Jazz Pharmaceuticals (JAZZ) Q2 2019 Earnings Call Transcript

Jazz Pharmaceuticals (JAZZ 1.27%)
Q2 2019 Earnings Call
Aug 06, 2019, 4:30 p.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Welcome to the Jazz Pharmaceuticals plc second-quarter 2019 earnings conference call. [Operator instructions] I will now turn the call over to Kathee Littrell, head of investor relations at Jazz Pharmaceuticals.

Kathee Littrell -- Head of Investor Relations

Thank you, Valerie, and thanks to those of you who are joining our investor call today. We reported our second-quarter 2019 financial results and updated our financial guidance for 2019. The press release and the slide presentation accompanying this call are available on the investors section of our website. On the call today are Bruce Cozadd, CEO; Rob Iannone, executive vice president, R&D Matt Young , EVP and CFO.

And joining for the Q&A session, Dan Swisher, president and COO; Mike Miller, executive vice president, U.S. commercial; Allen Yang, senior vice president, clinical development and acting CMO. I'd like to remind you that some of the statements we will make on this call relate to future events and performance rather than historical facts and are forward-looking. Examples of forward-looking statements include those related to our future financial and operating results, including: 2019 financial guidance and goals, future growth and growth strategy, product launches, sales and volumes, supply challenges, regulatory activities, ongoing and future clinical trials, and other product development activities and corporate development efforts.

These forward-looking statements involve risks and uncertainties that could cause actual events, performance and results to differ materially. They are identified and described in today's press release and the accompanying slide presentation under risk factors in our Form 10-Q for the quarter ended March 31, 2019, and our Form 10-Q for the quarter ended June 30, 2019, which we will file shortly. We undertake no duty or obligation to update our forward-looking statements. On this call, we discuss non-GAAP financial measures.

We believe these measures are helpful in understanding our past financial performance and potential future results. They are not meant to be considered in isolation or as a substitute for comparable reported GAAP measures. Reconciliations of GAAP to non-GAAP financial measures discussed on this call are included in today's press release and slide presentation available on our website. I'll now turn the call over to Bruce.

Bruce Cozadd -- Chief Executive Officer

Thanks, Kathee. Good afternoon, everyone, and thank you for joining us. This year, we've had significant achievements across all aspects of our business, including strong financial execution, expansion of our product portfolio, diversification of our development pipeline through internal and acquired R&D programs and continued global expansion. One of our most significant achievements was the approval and recent launch of Sunosi in the U.S.

for patients with excessive daytime sleepiness associated with narcolepsy or OSA. For the remainder of the year, our focus will be on preparing an NDA package for JZP-258, advancing our R&D programs and planning for the potential approval of solriamfetol in the EU as early as year-end. We're pleased to welcome new executive leadership to the company, including Rob Iannone, who's leading our R&D organization, and Neena Patil, who will lead our global legal department. After providing details on some of our commercial and regulatory activities, I'll turn the call over to Rob to provide an update on our development programs, and then Matt will update you on our financials.

We're delighted to be on the market with Sunosi in the U.S., and we'll begin reporting sales in the third quarter. As of July 8, Sunosi was available to retail pharmacies, and our expanded sleep sales force began contacting healthcare providers. Over the first three weeks of launch, we've had Sunosi interactions with over 7,500 healthcare providers and good utilization of our sample program. We have implemented robust patient service programs for Sunosi, which aim to reduce out-of-pocket expenses to as little as $9 a month, and discussions with payers are progressing with the goal of obtaining optimal patient access to this important new therapy.

Just a few weeks into launch, we are pleased with the strong interest from healthcare providers as they increase their knowledge of and experience with Sunosi and how best to incorporate Sunosi in the management of the narcolepsy and OSA patients, such as how to switch their patients to Sunosi from other medications and understanding Sunosi's clinical profile. Our medical team is working on a number of publications and other efforts to educate healthcare providers on the emerging science regarding the pathophysiology of EDS and OSA and the role of pharmacotherapy. Jazz will also be launching peer-to-peer Sunosi programs in the near future. Training for the physician speakers is complete and scheduling is under way.

Additionally, we are pleased with the response to Jazz's consumer disease awareness effort, A Different Kind of Tired. In the first half of this year, the campaign reached over 7 million people, and nearly 1 million unique visitors have visited www.adifferentkindoftired.com to learn more about their EDS and OSA. We're closely monitoring the launch and leading metrics to evaluate Sunosi's progress. We are encouraged by the positive feedback and interest we've received to-date and look forward to reporting our progress next quarter.

On the regulatory front, we submitted an MAA for solriamfetol in November, and we're expecting an EMA marketing authorization decision as early as the end of this year. We have added key sleep leadership to our EU team as we prepare for initiating a rolling launch in major EU countries next year. We're continuing to evaluate development program opportunities for solriamfetol in other conditions associated with debilitating EDS. We're currently discussing with regulatory agencies a program to evaluate solriamfetol for EDS in major depressive disorder.

Xyrem performance was strong again in the second quarter with bottle volume growth of 5%, compared to the same period last year. The average number of active Xyrem patients increased to 14,700, up 6%, compared to the same period last year. Our expanded sleep sales force is fully trained on Xyrem and Sunosi and began promotional efforts for both products in their new sales territories last month. We have increased our Xyrem media promotional efforts with the goal of maintaining the momentum from the first half of the year, while minimizing any short-term disruption that can occur from changing territories.

We look forward to a potential longer-term positive contribution from this. Now on to our hem-onc therapeutic area. In the second quarter, Vyxeos sales benefited from our ongoing EU launch. We made progress on the pricing and reimbursement front for Vyxeos, obtaining national reimbursement in Italy.

