Related Epilepsy (PCDH19-RE)
· | Top line data from PCDH19 Phase 2 Violet Study proof-of-concept trial (n=21) showed an encouraging efficacy signal, consistent with the Phase 3 Marigold Study (CDKL5) reported in September | |
· | Ganaxolone showed an absolute 61.5% improvement in seizure frequency compared to 24.0% in the placebo arm (p=0.17) | |
· | Ganaxolone was generally well tolerated, with one patient discontinuing in the ganaxolone arm due to a serious adverse event, psychogenic nonepileptic seizures, judged by the investigator to be ganaxolone-related | |
· | There was no efficacy signal for the allopregnanolone-sulfate biomarker | |
· | The company plans to present the findings from the Violet Study at a scientific meeting later this year, and also intends to submit the results for publication in a medical journal |
"These findings are very encouraging for those living with PCDH19-related epilepsy, in which many patients continue to experience clusters of seizures that often require inpatient hospitalization. Reducing seizure frequency for this patient population is clinically meaningful," said Joseph Sullivan, M.D., Professor of Neurology & Pediatrics, Director, UCSF Benioff Children’s Hospital Pediatric Epilepsy Center of Excellence.
Tuberous Sclerosis Complex (TSC)
· | The company’s interim evaluation of efficacy and safety from the CALM Study in TSC supports plan to move to a Phase 3 trial in Q3 2021 | |
· | Full top-line data (trial enrollment approximately 25 patients) is expected in Q3 2021 | |
· | The Phase 2 trial protocol was designed with a four-week baseline phase, followed by a 12-week treatment phase during which patients will receive up to 600mg of ganaxolone (oral liquid suspension) three times a day. Patients who meet eligibility criteria may continue ganaxolone treatment during a planned 24-week extension phase |
· | An end of Phase 2 meeting with the FDA is targeted for Q2 2021 and a meeting with the European Medicines Agency (EMA) is targeted for Q3 2021 | |
· | Enrollment of the first patient in double blind, placebo controlled, global Phase 3 trial is anticipated in Q4 2021 |
CDKL5 Deficiency Disorder (CDD)
· | A pre-NDA meeting with the FDA is scheduled for the end of the first quarter of 2021 to gain FDA’s alignment on the proposed format and content of the NDA, which is on track to be submitted by mid-year | |
· | The company presented additional details of the Phase 3 Marigold Study at AES 2020 in December, including: |
· | An analysis of data showing a consistent efficacy signal across multiple subgroups, including a 36.7% estimated difference in major motor seizure frequency relative to placebo in U.S. patients (n=41) | |
· | Preliminary analysis of data from the open-label extension provided supportive data on the durability of ganaxolone efficacy, demonstrating a 52.7% median reduction in major motor seizure frequency in patients who had completed approximately one year of therapy | |
· | Higher average ganaxolone plasma concentrations correlated with improvements in seizure frequency. Data were also presented that support three times a day dosing |
· | Marinus initiated an expanded access program (EAP) in the U.S. for patients with CDD | |
· | The Phase 3 Marigold Study was the first double-blind, placebo-controlled trial to demonstrate efficacy in CDD and the first Phase 3 trial to examine three times a day dosing of ganaxolone in pediatric patients | |
· | The company remains on track for an EMA pre-marketing authorization application (MAA) meeting to support a MAA submission targeted for the end of Q3 2021 | |
· | Discussions continue for European commercial partner, targeting a completion this summer |
Refractory Status Epilepticus (RSE)
· | Several patients have been enrolled in the RAISE trial for the treatment of RSE, with site activations, screening and enrollment ongoing | |
· | Company expects to have vast majority of sites for the Phase 3 RAISE trial open by the end of Q2, despite the headwinds at hospital intensive care units created by COVID-19 | |
· | Topline data expected in 1H 2022 |
· | The RAISE trial is a randomized, double-blind, placebo-controlled trial that will evaluate the efficacy and safety of IV ganaxolone in patients with RSE who have failed benzodiazepines and two or more second line intravenous antiepileptic drugs (AEDs) | |
· | The trial will examine the proportion of participants with RSE who experience seizure cessation within 30 minutes of initiation of IV ganaxolone as well as the rate of progression to IV anesthesia within 36 hours | |
· | Ganaxolone development for RSE is being funded, in part, by the Biomedical Advanced Research and Development Authority (BARDA), part of the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services, under contract number 75A50120C00159 | |
· | A Phase 2 trial of adjuvant use of ganaxolone in established status epilepticus (ESE) is planned to begin enrollment in Q1 2022; trial will investigate early intervention in the treatment of status epilepticus, targeting patients who present to the emergency room with convulsive SE, and who have been treated with and failed first-line treatment with benzodiazepines | |
· | Planning continues for a separate RSE trial to be conducted in Europe. Marinus intends to meet with the EMA to discuss trial design this quarter; trial planned to commence in the first half 2022 | |
· | Marinus continues to field requests from investigators for IV ganaxolone for patients with super refractory status epilepticus (SRSE) under an Emergency Investigational New Drug application (eIND) |
Corporate Update
· | Company raised $70 million of gross proceeds in an underwritten public offering of 5 million shares of common stock, before deducting the underwriting discounts and commissions and other estimated offering expenses payable by Marinus | |
· | Continued growing commercial team commensurate with planning for a mid-2021 NDA submission of ganaxolone in the treatment of seizure disorders in patients with CDD and a mid year 2022 launch, if approved |
CFO Transition
Edward F. Smith, Chief Financial Officer, will be leaving the company to pursue other career opportunities. Mr. Smith has been with the company since 2013, and during his tenure has driven the finance, accounting, information technology, and program management functions, as Marinus sharpened its focus onto its core rare epilepsy franchise. The company has appointed Steven Pfanstiel, who brings 16 years of J&J experience in various financial reporting and business support roles, and most recently at LifeScan Inc., a former J&J business unit focused on blood glucose monitoring, where he served as Vice President, Finance. Mr. Pfanstiel’s effective start date is April 12, 2021.
Financial Update
At December 31, 2020, the company had cash, cash equivalents and investments of $140.0 million, compared to $91.7 million at December 31, 2019. The company believes its cash and cash equivalents as of December 31, 2020 will enable it to fund the company’s current scale of operating expenses and capital expenditures into 2Q 2022. Marinus projects spend in the range of $18 to $20 million per quarter in 2021, offset by approximately $2 to $3 million per quarter from BARDA in 2021. This spend could increase in 3Q with the initiation of the TSC trial and ongoing expenses associated with the RAISE trial.
Marinus recognized $1.7 million in federal contract revenue in the year ended December 31, 2020 as a result of the BARDA contract the company entered into in September 2020. No federal contract revenue was recognized in the year ending December 31, 2019.
Research and development expenses increased to $13.0 million and $51.1 million for the three and twelve months ended December 31, 2020, respectively, as compared to $12.5 million and $43.0 million for the same periods in the prior year. The increase was due primarily to Marinus’ ongoing enrollment in the company’s Phase 3 Marigold Study, which top-line data were announced during the third quarter of 2020, and increased drug development activity, including preclinical studies and manufacturing activities in preparation for a potential NDA filing for ganaxolone in CDD and the recently initiated RAISE trial.
General and administrative expenses increased to $6 million and $18.6 million for the three and twelve months ended December 31, 2020, respectively, compared to $3.0 million and $11.5 million for the same periods in the prior year. The primary drivers of the increase were increased legal and consulting fees of $2.7 million and $1.5 million related to increased headcount as we scale up the company’s operations and prepare for potential commercialization, and noncash stock-based compensation of $1.6 million.
