Home Stock Market Adial Prescription drugs: Alternative Knocks For Micro Cap Focusing on Multi-Billion Alcohol...

Adial Prescription drugs: Alternative Knocks For Micro Cap Focusing on Multi-Billion Alcohol Use Dysfunction Market (NASDAQ:ADIL)


Funding Thesis

Shopping for Adial Prescription drugs’ (ADIL) inventory is an funding alternative I’ve thought of a number of instances prior to now 12 months, and up to date developments on the firm have lastly persuaded me so as to add the inventory to the Actively Traded mannequin portfolio I keep by way of my market channel at Haggerston BioHealth. The choice is broadly based mostly on 2 major components.

Firstly, though primarily a developer of medication to deal with alcohol use dysfunction (“AUD”), and probably different forms of habit, Adial has been awarded an Emergency Use Authorisation (“EUA”) for a serology-based level of care (“POC”) take a look at for the SARS Cov-2 virus utilizing fingerstick blood samples – the Guarantee/FaStep COVID-19 IgG/IgM Fast Check System.

Adial’s take a look at equipment is the primary of its sort to be given an EUA by the FDA, and the information despatched the microcap’s share worth skywards, from $1.2 on twenty fifth September, to $3 by COB on the twenty ninth, though the worth shortly corrected to ~$2. Adial announced its first gross sales order – for 10,000 take a look at kits, which retail at $297 – a couple of days later. Administration views the general market alternative to be in extra of $3.5bn, though there may be more likely to be intense competitors on this market as extra and higher resourced corporations launch take a look at kits.

Adial had been utilizing the fingerstick exams in its pivotal part 3 ONWARD trial of lead drug candidate, AD04, for therapy of alcohol use dysfunction. Exploiting this sideline alternative could nicely present a significant, medium-term income stream which is not going to solely enhance its share worth but additionally assist to help the prices of its late stage trial of AD04 – excellent news for buyers who now have much less purpose to worry being diluted by additional on the market fundraisings.

Secondly, in mild of the continued pandemic and the tough social situations that it has induced, which the Nationwide Institute on Alcohol Abuse and Alcoholism (“NIIAD”) has warned could enhance threat of relapse in people with alcohol and substance use issues, Adial has submitted a proper request to the FDA for an expedited evaluate for AD04.

AD04 – an ultra-low dose formation of a drug – Ondansetron – used to deal with nausea and illness in sufferers throughout chemotherapy, radiotherapy, or surgical procedure – has demonstrated a promising security and efficacy profile in a part 2 trial in sufferers with AUD who’re genotype optimistic for the therapy, which is estimated to be round 33% of all sufferers, and decided by a genetic screening instrument that can be offered by Adial.

Adial has designed part 3 trials in each the US and Europe in an effort to safe FDA and European Medicines Company (“EMA”) approval, with administration concentrating on a industrial launch in 2024 if the trials show profitable.

An expedited approval nod from the FDA, nevertheless, may see the therapy accepted earlier than the tip of 2021, provided that it often takes the FDA as much as 60 days to evaluate the request, adopted by a 6-month reasonably than 10-month utility evaluate course of, with components corresponding to a rolling NDA submission or Accelerated Approval additionally coming into play.

A speedy approval course of could be a big coup for Adial, and given the paucity of accessible therapies for AUD, an approval a minimum of 2 years forward of schedule actually looks as if a chance, if not a chance.

With the COVID take a look at equipment and expedited approval push, I imagine Adial has proven astute administration, and since Ondansetron is already accepted in different indications, the trial course of must be comparatively cheap and, based mostly on part 2 knowledge, more likely to meet its endpoints in a pivotal trial.

Adial IPO’d in July 2018, raising $7.32m at a worth per share of $5, and I can see the corporate’s present momentum driving the inventory worth again in the direction of that determine, and definitely again past $3 per share if its COVID take a look at kits generate vital Q3 or This fall ’20 revenues for Adial, as appears probably.