In France, Vyxeos did not qualify for central reimbursement, but will be funded by hospital budgets similar to other recently approved AML therapies. Our EU team continues pricing negotiations in Germany and Spain. In the U.S., demand trended upward, particularly in community accounts, where we've continued our intensive education and outreach initiatives emphasizing the strong overall efficacy profile of Vyxeos as the first-line therapy for fit secondary AML patients. Our most recent U.S.

market research in secondary AML indicates that our educational efforts are shifting use from 7+3 to Vyxeos. In order to increase our share of voice in the AML setting, we are expanding our Vyxeos dedicated sales force by 15 representatives. We plan to hire and train these new reps this quarter and expect them to begin promoting Vyxeos in the fourth quarter. Defitelio continued its strong global performance in the second quarter.

In June, Defitelio was approved for the treatment of VOD by Japan's Ministry of Health, Labor and Welfare, and we began shipping commercial vials to Nippon Shinyaku who is responsible for the commercialization of Defitelio in Japan. We are continuing to make progress with our global expansion plans for Defitelio and recently requested marketing authorization in Australia and Switzerland. Our global defibrotide development program continues to advance. Startup activities are under way for our exploratory Phase 2 study in prevention of CAR-T associated neurotoxicity, and we expect sites to activate this quarter.

We're also preparing to activate sites for our Phase 2 study for the treatment of TA-TMA late this year. Patient recruitment is ongoing in our Phase 2 prevention of acute GvHD study, and our goal is to complete enrollment at the end of the year. Enrollment in the prevention of VOD Phase 3 study has been strong. The study includes an interim analysis.

We expect to have an update on the timing of the interim analysis later this year. For Erwinaze, we experienced an extended out-of-stock period in the second quarter due to ongoing issues at the sole manufacturer, PBL, and we continue to expect further supply disruptions this year. Erwinaze has been the cornerstone of our hem-onc franchise since 2012 and remains a critical component of treatment for patients with ALL. We remain committed to working with PBL and taking steps within our control to improve the reliability of Erwinaze supply and to ensure that all available supply is made available to patients.

I'll wrap up by saying we're proud of our significant first half achievements. We remain on track to deliver more than $2 billion in revenues this year, while expanding our business and capabilities, advancing our global R&D efforts and successfully executing our multiple ongoing and planned commercial launches. Rob, I'll now turn the call over to you.

Rob Iannone -- Executive Vice President, R&D

Thank you, Bruce. I'm excited to have joined Jazz to lead a committed and capable R&D team focused on advancing the development of life-changing medicines for patients. In 2019, we have made progress in further diversifying our growing R&D pipeline with the addition of the pan-RAF inhibitor program and our exosome therapeutics collaboration. I'll begin with development activities in our sleep therapeutic area starting with JZP-258.

We are continuing to make progress toward bringing JZP-258 to narcolepsy patients. JZP-258 is a novel oxybate formulation with the unique composition of cations resulting in 92% less sodium than Xyrem. Most patients taking Xyrem receive between 1,100 and 1,640 milligrams of sodium per night from the medication alone. To put that in context, the American Heart Association recommends a daily sodium intake not to exceed 2,300 milligrams with an ideal limit of 1,500 milligrams.

Narcolepsy is a chronic disease in which lifelong therapy may be clinically indicated, and researchers have associated narcolepsy with an increased risk of comorbid conditions, including hypertension and cardiovascular disease. Many public health organizations, medical professional societies and patient advocacy organizations have highlighted the importance of sodium reduction to lower the risk of hypertension and cardiovascular disease. We believe that a substantial reduction of sodium intake for oxybate patients to a range of approximately 88 to 131 milligrams of sodium per night with JZP-258 represents a meaningful benefit for narcolepsy patients. We believe JZP-258 is a prime example of innovating to improve upon available therapies, in this case, by reducing the inherent risk associated with excessive sodium intake.

Data from our Phase 3 study evaluating JZP-258 for the treatment of cataplexy and EDS in adult patients with narcolepsy has been accepted for oral presentation during the World Sleep Conference on Wednesday, September 25 in the afternoon. We also expect to meet with FDA in the fourth quarter to discuss our NDA package with the goal of submitting as early as year-end. The Phase 3 study of JZP-258 in patients with idiopathic hypersomnia is enrolling well, and we recently activated study sites in Europe. Additionally, JZP-258 recently received orphan drug designation from FDA for the idiopathic hypersomnia indication.

Turning to our hem-onc development activities. I'll start with Vyxeos. At ASCO in June, the Children's Oncology Group, COG, presented positive Phase 1 and 2 data of Vyxeos in children and young adults with relapsed refractory AML. Primary objectives were focused on safety and efficacy, including determining the recommended Phase 2 dose.

Vyxeos was administered during Cycle 1 at 135 units per meter squared. Disease was then evaluated and patients continued with the combination of fludarabine, cytarabine and filgrastim also known as FLAG. Toxicity was consistent with intensive AML regiments. The overall response rate based on CR, CRp and CRi was 81.1% with 70% of patients achieving best response after Cycle 1 with Vyxeos.

Of patients who achieved an objective response, 80% have no residual disease by flow cytometry. The percent of patients who achieved MRD negative status was 75% after one cycle and 85% overall. Another important finding in the study is that 83.3% of patients successfully bridged the potentially curative hematopoietic stem-cell transplantation. This study was part of our pediatric investigation plan with the European Medicines Agency, and we expect to discuss these robust data with the regulatory authorities.

We're also continuing to make progress in a broad development program to generate data to facilitate physician's understanding of the value of Vyxeos to reach additional patients who may benefit from treatment with Vyxeos both as monotherapy and in combination and also to satisfy our postmarketing commitments. During the second quarter, MD Anderson Cancer Center initiated a Phase 1 attenuated dose binding study of Vyxeos in higher-risk MDS patients. This quarter we expect to enroll the first patient in a Phase 1b study evaluating low intensity therapy Vyxeos in combination with venetoclax in first-line unfit patients. Additionally, study sites have activated in two key cooperative group studies.