The company reported net losses of $17.5 million and $67.5 million for the three and twelve months ended December 31, 2020, respectively, compared to $15.4 million and $54.1 million in the same period a year ago. Cash used in operating activities increased to $60.9 million for the year ended December 31, 2020 compared to $48.6 million for the same period a year ago.
Readers are referred to, and encouraged to read in its entirety, the company’s Annual Report on Form 10-K for the year ended December 31, 2020, to be filed with the Securities and Exchange Commission, which includes further detail on the above-referenced matters and the company’s business plans, operations, financial condition and results of operations.
Marinus Pharmaceuticals, Inc.
Selected Financial Data (in thousands, except share and per share amounts)
Unaudited
December 31, | December 31, | |||||||
2020 | 2019 | |||||||
ASSETS | ||||||||
Cash and cash equivalents | $ | 138,509 | $ | 90,943 | ||||
Investments | 1,474 | 739 | ||||||
Contract revenue receivable | 1,646 | - | ||||||
Other assets | 8,833 | 7,160 | ||||||
Total assets | $ | 150,462 | $ | 98,842 | ||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||
Current liabilities | $ | 10,729 | $ | 8,031 | ||||
Other long term liabilities | 2,534 | 3,042 | ||||||
Total liabilities | 13,263 | 11,073 | ||||||
Total stockholders’ equity | 137,199 | 87,769 | ||||||
Total liabilities and stockholders’ equity | $ | 150,462 | $ | 98,842 |
Three Months Ended December 31, | Twelve Months Ended December 31, | |||||||||||||||
2020 | 2019 | 2020 | 2019 | |||||||||||||
Federal contract revenue: | $ | 1,546 | $ | — | $ | 1,718 | $ | — | ||||||||
Expenses: | ||||||||||||||||
Research and development | $ | 13,044 | $ | 12,512 | $ | 51,106 | $ | 42,966 | ||||||||
General and administrative | 6,005 | 2,960 | 18,549 | 11,456 | ||||||||||||
Loss from operations | -17,503 | (15,472 | ) | (67,937 | ) | (54,422 | ) | |||||||||
Interest income | 54 | 72 | 499 | 354 | ||||||||||||
Other (expense) income | -20 | (9 | ) | (37 | ) | (53 | ) | |||||||||
Net loss | $ | (17,469 | ) | $ | (15,409 | ) | $ | (67,475 | ) | $ | (54,121 | ) | ||||
Per share information: | ||||||||||||||||
Net loss per share of common stock—basic and diluted | $ | (0.55 | ) | $ | (1.02 | ) | $ | (2.80 | ) | $ | (3.97 | ) | ||||
Basic and diluted weighted average shares outstanding | 31,832,970 | 15,113,498 | 27,270,055 | 13,628,194 |
New Leadership Hires
Steven E. Pfanstiel, Chief Financial Officer (Effective April 12, 2021)
Mr. Steven Pfanstiel is an accomplished life sciences and
pharmaceuticals industry professional with extensive experience developing and implementing financing strategies to support R&D,
supply chain, and global commercialization organizations. He was most recently Vice President, Finance for LifeScan of Malvern,
PA, a world leader in blood glucose monitoring known for OneTouch brand products for managing diabetes, where he was responsible
for a finance team of over 40 and drove significant cost savings while optimizing investment in sales and marketing. Prior to LifeScan,
Mr. Pfanstiel held financial leadership roles in a wide range of life sciences and pharmaceutical organizations, including
Senior Director, Financial Planning and Analysis (FP&A) at Optinose; Senior Director, Global Strategic Marketing, at DePuy
Synthes (Johnson & Johnson); Senior Director, North America Commercial, Worldwide Financial Reporting, and Portfolio for
LifeScan & Animas (Johnson & Johnson). Prior to his roles with LifeScan and Optinose, Mr. Pfanstiel worked
for 16 years in various divisions and operating companies of Johnson & Johnson. Mr. Pfanstiel holds a B.A. in Physics
from Wabash College in Crawfordsville, IN; an M.S. in Environmental Systems Engineering from Clemson University in Clemson,
SC; and an M.B.A. in Finance from the Kelley School of Business at Indiana University in Indianapolis, IN.
Ian Miller, MD, Vice President, Clinical Development
Dr. Ian Miller is a pediatric epileptologist with 14 years of experience at Nicklaus Children's Hospital in Miami, where he most recently served as the Chair of the Neurology Department, and on the Board of Directors for First Choice Neurology (a private practice of over 80 neurologists). Within the hospital he was the founding Medical Director of the Ion Channel Epilepsy Program, co-Director of the Tuberous Sclerosis Program, and the Director of Neuroinformatics. Dr. Miller’s research experience includes participation in all five of the pivotal trials for cannabidiol, including one as a first author. He was also a primary investigator for fenfluramine, nasal diazepam, and neuropace, among others, and has provided input regarding trial design and endpoints for three early gene therapy candidates in SCN1A, and enrolled patients in one of them as PI. He is a member of the Medical Advisory Board for the Dravet Syndrome Foundation (DSF), and a member of the American Epilepsy Society. He is board certified in Neurology with a special qualification in Child Neurology, as well as Clinical Neurophysiology, Epilepsy, and Neuroimaging. Dr. Miller testified with the DSF at the FDA in 2018 regarding the need for an ICD10 code for Dravet syndrome, leading to the approval of the G40.83 and its subgroups in October of 2020. Dr. Miller received his M.D. degree from the University of Iowa, in Iowa City, where he grew up. He completed residency and fellowship training at the University of Utah and the University of Washington before completing Clinical Neurophysiology fellowship at Miami Children’s Hospital.
Ian Hunt, Vice President, Market Access & Channel Strategy
Ian Hunt has over 25 years of experience leading payer &
channel strategy, field sales and marketing in commercial and pre-commercial programs for some of the industry’s foremost
pharmaceutical and biotech companies. He has worked on the launch of over a dozen products and managed pricing and contracting
for both Pharmacy and Medical Benefit products. He was most recently Vice President of Market Access; Payor and Site of Care
Strategy & Marketing for Horizon Therapeutics where he was responsible for four Business Units, nine Brands, and investigational
new products. Previously, Mr. Hunt served as Head, Value & Access – Strategy/Marketing at Bioverativ, Inc.,
Vice President, Head Global Market Access, Patient Services, and Channel Strategy for Sage Therapeutics, and Senior Director, Payer &
Channel Strategy and Marketing for Genzyme. Mr. Hunt holds a Master of Science degree in Politics & Economics
from the University of Bristol in the United Kingdom where he was a Rotary Scholar, and a BA from Troy University in Alabama.
Fred Halperin, Vice President, Marinus Technology Solutions (IT)
Fred Halperin brings more than 35 years of healthcare and technology experience to Marinus. Immediately prior to joining Marinus, Mr. Halperin was Senior Director, IT Strategy, Transformation and Enablement Services for Otsuka Pharmaceuticals where he led a global effort to define a 3-year IT Roadmap as well as establish several internal technology support functions and processes. Prior to Otsuka, Mr. Halperin worked in the Office of the CIO at Johnson & Johnson as the Chief of staff to the Corporate Chief Information and Chief Technology officers. In this role, Mr. Halperin acted on their behalf as the primary technology liaison to the J&J Executive Committee and Board of Directors, led the creation and implementation of the enterprise IT strategy and managed several high-priority technology initiatives in partnership with the business lines and global technology infrastructure function. Prior to these recent corporate roles, Mr. Halperin was a senior life sciences technology practice leader with two leading global management consulting firms. Mr. Halperin earned his Bachelor of Science degree in both Computer Science and Industrial Psychology from Tulane University in New Orleans, LA.
