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Axsome Therapeutics, Inc. (AXSM 1.31%)
Q4Â 2019 Earnings Call
Mar 12, 2020, 8:00 a.m. ET
Contents:
- Prepared Remarks
- Questions and Answers
- Call Participants
Prepared Remarks:
Operator
Good morning, ladies and gentlemen, and welcome to the Axsome Therapeutics Conference Call. Currently, all participants are in a listen-only mode. Later, there will be a question-and-answer session and instructions will be followed at that time. As a reminder, today's conference call is being recorded. I would now like to turn the conference over to your host, Mark Jacobson, Chief Operating Officer at Axsome Therapeutics. Please go ahead.
Mark Jacobson -- Senior Vice President, Operations
Thank you, operator. Good morning and thank you all for joining us on today's conference call. Our earnings press release providing a corporate update and details of the Company's financial results for the fourth quarter and full-year ended December 31, 2019 crossed the wire a short time ago and is available on our website at axsome.com.
During today's call, we will be making certain forward-looking statements. These statements may include statements regarding, among other things, the efficacy, safety, and intended utilization of our investigational agents, our clinical and non-clinical plans, our plans to present or report additional data, the anticipated conduct in the source of future clinical trials, regulatory plans, future research and development, and possible intended use of cash and investments. These forward-looking statements are based on current information, assumptions, and expectations that are subject to change and involve risks and uncertainties that may cause actual results to differ materially from those contained in the forward-looking statements. These and other risks are described in our periodic filings made with the Securities and Exchange Commission, including our quarterly and annual reports. You are cautioned not to place undue weight on these forward-looking statements and the Company disclaims any obligation to update such statements.
Joining me on the call today are Dr. Herriot Tabuteau, Chief Executive Officer; Dr. Cedric O'Gorman, Senior Vice President of Clinical Development and Medical Affairs; Dave Marek, Chief Commercial Officer; and Nick Pizzie, Chief Financial Officer. Herriot will first provide a review of significant corporate and clinical developments for Axsome over the course of the past year and describe upcoming milestones. Following that, Nick will review our financial results. We will then open the line for questions. I shall now turn over the call to Herriot.
Herriot Tabuteau -- Chief Executive Officer
Thank you, Mark. Good morning everyone and thank you all for joining Axsome Therapeutics fourth quarter and full-year 2019 results conference call. 2019 was a transformative year for Axsome, as we generated important clinical data for all of our investigational medicines, which we are developing for serious and difficult-to-treat CNS disorders. The many important achievements of 2019 included positive NDA-enabling clinical trial readouts for AXS-05 in depression and for AXS-07 in migraine, propelling Axsome potentially toward commercial stage as early as next year. In addition, our AXS-12 product candidate for narcolepsy is progressing to Phase 3 based on positive Phase 2 results. And through our collaboration with Pfizer early this year, we expanded our Phase 3 pipeline with the addition of AXS-14 for the treatment of fibromyalgia.
All in all, we now have four differentiated CNS product candidates in clinical development, all of which have demonstrated efficacy in controlled trials, two of which are pre-NDA, with the other two entering or having completed Phase 3 trials. These product candidates provide new mechanisms of action and potentially faster, greater, and broader efficacy as compared to currently available treatments. Our investigational medicines, therefore, have the potential to change the current standard of care for difficult-to-treat brain disorders and transform the lives of patients living with these conditions.
We expect 2020 to be a year of continued operational, clinical, and regulatory progress. Preparations are under way for our planned NDA filing of AXS-05 in the treatment of major depressive disorder or MDD. AXS-05 has the potential to be the first and only oral NMDA receptor antagonist with multimodal activity for the treatment of depression. In December, we announced positive results from the Phase 3 GEMINI trial of AXS-05 in patients with confirmed moderate-to-severe MDD. In this study, AXS-05 met the primary endpoint by rapidly, substantially, and statistically significantly improving symptoms of depression, as compared to placebo. The positive results from the GEMINI trial, along with the previously completed ASCEND trial of AXS-05 in MDD, support an NDA filing for AXS-05 in the treatment of MDD, and we are on track to file this NDA in the fourth quarter of 2020. AXS-05 has been granted breakthrough therapy designation for the treatment of MDD.
Preparations are also under way for our planned NDA filing of AXS-07 in the acute treatment of migraine. AXS-07's multi-mechanistic approach is designed to provide enhanced efficacy as compared to currently available treatments. In December, we announced positive results from the Phase 3 MOMENTUM trial of AXS-07 in migraine patients with a history of inadequate response to prior acute treatments. In this study, AXS-07 met the co-primary and key secondary endpoints by significantly relieving migraine pain as compared to placebo. And, as compared to the active comparator, rizatriptan, the positive results from the MOMENTUM trial support an NDA filing for AXS-07 in the acute treatment of migraine and we remain on track to file this NDA in the second half of 2020.