Overall, there are currently 27 active studies. Now I'll turn to the recombinant crisantaspase development program. We are continuing our efforts to develop new recombinant crisantaspase product candidates with the goals of reliable and consistent manufacturing, quality and supply processes and a compelling target profile. JZP-458 is a recombinant crisantaspase that uses a novel Pseudomonas fluorescens expression platform.

We completed a Phase 1 study of JZP-458 in healthy volunteers in the U.S., and the study met safety and efficacy parameters based on measurement of serum asparaginase activity levels. Recently, we met with FDA to discuss these results and agreed on a path forward for Phase 2/3 study design and expectation of required information to support a BLA. We will be working with COG and FDA to finalize the protocol with plans to initiate a single-arm pivotal Phase 2/3 study later this year. Given the critical need for reliable therapy for patients who develop hypersensitivity to e coli-based asparaginase, our goal is to continue to work closely with FDA, COG and other global experts and health authorities to bring this treatment option to patients as soon as possible.

In R&D, we are focused on building a broad pipeline across multiple therapeutic areas and stages of development to fuel Jazz's future growth. In an effort to expand our portfolio of early stage precision oncology assets with high-value potential, we completed two key transactions this year. The first was Codiak and its innovative exosome technology for the potential treatment of hematologic malignancies and solid tumors. More recently, we acquired Redx Pharma's pan-RAF inhibitor program for the potential treatment of RAF and RAS mutant tumors.

Redx has made significant progress since prior published work and has matured the program to generate candidates with equal potent pan-RAF inhibition. This advancement differentiates Redx's pan-RAF inhibitor from other RAF inhibitors in development. And while early, we believe there is the potential for development of a best-in-class pan-RAF inhibitor. We are excited about these early stage programs as they provide an opportunity to transform future cancer treatment.

Now, I'll turn the call over to Matt.

Matt Young -- Executive Vice President and Chief Financial Officer

Thanks, Rob, and good afternoon, everyone. In the second quarter, we were pleased with our top and bottom line growth. Revenues increased 7% to 534 million, compared to 500 million in the second quarter of 2019. We are increasing our total revenue guidance for 2019 to a range of 2.07 to 2.15 billion from our previous range of 2.05 to 2.13 billion.

Now, I'll talk about the performance of our key products. Xyrem delivered another strong quarter with net sales of 413 million, up 16% from 356 million last year. As a result of Xyrem's strong performance in the first half of the year, we're increasing our 2019 Xyrem net sales guidance range of 1.55 to 1.59 billion from a previous range of 1.53 to 1.57 billion and are maintaining our expectation for mid-single-digit volume growth. Turning to Erwinaze.

Net sales for the quarter were 28 million, compared to 59 million in the same period in 2018. Product availability in the second quarter was significantly reduced. We expect further supply disruptions for the remainder of 2019, which will continue to create quarterly variability. Even so, we are maintaining our Erwinaze net sales guidance for 2019 in the range of 160 to 195 million.

Second-quarter Defitelio net sales were 46 million, up 14%, compared to the same period of 2018, primarily due to increases in demand. Reported sales also included a shipment of commercial vials to Nippon Shinyaku, our partner in Japan, as they prepare to launch Defitelio. We are maintaining our guidance for Defitelio net sales for this year in the range of 155 to 180 million. Vyxeos second-quarter net sales were 31 million, an increase of 12% over the second quarter of 2018 and an increase of 8% sequentially from the first quarter, primarily due to increasing contribution from EU sales.

We are maintaining our Vyxeos net sales guidance for this year in the range of 120 to 150 million. As a reminder, our total revenue guidance for 2019 includes minimal net sales contribution from Sunosi, which we launched in the U.S. in early July. We expect the gradual ramp of Sunosi net sales after 2019 as commercial insurance coverage expands, and we believe Sunosi could achieve U.S.

net sales of more than 500 million in its current indications in 2025. Turning to operating expenses. Adjusted SG&A for the second quarter increased 13% to 155 million, or 29% of total revenues, compared to 138 million, or 28% of total revenues in the second quarter of 2018. Adjusted SG&A expenses in the quarter increased primarily due to our ongoing and planned product launches, and we expect these expenses to increase in the second half of the year.

For 2019, our guidance for adjusted SG&A expenses remain in the range of 620 to 650 million or 29 to 31% of total revenue guidance. Adjusted R&D expenses for the second quarter of 2019 were 56 million or 11% of revenue, compared to 51 million or 10% of total revenues in the second quarter of 2018. Adjusted R&D expenses in the quarter reflected our growing investments in the development of defibrotide, Vyxeos, solriamfetol and JZP-458, preparation of the JZP-258 NDA package, as well as support of partner programs and IND-enabling work with the CombiPlex platform. We expect increasing R&D expenses in the second half as we continue to expand and advance our R&D programs.

For 2019, our guidance for adjusted R&D expenses remains in the range of 235 to 265 million, or approximately 11 to 13% of total revenue guidance. We are maintaining our 2019 adjusted effective tax rate guidance in the range of 17 to 19%. On a GAAP basis, the effective tax rate included a onetime tax benefit of 112 million resulting from an intra-entity intellectual property asset transfer in the second quarter. Adjusted net income for the second quarter increased 8% to 233 million, compared to 215 million in the second quarter of 2018, and adjusted net income per diluted share increased 16% to $4.05, compared to $3.49 in the second quarter of 2018.

As a reminder, our adjusted EPS for 2019 is positively impacted by significant share repurchases made in late 2018 and the first half of 2019. Please note that we are maintaining our 2019 non-GAAP adjusted EPS guidance range of $14.30 to $15 and our guidance for weighted average diluted shares outstanding of approximately 58 million. In the second quarter of 2019, we generated 149 million in cash from operations. We used 60 million to repurchase shares during the quarter and had 208 million remaining under our share repurchase program as of June 30.