About Ganaxolone
Ganaxolone, a positive allosteric modulator of GABAA receptors, is being developed in intravenous and oral formulations intended to maximize therapeutic reach to adult and pediatric patient populations in both acute and chronic care settings. Unlike benzodiazepines, ganaxolone exhibits anti-seizure and anti-anxiety activity via its effects on both synaptic and extrasynaptic GABAA receptors. Ganaxolone has been studied in more than 1,600 patients, both pediatric and adult, at therapeutically relevant dose levels and treatment regimens for up to four years.
About Marinus Pharmaceuticals
Marinus Pharmaceuticals, Inc. is a pharmaceutical company dedicated to the development of innovative therapeutics to treat rare seizure disorders. Ganaxolone is a positive allosteric modulator of GABAA receptors that acts on a well-characterized target in the brain known to have anti-seizure, anti-depressant and anti-anxiety potential. Ganaxolone is being developed in IV and oral dose forms intended to maximize therapeutic reach to adult and pediatric patient populations in both acute and chronic care settings. Marinus recently completed the first ever Phase 3 pivotal trial in children with CDKL5 deficiency disorder and is conducting a Phase 3 trial in refractory status epilepticus, Phase 2 trial in tuberous sclerosis complex and a Phase 2 biomarker-driven proof-of-concept trial in PCDH19-related epilepsy. For more information visit www.marinuspharma.com.
Forward-Looking Statements
To the extent that statements contained in this press release are not descriptions of historical facts regarding Marinus, they are forward-looking statements reflecting the current beliefs and expectations of management made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Words such as “may”, “will”, “expect”, “anticipate”, “estimate”, “intend”, “believe”, and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) are intended to identify forward-looking statements. Examples of forward-looking statements contained in this press release include, among others, statements regarding our clinical development plans for ganaxolone; our statement that we will complete enrollment in the CALM Study this week; our expectation to release top line TSC data from the CALM Study in Q3 2021; our plans to present the Violet Study at a scientific meeting later this year and to publish the trial in a scientific journal; our expectation to move to a Phase 3 trial in TSC in the third quarter of 2021; our plans to have a pre-NDA meeting with the FDA at the end of Q1 2021 for our planned mid-2021 NDA submission for CDD; our plans for the EMA pre-marketing authorization application meeting to support a MAA submission for CDD at the end of the third quarter of 2021; our plans for entering into an agreement with a European commercial partner, targeting completion in the summer of 2021; our expectation to have a vast majority of sites for the Phase 3 RAISE trial open by the end of Q2 2021 with topline data expected in 1H 2022; our plans for a separate RSE trial to be conducted in Europe to commence in the first half of 2022; our exploration of earlier intervention for treatment in SE in ESE, targeting convulsive patients in the emergency room who have been treated with and failed benzodiazepines; our plans for a potential mid-2021 NDA submission and a fiscal 2022 launch, if approved, of ganaxolone in CDD; our expectations to hold a meeting with the EMA in Q3 2021 with the first patient enrolled in a double blind, placebo controlled, global Phase 3 trial for TSC in Q4 2021; our expectations that our cash, cash equivalents and investments will be sufficient to fund our operating expenses and capital expenditures into the second quarter of 2022; the potential for our spend to increase in the third quarter of 2021 with the initiation of the TSC trial and ongoing expenses associated with the RAISE trial; the potential safety and efficacy of ganaxolone; expectations regarding our ability to receive and utilize a priority review voucher; the therapeutic potential of ganaxolone; our belief that ganaxolone has the potential to become an important drug in a variety of rare, pediatric seizure disorders; and our plans for an expanded access program for ganaxolone.
Forward-looking statements in this press release involve substantial risks and uncertainties that could cause our clinical development programs, future results, performance or achievements to differ significantly from those expressed or implied by the forward-looking statements. Such risks and uncertainties include, among others, uncertainties and delays relating to the design, enrollment, completion, and results of clinical trials; unanticipated costs and expenses; early clinical trials may not be indicative of the results in later clinical trials; clinical trial results may not support regulatory approval or further development in a specified indication or at all; actions or advice of the U.S. Food and Drug Administration may affect the design, initiation, timing, continuation and/or progress of clinical trials or result in the need for additional clinical trials; our ability to obtain and maintain regulatory approval for our product candidate; our ability to obtain, maintain, protect and defend intellectual property for our product candidates; delays, interruptions or failures in the manufacture and supply of our product candidate; our ability to raise additional capital; the effect of the COVID-19 pandemic on our business, the medical community and the global economy; and the availability or potential availability of alternative products or treatments for conditions targeted by us that could affect the availability or commercial potential of our product candidate. Marinus undertakes no obligation to update or revise any forward-looking statements. For a further description of the risks and uncertainties that could cause actual results to differ from those expressed in these forward-looking statements, as well as risks relating to the business of the company in general, see filings Marinus has made with the Securities and Exchange Commission.
Sasha Damouni Ellis
Vice President, Investor Relations & Corporate Communications
Marinus Pharmaceuticals, Inc.
484-253-6792
sdamouni@marinuspharma.com
Source: Marinus Pharmaceuticals
Exhibit 99.2
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Corporate Overview March 2021 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Safe Harbor Statement To the extent that statements contained in this presentation are not descriptions of historical facts regarding Marinus, they are forward-looking statements reflecting the current beliefs and expectations of management made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Words such as “may”, “will”, “expect”, “anticipate”, “estimate”, “intend”, “believe”, and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) are intended to identify forward-looking statements. Examples of forward-looking statements contained in this presentation include, among others, statements regarding our clinical development plans for ganaxolone; expected dosing in our clinical trials; the clinical development schedule and milestones; our expected timing to begin and complete enrollment in our clinical trials; the expected trial design, target patient population and endpoints for our clinical trials; interpretation of scientific basis for ganaxolone use; timing for availability and release of data, including the expected release of topline data from our Phase 3 trial in status epilepticus (SE) in 1H 2022; and from our Phase 2 tuberous sclerosis complex (TSC) trial in Q3 2021; our plans to begin enrollment in Phase 3 TSC trial in Q4 2021; our plans for clinical development in established status epilepticus (ESE); the potential safety and efficacy and therapeutical potential of ganaxolone; timing and expectation regarding submissions of regulatory applications, including our expectation to submit an NDA for ganaxolone in CDD in mid 2021 and an MAA