Aquestive Therapeutics, Inc. (AQST) Q1 2021 Earnings Call Transcript

Aquestive Therapeutics, Inc. (AQST 6.11%)
Q1 2021 Earnings Call
May 05, 2021, 8:00 a.m. ET

Contents:

• Prepared Remarks
• Questions and Answers
• Call Participants

Prepared Remarks:

Operator

Good morning, and welcome to Aquestive Therapeutics first-quarter 2021 conference call. [Operator instructions] As a reminder, this call will be recorded. I would now like to introduce your host for today's conference call, Ms. Stephanie Carrington of Westwicke Investor Relations.

Please begin.

Stephanie Carrington -- Investor Relations

Thank you, operator. Good morning, and welcome to today's call. On today's call I am joined by Keith Kendall, president and chief executive officer; and Ernie Toth, interim chief financial officer, who are going to provide an overview of recent business developments and performance in the first quarter of 2021, followed by a Q&A session. In total, we expect today's call to last approximately 60 minutes.

As a reminder, the company's remarks today correspond with the earnings release that was issued after market closed yesterday. In addition, a recording of today's call will be made available on Aquestive's website within the Investors section shortly following the conclusion of this call. To remind you, the Aquestive team will be discussing some non-GAAP financial measures this morning as part of its review of first-quarter 2021 results. A description of these measures along with a reconciliation to GAAP can be found in the earnings release issued yesterday, which is posted on the Investors section of Aquestive's website.

During the call, the company will be making forward-looking statements. We remind you of the company's safe harbor language as outlined in yesterday's earnings release, as well as the risks and uncertainties affecting the company are described in the Risk Factors section included in the company's annual report on Form 10-K filed with the SEC on March 10, 2021. As with any pharmaceutical company, the product candidates under development and products being commercialized, there are significant risks and uncertainties with respect to the company's business and the development, regulatory approval, and commercialization of its products and other matters related to operations. The impact of the ongoing COVID-19 pandemic is highly uncertain and cannot be predicted with certainty or clarity.

Given these uncertainties, you should not place undue reliance on these forward-looking statements, which speak only as of the date made. Actual results may differ materially from these statements. All forward-looking statements attributable to Aquestive or any person acting on its behalf are expressly qualified in their entirety by this cautionary statement and the cautionary statements contained in the earnings release issued yesterday. The company assumes no obligation to update its forward-looking statements after the date of this conference call, whether a result of new information, future events, or otherwise, except as required under applicable law.

With that, I'll now turn the line over to Keith.

Keith Kendall -- President and Chief Executive Officer

Thank you, Stephanie. And thank you to everyone on the call for joining us this morning. In our remarks today, Ernie and I will be discussing recent developments in our business during the first quarter of 2021 and through April. As always, Ernie and I will be joined by additional members of the Aquestive leadership team during the Q&A session afterward.

Through this period we were able to execute on our key priorities and delivered a number of key milestones that we'll talk about this morning. First and foremost, we continue to focus on building our CNS franchise. Our team is focused on preparing the resubmission of our new drug application for Libervant. After receiving guidance from the FDA on its expectations for information and supporting analysis relating to the pharmacokinetic modeling and simulations included in our prior submission to the agency in December 2020, we're completing the necessary analysis of the existing clinical data in response to the FDA's feedback.

We're developing Libervant as an alternative to more invasive, inconvenient, and difficult-to-administer device-driven products, including a rectal gel for patients with refractory epilepsy. As a result of these issues, a large portion of the patient population does not receive adequate treatment or foregoes treatment altogether. We continue to believe that Libervant, if approved by the FDA for U.S. market access, will enable a larger share of these patients to receive more appropriate treatment by providing consistent therapeutic dosing in a noninvasive and innovative treatment form.

As we previously communicated, we resubmitted to the FDA a revised weight-based dosing regimen, along with modeling and simulations data in December 2020 to address the issues raised by the agency in the CRL we received in September of 2020. The FDA confirmed that the issues identified in the CRL may be addressed by utilizing modeling and simulations based upon the information provided in our FDA meeting package submitted in October. In response to our December submission, the FDA provided written feedback in February that clarified the agency's expectations relating to the information to be presented in the population PK model and the safety data that should be included in the NDA resubmission. Based on the FDA's feedback, we continue to believe that no further clinical studies will be necessary for the resubmission of the NDA for Libervant.