These are the two major causes I’m bullish on Adial’s prospects and take into account the corporate to be a beautiful funding alternative. Within the the rest of this text, I’ll take a deeper dive take a look at the corporate, its administration, merchandise and financials.

The appreciable threat of a trial failure associated to its solely credible asset – AD04 – could put many buyers off Adial, however the COVID alternative, though growing the inventory worth from near $1 to $1.87 on the time of writing, offers worthwhile draw back safety in addition to an thrilling worth catalyst.

Firm Overview

Headquartered in Virginia (however reincorporated in Delaware in 2017 by way of a reverse merger), as talked about above, Adial IPO’d in 2018, elevating a modest $7.3m, and was based in 2010 by William B. Stilley, who has served as CEO all through.

An ex-Marine Captain, previous to founding Adial, Stilley labored at Medical Information Inc. (acquired by Forest Laboratories in 2012 for $1.2bn) on the profitable part 3 trial of main depressive dysfunction therapy Viibryd, a serotonin reuptake inhibitor that’s now marketed and bought by Allergan (AGN), making $412m of sales in FY19. Previous to that, Stilley was COO & CFO at Adenosine Therapeutics. Joseph Truluck, Adial’s COO and CFO, additionally labored at each Medical Information and Adenosine Therapeutics.

One other key determine on the firm is Chief Medical Officer and ex-Chairman of the Board Bankole Johnson – the inventor of all patents associated to AD04. Johnson was beforehand Chair of the Division of Psychiatry on the College of Maryland College of Drugs, and has spent greater than 30 years pioneering habit analysis and therapy growth, profitable a number of awards for his work, and appearing as a Principal Investigator on Nationwide Institutes of Well being (NIH)-funded analysis research into neuropharmacology and molecular genetics.

Johnson holds a 15.4% stake in Adial, and Stilley holds a 9.4% stake, while one other board member, Kevin Schulyer – Senior Managing Director at Virginia VC agency CornerStone Companions LLC – owns a 19% stake. One other board member, James Newman, founding father of med system firm Medical Predictive Science Company, owns 9% of Adial, and curiously, Armistice Capital – the VC agency which made a 200% ROI on its investment into oral COVID vaccine developer Vaxart – owns a 5% stake.

In its 2019 10-Ok submission, Adial reported simply 4 workers, and its market cap is a miniscule $25.53m, with 13.56m shares issued up to now.

AD04 – An Revolutionary Method To Sort out An Unmet Want

Adial’s solely present therapy in growth – AD04, concentrating on AUD – is a micro-dose formulation of Ondansetron, which was first accepted by the FDA underneath the model identify Zofran in 1991. Marketed and bought by GlaxoSmithKline (NYSE:GSK) to deal with nausea and illness, primarily in sufferers present process chemotherapy, Zofran gross sales peaked at ~$1.3bn in 2006 earlier than the drug went off patent, permitting generics to enter the market.

In 2012, GSK paid a $3bn settlement after admitting to selling a number of medicine, together with Zofran, for off-label use. GSK is currently facing >250 lawsuits from ladies who had been prescribed Zofran for morning illness and whose youngsters could have suffered delivery defects consequently. GSK is believed to have recognized concerning the potential threat of prescribing Zofran to pregnant ladies since 1992. AD04 accommodates lower than 1/twelfth the bottom Zofran dose, nevertheless, that means its security profile might be thought of to be sturdy, and never topic to the problems which have plagued Zofran, since AD04 is extremely unlikely to be prescribed off-label.

AD04/Ondansetron’s mechanism of motion relies on the blocking of serotonin-3 receptors which decreases the discharge of dopamine, and due to this fact decreases the dopamine reward system that’s triggered by alcohol consumption, theoretically lowering an AUD sufferer’s longing for alcohol.

Adial administration believes {that a} micro-dose of Ondansetron is just more likely to be efficient in a selected genetic subset of sufferers who’ve a sensitivity to the serotonin modulation results of Ondansetron, and as such, the corporate has developed a genetic take a look at to display for such sufferers, which handily for the corporate, additionally conveys a novel type of patent safety.