During the quarter, we made milestone payments totaling 26 million related to the FDA's approval of Sunosi. As of June 30, we had $883 million in cash, cash equivalents and investments, borrowing capacity under our revolver of 1.6 billion and 1.8 billion in outstanding principal balance on our long-term debt. We're pleased with our strong companywide execution this year with multiple product launches under way and corporate development efforts that have resulted in the addition of novel, potentially best-in-class product candidates and technologies to our rapidly expanding pipeline. As we head into the second half of 2019, we expect multiple catalysts to fuel our positive momentum.

We look forward to several data presentations, including JZP-258 and solriamfetol data at [Audio gap] On the regulatory front, we are preparing an NDA for JZP-258 and expecting the EMA decision on solriamfetol as early as year-end. We also look forward to initiating the Phase 2/3 study of JZP-458. As part of our business strategy to drive shareholder value, we're focused on preparing for and delivering on successful product launches, driving internal and external efforts to diversify our R&D and commercial portfolios and, importantly, prioritizing patients and their access to our differentiated medicines. Thank you for joining us on the call today, and I'll now turn the call back over to Kathee.

Kathee Littrell -- Head of Investor Relations

Thanks, Matt. We kindly request that you limit yourselves today to one to two questions during this call so that everyone has an opportunity to ask their question. We will gladly address any additional questions after the call or you can reenter. With that said, operator, please open the line for questions.

Questions & Answers:

Operator

[Operator instructions] Our first question comes from Ami Fadia of SVB Leerink. Your line is open.

Ami Fadia -- SVB Leerink -- Analyst

Hi. Good evening. Thanks for the questions. Perhaps if you could provide us some additional details around the discussions with the FDA around the asparaginase study that you're going to run.

Maybe give us some sense of the endpoints, the duration of the study. And also, how would the cost structure of -- the cost of manufacturing this product look like relative to your current cost of acquisition for Erwinaze?

Bruce Cozadd -- Chief Executive Officer

So Ami, this is Bruce. So on the second part of that question, we're not going to release that information right now, although we're designing this to be a modern production methodology, and we think it will be relatively efficient. But perhaps I can have Rob jump in and answer your question about size and endpoints on the JZP-458 Phase 2/3 pivotal trial.

Rob Iannone -- Executive Vice President, R&D

Happy to, Bruce. So for starters, we have what I really feel was a very collaborative and productive discussion with the FDA, so that we came away from that meeting having clarity around the study design that would ultimately support approval on the U.S. With that, we arrived at a single-arm design where the primary endpoint is asparaginase activity. We anticipate enrolling 100 patients.

However, there is an opportunity for an interim analysis after 50 patients. It could support an earlier BLA submission.

Operator

Thank you. Our next question comes from Akash Tewari of Wolfe Research. Your line is open.

Akash Tewari -- Wolfe Research -- Analyst

Thanks so much. So it looks like we'll get some readouts and approvals in the oral narcolepsy space in the back half of this year. How do you see these new treatment options kind of changing Xyrem's current market dynamics? Will they change it in any meaningful way? And then on 258, considering that you didn't run a head-to-head study versus Xyrem, can you give us a sense of what other language we could get on 258's label outside of not including a warning on the high sodium content?

Bruce Cozadd -- Chief Executive Officer

Yeah. On the first question about narcolepsy treatment options, of course, we're happy. We've introduced a number of new treatment options for narcolepsy patients already this year starting with expanding the Xyrem label to pediatric patients and now launching Sunosi for EDS and narcolepsy patients, as well as OSA patients, of course. As we look at the potential expansion of the number of treatments for narcolepsy, we're reminded that narcolepsy remains an underdiagnosed and undertreated disease.

And while Xyrem we think is a particularly effective drug for those patients that take it, you know that the number of patients that take that drug is small relative to either the number of diagnosed narcolepsy patients or the broader number of patients who suffer from the disease, but are not yet appropriately diagnosed and treated. And so, additional treatment options, additional focus on the correct diagnosis and treatment of narcolepsy patients we think is a really important thing for the narcolepsy community. And we continue to want to be part of that conversation with our treatment options. Maybe on your question on JZP-258, I can let Dan talk about that a little bit.

Dan Swisher -- President and Chief Operating Officer

Yeah. Thanks, Bruce. Just to remind people of the upcoming milestones on 258. So the Phase 3 data readout that we've just given the top line to will have that data presentation at World Sleep Conference in September.

We do have a scheduled NDA meeting with the FDA -- pre-NDA meeting with the FDA in the fourth quarter and looking to put that package together. And obviously, we'll be in discussion then with the FDA around label. It's a little premature to talk about that now, albeit that this was a pretty streamlined clinical study to get to initial approval with relevant endpoints that we've got in the Xyrem label, but clearly not having the sodium content, sodium level will be reflected in that label. I think, increasingly, we're also really looking at that data to think about what additional data do we want to generate both in real-world studies and how that -- how might that continue to supplement what's on the market, both in terms of label, but also in publications.

Operator

Thank you. Our next question comes from Jessica Fye of JP Morgan. Your line is open.

Jessica Fye -- J.P. Morgan -- Analyst

Great. Good afternoon. Thanks for taking my questions. On 458, can you help us think about how long it might take to recruit that pivotal Phase 2/3, particularly in light of the Erwinaze supply issues? And second part to that with part of the company's focus on driving global growth, do you see any potential that this single arm pivotal could support approval in Europe? Or would that take a subsequent trial?

Bruce Cozadd -- Chief Executive Officer

So Jess, I don't think we're going to provide a specific projection of enrollment time line for the 458 trial. We need to finalize that protocol, get sites open and start that process. We do believe there's strong interest on the part of COG membership on getting this trial up and running. And we certainly expect that will go well.

I will remind you this is an orphan condition. While it's the most common childhood cancer, there's still limited number of patients who would be eligible for a trial like this, but we're going to do everything we can to move this right along. Maybe I'll turn the global growth question over to Dan.