With these two planned NDA filings, Axsome is on track to transition to commercial stage potentially as early as next year. And to that end, we have been building out our commercial capabilities. In December, we also announced positive topline results from Phase 2 CONCERT trial of AXS-12 in the treatment of narcolepsy. In this study, AXS-12 significantly reduced cataplexy attacks and excessive daytime sleepiness and improved cognitive function, sleep quality, and sleep-related symptoms. These results point to a differentiated clinical profile for AXS-12 with the potential to address all the key symptoms of narcolepsy. Based on these positive results, AXS-12 is scheduled to enter Phase 3 clinical trials in narcolepsy in the second half of this year.
We expect the development of AXS-12 to accelerate as a result of our agreement with Pfizer, which we announced in January. This agreement covers an exclusive U.S. license to Pfizer's clinical and non-clinical data and intellectual property for reboxetine, the active pharmaceutical ingredient in AXS-12. This agreement also expands our late-stage CNS pipeline by providing us exclusive rights to develop and commercialize a new product candidate, esreboxetine or AXS-14, in the U.S. for the treatment of fibromyalgia. AXS-14 has previously demonstrated positive and statistically significant results in a Phase 3 and in a Phase 2 trial in the treatment of fibromyalgia. In addition to its effects on pain and function, AXS-14 demonstrated in both of these studies an effect on fatigue, a difficult-to-treat symptom of this condition. Axsome plans to meet with the FDA this year to discuss the further clinical development of AXS-14 for fibromyalgia.
Turning now to our ongoing efficacy trials. We recently completed randomization into our STRIDE-1 trial of AXS-05 in treatment resistant depression and into our INTERCEPT trial of AXS-07 in the early treatment of migraine. We remain on track for topline results from both of these trials before the end of this month. Our ADVANCE-1 Phase 2/3 trial of AXS-05 in the treatment of agitation associated with Alzheimer's disease is now more than 80% enrolled, and based on this trend, we expect topline results from this trial in the third quarter.
In summary, over the balance of the year, we look forward to several important milestones, including the NDA filings for AXS-05 in MDD and AXS-07 in migraine anticipated in the fourth quarter, topline results from the STRIDE-1 trial of AXS-05 in TRD and the INTERCEPT trial of AXS-07 in migraine this quarter, topline results from the ADVANCE-1 trial of AXS-05 in Alzheimer's disease agitation in the third quarter, and initiation of Phase 3 trials of AXS-12 in narcolepsy in the second half of this year.
I would also like to recognize and congratulate Mark Jacobson on his recent appointment to Chief Operating Officer. Mark has been a valued member of the Axsome team since 2014 and served as Senior Vice President of Operations since 2017.
I will now turn the call over to Nick to provide financial update for full year of 2019.
Nick Pizzie -- Chief Financial Officer
Thank you, Herriot, and good morning, everyone. I will focus on key highlights in the quarter and provide some financial guidance. R&D expenses were $19.2 million for the quarter-ended December 31, 2019 versus $7.2 million for the comparable period in 2018. This increase was due to a significant number of new clinical trials that were conducted during the quarter as compared to the prior period, including the CONCERT, GEMINI, MOMENTUM, and INTERCEPT trials, along with the AXS-05 and AXS-07 open-label safety studies in addition to the ongoing progress of the STRIDE-1 and ADVANCE-1 trials. G&A expenses were $5.2 million for the quarter-ended December 31, 2019 and $2.3 million for the comparable period in 2018. The change was primarily due to personnel costs, mainly from higher stock compensation expense, along with the build-out of the commercial functions.
In December, we completed an underwritten public offering that yielded aggregate gross proceeds before deducting offering expenses of approximately $200 million. SVB Leerink and Morgan Stanley acted as joint bookrunning managers for the offering. As a result, we ended the fourth quarter with $220 million in cash, compared with $44 million at the end of the third quarter. We believe that our current cash position will be sufficient to fund our anticipated operations based on our current operating plan for at least two years. That concludes our fourth quarter 2019 financial review.
I will now turn the call back to Mark to lead the Q&A discussion.
Mark Jacobson -- Senior Vice President, Operations
Thank you, Nick. Operator, may we please have our first question.
Questions and Answers:
Operator
[Operator Instructions] Your first question comes from the line of Charles Duncan with Cantor Fitzgerald. Please go ahead.