We are on track to complete these analyses and resubmit the NDA as committed by the end of the second quarter of 2021. Once resubmitted, we anticipate a 6-month review process. We continue to expect the PDUFA action date in 2021. There have been no indications to date from the FDA relating to approval for market access, however, and we do not expect to receive any FDA guidance regarding market access prior to the PDUFA action date.

Regarding FDA approval of U.S. market access, we believe that we have provided a strong set of facts supporting a decision by the FDA of clinical superiority, prior-approved drugs for this indication based upon a finding that Libervant represents a major contribution to patient care. Once we've resubmitted the NDA for Libervant, we will reengage with the FDA and update our prior communications to demonstrate our position that Libervant as an orally delivered product meets one or more of the following criteria to be considered a major contribution to patient care. Convenience of treatment location, duration of treatment, patient comfort, reduced treatment burden, advances in ease and comfort of drug administration, and longer periods between doses.

Subject to FDA approval, we're committed to launching Libervant as soon as possible after that approval. Our next key priority is our epinephrine program. At our R&D event in March of this year, our team and two nationally recognized KOLs provided an overview of anaphylaxis, discussed the hurdles that accompany the needle-based delivery standards of care, and outline the significant market opportunity that exists for a highly differentiated formulation utilizing our PharmFilm sublingual formulation. Our R&D team provided an extensive review of our two epinephrine prodrug candidates, clinical results, and development strategy for the program.

As you may recall, our first-generation candidate, AQST-108, was granted Fast Track designation last year and was approved to use the 505(b)(2) regulatory pathway by the FDA, potentially making the clinical development trajectory faster and cheaper. Moreover, the FDA acknowledged that our sublingual film formulation of epinephrine satisfies an unmet need in the patient population relating to those patients resistant to taking intramuscular or subcutaneous injections. As such, our candidates have the potential to be the first orally administered epinephrine-based rescue medications for this patient population. We anticipate that any product candidate that we bring forward for this indication would be eligible for Fast Track designation.

At the March R&D event, our team reviewed the clinical data from the two completed phase 1 PK studies for Aquestive-108, composed of the prodrug dipivefrin. The data from the two phase 1 PK studies demonstrate that Aquestive-108 can consistently deliver epinephrine sublingually and all subjects had measurable plasma concentrations of epinephrine. The top-line data for Aquestive-108 provides further evidence that we have developed a unique technological solution that can deliver epinephrine sublingually. We have filed multiple patent applications to protect these findings, and we're excited by the possibilities this new platform presents to Aquestive.

The first-in-human PK study for our second-generation candidate, AQST-109, commenced just a few weeks ago after the trial dossier received clearance from Health Canada. We are on track to complete Part 1 of this study in the second half of 2021 and anticipate scheduling a meeting with the FDA shortly thereafter to discuss a path forward to the regulatory approval for AQST-108 and AQST-109. Finally, our first proprietary commercial product, Sympazan, continues to meet key performance metrics. Throughout the first quarter of 2021, Sympazan continued to perform and grow despite COVID-19 related restrictions on face-to-face interactions with healthcare providers.

It is worth noting that while total prescriptions nationally were down 8% in the first quarter of this year, Sympazan scripts shipped to pharmacies grew nearly 13% quarter over quarter and 40% year over year. Our continued growth in prescriptions and net revenue demonstrates our ongoing ability to continue to connect with the prescribers even virtually and grow this product. Sympazan saw continued growth in the prescriber base with over 30% penetration into the company's focused group of prescribers with approximately 80% of those prescribers writing multiple scripts. We believe our position with prescribers in the epilepsy field and payers continues to pave the way for a successful launch of Libervant if approved, given their familiarity with our PharmFilm technology and the major contribution to patient care that our products provide to epilepsy patients.

In conclusion, as we progress through the spring, we're focused on advancing our proprietary products. Our team is continuing to perform the additional analyses outlined by the FDA and actively drafting our NDA resubmission for Libervant. We expect to resubmit at the end of the second quarter of 2021 and subject to FDA approval for U.S. market access, we are committed to launch Libervant as soon as possible after approval.

We commenced the first-in-human phase 1 PK study for Aquestive-109 in April 2021. This prodrug candidate has demonstrated very compelling data for rapidly converting into systemic epinephrine in animal models. We look forward to completing the Part 1 of this study later in the year. Thereafter, we're planning for an FDA meeting in the second half of 2021 to discuss a path forward for AQST-108 and AQST-109.