by the end of Q3 2021; expectations regarding commercial launch of ganaxolone in CDD in 1H 2022; expectations regarding our agreement with BARDA; expectations regarding the potential market opportunities for our product candidates, including oral ganaxolone; potential commercial alliances; and our expectations regarding the effect of the COVID-19 pandemic on our business and clinical development plans. Forward-looking statements in this presentation involve substantial risks and uncertainties that could cause our clinical development programs, future results, performance or achievements to differ significantly from those expressed or implied by the forward-looking statements. Such risks and uncertainties include, among others, uncertainties and delays relating to the design, enrollment, completion, and results of clinical trials; interpretation of results of clinical trials; unanticipated costs and expenses; early clinical trials may not be indicative of the results in later clinical trials; clinical trial results may not support regulatory approval or further development in a specified indication or at all; actions or advice of the FDA or other regulatory agencies may affect the design, initiation, timing, continuation and/or progress of clinical trials or result in the need for additional clinical trials; our ability to obtain and maintain regulatory approval for our product candidate; our ability to obtain and maintain patent protection for our product candidates; the impact of third party patents; delays, interruptions or failures in the manufacture and supply of our product candidate; our ability to raise additional capital; the effect of the COVID-19 pandemic on our business, the medical community and the global economy; and the availability or potential availability of alternative products or treatments for conditions targeted by us that could affect the availability or commercial potential of our product candidate. Marinus undertakes no obligation to update or revise any forward-looking statements. For a further description of the risks and uncertainties that could cause actual results to differ from those expressed in these forward-looking statements, as well as risks relating to the business of the Company in general, see filings Marinus has made with the Securities and Exchange Commission. You may access these documents for free by visiting EDGAR on the SEC web site at www.sec.gov. 2 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Ganaxolone (GNX) Targets Synaptic & Extrasynaptic GABAA Receptors allopregnanolone 3 ©2021 Marinus Pharmaceuticals. All Rights Reserved I GNX is a synthetic analog of a positive allosteric GABAA receptor modulator with a well-defined MOA designed to treat patients suffering from epilepsy Ganaxolone and neuropsychiatric disorders. GNX is designed to modulate both synaptic and extrasynaptic GABAA receptors to calm over-excited neurons Clinical focused on status epilepticus and rare genetic epilepsies that development have few or no treatment options Multiple dose IV and oral – to meet the needs of adult and pediatric patients in formulations acute and chronic care settings Extensive in more than 1,600 patients both pediatric and adult, at safety record therapeutically relevant dose levels for up to two years |
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Corporate Strategy Evaluation of IV and Oral Opportunities 4 ©2021 Marinus Pharmaceuticals. All Rights Reserved I • Expand clinical opportunities from refractory status epilepticus (RSE) to broader established status epilepticus (ESE) market • Initiate commercial plan • Create a global development strategy • Develop pharmacoeconomic, value proposition and outcomes assessment • Explore opportunities to improve bioavailability, PK profile & clinical outcomes • Engage in strategic collaborations on novel technologies & formulations • Evaluate new indications based on unmet need, and scientific rationale • CDKL5 deficiency disorder (CDD) commercialization strategy • Advance tuberous sclerosis complex (TSC) clinical development • Research scientifically based expansion opportunities • Global integrated commercialization strategy Leveraging GNX Molecule Maximizing Value for Orphan Epilepsies Building Upon Status Epilepticus (SE) |
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Ganaxolone Development Pipeline 5 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Orphan Epilepsy Franchise |
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CDKL5 Deficiency Disorder “CDKL5 is painful. It’s a hard, sad at times, thing that we face. When you have a relationship with people like Marinus and their researchers, you are able to help be a driving force behind that work. - Karen Utley, Mother to Samantha, President of International Foundation for CDKL5 Research |
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CDKL5 Deficiency Disorder (CDD) • Genetic testing available 1Symonds JD 2019 Brain 8 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Cause •Mutation of the cyclin-dependent kinase-like 5 (CDKL5) gene, located on the X chromosome •Early-onset, treatment refractory seizures, & severe neuro-developmental delay Symptoms •Most can’t walk, talk or care for themselves •Suffer from scoliosis, visual impairment, gastrointestinal difficulties & sleeping disorders •1:40,000 live births1; approx. 75-100 newborn in US and EU5 •Predominantly affects females Incidence •Orphan Disease Treatments •No disease-specific treatments are approved Rationale •Potential GABAergic dysfunction, achieved Primary endpoint in Marigold Phase 3 study |
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Completed Global Phase 3 Trial Design Historical Control 8 weeks Titration 4 weeks Titration 4 weeks Baseline 6 weeks Maintenance 13 weeks Open-Label Phase Double-Blind Phase Open-Label Phase Trial Details ► Evaluated the use of oral ganaxolone in children and young adults Global, double-blind, placebo-controlled, clinical trial enrolled 101 patients between the ages of 2 and 19 with a confirmed disease-related CDKL5 gene variant Ages 2-19, ≥16 major motor seizures/month; up to 4 concomitant AEDs Endpoints ► Primary endpoint of the trial was percent change in 28-day major motor seizure frequency * Non-seizure secondary outcome measures: Behavioral/neuropsychiatric changes correlated with domains of attention & sleep * Major motor seizures were defined as bilateral tonic, generalized tonic-clonic, atonic/drop, bilateral clonic, or focal to bilateral tonic-clonic ©2021 Marinus Pharmaceuticals. All Rights Reserved 9 I |
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Marigold Baseline Clinical Characteristics (n=101) Baseline seizure burden and AED history highlights unmet need 10 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Characteristic Placebo (n=51) Ganaxolone (n=50) Total Baseline Primary Seizure Frequency, per 28 days (median, min-mix) 50.0 0.7 – 1021.3 57.3 5.5 – 651.3 - Number of AED Medications Taken Prior (median) 7 7 7 Concomitant AED Medications, n (%) Valproate 16 (31.4) 18 (36.0) 34 (33.7) Levetiracetam 13 (25.5) 13 (26.0) 26 (25.7) Clobazam 13 (25.5) 12 (24.0) 25 (24.8) Vigabatrin 12 (23.5) 10 (20.0) 22 (21.8) |
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Ganaxolone Achieved Primary Efficacy Severity Endpoint in Seizure Reduction and Secondary Endpoint for Seizure 40 p = 0.002** 30 20 10 0 Ganaxolone Placebo *Hodges-Lehm an Estim ate of M edian Difference **W ilcoxon Rank-Sum Test 11 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Median Percent Reduction 28-day Frequency of Major Motor Seizures = 29.7%* 32.2% 4.0% Caregiver Global Impression of Change in Seizure Intensity / Duration (CGI-CSID) |
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Marigold Cumulative Response Curve 12 ©2021 Marinus Pharmaceuticals. All Rights Reserved I % of Patients |
