Joseph K. Belanoff
Thank you, Charlie, and thank you, everyone, for joining us this afternoon. This has been a tremendously active period at Corcept. Our commercial business is thriving, and we are making substantial progress in every one of our development stage programs. In the past few weeks, we completed enrollment in 4 late-stage studies, and we released open-label data from our GRACE study that takes us one step closer to submitting our NDA and bringing relacorilant to patients with Cushing's syndrome. Our commercial growth was driven by a record number of new Korlym prescribers and a record number of patients receiving the medication. Hypercortisolism is commonly misdiagnosed, in large part, because its frequently expressed and burdensome symptoms, hyperglycemia and hypertension, have become so common in the population as a whole. As physicians become increasingly aware that hypercortisolism is much more prevalent than previously assumed, they are screening and treating more patients for hypercortisolism than ever before. When Korlym is prescribed, we use the expertise and infrastructure that we have developed and refined over many years to support physicians and patients. This additional care helps create a life-changing impact for patients who receive Korlym treatment. We have known for some time that there are large groups of patients who are far too infrequently screened for Cushing's syndrome. The initial findings of the CATALYST study make that clear. CATALYST is the largest and most rigorous clinical study ever conducted to examine the prevalence of hypercortisolism in patients with difficult to control type 2 diabetes. Over 1,000 patients were enrolled by the leading diabetologists in the United States, and 25% of these patients were found to have hypercortisolism. This is a far higher prevalence rate than is generally assumed with potentially far-reaching implications for patient care. The final results from the prevalence portion of the study will be presented at a keynote session at the American Diabetes Association's annual scientific sessions in Orlando next month. The second portion of the CATALYST study, the treatment phase, is ongoing. As the awareness and diagnosis of Cushing's syndrome increases, we are simultaneously working to advance our proprietary selective cortisol modulator, relacorilant. Relacorilant has unique characteristics, and our confidence in its efficacy and safety profile has only been increased by the open-label results from the GRACE study. Our pivotal trial for relocorilant, GRACE, has 2 parts. In its first, open-label phase, 152 patients with Cushing's syndrome and either hypertension, hyperglycemia or both received relacorilant for 22 weeks. Patients who exhibited prespecified improvements in either or both symptoms were given the opportunity to enter the trial's randomized, double-blind, which were all phased, during which half of the patients continued to receive relacorilant and have received placebo for 12 weeks. GRACE'S primary endpoint is maintenance of blood pressure control in the randomized withdrawal phase of the study with maintenance of glycemic control as the key secondary endpoint. Last week, we released results from GRACE's open-label phase. As I review these data here, please keep in mind this important point: Because excess cortisol activity affects nearly every tissue in the body, patients with Cushing's syndrome exhibit a wide array of signs and symptoms. Hypertension and hyperglycemia are among the most common and destructive. Patients in the open-label phase of GRACE exhibited clinically meaningful and statistically significant improvements in hypertension, hyperglycemia, weight, waist circumference, cognition, Cushing's quality-of-life score and other measures of clinical importance. In the open-label phase of GRACE, 63% of patients with hypertension met the study's response criteria. For the patients who entered the randomized withdrawal phase, improvements in mean systolic and diastolic blood pressure of 12.6 and 8.3 millimeters of mercury from baseline with P values of less than 0.0001 were observed. To ensure accuracy, hypertension was measured by 24-hour ambulatory blood pressure monitoring or ABPM, which is the gold standard for hypertension monitoring. 50% of the patients who entered GRACE with hyperglycemia, which includes patients with diabetes and patients with impaired glucose tolerance or prediabetes, responded to relacorilant. For the patients who entered the randomized withdrawal phase, improvements in the oral glucose tolerance test or mean glucose area under the curve of 6.2 millimoles per liter, reduction in mean hemoglobin A1c of 0.7% and reduction in mean fasting glucose of 25.2 milligrams per deciliter, all with P values of 0.006 or less, were observed. Relacorilant was well tolerated, consistent with its known safety profile. Due to its unique mechanism of action, which, unlike Korlym, does not increase patient's cortisol levels, there were no relacorilant-induced instances of hypokalemia. In addition, no cases of drug-induced endometrial hypertrophy with or without vaginal bleeding, adrenal insufficiency or QT prolongation, which was independently confirmed, were reported. Both parts of GRACE are complete. Our task now is to collect, review and analyze the full data set, including the currently blinded results of the randomized withdrawal phase, and incorporate it into our new drug application, which