The usage of genetic screening to detect the presence of a minimum of one in all as much as 4 recognized genotypes, that are considered current in ~33% of all sufferers (the determine could rise to ~50% in sufferers in Europe) is a key element of AD04’s 3 patent households – issued in >40 international locations and lasting till 2032 on the earliest. The distinctive testing aspect and genotype definitions will shield in opposition to opponents growing their very own ultra-low dose Ondansetron options and bringing generic AD04 opponents to market.

Adial’s IP technique for AD04 to deal with AUD and different forms of habit. Supply: Adial investor presentation.

Moreover, in a current webcast given on the LD Micro 500 Convention in September, CEO Stilley argues that utilizing one other dosage of Ondansetron (apart from AD04’s 0.33 mg/tab) could be ineffective in treating AUD since serotonin-modulating medicine are extremely delicate, and a too excessive or too low dose wouldn’t set off the identical impact on the dopamine reward system, which provides to AD04’s degree of safety in opposition to generics.

There are additional benefits worthy of consideration. AD04 doesn’t require sufferers to be abstinent for a time frame earlier than beginning therapy, in contrast to FDA accepted Acamprosate (Campral), for instance, or Naltrexone (Antabuse). Its twice day by day, orally administered tablets are discrete and minimally disruptive to a affected person’s way of life, and there’s no requirement for sufferers to endure painful injections, or for the dosage degree to be elevated.

If accepted, the security and efficacy profile of AD04 will probably examine favourably to present AD04 therapies, based mostly on knowledge readouts from its part 2 trials.


Adial part 2b trial outcomes meet main and secondary endpoints. Supply: Adial Investor Presentation.

In its College of Virginia sponsored part 2b trial of 283 sufferers, Adial was in a position to present that AD04 demonstrated a statistically vital distinction in comparison with placebo for its goal genotype in each its main and secondary endpoints. Sufferers within the AD04 arm of the trial lowered drinks per ingesting day from 9.5, to 4 – a ~60% lower – while these on placebo dropped from 9.5 drinks, to six. When it comes to % of days abstinent (the secondary endpoint) sufferers utilizing AD04 have been abstinent for almost 50% of days, up from a baseline of 17%, which compares favourably with placebo (35%).

Importantly, sufferers utilizing AD04 additionally lowered their % of heavy ingesting days to 30%, in comparison with these on placebo – ~40% – vs. a baseline of 70%. After dialogue with the FDA and EMA, Adial administration anticipate that this will likely be accepted as the first endpoint in its part 3 trials, which is able to happen in Europe throughout two 24-week trials enrolling 294 sufferers every, and within the US, the place a minimum of 580 sufferers will likely be required. In Europe, regardless of wide-scale disruption attributable to the pandemic, trials have been accepted and began in Poland, Latvia, Sweden and Estonia, with knowledge anticipated to be accessible in 2021.

Manufacturing & Advertising and marketing

Adial has an settlement in place with a 3rd celebration vendor to fabricate and provide its low-dose Ondansetron tablets, and calculates the price to be not more than $0.01 per dose, with packaging prices anticipated to be lower than $0.05 per dose. Administration says it has enough provides for its preliminary part 3 trials, though there isn’t any long-term manufacturing dedication in place – with a number of various suppliers into account. Drug stability is anticipated to exceed 4 years.

Analysis exhibits that AUD constitutes a serious well being drawback within the US – the place it’s estimated that there are 35m victims (9% of males and 5% of ladies, according to the Nationwide Institutes of Well being), and extreme alcohol use is the third main reason for preventable dying. The issue is even worse in Europe, the place there are an estimated 55m victims, and the prevalence of AUD is estimated to be as excessive as 31% in Russia, for instance, the place alcohol performs a component in 30% of all deaths, based on the World Well being Organisation (“WHO”).

Solely Acamprosate, aldehyde dehydrogenase inhibitor Disulfiram, and Naltrexone, an opioid antagonist – marketed and bought by Alkermes (ALKS) as Vivitrol, making sales of $335m in 2019 – are at the moment accepted by the FDA for therapy of AUD, however none of those three have demonstrated enough efficacy to be thought of a standard-of-care, while anti-depressants corresponding to Sertraline and Prozac are sometimes prescribed regardless of there being no exhausting proof that they’ve a optimistic impact on a affected person’s ingesting habits.