Charles Duncan -- Cantor Fitzgerald -- Analyst
Good morning, Herriot and team. Congratulations on a very good year and last year and what could prove to be a very interesting one this year. I wanted to ask you just a couple of quick questions on the pipeline and then maybe one on commercial build. For AXS-05, relative to the upcoming TRD results, I guess I'm wondering what you're thinking about the different scenarios that could be and the impact on the regulatory and/or commercial strategy for AXS-05. Can you lay out a couple of scenarios of either the drug clearly working, the drug may be working, or the drug not working in TRD?
Herriot Tabuteau -- Chief Executive Officer
Thank you, Charles. With regards to TRD, what's nice about that study is that it is targeting a patient population, which is in great clinical need. What's nice about our regulatory strategy and our commercial strategy is that we have now demonstrated positive efficacy results in the treatment of MDD with very differentiated product profile and we're very much on track to filing our NDA and our commercial prep is also under way, assuming that the product gets approved for MDD. If TRD -- if the TRD trial is positive or if it's negative or if it's mixed, it will not have any impact on our filing strategy. However, should the study be positive, it would be included in our NDA package and we believe that it would be included in the clinical trial section of the package insert. It would not change the indication for the product, the indication would still be MDD.
In order to get a formal label for treatment resistant depression, we -- it is our understanding that the FDA would require a second trial in TRD. Importantly, as we said before, that study could be a placebo-controlled trial. So, under the various scenarios, assuming that that the study is positive or if it's negative or if it's somewhere in the middle, I think we're very well positioned. We will not speculate on what the results could be, but we certainly have scenarios planned internally and we're very much looking forward to the readout before the end of the month.
From a commercial perspective -- yeah, and just from a commercial perspective, I'll turn it over to Dave.
David Marek -- Chief Commercial Officer
Good morning, Charles. Thank you for the question. As we think about the commercial build-out relative to TRD, as we've talked to physicians, the good news is that with MDD, we have the broader indication that already gives us access to a broad range of patients with MDD, and when we talked to physicians, given the clinical data that we've already produced, there is quite a high degree of enthusiasm toward AXS-05 already. So the question is, well, if we have positive results with TRD, how does that change and I think the single greatest factor that we've seen in terms of talking with clinicians is it increases their enthusiasm for the patients that they would view for -- appropriate for AXS-05.
So, if you look at that, there is already a tremendous degree of enthusiasm for MDD in general and this would even further strengthen their conviction around either more patients or perhaps deepening their -- the range of patients that they would consider appropriate for AXS-05.
Charles Duncan -- Cantor Fitzgerald -- Analyst
Yeah, that's helpful. That's actually consistent with our KOL diligence as well. So it doesn't seem like TRD is needed and it's nice to have. Moving on just to -- quickly to 07, I think Herriot, you mentioned 2H '20 for an NDA filing and I read in the press release and it was 4Q. So, is that just a slip or is it possible that the NDA filing for AXS-07 could actually come yet in the third quarter?
Herriot Tabuteau -- Chief Executive Officer
It is possible that it comes in the third quarter, but our formal guidance is the fourth quarter though, and the gating factor to the NDA filing is our safety database, which leads to include 100 patients treated for one year, and that we do have an open-label safety extension trial ongoing. And so, we will need to anniversary that 100th patient at the one-year point in order to file the NDA.
Charles Duncan -- Cantor Fitzgerald -- Analyst
Okay. Final question, commercial capabilities, you say, have been built. I guess, instead of what you've been doing, maybe what you will do in terms of sizing and timing, do you have any thoughts, and really the size of the field force that you'll need to amount to effectively market these two drugs in somewhat different although somewhat the same markets for prescribers?
Herriot Tabuteau -- Chief Executive Officer
Yeah, regarding the commercial build-out, you're absolutely correct, when we think about building out our commercial team, we have a solid foundation now and we want to make sure that we're adding the appropriate resources kind of at the appropriate stage as we march toward potential launches coming. When we think of field force, the benefit of clarity around both having MDD and migraine allows us to think in a highly efficient way, as you mentioned, around our prescriber base, and we have been looking at a variety of scenarios in terms of field force sizing, structure, etc. I think one of the kind of tenets that we've been using is how do we make sure that we have a very efficient launch where we're looking at using data and analytics in a very contemporary way to ensure that we are targeting those prescribers who have the highest willingness to prescribe and also ability to prescribe, given what we believe the payer environment could be.
And so, you could envision a very efficient and targeted launch with the ability to scale very quickly as prescriber adoption and access open up, we would be ready to scale very quickly. So think of an efficient sales force presence at the beginning and one that could scale very quickly.