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Consistent Efficacy Signal Across the Broader CDD Population ► Ganaxolone demonstrated a similar efficacy signal across multiple subgroups related to baseline demographics and seizure frequency Supports beneficial effect in the U.S. patient population • 50 40 30 20 10 0 -10 Female (n=79) Male (n=21) Gender 13 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Percent Reduction in Median Major Motor Seizure Frequency (per 28 days) Percent Reduction in Median Major Motor Seizure Frequency (per 28 days) Percent Reduction in Median Major Motor Seizure Frequency (per 28 days) Ganaxolone Placebo 31.8% 33.3% 10.2% -7.8% |
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Phase 3 Safety Summary Serious Treatment Emergent Adverse Events Treatment Emergent Adverse Events (TEAE) (n=50) Includes AEs that occurred >5% of subjects in ganaxolone arm and ganaxolone > placebo 14 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Preferred Term Placebo (n=51) Ganaxolone Any Serious TEAE, n (%) 5 (9.8) 6 (12.0) Bronchitis 0 (0.0) 1 (2.0) Rhinovirus Infection 0 (0.0) 1 (2.0) Urinary Tract Infection 0 (0.0) 1 (2.0) Pneumonia Mycoplasmal 1 (2.0) 0 (0.0) Pneumonia Viral 1 (2.0) 0 (0.0) Respiratory Syncytial Virus Bronchiolitis 1 (2.0) 0 (0.0) Oxygen Saturation Decreased 0 (0.0) 1 (2.0) Food Refusal 0 (0.0) 1 (2.0) Pneumonia Aspiration 0 (0.0) 1 (2.0) Hypoxia 1 (2.0) 0 (0.0) Faecaloma 1 (2.0) 0 (0.0) Hypotonia 1 (2.0) 0 (0.0) Seizure 1 (2.0) 0 (0.0) Unresponsive to Stimuli 1 (2.0) 0 (0.0) Preferred Term Placebo (n=51) Ganaxolone (n=50) Any TEAE, n (%) 45 (88.2) 43 (86.0) Somnolence 8 (15.7) 18 (36.0) Pyrexia 4 (7.8) 9 (18.0) Upper Respiratory Tract Infection 3 (5.9) 5 (10.0) Constipation 3 (5.9) 3 (6.0) Salivary Hypersecretion 1 (2.0) 3 (6.0) Sedation 2 (3.9) 3 (6.0) |
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Ganaxolone’s Potential to Provide Durable Seizure Improvements in the Open Label Extension 70 Patients treated with ganaxolone for approximately 12 months experienced a median 52.7% reduction in major motor seizure frequency 60 50 40 Patients transitioning from placebo to ganaxolone demonstrated seizure frequency improvements 30 20 No new safety findings emerged in the OLE to date 10 4.0% 0 Primary Endpoint (17 wks) 1-2 3-4 5-6 7-8 Open-Label Ganaxolone 1. Müller A, et al. Eur. J. Paediatr. Neurol. 2016 Time in OLE (Months) 15 ©2021 Marinus Pharmaceuticals. All Rights Reserved I *Data as of September 1, 2020 Ganaxolone Placebo (DB) Ganaxolone (OLE) 52.7% n=17 Placebo (DB) 44.5% n=26 29.6% n=20 37.2% 33.3% n=36 35.0% n=24 32.2% n=39 22.6% n=34 12.7% n=3 8 • Seizures associated with CDD are often refractory to treatment with existing AEDs and improvements may be short-lived (<3 months)1 • Preliminary analysis* of the open-label extension (OLE) provides insights into the extended duration effects of ganaxolone (GNX) in CDD |
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Average Ganaxolone Levels Correlate with Seizure Reduction Loge percentage change in major motor seizure frequency was calculated as loge(percentage change + 100) 16 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Equivalent % Change in Major Motor Seizure Frequency Loge Percent Change Major Motor Seizure Frequency Percent Change in Major Motor Seizure Frequency • Logarithms of plasma GNX level and percentage change in major motor seizure frequency were negatively correlated • Patients in the Medium and High GNX level groups had an average GNX concentration of 120 ng/mL and a median 43% reduction in seizure frequency – Incidence of CNS-related adverse events was similar across GNX dose level groups |
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PCDH19 Related Epilepsy ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Biomarker Stratified Proof of Concept (POC) Study in PCDH19 Low Allo-S Placebo R 1:1 Biomarker + Ganaxolone Up to 600 mg 3x/day PCDH19 (all-patients) n=21 Ganaxolone Up to 600 mg 3x/day High Allo-S Biomarker - Placebo R 1:1 Ganaxolone Up to 600 mg 3x/day Primary efficacy analyses conducted using all patients Baseline 12 weeks Titration 4 weeks Maintenance 13 weeks Titration 4 weeks Open-Label Phase (52 weeks) * not drawn to scale Pre-baseline Screening Screening Visit Trial Details ► Ages 1-17 with 8 or more seizures in 8 weeks, failed 2 or more AEDs ► Completed double-blind portion of the trial with 21 patients ► Primary efficacy analysis based on change in seizure frequency in all patients ► Stratify patients into one of two biomarker groups based on baseline allopregnanolone sulfate levels and randomized (ganaxolone or placebo) within each stratum 18 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Ganaxolone Demonstrates Directional Improvement in Change in Seizure Frequency 90 80 70 60 (median) Ganaxolone 14.5 Placebo 17.7 50 40 30 20 10 0 Ganaxolone (n=10) Placebo (n=11) 19 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Percent Reduction in Primary Endpoint Seizure Frequency (per 28 days) Primary endpoint seizure types are defined as countable focal seizures with impaired awareness or generalized seizure with a clear motor component. Baseline Primary Endpoint 28-day Seizure Frequency p=0.17 61. 24.0% 5% |
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Ganaxolone Response Independent of Biomarker Status 20 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Percent Reduction in Primary Endpoint Seizure Frequency (per 28 days) Primary endpoint seizure types are defined as countable focal seizures with impaired awareness or generalized seizure with a clear motor component. No biomarker efficacy signal for greater seizure reduction with low Allo-S |
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Phase 2 Safety Summary TEAE: treatment emergent adverse event *Patients in the placebo group had a higher frequency of hospitalizations during baseline 21 ©2021 Marinus Pharmaceuticals. All Rights Reserved I ► Ganaxolone was generally well-tolerated • One GNX patient discontinued study due to an SAE which the investigator assessed as related to treatment • SAE was moderate in severity and included 24hr EEG monitoring which required hospitalization ► Treatment emergent serious adverse events were observed primarily in the placebo group Placebo (n=11) Ganaxolone (n=10) Patients With Any Serious TEAE, n (%) 5 (45.5) 1 (10.0) Total Serious TEAE events, n 9 1 Increased seizure frequency / seizure cluster 8 0 Cluster - atypical absence status epilepticus 1 0 Psychogenic nonepileptic seizures 0 1 |
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Tuberous Sclerosis Complex “Many individuals with TSC continue to experience uncontrolled seizures despite a cocktail of multiple antiepileptic drugs. Because new options are always needed, the TSC community welcomes clinical evaluation of new epilepsy treatments” - Kari Luther Rosbeck, President & CEO of the Tuberous Sclerosis Alliance |
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Tuberous Sclerosis Complex (TSC) 1 diMichele, et al, J. Neuro Neurosurg Psychiatry, 2003 *Failure of two prior antiseizure medications with ongoing, frequent seizures. 23 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Cause •Defect or mutation of TSC1 and/or TSC2 genes Symptoms •Benign tumors, seizures, cognitive impairment, behavioral problems, skin abnormalities Incidence •1:6,000 live births Prevalence •~25K-40K refractory TSC patients in the U.S.* Treatments •Despite available treatments, continued unmet medical need Mechanistic •Potential neurosteroid deficiency1 Rationale •Pathophysiology may involve GABAergic dysfunction |