And as demonstrated by our first-quarter figures, we continue to efficiently grow Sympazan shipments and revenue, as well as expanding strategic relationships across the epilepsy market in preparation of a potential Libervant launch. We look forward to continuing to update all of you as we advance these initiatives throughout 2021. With that, I'd like to turn the floor over to Ernie, who'll provide specifics of our financial performance and outlook. Ernie?

Ernie Toth -- Interim Chief Financial Officer

Thank you, Keith, and good morning, everyone. By now, you will have seen our financial results in our 10-Q and earnings release that were filed last evening. As we typically do, we will address most of the discussion related to the first-quarter 2021 results in the Q&A. We have reconfirmed our full-year 2021 financial guidance, as previously indicated in our fourth-quarter release issued during the second week of March 2021.

Overarching our 2021 strategy are some key principles that Keith outlined in his remarks, including we are focused in 2021 on our two most important value drivers: Libervant's resubmission, approval and launch, and the continued development of our epinephrine program. While we are targeting a late 2021 PDUFA date, we have included zero revenue from Libervant in our full-year 2021 guidance until we are certain of approval and launch timing. Our epinephrine program is advancing with our second prodrug, AQST-109, currently in a phase 1 PK trial. And while we do not specifically guide on Sympazan revenue, as Keith mentioned previously, our trends on wholesaler shipments to retail pharmacies and growth in new and repeat prescribers are very solid quarter over quarter.

And we anticipate continued growth into 2021. And while Suboxone is a legacy product for us, it remains a significant part of our near-term revenue outlook. Our total revenues were $11.1 million in the first quarter of 2021, compared to $8.8 million in the first quarter of 2020. This year-over-year increase reflects higher license and royalty revenue and growth in Sympazan revenue.

We saw net revenue growth in the first quarter of 2021 compared to the prior-year period, up 56% for Sympazan, the first of our proprietary products to be launched. Our net loss for the first quarter of 2021 was $14.7 million or $0.41 loss per share. The net loss for the first-quarter 2020 was $16.5 million or $0.49 loss per share. The year-over-year change in net loss was driven by higher revenue and reductions in cost and expenses, partly offset by increased interest expense related to the sale of future revenue.

This interest expense is due to the accounting associated with the KYNMOBI monetization on November 3, 2020, and does not represent a cash output or monetary obligation at any time during the life of the transaction. Adjusted EBITDA loss was $6.3 million in first-quarter 2021, compared to $11.2 million in the first quarter of 2020. The year-over-year change in adjusted EBITDA loss was driven by higher revenue and reductions in cost and expenses. As of March 31, 2021, cash and cash equivalents were $27.5 million.

During the first-quarter 2021, we access capital under our at-the-market or ATM facility, resulting in net proceeds of $9.9 million. The ATM facility, as amended, has approximately $57.1 million available at March 31, 2021. As outlined in the press release issued last night after market close, we are reaffirming our full-year 2021 financial guidance that we previously provided during the second week of March when we reported our year-end results. For the full-year 2021, we expect total revenues of approximately $38 million to $42 million, non-GAAP adjusted gross margins of approximately 70% to 75% on total revenues, and non-GAAP adjusted EBITDA loss of approximately $42 million to $45 million.

With that, I will now turn the line back to the operator to open the line for questions.

Questions & Answers:

Operator

Thank you. [Operator instructions] Our first question comes from Gary Nachman with BMO Capital Markets. Your line is open.

Unknown speaker -- BMO Capital Markets -- Analyst

Hi. This is Evan Flaus filling in for Gary Nachman. So I have a few questions. So first, for the additional work that you're doing for Libervant, both for the PK and safety, could that potentially be helpful to showing a meaningful improvement to patient care and getting the orphan drug designation? And secondly, how soon can you reengage with the FDA on Libervant after you resubmit at the end of the second quarter? Is that immediate? Or would it take a while and closer to the PDUFA date?

Keith Kendall -- President and Chief Executive Officer

Sure. Dan, do you want to take that?

Dan Barber -- Chief Operating Officer

Sure. Good morning. So in terms of the safety and PK work that's going into the resourcing, the way I would think about the refiling or the resubmission in terms of the benefits of our product, it's the totality of the package. That is really what drives the value.