we are on track to submit this quarter. We plan to present data from both the open-label and randomized withdrawal phases at a current -- at a medical conference in June. GRACE is not our only Phase III trial of relacorilant in patients with hypercortisolism. GRADIENT is a randomized, double-blind, placebo-controlled study in 137 patients whose hypercortisolism is caused by an adrenal tumor or adrenal hyperplasia. Patients with this etiology of Cushing's syndrome often experience a less rapid decline, but their health outcomes are poor and include a significantly higher risk of premature death. We expect the study to produce valuable data about the treatment of an etiology of Cushing's syndrome that affects many patients. Enrollment is complete, and we expect data in the fourth quarter of this year. We are also studying relacorilant as a treatment for different types of cancer mediated by cortisol activity. Our most advanced oncology program is in platinum-resistant ovarian cancer. We recently completed enrollment of 381 women in our pivotal ROSELLA study, and we expect data by the end of the year. Women with platinum-resistant ovarian cancer are in urgent need of new treatment options. The goal of using relacorilant in this context is to resensitize ovarian tumors to the effects of chemotherapy by blunting the anti-apoptotic effect of elevated cortisol activity. Our successful Phase II trial showed that women who received relacorilant intermittently, the day before, the day of and the day after they receive nab-paclitaxel, exhibited a statistically significant improvement in progression-free survival and duration of response compared to the group who received nab-paclitaxel monotherapy. Women in the intermittent relacorilant group also lived longer than those in the comparator arm. 29% of the patients who took intermittent relacorilant were alive 2 years after study start versus only 14% who took nab-paclitaxel alone. Importantly, the women who received relacorilant plus nab-paclitaxel experienced no additional side effect burden compared to those who received nab-paclitaxel alone. The results from this study were published in the Journal of Clinical Oncology in June 2023 with an accompanying editorial and presented at multiple U.S. and European medical conferences. ROSELLA aims to replicate our Phase II study results. Its design closely tracks our previous study. Women are randomized 1:1 to receive either relacorilant plus nab-paclitaxel or nab-paclitaxel alone. The primary endpoint of ROSELLA is progression-free survival with overall survival, a key secondary endpoint. We are conducting this study in collaboration with leading clinicians from the Gynecologic Oncology Group or GOG in the United States and the European Network for Gynaecological Oncological Trial or ENGOT group in Europe and deeply appreciate their enthusiasm and support. Because of our confidence in the positive results of our Phase II trial, we've begun initial planning for relacorilant's launch in oncology. The President of our oncology division, Roberto Vieira, who joined Corcept earlier this year, is building the organization we need to help as many women as quickly as possible following approval. We are also evaluating relacorilant as a treatment for prostate cancer and adrenal cancer. Leading academic researchers and clinicians hypothesized that cortisol modulation may block an important tumor growth pathway in prostate cancer. Cortisol stimulation is thought to be a major reason why patients with prostate cancer treated with the widely prescribed androgen receptor antagonist enzalutamide eventually experience resurgent disease. Deprived of androgen stimulation, their tumor switch to cortisol activity to stimulate growth. Adding a cortisol modulator to androgen deprivation therapy could close this tumor escape route. Our collaborators at the University of Chicago are enrolling a randomized, placebo-controlled Phase II trial of relacorilant plus enzalutamide in patients with prostate cancer before these patients have had an initial prostatectomy. In adrenal cancer, patients' tumors produce excess cortisol in about 50% of cases. Unfortunately, patients with this form of adrenal cancer virtually never respond to immunotherapy. Because cortisol suppresses the immune system, it may blunt the effectiveness of cancer therapy intended to stimulate the immune system. Our hypothesis is that adding a cortisol modulator to immunotherapies such as checkpoint inhibitors may enhance their effectiveness. We are conducting a Phase Ib trial of relacorilant plus the PD-1 checkpoint inhibitor pembrolizumab in patients with advanced adrenal cancer whose tumors produce excess cortisol. Our research team, led by Hazel Hunt, has designed a library of over 1,000 selective cortisol modulators. All of these compounds modulate the activity of cortisol, but they have distinct pharmacodynamic properties. Some are more potent at improving insulin sensitivity. Some are more potent at creating weight loss. Some get into the brain, some don't. Some are very potent in oncologic models, some less so. One of these compounds, dazucorilant, which is highly brain penetrant, has shown great promise in an animal model of ALS. We advanced dazucorilant into clinical studies based on compelling preclinical data that showed improved motor performance and reduced neuroinflammation and muscular atrophy. Our double-blind, placebo-controlled Phase II DA