Dan Swisher -- President and Chief Operating Officer

Yeah. Thanks, Jess. On the global growth side, just to really streamline our effort to get to market as quickly as possible, yes, we focused our regulatory interactions to-date with the FDA. But we think the same market need, market conditions are similar in the other countries where both clinicians and regulators are looking for additional new treatment options that provide reliable, safe and potentially differentiated products.

So we're actively planning, now that we've got the FDA input how we approach the other regulators, and we'll update at future calls.

Operator

Thank you. Our next question comes from David Risinger of Morgan Stanley. Your line is open.

Zhu Shen -- Morgan Stanley -- Analyst

Hi, there. It's Zhu Shen for David Risinger. I have two questions. The first one is are there any risks associated with the sought replacement components of the 258 formulation? And the second question is when the 258 data is released in September, how should investors assess its efficacy profile relative to Xyrem? Thank you.

Bruce Cozadd -- Chief Executive Officer

So David, on cation mixture we've used to reformulate this innovative new product that we think provides this benefit of lower sodium, we certainly had in mind to do that in a way that would not introduce additional risk in the product. Obviously, we are collecting safety data in all our work, but we don't have any particular concerns in that regard. On how to think about efficacy, we talked about that a little bit when we released the top line data from the trial. Just to remind people that in addition to the primary endpoint, prespecified secondary endpoint, there's a lot of data we're collecting in this trial.

Remember that the trial design was four arms with patients entering either naïve, already on Xyrem treatment or naïve or on Xyrem treatment with also anticataplectic treatment. And so, we're really watching these four different groups of patients as they enter the trial, as they ramp up on JZP-258 and as they either come off Xyrem or taper down on the anticataplectics. And so, watching each of those groups and looking at efficacy and tolerability over the run-in period both in this trial and then thinking about how that compares to what we would expect to see relative to prior Xyrem treatment or data we've had on naïve patients in the past gives us a lot of information. In the end, the primary endpoint and the one that supports our regulatory strategy and where we gave you a sense for how the results came out in the trial was based on a randomization period.

At the end, we either kept people on 258 or randomize them back to placebo, and we looked at what happened in the primary endpoint to cataplexy attacks over a two-week period. So we've already told you that part of the data was strong, but we'll look forward to presenting a little more information, both at the World Sleep Congress and as we move forward.

Operator

Our next question comes from Gary Cachman of BMO Capital Markets.

Gary Nachman -- BMO Capital Markets -- Analyst

Hi. Actually, Gary Nachman. So on Sunosi, what has the early read been from payers on your WAC price that you came out with? It seemed pretty reasonable. Do you think coverage could happen a bit more quickly potentially than what you guys talked about? And are you starting to make some progress with OSA or focusing more on the beachhead and narcolepsy? How do you think those two markets are going to shake out?

Bruce Cozadd -- Chief Executive Officer

Maybe I'll have Mike respond on payers and coverage speed side and then how we're doing in OSA.

Mike Miller -- Executive Vice President, U.S. Commercial

Gary, this is Mike. Yeah. So I think the payer discussions have progressed nicely. At this point, we are not giving any guidance differently than what we already have about it.

It is -- I think the payers have responded well to the data. And I think, importantly, to your point, when you think about narcolepsy and OSA, almost all patients being treated with narcolepsy have EDS. So that is a natural beachhead, as you said, in our launch plans. Importantly, though, the real OSA market exists with the pulmonologist, and that's really, really opens up the opportunity for the brand.

Those discussions have gone well. I think particularly the differentiated MOA, the robust efficacy in both indications, the lack of drug-drug interaction and the nine-hour activities has been received well.

Gary Nachman -- BMO Capital Markets -- Analyst

OK. Thank you.

Operator

Our next question comes from Umer Raffat of Evercore. Your line is open.

Umer Raffat -- Evercore ISI -- Analyst

Thanks so much for taking my questions. Bruce, I have two today. And perhaps the first one is what's the level of urgency in the organization on expanding the reliance of the P&L beyond Xyrem, specifically in M&A? So for instance, should we be expecting a sizable transaction before year-end? Are you guys competitive in the valuation ranges you're looking at? I'm sure you understand a lot of investor concern around the reliance on the Xyrem franchise, especially in the backdrop of how Vyxeos has been doing. And secondly, there was a moderation in the pace of price increases for Xyrem last year, but I noticed with the July increase this year, there's sort of a move back toward the 9 to 10% range.

Should we expect that to be the norm now going forward again?

Bruce Cozadd -- Chief Executive Officer

Yeah. Umer, on the -- I'll take the second part of your question first. We, for many years now, have not commented on forward thinking on price increases. I think it's important to look at the situation when we arrive at a particular moment in time and do something responsible that supports our level of commitment to ongoing R&D to help narcolepsy patients.

So I wouldn't think of this in terms of setting a new trend. It's just what we happened to do at this period. On your second question, in terms of diversifying our top line, we're tremendously pleased by Xyrem's continued strong performance, and we'd like nothing more than to see that continue in the years ahead as we expand into the pediatric population and as we continue to try to help more narcolepsy patients with this product. Also remind you that under settlement agreements, while there will be generic competition in the future, that is still a ways off and includes a number of components, including authorized generics, where there are some economics to Jazz.

And we've been talking, of course, about our efforts to introduce an even better product for narcolepsy patients in the years to come. But that said, we would love to build additional growth drivers into our overall business. We continue to look at that by growing existing products, by advancing products in our R&D pipeline and by broadening our R&D pipeline. We remain interested in bringing marketed products or near-market products into our corp dev efforts as well.

And maybe I'll ask Matt to comment a little bit about our efforts there and how we think about the market we're in today for those type of assets.

Matt Young -- Executive Vice President and Chief Financial Officer

Yeah. So I mean, we remain very enthusiastic about what we're evaluating and continue to build cash and firepower currently at around 2.5 billion before any external funding. And again, those leveraged finance markets are relatively strong. We continue to look really across the spectrum of opportunities and believe we have both the capacity to evaluate and acquire a broad range of assets to build our pipeline or bring in product opportunities.