Adial administration’s estimated market alternative for AD04. Supply: Investor Presentation.

As such, Adial views its theoretical whole addressable market to be within the area of $36bn, after the removing of all sufferers who usually are not genetically predisposed to therapy with AD04. Primarily based on present ranges of sufferers actively searching for assist for AUD seen by a healthcare practitioner, the market is estimated to be ~$1.3bn.

Adial has a advertising technique in place based mostly on a specialised gross sales staff concentrating on incremental development in core markets at first, adopted by enlargement into concentrating on Basic Practitioners and direct-to-consumer gross sales, in addition to worldwide enlargement, and charges AD04 as a possible blockbuster (>$1bn) promoting drug.

Personally, I might suppose the corporate would do exceptionally nicely to hit peak gross sales of $500m inside 5 years of launch owing to its small measurement and inexperience dealing with sale and advertising operations, however long run, there isn’t any query that if AD04 proved superior sufficient to present therapies to turn out to be an accepted standard-of-care, blockbuster gross sales may very well be achievable, based mostly on the size of the demand. After we issue the chance that Adial may comply with up an approval in AUD with additional approvals in smoking cessation, playing habit, and opioid habit, the long-term market alternative begins to look very enticing certainly.

Nevertheless, it is vital to recollect that is dependent each upon the corporate securing approval in Europe and the US, and its patent safety holding up in opposition to generics.


Though I feel Adial administration seems to have a well-defined market alternative, and an progressive and differentiated answer that has carried out nicely in part 2 trials, and that the corporate has probably discovered a technique to maintain off generic and off-label competitors, it might in all probability not be clever to fee the corporate’s probabilities of industrial success any increased than 50/50.

Adial highlights its genetic testing capabilities as a power, arguing that it engages sufferers searching for assist for AUD, and offers an incentive – if there’s a genotype match – for a affected person to pursue the therapy possibility. However it is usually a convoluted technique which will dissuade many people who find themselves not prepared to just accept that their alcohol use is problematic from pursuing the therapy.

Equally, the patent workaround additionally appears convoluted, and with restricted funds, if a rival firm introduced a copycat therapy to market, Adial could battle to defend its patents within the courts.

A small staff with restricted gross sales expertise might also discover it very difficult to seek out favour with influential figures throughout the AUD therapy market, regardless of the presence on the staff of an trade veteran in Bankole Johnson, and to influence prescribing physicians that micro-doses of Ondansetron is a reputable therapy possibility, even when part 3 trial outcomes point out the product is efficacious.

The part 3 trials could nicely characterize the largest impediment for Adial, nevertheless. As soon as once more, administration doesn’t have a lot expertise working medical trials, and is reliant upon its outsourcing associate Crown CRO Oy – with which it has entered right into a 5-year settlement – to handle operations, which, as talked about, have already been severely disrupted by the pandemic.

From a monetary perspective, the corporate’s money burn in FY19 was $8.2m, and $7m in FY18, with R&D spending rising from $0.4m in FY18 to $4m in FY19, while G&A bills declined from $6.6m to $4.3m over the identical interval. Complete present liabilities as of Q220 have been simply $0.7m, though the corporate’s amassed deficit now stands at $24.7m.

Adial estimates the overall value of its part 3 trials in Europe to be $9.1m, of which it has already paid $2.9m, and as of June thirtieth this yr, the corporate had a money place of $8.6m. The part 3 trials within the US are anticipated to value $20m, nevertheless, that means that Adial will virtually actually want to finish additional fundraisings. The corporate’s share worth fell by 17% in June when it accomplished a $5.2m providing of two.82m shares at $1.85, and Adial may increase as much as $50m due to a shelf offering agreed in February.