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TSC - Phase 2 Open-Label Clinical Trial Design (24 Weeks) Baseline Period Treatment Period OLE Period 2-week taper upon GNX discontinuation (if not continuing to Part B) Baseline Treatment Visit Screening Visit ► n = Approx. 25 ► 8 U.S. sites ► Electronic diaries will be used for data capture ► At least 8 seizures per month ► Primary efficacy endpoint: % change in 28-day primary seizure frequency through the end of 12-week treatment period relative to 4-week baseline period ► Patient enrollment to be completed March 2021 ► Top-line data expected Q3 2021 Primary seizure types: focal motor seizures without impairment of consciousness or awareness, focal seizures with impairment of consciousness or awareness, focal seizures evolving to bilateral generalized convulsive seizures, and generalized seizures with a motor component that are countable 24 ©2021 Marinus Pharmaceuticals. All Rights Reserved I PART A PART B Baseline (4 Weeks) GNX Titration (4 Weeks) GNX Maintenance (8 Weeks) Open-Label Extension (OLE) * Available to patients that respond to GNX as defined per protocol |
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Proposed Phase 3 TSC Study Design Historical Data (if available) 8 weeks Titration 4 weeks Titration 4 weeks Baseline 4 weeks Maintenance 12 weeks Open-Label Phase Double-Blind Phase Open-Label Phase Trial Details ► Evaluates the use of oral ganaxolone in children and adults with seizures associated with TSC Global, double-blind, placebo-controlled clinical trial Aims to enroll ~160 total patients between the ages of 1 and 65 (1:1 randomization) Up to 60 sites, including ex-US (e.g., EU, Canada, Australia, Russia). Target start Q3 2021(Projected first patient enrolled in Q4) Primary Efficacy Endpoint ► Percent change in 28-day primary endpoint seizure frequency* * Primary endpoint seizure types: focal motor seizures without impairment of consciousness or awareness, focal seizures with impairment of consciousness or awareness, focal seizures evolving to bilateral generalized convulsive seizures, and generalized seizures with a motor component that are countable 25 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Formulation Development |
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Efforts to Improve Ganaxolone Exposure in Chronic Epilepsies Dosing regimen: Marigold Study was the first Phase 3 study of ganaxolone to evaluate three times a day (TID) dosing ► • Predicted pharmacokinetic (PK) curves for TID and two times a day (BID) dosing demonstrate increase trough GNX levels which may provide improved seizure control 53 BID 286 3135 Support the continued study of ganaxolone TID dosing in other epilepsies Formulation development: new oral ganaxolone formulations in development that aim to improve PK properties to better achieve target ganaxolone levels ► ► 27 ©2021 Marinus Pharmaceuticals. All Rights Reserved I DoseCmax AUC0-24% time (>100 regimen(ng/mL)(ng ∙ h/mL)ng/mL GNX) TID281376378 |
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Ganaxolone Formulation Work in Progress for Second Generation Candidate Oral Dosing IV Dosing Step down IV to oral Pediatric Dosing 28 ©2021 Marinus Pharmaceuticals. All Rights Reserved I •Exploring opportunities to improve bioavailability and PK profile •Potential expansion into new indications and into new therapeutic areas •Targeting IV-to-oral step down for patients that may benefit from continued therapy |
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Commercial Opportunity ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Commercialization Preparedness Executing research with Payers and Physicians around TPP* / Value Proposition Identifying organizational needs for field resources, systems and processes Development plans to scale up access, scientific affairs and commercial teams Readying supply chain to support patient services, channel strategy and scale up needs Potential for operational leverage across indications *TPP – Target Product Profile 30 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Key Findings from Recently Conducted Market Research Show that Ganaxolone is Well Suited for Broad Clinical Adoption Across Indications Reactions Usage Drivers Source: ZS Associates Primary Research and Analysis (N=35 HCP Interviews) 31 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Awareness Neurologists who treat both CDD and TSC patients had high awareness of ganaxolone Primary • Disease-specific indication, response rate, and durability of response • Ability to be used with antiseizure medications across mechanisms (i.e., sodium channel blockers, GABA transmission inhibitors, cannabidiol) in refractory patients TPP Many HCPs are excited about the opportunity to use ganaxolone, especially for CDD, given favorable reactions to its efficacy and durability data, and safety profile Mechanism of Action Ganaxolone’s extrasynaptic mechanism of action well understood and viewed as differentiable |
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Status Epilepticus ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Status Epilepticus (SE): Definition and Epidemiology Background Prolonged continuous seizures ► Heterogenous patient population with various etiologies, including glioblastoma, vascular disease, encephalitis, drug or alcohol withdrawal or overdose ► SE is the second most common neurologic emergency in the U.S.1 150,000 SE patients2 Pre-existing epilepsy in less than half of SE cases ► Status epilepticus can result in permanent neuronal damage and contribute to high morbidity and mortality ► Becomes more treatment refractory with progression ► 1. Anaethesia and Intensive Care Medicine, February 02, 2018 , Update on the management of status epilepticus 2. DeLorenzo RJ Pellock JM Towne AR Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol. 1995; 12: 316-325 ©2021 Marinus Pharmaceuticals. All Rights Reserved I 33 |
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Goals of a New Therapy for the Treatment of SE Epilepticus (ESE) Epilepticus (RSE) Epilepticus (SRSE) IV GNX Administered (antiepileptic drugs) 34 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Medically induced Coma Established StatusRefractory StatusSuper Refractory Status 1st line2nd line3rd line BenzodiazepineIV AED’sIV Anesthetics |
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Pharmacokinetics/Pharmacodynamics Well Suited for Acute SE Treatment Brain and plasma concentration after ganaxolone 3 mg/kg IM in mice EEG bispectral index in healthy volunteers following IV ganaxolone Ganaxolone activates the extrasynaptic GABAA receptor, is associated with high brain concentrations, and delivers a rapid onset of action Following 20 mg ganaxolone bolus (over 2 minutes): Cmax 1,240 ng/mL Tmax 0.08 hrs 1. Zolkowska D, Wu CY, Rogawski MA. Intramuscular allopregnanolone and ganaxolone in a mouse model of treatment-resistant status epilepticus. Epilepsia. 2018 Oct;59:220-7. 2. Data on file, Marinus Pharmaceuticals, inc. ©2021 Marinus Pharmaceuticals. All Rights Reserved I 35 Human PK2 Human PD – EEG changes2 Experimental PK – plasma and brain1 |
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Phase 2 RSE Trial Design Evaluate IV ganaxolone in refractory SE patients SE Patients require escalation of treatment with IV Secondary: Additional efficacy, safety 36 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Endpoints Primary: Percent of patients who did not anesthetic within the first 24 hours after ganaxolone initiation and tolerability Limitations of current treatments 1st line Benzodiazepines ineffective in 45%-50%; limited by cardiovascular and respiratory side effects 2nd line Ineffective in over 50% of established SE; further decreased response in refractory SE 3rd line IV Anesthetics: high morbidity, mortality ~35%; increased duration of hospitalization and costs of care Goals of a new treatment Rapid cessation Maintenance of seizure control Prevent progression to IV anesthetics Diagnosis of convulsive or non-convulsive SE Failed at least one 2nd line IV AED but had not progressed to 3rd line IV anesthetics Screening Bolus plus continuous2-4 day infusion18-hour taper infusion CohortDose of GNX/dayN Low500mg/day5 Medium650mg/day4 High713mg/day8 Post-treatment Follow-up 24 hour Weeks 2, 3, 4 Treatment Period Loading Dose Maintenance Taper |