So while we've done a couple of early pipeline-building transactions, we're clearly very focused on larger and later stage opportunities as well, both in ways to build upon our existing franchises and looking even.

Operator

Thank you. Next question comes from David Maris of Wells Fargo. Your line is open.

David Maris -- Wells Fargo Securities -- Analyst

Good afternoon. Thank you. The drastically widening proposal calls for manufacturers to exclude the value of coupons for the ASP calculation for Medicare Part B. So maybe can you talk a little bit about your overall Medicare exposure, Medicare Part B exposure? And any color on the use of couponing? I would imagine that's mostly related to Xyrem.

So maybe what percentage of patients use coupons for Xyrem? And then, separately, I don't know if you addressed this, but the Xyrem guidance assumes or looks to project that things are flat first year to the second -- first half of the year to the second half of the year. Is there any reason for that? Or is it just conservatism?

Bruce Cozadd -- Chief Executive Officer

Yeah. Thanks, David. On the first part of your question, there are a host of possible outcomes to how the government approaches pharmaceutical pricing through legislative action or otherwise. We don't think that has landed yet.

And we may feel like we have direction, but I don't know where it's going to land. So rather than going through sort of a product-by-product mix and coupon discussion, I'll just say, generally, our products on average have a lot of commercial pay. I don't feel like we line up as a company particularly skewed toward any one piece of Part B, Part D or otherwise. I don't think we're at an extreme on any measure.

So we, like other companies, are watching what is happening. I think we'll have a lot more clarity over the next few months as we move into the fall and toward the end of the year. And then maybe we can give you a better sense -- you and others a better sense of potential impact on the company. But in general, we don't think the types of things that are being talked about as we look at our current product portfolio would have an overly outsized result.

On your Xyrem question, maybe I'll have Matt address that.

Matt Young -- Executive Vice President and Chief Financial Officer

Yeah. Thanks, David. Just quickly, I'd say, remember this is the first time we've had our field force in our sleep franchise focused on two products. So I think we want to make – account for uncertainties in that regard.

And while there's nothing specific that portends what we're guiding to your question, we believe our guidance reflects a range of expected scenarios that could materialize as the year progresses and want to just take some of those nuances into account.

David Maris -- Wells Fargo Securities -- Analyst

Great. Thank you very much.

Operator

Thank you. Our next question comes from Jason Gerberry of Bank of America. Your line is open.

Jason Gerberry -- Bank of America Merrill Lynch -- Analyst

Hey, good evening. Thanks for taking my questions. Just to the update on JZP-458. Can you confirm or clarify does this have any implications on the PBL agreement? Does this indicate that their bidding process has concluded? And if your pivotal trial is as accelerated as the Erwinaze pivotal trials were and you are able to get to NDA stage before end of 2020, does that have implications on the relationship? And then also just outside of supply, how might 458 differentiate from Erwinaze?

Bruce Cozadd -- Chief Executive Officer

Yeah. Jason, maybe I'll ask Dan to take this question.

Dan Swisher -- President and Chief Operating Officer

Yeah. Thanks, Jason, for those questions. So for a number of years now, we've been focused on looking at other recombinant approaches to crisantaspase programs. And we're just happy that we've got now one that's moving from good healthy volunteer experience into a Phase 2/3.

We continue to believe both short-term and longer-term that we're a natural partner for PBL. We've built the market. We've got the KOL relationships. We've got regulatory filings in most countries.

And so yes, we continue to be involved with PBL, both for short term and long term. In terms of the actual process, we can't comment on that. That's their process. But it is still under way, and we are still engaged in that process.

And in terms of differentiation, it's a little premature now other than, obviously, high-quality reliability, a much more modern manufacturing process, faster cycle times, etc. So we feel very confident about the supply we would have and the ability to really grow the market into the AYA segments, into geographies like Japan where we've got approval but have not been able to launch. So there's a lot of opportunity to have a second product.

Jason Gerberry -- Bank of America Merrill Lynch -- Analyst

OK, thanks.

Operator

Our next question comes from Randall Stanicky of RBC Capital Markets. Your line is open.

Randall Stanicky -- RBC Capital Markets -- Analyst

Great, thanks. Bruce, first one for you. As we think about the upcoming FDA meeting for 258, what are you looking for? Should we think about this as largely informing REMS? Is there anything else we should be thinking about? And then, secondly, for Matt. SG&A stepping up in the back half over the first half about 10% at the midpoint.

I understand there's a lot of infrastructure -- commercial infrastructure going into this. Last couple years there's been a little more flat second half over first half. Should we think about this back half SG&A spend as a new appropriate run rate going forward?

Bruce Cozadd -- Chief Executive Officer

On the first part of your question, our pre-NDA meeting will just be focused on making sure we submit a high-quality package that's going to meet the regulators. We think of this product as a significant advance, and we want to get it to patients, but we want to make sure we handle that regulatory interaction in the way that optimizes the ultimate review and approval of that product broadly, including REMS. But I don't think that's a particular focus of this meeting, so much as just making sure we're synced up across the board. Matt on SG&A?

Matt Young -- Executive Vice President and Chief Financial Officer

Yeah, Randall. Certainly, some of the investments we're making will be ongoing investments on a dollar basis, for sure. And recall, given the early July launch for Sunosi in the U.S. and the hiring of the field force just before that and then acceleration of sales expense but then marketing and medical expenses, while that had been picking up even through part of last year, it certainly accelerates with the formal launch.

We are also doing the market building and some of the hiring and activities in Europe in anticipation of our result in the European theater later this year or early next, and so, that's a big investment. And we, as we mentioned, are making an investment behind Vyxeos commercially as well with an additional 15 reps in the back half of this year. So again, those are costs I would expect to be layered in on an ongoing basis that should support, again, a significant uptick in commercial performance.

Randall Stanicky -- RBC Capital Markets -- Analyst

Great, thanks.