Charles Duncan -- Cantor Fitzgerald -- Analyst
It sounds like more on that later on this year or into next year as we get closer with the NDA filings?
Herriot Tabuteau -- Chief Executive Officer
Yeah, correct. I mean, if you think about build force being hired about six months in advance, we want to keep our options activity active as we approach that time period and make sure that we're looking at the latest data, the latest analytics and that will help us solidify our final sales force size and structure as we get a little closer to launch.
Charles Duncan -- Cantor Fitzgerald -- Analyst
Sounds good. Thank you for taking my questions.
Herriot Tabuteau -- Chief Executive Officer
Thank you.
Operator
Your next question comes from the line of Ram Selvaraju with HC. Please go ahead.
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Thanks very much for taking my questions. I was wondering, if -- maybe we could start with the narcolepsy program. Can you give us a sense of how large the scope of the clinical trial program is going to be in the pivotal setting, if you have a sense of that at this juncture, and whether you expect to seek an SPA from the FDA regarding this?
And then also on esreboxetine, I was wondering whether you have at this point a sense of whether the discussions with the FDA are going to center around the possibility of being able to file with the data that Pfizer has already generated or if they are going to center around the need for additional clinical development work of the pivotal setting before you are able to potentially submit an application for that product candidate in fibromyalgia?
Herriot Tabuteau -- Chief Executive Officer
Thanks, Ram, for the question. With regards to narcolepsy, we have gotten feedback already in -- from our initial interactions with the FDA with regards to the Phase 3 plan. And, before we actually launch that Phase 3 trial, actually we're thinking two Phase 3 trials for Narcolepsy, we wanted to refine those plans and make sure that that the FDA's thinking has not changed. So stay tuned with regards to that. What I would say is, if you look at the result of our clinical trial, the results did reflect the pretty large treatment difference even with approximately or the equivalent of 20 patients per arm, assuming that this had been a parallel designing trial.
With regards to what has been sized in previous trials for registration in cataplexy, for example, those studies in the past have been in the range of around 30 patients to 40 patients per treatment arm. So that gives you a sense for excess of daytime sleepiness. The numbers do go up from there in order to adequately power studies. But we will be coming back to you as we finalize the Phase 3 trial designs before we launch those studies.
With regards to esreboxetine, as I mentioned, we do intend to meet with the FDA to discuss the clinical development plan. For esreboxetine going forward, we think this is a very differentiated product candidate, especially with regards to the breadth of symptoms of fibromyalgia that it can treat. As a reminder, there are only three products that are currently approved to treat fibromyalgia in the U.S.
So, we're looking forward to those discussions. Obviously, as part of those discussions, we will like to understand the FDA's view of the data that has been generated to-date and the appropriateness of those clinical trials potentially for registration. Certainly, that will be an important point of discussion at least as it relates to any further clinical trials that we may have to conduct.
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Okay, thanks for that clarity. And then I wanted to ask a question regarding AXS-05 for the ADVANCE-1 target indication. So, I was hoping you could maybe comment on perspectives regarding what the path forward would be for AXS-05 assuming ADVANCE-1 is positive?
Herriot Tabuteau -- Chief Executive Officer
Assuming ADVANCE-1 generates positive results, the assumption -- our working assumption is that we would need one additional trial -- one additional efficacy trial in Alzheimer's disease agitation. As a reminder, this is an area of high unmet medical need. There currently is no product that is approved to treat Alzheimer's disease agitation. We're happy with the progress of the clinical trial thus far, and this is a pivotal trial, and so it would make sense, obviously that we would need an extra trial in order to get the product approved. That has also been the feedback from the FDA. So, that is our working assumption.
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Okay. And then just a couple of other very quick ones. I remember that at one point, you were talking about the possibility of monetizing some of the intellectual property that Axsome holds in the area of, I believe, it was complex regional pain syndrome. Is there any update on that or any way in which you see that situation evolving in the near term?
Herriot Tabuteau -- Chief Executive Officer
You are correct that we do have other assets, which are not core assets. So our core focus right now is our CNS pipeline, which consists of four product candidates in active clinical development, and these other assets, we're pretty excited about, and we think that they are potential sources of non-dilutive funding and so those have been placed into a separate business unit. We took in order to facilitate business development negotiations. We currently do not have any immediate update on that business unit. However, as things progress, if there is anything worth updating you on, we certainly will.