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Patient Demographics of Phase 2 Trial Mean age: 57 years old first-and-second line IV AEDs 37 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Mean # of failed (including benzodiazepines) 2.9 (range: 2-5) Mean # of failed 2nd-line IV AEDs • 2.1 (range: 1-4), all failed LEV or LAC • 14/17 patients failed two or more 2nd-line AEDs • All prior AEDs were administered within recommended dosing guidelines Etiologies 7 Vascular 4 Tumor 2 Autoimmune 2 Drug overdose 2 Unknown 17 patients enrolled 8 males, 9 females (range: 23-88) History of Epilepsy 7 (41%) yes, 10 (59%) no Types of SE 5 (29%) CSE, 11 (65%) NCSE, 1 (6%) CSE→NCSE |
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Phase 2 Trial Results Demonstrated Rapid Onset And Durability of Effect No escalation to additional IV AEDs or IV anesthetics for status relapse at any time through 24 hours after ganaxolone discontinuation No escalation to IV anesthetics within 24 hours from infusion initiation (Primary Endpoint) Status-free through 24 hours from infusion initiation (investigator determination) No SE Relapse at anytime during the 4-wk follow up period Cohort Data presented at AES 2019 AEDs – antiepileptic drugs 38 ©2021 Marinus Pharmaceuticals. All Rights Reserved I High (713 mg/day) (n=8) 100% (8 of 8) 88% (7 of 8) 100% (8 of 8) 100% (6 of 6) (1ET, 1 died) Medium (650 mg/day) (n=4) 100% (4 of 4) 100% (4 of 4) 75% (3 of 4) 67% (2 of 3) (1 ET) Low (500 mg/day) (n=5) 100% (5 of 5) 100% (5 of 5) 60% (3 of 5) 50% (1 of 2) (1 died) Immediate Prior AED Administered 4 Hours (mean) to ganaxolone treatment SE Cessation Occurred Rapidly in All Dose Groups (median = 5 minutes) |
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PK/PD Relationship and Rationale for Target Dose Data presented at AES 2019 PK: Pharmacokinetics / PD: Pharmadynamic 39 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Seizure Burden Reduction Occurred Rapidly in All Dose Groups Only High Dose Provided Sustained Reduction (>80%) Throughout Entire Analysis Window Modeled PK Curves for All Dose Groups High Dose Achieves Target Range ≥ 500 ng/mL for ~8 hours |
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IV Ganaxolone Safety Summary •9 severe (respiratory depression, death due to Intubation: 9 patients were not intubated upon enrollment. Of these, 6 remained intubation-free during the entire ganaxolone treatment period Data presented at AES 2019 AE: adverse event / SAE: serious adverse event 40 ©2021 Marinus Pharmaceuticals. All Rights Reserved I 50 AEs in 16 patients 13 related in 7 patients •6 mild (2 hypotension, 2 somnolence, 1 urinary retention, 1 hypercarbia) •5 moderate (4 somnolence; 1 hypercarbia) •2 severe (2 sedation) 37 not-related in 12 patients •20 mild •8 moderate (2 pain; 2 pneumonia, 2 dysphagia, •1 delirium, 1 hypertension) withdrawal of support, sepsis, embolic stroke, perforated bowel, fall, loss of consciousness, multiple fractures, pneumothorax) 10 SAEs in 6 patients (also included in AEs) 2 related in 2 patients •2 severe sedation 8 non-related in 4 patients •1 Death due to withdrawal of life support - 1 Respiratory depression •1 Bowel perforation (fatal) •1 Sepsis (fatal) •1 Fall - 1 Loss of consciousness - 1 Pneumothorax - 1 Multiple fracture |
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Overview of U.S. Phase 3 RSE RAISE Trial Design • Status epilepticus patients (n=124) who have failed benzodiazepines and ≥ 2 IV AEDs Co-primary endpoints 41 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Trial design • Randomized, placebo-controlled (adjunctive to standard-of-care) clinical trial Target patient population • 36-hour infusion followed by a 12-hour taper (48-hour treatment) Dosing • Phase 2 dose paradigm and extends ganaxolone plasma exposure ≥ 500 ng/mL for 12 hours • Proportion of participants with SE cessation within 30 minutes of study drug initiation without medications for the acute treatment of SE • Proportion of participants with no progression to IV anesthesia for 36 hours following study drug initiation • No progression to IV anesthesia for 24 hours off study drug (i.e., 72 hours) • Time to SE cessation Secondary endpoints • Healthcare utilization metrics (eg, length of stay, # of days in the ICU) • Functional outcomes • Safety measures |
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RSE Phase 3 RAISE Clinical Planning Phase 3 Target Plasma Concentration S C R E E N I N G Continuous Infusion Dose Initiation (Time 0) 42 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Trial Overview •1:1 randomized, double-blind, placebo-controlled trial •Failure of a benzodiazepine and 2 second-line IV AEDs •3-minute bolus, 36-hour infusion, 12-hour t4a2per •Approx. 125 randomized patients •80-100 sites Treatment Period Follow-up Period Daily Hours 0 -24 Bolus dose Day 2 Hours 24-36 Hours 36-48 Continuous Infusion Daily 24-120 hours Infusion Taper Weeks 1,2,3 & 4 Taper Treatment is planned to be 2 days (including a 12-hour taper). Currently recruiting patients Topline data expected 1H 2022 |
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RAISE Trial Sites Standard of Care Progression to IV Anesthesia Surveyed PI’s at selected RAISE Trial sites to learn more about their standard of care natural history progression to IV anesthesia following the failure of one versus more than one 2nd-line IV AEDs ► population Of those that escalate to 3rd-line IV anesthesia, they do so in ~2.5 hours median following failure of the second 2nd-line IV AED Patients with non-convulsive status epilepticus (NCSE) 43 ©2021 Marinus Pharmaceuticals. All Rights Reserved I ear unmet medical need in patients that fail two or more 2nd line IV AEDs Guides site selection and approximates placebo response for escalation to IV anesthesia co-primary Tr ial |
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BARDA Contract – Refractory Status Epilepticus Key Contract Parameters BARDA to contribute $21 million in base contract to support the Phase 3 RAISE clinical trial in RSE and preclinical studies of ganaxolone in nerve agent exposure animal models. ► BARDA may contribute up to an additional $30 million in support of manufacturing, supply chain, clinical, regulatory and toxicology activities based on favorable clinical and pre-clinical outcomes. ► Total contract value = $84 million; $51 million BARDA / $33 million Marinus - if all options are undertaken. ► On successful development, BARDA and Marinus may negotiate for a supply of ganaxolone for a potential response to nerve gas exposure threats. ► 44 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Commercial Opportunity ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Quantifying the Significant Clinical and Economic Burden of RSE The Phase 3 trial of ganaxolone in refractory SE aims to demonstrate rapid onset of action capable of preventing escalation to IV anesthetics, and downstream associated clinical outcomes Treatment with IV anesthetics has been reported to lead to increased length of hospital admission and risk of infections, new disability, and death1-3 $ $ Pharmacoeconomic opportunity to quantify cost of care and characterize clinical outcomes based on treatment progression to IV anesthetics 1 Sutter R et al. 2014 Neurology 2 Hawkes MA et al. 2019 Crit. Care Med. 3Marchi NA et al. 2015 Crit. Care Med. 46 ©2021 Marinus Pharmaceuticals. All Rights Reserved I To support value-based economics / approach will be a key tool with reimbursement experts |