Operator

Our next question comes from David Amsellem of Piper Jaffray. Your line is open.

David Amsellem -- Piper Jaffray -- Analyst

Thanks. So on Sunosi, can you just remind us how long you're planning to sample aggressively and also how long you're planning to subsidize out-of-pocket exposure aggressively? Is that going to persist through much of 2020? And then, secondly, regarding competition in narcolepsy, cataplexy is what's the extent to which you think that pitolisant and Xyrem could potentially be complementary over the long term? And is that something you've given thought to?

Bruce Cozadd -- Chief Executive Officer

Yeah. So David, on sampling and patient access, our goals out of the gate are to get good trial of this product. We think it's an excellent product. We certainly saw in our clinical experience the patients treated with Sunosi benefited significantly over time.

We'd like to give HCPs and patients the opportunity to gain experience with Sunosi, and that's underlying a lot of our early efforts. In terms of the degree to which we'll need to continue to do that, Mike described our efforts to gain payer access over time. And I think we'll watch how that plays out over time, but that will certainly have an impact on how our programs work. On the potential for use of pitolisant with Xyrem, maybe I'll have Rob comment on how patients often use Xyrem in combination with other agents.

I'll remind you that we'll wait to see an ultimate approval and label for pitolisant before we can make more informed comments on that. But Rob, maybe you could address this generally.

Rob Iannone -- Executive Vice President, R&D

Sure. So just to reiterate, we know that patients who are on Xyrem often are also using daytime treatments. And that may well be the case with pitolisant. There's an obvious need for the benefits for Xyrem overnight, and we certainly think that that's a possibility with Sunosi as well.

David Amsellem -- Piper Jaffray -- Analyst

Thanks.

Operator

Thank you. Our next question comes from Esther Rajavelu of Oppenheimer. Please make sure your phone isn't on mute. One moment please. Our next question comes from Gregg Gilbert of SunTrust.

Your line is open.

Gregg Gilbert -- SunTrust Robinson Humphrey -- Analyst

Thank you. Back on 458 and I assume we're talking about the longer half-life or the half-life extended version here. Can you talk about how larger you think the market is when given a full supply scenario? And whether there are any other products as part of your arrangement with Phoenix that you could speak to or are interested in? And my other question is about Vyxeos. Based on that very strong data in relapsed refractory AML in young adults and kids plus your intention to file, can you put a little bit of context around the commercial opportunity?

Bruce Cozadd -- Chief Executive Officer

So Gregg, on your first question, JZP-458 is in fact not a longer half-life product. It's more similar to the Erwinaze product in that regard. We -- as you'll see in our slide deck that we make available on our website, we do have an earlier attempt to look at the potential for less frequent dosing of the product, which will be another advantage. But to be clear, the one we're talking about taking into pivotal trial is in fact not that.

In terms of how much larger the market is, it's a great question. And I think Dan talked about the opportunity for multiple products on the market here. We haven't been able to meet existing market need that's caused us to certainly take our foot off the gas in terms of continuing to promote for expanded use of asparaginase in adolescent and young adult market. Dan specifically mentioned its limited ability to do geographic expansion with approval in Japan but no launch product.

And even beyond that, the ability to do additional clinical investigation of the product and potentially broader applications, I think, could open up new use. So we think there's a significantly expanded market for use of asparaginase overall, and we think JZP-458 could help unlock that potential. On Phoenix, I don't think we have that much more to say other than what we've said publicly before. That the deals we've cut with Phoenix are a little broader than just what we're talking about here.

And in Vyxeos, in terms of commercial potential, maybe I'll ask Allen to talk about that a little bit.

Allen Yang -- Senior Vice President, Clinical Development, and Acting Chief Medical Officer

In pediatric population, Bruce, to clarify. Yeah. So I think in the pediatric population, AML is rare than ALL. So it is a small population.

But I think what that ASCO data represents is an opportunity, right, that the drug is effective in pediatrics. So it's not the high-risk AML, the therapy-related AML or AML-MRC. This is a younger population with relapsed refractory disease, different genetic profile, and the drug is still highly active. And so, it sort of fits our hypothesis that this drug has wider implications outside of the current indication.

Gregg Gilbert -- SunTrust Robinson Humphrey -- Analyst

Thanks.

Operator

Thank you. Our next question comes from Annabel Samimy of Stifel. Your line is open.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Hi, thanks for taking my questions. Just to piggyback off of some of the narcolepsy question for the Xyrem. You mentioned how you're viewing the market evolution with new competitive entrants. Could you maybe give us a sense on how this might affect you on the payer landscape? I mean, you've always been sort of the only one playing in the market for narcolepsy and just want to know if you expect any kind of rebate pressures on Xyrem if there's new options available.

And then separately on Vyxeos, I guess you kind of touched on this. But outside of the high-risk populations that you have, the world study population and with some of the new studies under way, has there been any additional comfort to move Vyxeos earlier in treatment? And do you have any updates on the MDS study design?

Bruce Cozadd -- Chief Executive Officer

On Xyrem in terms of the payer landscape, again, we view this as an important treatment option for patients. We have a number of patients who we think are well treated on Xyrem, many of whom have been on the medication for a number of years. We think it's important to maintain that access. We're committed to that.

I don't think I want to say anything beyond that in terms of particular pressure from payers. On Vyxeos, I'm not quite sure I understand your question. Vyxeos is a frontline treatment. It's a frontline treatment for the secondary AML, high-risk AML patients.

But on your question on what we're doing in MDS, maybe I could ask Rob to jump in on that.

Rob Iannone -- Executive Vice President, R&D

Yeah. So as we have mentioned in the prepared comments, we are activating through the MD Anderson collaboration study in MDS. And on that, Allen, do we have any other studies?

Allen Yang -- Senior Vice President, Clinical Development, and Acting Chief Medical Officer

Yeah. I think we've publicly disclosed a randomized study that will be conducted in Europe by one of the cooperative groups. So just remember in MDS, there is a fit population that is transplant eligible. And so, I think you could go with your current dosing regimen in that population.