So the safety piece that we're updating, which is a very simple piece, of course, is part of our story. And the PK modeling, which relates to the dosing regimen we're creating also is a component of the value that we will drive. So there's absolutely additional value in the work that we're doing that will go in the resubmission that will tie to our market access. In terms of reengaging with the FDA, we will reengage immediately upon resubmission.

In fact, I would argue, we've been in contact with the FDA. We received their feedback back in February. We have engaged back and forth with them from February to now. And after resubmission, that will continue.

Unknown speaker -- BMO Capital Markets -- Analyst

Great. And one more follow-up. Would you be able to remind us how you view the size of the market opportunity for Libervant, as well as your thoughts on the competing product for Neurelis, VALTOCO, and how you are differentiated?

Keith Kendall -- President and Chief Executive Officer

Yes. Evan, there was some noise in the background. We're not sure where it's coming from. Could you just repeat that question, please?

Unknown speaker -- BMO Capital Markets -- Analyst

Yes. So would you be able to remind us on how you view the size of the market opportunity for Libervant and as well as your thoughts on the competing product Neurelis, VALTOCO, and how you're differentiated? Thanks.

Keith Kendall -- President and Chief Executive Officer

Sure. Ken, you want to take that?

Ken Marshall -- Senior Vice President, Chief Commercial Officer

Yes, sure, Keith. Thanks. Yes, the market opportunity is pretty substantial. If you look at the overall epilepsy market of about 3.2 million patients, about 1.2 million of them have some level of refractory disease.

And as you talk to physicians, those are the types of patients that they would look to have a rescue strategy in place, which has created an opportunity, quite frankly, for all the rescue medicines. So it's a pretty substantial market. And if you look at VALTOCO and key points of differentiation, I mean, clearly, one is a nasal and the other is an orally administered medicine. The key points of differentiation in my mind are the preferred route of administration and in what will likely be our labeled population 12 and older, the need to use two doses of the nasal VALTOCO to get an effective level of therapy in those patients, will be a pretty significant point of differentiation.

Unknown speaker -- BMO Capital Markets -- Analyst

Thank you.

Operator

Thank you. Our next question comes from Jason Butler with JMP Securities. Your line is open.

Jason Butler -- JMP Securities -- Analyst

Hi, thanks for taking the questions. I had a couple on the financial programs. Can you just remind us for AQST-108, how predictive the preclinical data were in translating into the PK profile you saw in the initial human studies? And then following on from that, can you just compare and contrast the profiles you've seen preclinically to date for 109 versus what you saw for 108? Thanks.

Keith Kendall -- President and Chief Executive Officer

Sure. Jason, I'll let Dan take that question.

Dan Barber -- Chief Operating Officer

Good morning, Jason, and great question. When you look at the preclinical data for 108, it was very predictive in our minds of what we saw in the clinic. We saw solid absorption with our prodrug platform. And then we saw a rapid peak of dipivefrin and conversion into epinephrine.

And as you know, prodrugs are simply a chemical derivative of the molecule. And after absorption, enzymatic cleavage turns the prodrug back into the original molecule. With that predictive model, what we saw was, and we talked about this at the R&D Day, the dipivefrin gave a really interesting and compelling curve, but we think we can do better on the conversion rate. So with 109 in preclinical models, we have a much faster conversion rate in our second generation prodrug.

So preclinically, you see rapid absorption, a nice big peak, and then you see rapid conversion into epinephrine through the enzymatic cleavage. We're currently in the clinic, as you know, with 109, and we're excited to see the data as we go through that study, and we expect that study to read out, as Keith mentioned in his remarks earlier, in the second half of 2021.

Jason Butler -- JMP Securities -- Analyst

Great. And then just one point from the R&D Day that the docs brought up was what seems to be a pretty meaningful risk of incorrect use or delayed use of injectable epinephrine. Just wondering if you've got any market research to support how important these factors are to both the physician and to patients when thinking about the potential for a different delivery method like in oral epinephrine.

Dan Barber -- Chief Operating Officer

Sure. Thank you, Jason. Yes, we do have market research that indicates that patients do delay using the current standards of care because of a variety of issues. And in fact, it's not just our market research.

There's a whole wealth or body of research outside of our company that indicates the patient's delay using an EpiPen or other injection-type epinephrine product for a variety of reasons. And we do believe that our product lowers those barriers and will be a product that over time we can show patients are more willing to take at the onset of any allergic reaction. So that is absolutely a key differentiator of our oral sublingual product, and we will continue to ensure we understand how to use that differentiation as we go forward.