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Okay, perfect. And then this is just a question for David, I was wondering if at this juncture since a lot of the clinical efficacy data for AXS-05 and indeed also 07 is out there, if you are receiving inbound interest from people who might potentially become part of the sales and marketing team at Axsome, and if you could perhaps comment just qualitatively on the caliber of these people, potentially some of their background in promoting drugs in the CNS and neuropsychiatric spaces and to what extent this potentially gives you confidence that you can establish a sales and marketing team that would be best of breed, as it were in the industry as and when 05 and 07 are approved.
David Marek -- Chief Commercial Officer
Well, thank you, Ram. I think you're exactly right that as more and more information comes out and not only regarding those programs, but the company itself and there are a couple of things that I think get people really excited. If you have been in the depression space or the migraine space and you're watching what's happening in terms of the evolution of new potential therapies, there are a lot of commercial people out there who are just as excited as our prescribers are around the potential of what we can do in the marketplace and how we can serve patients.
Also, I think there are commercial individuals, who are very excited about the idea of a highly efficient and contemporary launch. And so, we kind of disproportionately attract those types of talents, whether that's within the marketing function, or the data and analytics function. So, we feel very good about the type of interest that we're receiving unsolicited, but also through contacts and relationships that we have in the industry, we feel very, very confident that we're going to be able to field a very strong sales force as well as other commercial talent.
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Great. Thank you very much.
Herriot Tabuteau -- Chief Executive Officer
Thank you.
Operator
Your next question comes from the line of Yatin Suneja with Guggenheim Partners. Please go ahead.
Yatin Suneja -- Guggenheim Partners -- Analyst
Hey, guys. Thank you for taking my question, and Mark, congrats on the new role. Just a couple of question on a few things. I mean, we will start with TRD first. Can you talk a little bit about how you are qualifying a non-responder in the STRIDE study? And then, in terms of the dose that you might be using in the open-label phase and the randomized phase, is there a reason to believe that you might be using a different dose in the open-label versus the randomized phase? And I have two follow-ups.
Herriot Tabuteau -- Chief Executive Officer
Thanks, Yatin, for the question and I'll turn it over to Cedric to answer that.
Cedric O'Gorman -- Senior Vice President, Clinical Development and Medical Affairs
Yeah, thanks. So first of all, with regard to treatment resistant depression and the -- I think it was definition of treatment resistant depression that you had asked about...
Herriot Tabuteau -- Chief Executive Officer
Non-responder.
Cedric O'Gorman -- Senior Vice President, Clinical Development and Medical Affairs
Non-responder, right. So, there is a standard approach that, just as a reminder, within the open-label period, the patients being treated with bupropion and if they fail to respond, they're randomized. Now, with regards to both the dosing and the criteria by which we measure response or non-response, the start that we disclose that once we have topline data, which will be before -- just before the end of the month. So we're on track for that.
Yatin Suneja -- Guggenheim Partners -- Analyst
Okay, understand. And then in terms of the -- again, on the dose, like, have you manufactured your own dose to use in this study for bupropion? Or are you using a commercially available? Because I remember in the ASCEND study, the dose that you have used is not commercially available. So you had to make your dose. So help us understand the situation here?
And then moving to the agitation side, can you maybe comment what was the reason for delay? Why it got postponed [Phonetic] from first half to Q3? Thank you.
Herriot Tabuteau -- Chief Executive Officer
So, Yatin, thanks for all the additional questions. With regards to drug product, which is used in the clinical trials, as a reminder, clinical trials do require that products be blinded. And so, therefore, the drug product for the various arms and in the various treatment periods have to be made that they match in appearance. With regards to our Alzheimer's disease agitation and our updated guidance, so our previous guidance was the first half of this year and we had talked about roughly mid-year. That has not changed significantly. What we wanted to do was to build-in some potential buffer. As you know, there are some external factors and not to talk too much about the impact of the coronavirus, but it is something that we do have to be mindful of given that Alzheimer's disease agitation is targeting a patient population, which is elderly. Right now, we've not seen any impact, but we do think that it's -- it is prudent to, in our range of guidance, make sure that we take into account any potential eventualities.
Yatin Suneja -- Guggenheim Partners -- Analyst
Got it. And thank you, I'll get back in the queue.
Operator
Your next question comes from the line of Marc Goodman with SVB. Please go ahead.
Marc Goodman -- SVB Leerink -- Analyst
Yes, good morning. Dave, I was wondering if you could talk about the migraine space a little bit. Obviously, a crowded market with some new players coming in, one that's already launched and doing pretty well. Talk about how you view the market, how that's changed, and how you're thinking about differentiating your product when it comes out.