And then as Rob alluded to, we have a collaboration with MDS which is the -- MDS is usually a disease of older patients, and those patients tend to be less fit. And so, we'll have a number of activities exploring lower doses for those less fit patients sort of building on the data generated by Roland Walter and Jorge Cortes. And just to add, I think, what you meant by earlier, we are frontline therapy, but I think you're talking about standard risk in younger patients. And again, alluding back to the ASCO data from the Children's Oncology Group, I think, one of the things that we're so excited about it, this is a difficult-to-treat population.

They were relapsed refractory patients. This was used as a single agent in patients already exposed to cytarabine and daunorubicin. You had a very high CR rate. You had a very high MRD rate as well.

And I think that gave the Children's Oncology Group confidence to test this agent in frontline, and that's going to be moving to a large pediatric frontline study. And I think you'll see that as a common theme in other populations as well.

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Yeah. That's what I meant. Thank you.

Allen Yang -- Senior Vice President, Clinical Development, and Acting Chief Medical Officer

Thank you.

Operator

Thank you. Our next question comes from Liav Abraham of Citi. Your line is open.

Liav Abraham -- Citi -- Analyst

Good afternoon. Regarding JZP-258, Bruce, would you consider using your priority review voucher for the FDA review of this drug? And how important is it for you to get 258 to market as soon as possible given some of the various considerations you have to take into account in commercializing the drug?

Bruce Cozadd -- Chief Executive Officer

Yeah. Liav, great question. We haven't announced what our intentions are with respect to the PRV. We own -- we think 258 represents an important advance for patients, and we are looking forward to getting it to patients as quickly as we can.

That said, there are a number of ways to do that and other uses we might have for that PRV as well. So I think we're going to avoid commenting more, particularly on that at this point. But we do feel good about where we are from a time line perspective that we've made rapid progress. I think if you look back, we enrolled our 258 trial well, got the positive results.

We're looking forward to that data presentation next month now and already are under way preparing an NDA. So we feel good about the progress we're making in that program and look forward to bringing it to market.

Liav Abraham -- Citi -- Analyst

Thank you.

Kathee Littrell -- Head of Investor Relations

Operator, this will be our last question.

Operator

Thank you. There's no further questions, I'd like to turn the call back over to Kathee for any closing remarks.

Kathee Littrell -- Head of Investor Relations

I think there's --

Bruce Cozadd -- Chief Executive Officer

Do you want to go back to Esther and see if the line is unmuted?

Esther Rajavelu -- Oppenheimer and Company -- Analyst

Hey, thank you so much for taking my question. Apologies for earlier. Just a quick question on Defitelio. What was the segment benefit in the quarter? And is the inter-quarter variability just for the remainder of 2019? Or should we expect that to last longer?

Bruce Cozadd -- Chief Executive Officer

Yeah. Matt, are we going to characterize the Nippon?

Matt Young -- Executive Vice President and Chief Financial Officer

Yeah. I mean, we still saw growth in both the U.S. and Europe ongoing basis apart from that. And so, I think, importantly, we're seeing growth across the board.

So I wouldn't consider it material to the way we describe the quarterly results. And as it relates to inter-quarter variability that will be true with this product just given the timing of transplants and VOD being a relatively rare occurrence, even within that transplant environment. So I think we will still see some effect of that just based on patient presentation.

Bruce Cozadd -- Chief Executive Officer

But I will say we're very happy with how we've seen Defitelio growing, particularly in the U.S. market of late. That, coupled with sort of reestablishing a positive Vyxeos trend, really strong start to Vyxeos in Europe, superstrong Xyrem performance in the first half of the year, our team working hard to address the Erwinaze challenges, a good launch of Sunosi and the rapid progress of R&D pipeline, leaves us feeling really good about where we are going into the back half of the year. We're not done yet.

We've got a lot to accomplish, including staying busy on the corp dev side. So I don't want to make it sound like we can coast through the second half of the year. But I think I want to thank our employees for a great start to the year, and we're looking forward to reporting our progress in the months to come.

Esther Rajavelu -- Oppenheimer and Company -- Analyst

Thank you.

Operator

I'm showing no further question at this time. I'll turn the call back over to Kathee for any closing remarks.

Kathee Littrell -- Head of Investor Relations

Thank you, Valerie, and thank you again for joining us today. We will be participating in the upcoming Wells Fargo and Morgan Stanley healthcare conferences, and we'll also host an investor update around the World Sleep Congress and hope to see many of you there. This will now end our call.

Operator

[Operator signoff]

Duration: 63 minutes

Call participants:

Kathee Littrell -- Head of Investor Relations

Bruce Cozadd -- Chief Executive Officer

Rob Iannone -- Executive Vice President, R&D

Matt Young -- Executive Vice President and Chief Financial Officer

Ami Fadia -- SVB Leerink -- Analyst

Akash Tewari -- Wolfe Research -- Analyst

Dan Swisher -- President and Chief Operating Officer

Jessica Fye -- J.P. Morgan -- Analyst

Zhu Shen -- Morgan Stanley -- Analyst

Gary Nachman -- BMO Capital Markets -- Analyst

Mike Miller -- Executive Vice President, U.S. Commercial

Umer Raffat -- Evercore ISI -- Analyst

David Maris -- Wells Fargo Securities -- Analyst

Jason Gerberry -- Bank of America Merrill Lynch -- Analyst

Randall Stanicky -- RBC Capital Markets -- Analyst

David Amsellem -- Piper Jaffray -- Analyst

Gregg Gilbert -- SunTrust Robinson Humphrey -- Analyst

Allen Yang -- Senior Vice President, Clinical Development, and Acting Chief Medical Officer

Annabel Samimy -- Stifel Financial Corp. -- Analyst

Liav Abraham -- Citi -- Analyst

Esther Rajavelu -- Oppenheimer and Company -- Analyst

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