Jason Butler -- JMP Securities -- Analyst

Great, helpful. Thanks for taking questions.

Dan Barber -- Chief Operating Officer

Thanks, Jason.

Operator

Thank you. Our next question comes from Dan Busby with RBC. Your line is open.

Unknown speaker -- BMO Capital Markets -- Analyst

Great. Hey, guys, this is Steve on for Dan. I've got two, and I'll ask them both upfront. So the first one is related to Sympazan.

And I'm kind of curious, as we were looking at the current COVID environment and how it's impacting patients to getting in front of doctors and now that our people are getting more vaccinated and restrictions across the U.S. are starting to lighten up, how are you thinking about those dynamics and how it's going to impact your business here going forward? And there's any pent-up demand for -- that you guys are thinking about? And then my second question is related to epinephrine. You guys are in the process of your first-in-human PK data, which looks like you're going to have some data readout later this year, along with having some conversations with the FDA. I guess I'm trying to get a sense as, ultimately, what are you looking for to help you make a decision as to which asset you will be more comfortable to pursuing 108 versus 109? Thanks for taking the questions.

Keith Kendall -- President and Chief Executive Officer

Sure. I'll let Ken Marshall, our chief commercial officer, answer the first part of your question. And then Dan will take the epinephrine part of your question, OK?

Ken Marshall -- Senior Vice President, Chief Commercial Officer

Hi, Steve, this is Ken. If you look back to the start of the pandemic last March, leading into that, about 90% of our interactions with healthcare practitioners were live. It went almost immediately to 10% in that April time frame. So it was a very radical shift.

And now, over time, as people have figured out how to manage it and set guidelines, you're seeing about a 65:35 ratio of live to virtual visits, and it's ever so slightly trending back up. Depending on the week we look at, it can be 70%, 75% live. And that's for all healthcare practitioners, physicians, and their mid-levels. We feel like we're definitely more effective in those types of settings, but we've also learned how to very effectively work in a virtual world with our speaker and peer programs and our interactions with physicians.

Speculating, I don't know if it will go back to 90-10. And what we're doing as a company is, are encouraging live visits where possible. And following the guidelines of the hospitals and clinics. If they allow folks in, we go visit them; if they don't, we set up virtual meetings.

Dan Barber -- Chief Operating Officer

And, Dan, I'll take the second part of your question. And this is Dan. From a 108 and 109 perspective, if you look at the data as we laid out for 108, what we were really excited by are a couple of things: one, the rapid peak of dipivefrin, so a Tmax of under 20 minutes for the prodrug itself; and two, the really interesting PD effect that we saw, our pharmacodynamic effect that we saw throughout the data that we collected. So what we're doing right now with 108 is modeling all of that PD data and how it relates to the PK work that we have to date.

We will go forward and talk to the FDA about how they think about PD data and how we can use that in our 108 program. So that's the path for 108. On 109, while we anticipate seeing -- or we would expect to see a PD effect, 109, we're looking to see what the PK looks like at this time, right? So do we see the same rapid absorption of the prodrug and do we see the rapid conversion that we anticipate based on our preclinical models. So we'll take both 108 and 109 forward at this time.

And then based on our FDA interactions, we'll make a decision on where those two programs go, whether they both go in parallel, whether one goes ahead of the other or whether there are different purposes for the assets in different indications. So we're excited about both, and we look forward to talking about them in the second half of the year.

Unknown speaker -- BMO Capital Markets -- Analyst

Great. Thanks for the color, guys.

Operator

Thank you. Our next question comes from Shveta Dighe with Wedbush. Your line is open.

Shveta Dighe -- Wedbush Securities -- Analyst

Hi, this is Shveta for Liana. Thank you for taking our question. For the Libervant NDA resubmission, what are the steps remaining to refile by end of Q2? And is there any new information that you plan to add to the NDA resubmission?

Keith Kendall -- President and Chief Executive Officer

Dan?

Dan Barber -- Chief Operating Officer

Sure. Good morning, Shveta. So the new information that will be in the NDA, let me put it this way. The most important thing to remember is there is no new clinical data in this NDA.

So this NDA is all of the information from the previous NDA, along with our population PK modeling updates. So what we have focused on is, if you look at the CRL from September of 2020, as we laid out to all of you, there are a couple of deficiencies that we needed to address. One of those was making sure that we update our safety area in order to talk directly about the patient population, we've done that. The other was to make sure we justified our dosing regimen based on the different weight groups and the performance in our prior -- our 180323 study.