David Marek -- Chief Commercial Officer
Yeah. Good morning, Marc. Thank you. Well, I think when we look at the migraine market, it's -- for those of us who have been associated with the migraine market for many years, it couldn't be a more exciting time and that's really good for clinicians and it's good for patients. So, certainly we have long wanted to have more options to provide for patients and really help them better manage migraine. When you look at the frustration in the marketplace, the first place we go to, and I say this often, is to really clarify what do we solving for in terms of the frustration or the unmet need in the marketplace. When we talk to clinicians and patients consistently in the acute therapy setting, what physicians and patients are frustrated by is just pure efficacy. While there are a variety of needs out there, the one that rises to the top, and in our research, it was eight out of 10 physicians prioritize improved efficacy was their greatest unmet need.
And so, we've built a clinical program around solving that issue of how can we improve efficacy. And I'm really proud of the clinical program we put together, because I think with MOMENTUM, it really focused on answering the question that a clinician faces every single day. So, you start with who is the right patient population with the greatest unmet need and those are those who have failed at least one prior therapy, and those are the types of patients that we enrolled in MOMENTUM, those that were treatment experience and had a prior suboptimal response to their acute therapy. And again, those are the patients that physicians tell us that they are dealing with day in and day out.
And then we took the next step and said, OK, well, what are their treatment options and what would they be faced with. And in MOMENTUM, we went head-to-head against rizatriptan, which is largely viewed as one of the most effective treatment options out there, certainly one of the most effective triptans. And by showing superiority, we think that we've really helped clinicians understand for their most difficult patients where we have the next best step. And those are the data that we think will be highly differentiating in the marketplace. The right patient that they're dealing with, with the right clinical data that allows them to make a treatment decision that we think can deliver better efficacy, which is what the marketplace is looking for. And I think that's really the core of our differentiation and why we think there is tremendous enthusiasm for AXS-07.
And you may recall, in our MINDSET survey, we asked migraine treating physicians their degree of enthusiasm toward AXS-07, should we be superior to rizatriptan and I think we've talked about those results, where the vast majority of physicians say they would prescribe AXS-07 over currently available treatments but also over the emerging treatments as well. So, we see a very strong commercial opportunity to benefit patients with AXS-07.
Marc Goodman -- SVB Leerink -- Analyst
And how does the INTERCEPT study play into it?
David Marek -- Chief Commercial Officer
Well, I think what INTERCEPT does is it helps inform and provides a greater foundation for how they treat and direct patients in the real world setting. We know in the typical clinical trials, we need patients to wait until their pain is moderate to severe and those data are very helpful for registration processes and etc. When we look at how clinicians typically tell their patients to administer their acute therapy, they say take it at the first sign of migraine pain. And so we think that INTERCEPT will provide kind of the real world setting information for how we think this product will perform in a manner that they will likely instruct patients to administer. So we think it's additional information that's not required for the NDA filing, but will be important in the setting as we educate physicians around the utility of AXS-07.
Marc Goodman -- SVB Leerink -- Analyst
And last question, as you're thinking about the sales force, is it going to be one sales force that sells both products, the depression product and this one? Will it be two separate ones? How much overlap is there?
David Marek -- Chief Commercial Officer
Well, as mentioned earlier, we will still look at options around looking at both migraine and depression and how we -- the size and structure of that deal for us. So, while we have a variety of options, we haven't landed specifically. We'll do more work around that. I will say though we will look for efficiencies across promoting both migraine and depression. There is some overlap in -- mainly in the primary care setting as you can imagine with some physicians who are high prescribers of both and we would certainly take advantage of that synergy, the degree to which we're still evaluating as we look at our options. So, we haven't landed on one field force or two, but what we will do is as we make that decision, look for the greatest efficiencies that we can lean.
Marc Goodman -- SVB Leerink -- Analyst
Thanks.
Operator
Your next question comes from the line of Matt Kaplan with Ladenburg. Please go ahead.
Matt Kaplan -- Ladenburg Thalmann -- Analyst
Hi, good morning, guys. Congrats on the progress. Just wanted to zero-in a little bit more on STRIDE-1, given the near-term readout of results you expect there. So, can you please remind us of the sizing and the powering of the study? I guess, given the fact that you continued enrollment to build your safety database, can you give us a sense of that?
Herriot Tabuteau -- Chief Executive Officer
Good morning, Matt, and thanks for the question. So, in terms of sizing, the last update that we gave was that the study had randomized approximately 300 patients. That was at the end of November. And so the final number will be north of 300. In terms of the powering of the trial, the study was powered at the 90% level to detect and effect size of somewhere between 0.3 and 0.35, which is in line with the effect sizes of antidepressants that have been shown to work and they have been currently approved.