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High Cost of Care Currently Associated with RSE Population Ganaxolone may provide an opportunity to reduce hospital costs and save lives by altering how medicine is practiced Clinical Outcomes Utilization and Cost Outcomes (≥ 1 IV (≤ 1 IV AED) (> 1 IV AED) (100) 0.2 0.2 0.4 infectionŦ (%) Manuscript in preparation ©2021 Marinus Pharmaceuticals. All Rights Reserved *Indicates p<0.05 across all pairwise comparisons ŦIndicates p<0.05 C1 or C2 vs. C3 47 I Marinus estimates that safe and effective therapeutics that prevent progression to SRSE (i.e., treatment with IV anesthetics) may reduce mortality rates and hospital costs Metric Cohort 1 Cohort 2 Cohort 3 All anesthetic) Unique RSE patient encounter,14,69410,14019,154 N (%)(33.4)(23.1)(43.5) 43,988 Discharge disposition (%) Expired*4.66.318.9 11.2 Hospital-acquired condition (%Y)14.019.423.1 19.2 Catheter-associated UTI (%)12.017.418.3 16.0 2.8 Miscellaneous infectionŦ (%)1.61.74.3 Vascular catheter-associated 0.3 Mechanical ventilator -associated complication (%)0.20.21.6 0.8 Metric Cohort 1 Cohort 2 Cohort 3 All (≤ 1 IV AED) (> 1 IV AED) (≥ 1 IV anesthetic) Unique RSE patient encounter,14,69419,154 N (%)(33.4)10,140 (23.1)(43.5) 43,988 (100) Hospital length of stay (LOS) (days) Mean*4.77.212.0 8.4 5 Median*348 ICU LOS (for ICU patients only) Mean*2.73.16.6 5.4 3 Median*224 Total hospital cost* ($USD) Mean*$11,532$18,328$41,858 $26,304 $13,201 Median*$6,812$10,592$24,105 |
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Additional Commercial Opportunities Along SE Continuum Potential to leverage future hospital sales force to address > 3x patient population in ESE & SRSE ESETT 1. DeLorenzo RJ Pellock JM Towne AR Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol. 1995; 12: 316-325 2. Kapur et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus N Engl J Med 2019;381:2103-13. 3. Rossetti and Lowenstein. Management of refractory status epilepticus in adults Lancet Neurol. 2011 Oct; 10(10): 922–930 48 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Established Status Epilepticus – Potential Use of Ganaxolone in Emergency Room Room 49 ©2021 Marinus Pharmaceuticals. All Rights Reserved I • Unique Environment: -No EEG -Risk of rapid escalation of care -Convulsive patients: new dosing paradigm – bolus and short infusion time (2-24 hours) Emergency Tertiary Center ICU ICU |
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Established Status Epilepticus – Potential Use of Ganaxolone in Emergency Room Proposed ESE Clinical Trial Design Failed benzodiazepine Bolus IV ganaxolone infusion Pilot: N = 4-5 per cohort Open Standard of care IV AED Bolus IV ganaxolone: Failed benzodiazepine Blinded: N = 40 per arm 1:1 Placebo bolus Placebo Standard of care IV AED Screening Randomization Double-blind treatment (2-24h) <30 min 2-24h 50 ©2021 Marinus Pharmaceuticals. All Rights Reserved I • Not enough time for consent - Exception from Informed Consent (EFIC) / Community consent activities • First patient expected to be enrolled in 1H of 2022 |
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Intellectual Property |
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Multiple Layers Of Potential Protection Orphan drug designations for CDD and PCDH19 provide 7 and 10 years regulatory exclusivity in US and EU, respectively. Orphan drug designation for SE provides 7 years regulatory exclusivity in US. 52 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Patent/Patent Applications Expiration Date IV formulations containing exclusively in-licensed proprietary Captisol® product 2033 SE – patent application pending on IV formulations and methods of use 2036 SE – patent application pending on clinical treatment regimen Oral Formulations – nanoparticulate formulations (2026 + up to 5 Year PTE) CDD & PCDH19 – patent application pending on methods of use, patient stratification TSC – patent application pending on methods of use Oral Formulations containing cyclodextrin 2040 2031 2038 2040 2042 |
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Thank You |
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Subject Baseline Demographics & Country Enrollment in Marigold Study (CDD) 42 US 15 14 10 IT RU PL UK 7 6 6 1 FR AU IL 54 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Demographic Placebo (n=51) Ganaxolone (n=50) Total (n=101) Age, median 7.0 5.0 6.0 Gender, n (%) Male 10 (19.6) 11 (22.0) 21 (20.8) Female 41 (80.4) 39 (78.0) 80 (79.2) Ethnicity, n (%) Hispanic or Latino 6 (11.8) 4 (8.0) 10 (9.9) Not-Hispanic or Latino 43 (84.3) 44 (88.0) 87 (86.1) Unknown 1 (2.0) 1 (2.0) 2 (2.0) Not reported 1 (2.0) 1 (2.0) 2 (2.0) Race, n (%) White 47 (92.2) 46 (92.0) 93 (92.1) Asian 3 (5.9) 2 (4.0) 5 (5.0) Other 1 (2.0) 2 (4.0) 3 (3.0) |
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Responder Analysis – Marigold Study 55 ©2021 Marinus Pharmaceuticals. All Rights Reserved I Percent Reductions in Major Motor Seizure Frequency |
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Unmet Need in TSC Epilepsy and Scientific Rationale for Ganaxolone ► Epilepsy present in ~90% of individuals affected with TSC1 ► Existing treatments fail to control seizures in ~60% of individuals with TSC-associated epilepsy2 ► Uncontrolled seizures, especially early in life, may lead to developmental delays and cognitive dysfunction Clear need to evaluate treatments with a differentiated mechanism of action Data generated in collaboration with the TS Alliance and utilization of their biosample repository Patients aged 1-14 1. Canevini MP et al 2018 Am J of Med Genetics_ Current concepts on epilepsy management in TSC. 2. ChuShore CJ et al Epilepsia_The natural history of epilepsy in TSC. 56 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |
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Details on Baseline Patient Characteristics for Phase 2 SE Trial 1 Low Vascular No NCSE LAC, LEV 200mg (200-600mg) 3 Low Vascular No NCSE LOR, LAC, LEV 600mg (200-600mg) NCSE: Non-convulsive status epilepticus 5 Low Tumor No CSE LOR, LAC, LEV 2,000mg (1000-3000mg) CSE: Convulsive status epilepticus LAC: Lacosamide Drug Overdose / Withdrawal 7 Medium Yes CSE LOR, LEV 1,000mg (1000-3000mg) LEV: Levetiracetam LOR: Lorazepam 9 Medium Tumor Yes NCSE LAC, LEV, PHT 200mg (100mg) PHT: Phenytoin Drug Overdose / Withdrawl fPHT: Fosphenytoin 11 Target No CSE LOR, LAC, LEV 400mg (200-600mg) VPA: Valproic Acid 13 Target Autoimmune No NCSE LOR, LEV 1,000mg (1000-3000mg) 15 Target Vascular Yes CSE LOR, LEV 1,000mg (1000-3000mg) 17 Target Autoimmune No NCSE LOR, fPHT, LAC, LEV, VPA 200mg (200-600mg) 57 *Bolded, underlined IV AED’s were the last ones administered prior to GNX ©2021 Marinus Pharmaceuticals. All Rights Reserved I 16 Target Tumor No NCSE LOR, LAC, LEV 400mg (200-600mg) 14 Target Vascular No NCSE LOR, LAC, LEV, PHT 200mg (200-600mg) 12 Target Tumor Yes NCSE LOR, LEV, VPA 700mg (1000-3000mg) 10 Target Vascular Yes CSE LOR, LAC, VPA 400mg (200-600mg) 8 Medium Unknown Yes CSE → NCSE LOR, LAC, LEV 1,000mg (1000-3000mg) 6 Medium Vascular No NCSE LOR, LAC, LEV 600mg (200-600mg) 4 Low Vascular No NCSE LOR, LAC, LEV 600mg (200-600mg) 2 Low Unknown Yes NCSE fPHT, LEV 1,000mg (1000-3000mg) Patient Dosing Cohort Etiology History of Epilepsy Type of SE Failed Antiseizure Medications Prior to GNX* Dose of Last IV AED Administered Prior to GNX (Recommended Dose) |
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Potential Launch Into the Hospital Setting Designed to be Driven by Data, Customer Collaboration & Protocolization of Ganaxolone in RSE Critical Success Factors for RSE Launch Clinical and Economic Evidence Access Society Guideline & Account Protocol Inclusion Experienced Hospital Sales Force • Phase 3 data to support clinical adoption and budget model • Clear clinical benefit eg, SE cessation, IV escalation • Economic advantage – LOS*, ICU duration, clinical outcomes • Early engagement with hospital stakeholders to best understand and frame value proposition • Determine formulary process and requirements • Reimbursement, logistics and operational processes • Identify, navigate and influence unique hospital decision makers • Educate and generate customer usage data • Collaborate internally to protocolize usage and translate success • Partner with KOLs and societies to update RSE treatment guidelines • Collaborative approach to protocol augmentation with health systems and local hospitals Compelling Clinical and HEOR* Data C-Suite, Pharmacy, & Admin Engagement Clinical Adoption Pull-Through *LOS – Longer length of stay *HEOR – Health economics and outcomes research 58 ©2021 Marinus Pharmaceuticals. All Rights Reserved I |