We've done that. So that's the data that will go into the resubmission. In terms of the steps between here and the submission in June, at this point, it is an administrative task. We have many of the parts of the NDA already ready to go.

The safety part, in particular, is well on its way. The last piece to put into the NDA will be the final report from our modeler. And once we have that, the step will simply be sending the NDA into the FDA for resubmission. There's nothing else that we need to do at this point.

Shveta Dighe -- Wedbush Securities -- Analyst

Got it. Thank you.

Operator

Thank you. Our next question comes from Thomas Flaten with Lake Street Capital. Your line is open.

Thomas Flaten -- Lake Street Capital Markets -- Analyst

Great, thanks. Good morning, guys. A couple of follow-ups, I think, mostly for Dan. Dan, you mentioned you've continued interacting with the FDA on Libervant since the February guidance.

Has anything changed? Or has it been consistent in terms of what you're required to send in? Have they added any color? I'm just curious to get some color on those interactions.

Dan Barber -- Chief Operating Officer

Yes. Yes. And Thomas, thank you. That's good clarification.

The interactions are simply ensuring that we maintain the relationship specifically with the project manager, letting them know that we will be resubmitting, letting them know that we understand the feedback they've given, and making sure that everything is prepared for when that resubmission occurs. So there have been no interactions around the deficiencies or any of the clarifying components that you would -- that perhaps you're looking for. At this point, it's administrative. The substantial conversation will occur after resubmission once they have seen our application.

Thomas Flaten -- Lake Street Capital Markets -- Analyst

And then just a follow-up on some clarification you guys made on this call with respect to 109. I think in the prepared comments you said that Part 1 of the 109 study would be completed in the second half. And just reflecting back on the R&D Day, there was a Part 1 ascending dose component, but then there was a Part 2 crossover. So what's the implication for timing on Part 2 there? Is it going to be completed this year? Or is that something that will be initiated once you've met with FDA?

Dan Barber -- Chief Operating Officer

Sure. The meeting with the FDA will occur between Part 1 and Part 2, but it is not a gating event. So Part 2 will continue onward, the preparation, the dosing, and the -- all of the results are on its own track. So I would think about it this way.

Part 1 will read out. We will take that data. We will go talk to the FDA. And while we're talking to the FDA, the plans for Part 2 will be under way.

We do anticipate at this time that Part 2 of our program will begin dosing in 2021 and the final date of when that completes remains to be seen.

Thomas Flaten -- Lake Street Capital Markets -- Analyst

Great. And then just a quick one for Ernie if I may. On the fourth-quarter call, you guys mentioned that you would do a $3 million payment. I think it was for Mitsubishi.

Yet in the license and royalty number, it was less than $3 million. Could you just clarify if that payment did come in or how we should understand that?

Ernie Toth -- Interim Chief Financial Officer

Hi. So there's two components to the Mitsubishi Tanabe amount. There is an amount that was based on signing, and there is an amount that is based on shipments. And we did receive the cash of $3 million for Mitsubishi Tanabe.

Thomas Flaten -- Lake Street Capital Markets -- Analyst

But that was not reflected in its entirety in the first-quarter number?

Ernie Toth -- Interim Chief Financial Officer

That's right. It's not all considered revenue in the first quarter.

Thomas Flaten -- Lake Street Capital Markets -- Analyst

Got it. Thanks much. Thanks for taking the questions, guys.

Operator

Thank you. Our next question comes from Ram Selvaraju with H.C. Wainwright. Your line is open.

Ram Selvaraju -- H.C. Wainwright -- Analyst

Thanks so much for taking my questions. Can you hear me?

Keith Kendall -- President and Chief Executive Officer

Yes, Ram, how you doing this morning?

Ram Selvaraju -- H.C. Wainwright -- Analyst

Pretty good. Pretty good. So just to start off with Sympazan kind of learnings as we approach the potential Libervant commercialization. I was wondering if you could comment specifically on what looks like an impressively high retention rate when it comes to repeat prescribers.

I think you quoted an 80% rate on that metric for Sympazan script writers. So I was wondering if you could give us some color on whether you expect that repeat prescriber rate to be similar for Libervant as and when Libervant gets to the market. If you can give us some perspectives on what the experience with Sympazan so far might portend for Libervant, specifically with respect to repeat prescriber rates.