Matt Kaplan -- Ladenburg Thalmann -- Analyst
Great, thank you. And then in terms of the open-label extension study for 05 that's enrolling both MDD and TRD patients, how is that progressing, and can you give us an update in terms of how many patients you expect in -- ultimately in the open-label extension?
Herriot Tabuteau -- Chief Executive Officer
That study is progressing well. As you know, that is a gating factor to us filing an NDA. We do need to build a safety database of 300 patients treated for six months and 100 patients treated for one year and we're on track to do that. So we're pretty happy with the way that that is currently enrolling. It is enrolling at a pace that will allow us to meet our guidance of filing an NDA before the end of the year.
Matt Kaplan -- Ladenburg Thalmann -- Analyst
Okay, thank you. And I guess just going back to following up on the questions that we had on excess on AXS-14, esreboxetine for fibromyalgia. Can you give us a sense in terms of the potential regulatory path forward for esreboxetine of fibromyalgia?
Herriot Tabuteau -- Chief Executive Officer
So, we first want to meet with the FDA. As a reminder though, esreboxetine has completed two efficacy trials of significant size. One was a Phase 3 trial, which enrolled and randomized over 1,000 patients. That study was positive. And there was also a Phase 2 trial, which was also positive. Both of these studies were randomized, double-blind, placebo-controlled trials. And so, we certainly will want to get the FDA's feedback on those clinical studies. Those studies were run by Pfizer. So we want to make sure that that we get feedback from the FDA in terms of what else would be required in order to file an NDA. We will not speculate on what those requirements could be and -- until we meet with the agency.
Matt Kaplan -- Ladenburg Thalmann -- Analyst
Great. Very helpful, thank you, and good luck going forward.
Operator
Your next question comes from the line of Bert Hazlett with BTIG. Please go ahead.
Robert Hazlett -- BTIG -- Analyst
Thank you. I just have a couple of quick ones. Just what -- you have a lot on your plate with a number of different indications. Where does AXS-05 smoking cessation indication sit and in terms of urgency and in terms of corporate priorities? Thanks.
Herriot Tabuteau -- Chief Executive Officer
Thanks for the question. So, you are correct that AXS-05 does have a number of potential indications and we do have a lot on our plate. So, one of the challenges that we're facing and that we're keeping in mind is the need to focus, while at the same time, avail ourselves of the various opportunities in the pipeline. So, our priorities clearly this year are to make sure that we file our NDAs in a timely manner and also those filings are of significant quality. So that is our top priority, which is our NDA filings.
And then beyond that is advancing our product candidate in narcolepsy into Phase 3 based upon very positive Phase 2 data. So, I'd say that's priority number two. And then, of course, getting FDA feedback on AXS-14, given the very positive efficacy results there. And then we absolutely will be meeting with the FDA this year with regards to smoking cessation to delineate a path forward there and understand what the clinical development -- what the further clinical development for that indication will look like.
Robert Hazlett -- BTIG -- Analyst
Okay, thank you. Could you just remind us of the CMC progress or characteristics or status of 05 at this point?
Herriot Tabuteau -- Chief Executive Officer
The clinical trial material for AXS-05 -- for our AXS-05 trials have been made at commercial scale. So, we're in very good shape there and they've also been made at the -- they've also been made at the -- a contract manufacturer that will be manufacturing the commercial supply. They're all registration batches, which must be made, specifically for the purpose of submitting an NDA. And so, that work is under way.
Robert Hazlett -- BTIG -- Analyst
Okay. Thank you. And then just one on migraine, does it make sense to have a study in combination with a long-acting CGRP and with acute migraine therapeutics such as you have with 07? Does that make any sense commercially at all?
Herriot Tabuteau -- Chief Executive Officer
We certainly don't see any reason why AXS-07 could not be administered with other types of therapies. Right now, we're focusing on getting the product approved, and it will be interesting to see how clinicians eventually choose to use it as part of their armamentarium.
Robert Hazlett -- BTIG -- Analyst
Okay, thanks. That's all for me. Thank you very much.
Operator
Your next question comes from the line of Myles Minter with William Blair. Please go ahead.
Myles Minter -- William Blair -- Analyst
Hi, guys, thanks for taking the questions, and congrats, Mark, on the new position at the Company. Just the first question is on ADVANCE. 80% enrolled pushed the guidance slightly out to third quarter. I'm wondering whether you're proactively cautioning physicians to enroll new patients into that trial currently, given the unfortunate risk with COVID-19 at the moment and that highly susceptible population. And also, you mentioned 80% enrollment, I'm wondering what proportion of patients who are enrolled in that trial at the December 2018 timeline, where you discontinued enrollment into the bupropion alone arm?