Keith Kendall -- President and Chief Executive Officer

Ken?

Ken Marshall -- Senior Vice President, Chief Commercial Officer

Sure. Yes. I think what drives the repeat prescriber rate for Sympazan is just the clear patient type or patient profile that benefits from getting their clobazam on a strip rather than tablets or liquids. That's a nice way to position your brand.

It creates a clear patient type, and that's usually what drives multiple uses in those types of patients. And I would expect the same type of thing with Libervant. And it will be the only orally delivered rescue medicine. So it's going to own that space.

There's no doubt that orals are preferred over other routes of administration, especially as they get more invasive and more challenging from a drug-device standpoint. So I would expect that physicians would adopt, and I would expect that the vast majority would write for multiple patients, multiple scripts for those patients.

Ram Selvaraju -- H.C. Wainwright -- Analyst

Great. Very helpful. So secondly, again, on Sympazan, I understand that you're not giving specific Sympazan product revenue guidance. But if you could just qualitatively comment on what you expect the kinetics of the Sympazan revenue growth curve to look like over the course of 2021? Are you anticipating, first and foremost, sequential quarter-over-quarter growth going forward as we look toward the remainder of 2021? And then secondly, do you expect that quarter-over-quarter growth, if indeed you're expecting quarter-over-quarter growth, to accelerate over the course of the remaining quarters of 2021? And to what extent might that be driven by "normalization" of the overall market conditions relative to the COVID-19 pandemic?

Keith Kendall -- President and Chief Executive Officer

So, Ram, can you hear me?

Ram Selvaraju -- H.C. Wainwright -- Analyst

Yes.

Keith Kendall -- President and Chief Executive Officer

Ram, can you hear me?

Ram Selvaraju -- H.C. Wainwright -- Analyst

Yes. I can hear you.

Keith Kendall -- President and Chief Executive Officer

We lost the last part of your question. You asked whether we -- what we viewed or how we were feeling about the sequential growth quarter over quarter. And before I let Ernie answer that, we lost the last part of your question. We'd like to make sure we respond to you.

Could you repeat it, please? We may have lost Ram. Ernie, do you want to at least take a crack at the part of the question you could hear?

Ernie Toth -- Interim Chief Financial Officer

Sure. Ram, so again, we don't provide any specific guidance on products. We don't break it out on a full-year basis. But I think as we look at Sympazan going through the rest of the year, that we would expect quarter-over-quarter growth as we continue to have the -- as Ken had mentioned the in-person and face-to-face meetings with the physicians.

And that also it is part of our strategy as we prepare for the launch of Libervant, that this -- as we've talked about previously, that this dovetails with the Libervant launch because of the overlap in the prescribers. So we would continue to expect to see quarter-over-quarter growth at this point.

Keith Kendall -- President and Chief Executive Officer

Great. Thanks, Ernie.

Operator

There are no other questions in the queue. I'd like to turn the call back to Keith for any closing remarks.

Keith Kendall -- President and Chief Executive Officer

Great. Thank you, operator. And thank you, everyone, for joining us this morning. We appreciate your time and your continued interest in Aquestive.

Obviously, we're going to be focused on the things that are most important to driving the value of our company. We're going to get -- we're going to continue to focus on delivering the results out of epinephrine and trial on 109, as we've described, and then setting up our discussion with the regulators later in the year. We remain laser-focused on finishing out the pieces of work that we need to do to prepare our refiling for the end of the second quarter. We'll continue to grow Sympazan, as Ernie talked about.

And we look forward to updating you all on the progress we make on those key items throughout the year. So thank you very much for coming this morning, and we look forward to talking to you all again soon.

Operator

[Operator signoff]

Duration: 46 minutes

Call participants:

Stephanie Carrington -- Investor Relations

Keith Kendall -- President and Chief Executive Officer

Ernie Toth -- Interim Chief Financial Officer

Unknown speaker -- BMO Capital Markets -- Analyst

Dan Barber -- Chief Operating Officer

Ken Marshall -- Senior Vice President, Chief Commercial Officer

Jason Butler -- JMP Securities -- Analyst

Shveta Dighe -- Wedbush Securities -- Analyst

Thomas Flaten -- Lake Street Capital Markets -- Analyst

Ram Selvaraju -- H.C. Wainwright -- Analyst

More AQST analysis

All earnings call transcripts