Herriot Tabuteau -- Chief Executive Officer
So thanks for the questions, Myles. The -- with regards to cautioning physicians around enrollment into the trial, I mean, we're not currently doing that, but what we are doing is monitoring very closely from the clinical trial sites any information that they have, any concerns that they might have with regards to enrollment. Currently, we're not hearing anything that is of concern, but it is the situation that we're monitoring pretty closely. And with regards to the percentage of patients at the time of the interim analysis, at that -- the interim analysis, as a reminder, was conducted at the 30% enrollment point. So that should allow you to get a sense of what the subsequent enrollment was after that. So, it was enrolled -- so 30% enrollment point and remember the size of the trial was 435 subjects total.
Myles Minter -- William Blair -- Analyst
That's helpful. Thanks for that. And then maybe a question for Dave, just some KOL diligence we have been doing suggest that relation specialist centers, they've started using SSRIs and rather than waiting for four, six to eight weeks for a response, they're trying to say an early response at two weeks with those drugs, maybe 20% improvement to predict whether those patients are truly going to have a response later down the track. Just looking at the data from GEMINI and ASCEND and the early rapidity of response, I'm wondering in your conversations with clinicians, both in specialty centers and in PCPs, whether a focus on their behalf is actually on the rapidity of effects and maybe not so much focused on MADRS, but maybe on some of those patient quality of life questionnaires, which are more routinely used in the clinic. What are you hearing from the community? What are they most excited about this product? Cheers.
David Marek -- Chief Commercial Officer
Yeah. Good morning, Myles. Thank you for the question. We are hearing some of the same in our research around what physicians are looking for. And when we put the current data that we have for 05 in front of specialists, one of the things that really -- that they light up about is really around the rapidity of effect, but also what they get excited about is kind of the reason to believe that. And when you look at the NMDA plus multimodal activity, they're really hungry for a different pathway that kind of get them off the merry-go-round of the SSRIs, SNRIs and they're looking for another pathway and one that would be potentially delivered in a very patient friendly way.
So that gives them reason to really sit up and look at our data, and then when they see the rapidity of effect and the robust nature of effect, that's where they start to look at this as certainly for patients that they've struggled with who are treatment experienced but also they start to move up very quickly earlier to think about patients where they would want that rapidity of effect and moving it up earlier as kind of foundational therapy.
So we're very excited about the response we're getting from the clinical profile. We think the more there is focus on rapidity of effect is good for clinicians and it's very good for patients and we think that we're going to be able to fit nicely in that unmet need.
Myles Minter -- William Blair -- Analyst
So just a follow-up, does that logic change between specialist centers that are most likely monitoring their patients consistently over that early treatment period versus a PCP that might just prescribe and then come back six weeks later and not actually monitor that patient's response early on?
David Marek -- Chief Commercial Officer
Yeah, I mean, I don't have the data to answer that question, but intuitively, I think it makes sense that those centers who are very actively monitoring rapidity effect and the types of patients that they may be seeing could be very different in terms of sense of urgency that we might see in the -- with primary care specialists out in the field. I think the desire is the same that everybody wants their patients to get better sooner, but I think the adoption curve could be different across those two areas of treatment.
Myles Minter -- William Blair -- Analyst
Fair enough. Thanks for the questions and congrats on the year.
David Marek -- Chief Commercial Officer
Thank you, Myles.
Operator
There are no further questions at this time. I will turn the call back over to the presenters for closing remarks.
Herriot Tabuteau -- Chief Executive Officer
Well, thank you all for joining us on the call today. Axsome is committed to accelerating the invention, development, and adoption of life-changing medicines for many people facing unsatisfactory treatments for CNS diseases. We anticipate a number of important milestones over the balance of the year and we look forward to updating you on our progress.
Operator
[Operator Closing Remarks]
Duration: 53 minutes
Call participants:
Mark Jacobson -- Senior Vice President, Operations
Herriot Tabuteau -- Chief Executive Officer
Nick Pizzie -- Chief Financial Officer
David Marek -- Chief Commercial Officer
Cedric O'Gorman -- Senior Vice President, Clinical Development and Medical Affairs
Charles Duncan -- Cantor Fitzgerald -- Analyst
Raghuram Selvaraju -- H.C. Wainwright -- Analyst
Yatin Suneja -- Guggenheim Partners -- Analyst
Marc Goodman -- SVB Leerink -- Analyst
Matt Kaplan -- Ladenburg Thalmann -- Analyst
Robert Hazlett -- BTIG -- Analyst
Myles Minter -- William Blair -- Analyst