On some ranges, Adial’s try and convert Ondansetron into an AUD therapy at an ultra-low dose could show to be too convoluted for the corporate to firstly persuade regulatory authorities, after which prescribing physicians, that AD04 is a greater therapy possibility than what’s already accessible, and that the genetic testing angle is definitely worth the effort.

However, if the corporate’s medical trials do display that the therapy compares favourably to present standards-of-care – none of that are really passable based mostly on their inconclusive medical trial outcomes – and the therapy positive aspects approval and finds favour with physicians, then Adial’s worth as an organization will virtually actually enhance exponentially and share worth positive aspects within the triple digits could be virtually assured, for my part.

Approval in 2 main markets (Europe and the US), mixed with the growing prevalence of AUD, and maybe, an growing willingness for docs to diagnose the illness (understanding there may be an efficient therapy possibility accessible) and an growing willingness for sufferers to acknowledge the sickness and go for therapy (for a similar purpose), means that AD04, if marketed accurately, is a probably enormous market alternative.

Matching the gross sales of e.g. Vivitrol over time would recommend that Adial may obtain gross sales near $500m each year, however there’s a good probability that AD04 may show to be safer, extra handy, and simpler as a therapy possibility than Vivitrol, or Antabuse, or Campral, by which case Adial administration could be right to recommend that AD04 can goal blockbuster gross sales. Moreover, if we assume that Adial’s patent technique pays off – not totally unreasonable given {that a} pivotal trial has been signed off by the FDA and can shortly be underway – then Adial’s worth as a enterprise will increase nonetheless additional.

Inevitably, if this have been to show the case, Adial would turn out to be an acquisition goal, and its administration staff, who helped develop Viibryd at Medical Information Prescription drugs, which turned the corporate right into a $1.2bn acquisition goal (and created a $400m promoting MDD drug), could have the expertise and know-how to safe beneficial phrases.

Within the quick time period, buyers virtually actually face dilution if the US trials of AD04 go forward, given the $20m prices concerned, however as I discussed in my intro, any share worth losses might be offset by positive aspects in relation to gross sales of Adial’s fingerstick COVID exams.

It is exhausting to place a price on the dimensions of this chance, since Adial has not revealed the phrases of its agreements with distributors iRemedy and Brik LLC, or the test-kit producer BioLab, however promoting 10,00 take a look at kits at $300k interprets to $3m of revenues. Buyers do not understand how that determine has been divided up, however could uncover when Q3 outcomes are launched, which must occur this month or early subsequent month.

To summarise, investing in Adial is considerably speculative and opportunistic, as a result of Adial’s marketing strategy can be speculative and opportunistic in nature, its administration staff comparatively inexperienced, and its sources restricted.

Nevertheless, I imagine the corporate scores extremely on ingenuity, has a reputable case for approval in a really massive market with a excessive unmet want – which has superior so far as the pivotal trial stage – plus there are quite a few short-term catalysts in play – notably the COVID take a look at equipment alternative, the expedited evaluate request, and the progress of European trials.

Any of those may set off a surge in worth of >50%, and extra probably >100% – if the information is optimistic. As talked about, if Q3 outcomes reveal that gross sales of COVID take a look at kits have opened up a revenues stream >$1m, and there may be the chance

I reiterate my perception that optimistic news-flow may – in a greatest case state of affairs – see the share worth return to its authentic IPO worth of $5, notably if the COVID testing alternative can create a sustained income stream, and that long term (by YE24), an approval in AUD would create sufficient goodwill to probably drive the share worth into double figures.

I might count on to see a >50% achieve within the inventory worth if Q3 outcomes (due later this month) reveal that the COVID alternative can present a significant and sustainable income stream, and an expedited evaluate settlement may present much more substantial upside (>$3), with a choice more likely to be made throughout the subsequent 3-6 months.

Readouts from the European part 3 trials must be accessible within the first half of subsequent yr, while the US trials will hold buyers ready longer, maybe as early as H2 2021 if an expedited approval is acquired, but when not, no sooner than H1 2023. It’s probably leads to the US will mirror these in Europe, though efficacy could also be tougher to show in a area the place it’s thought sufferers could also be much less predisposed to profit from therapy.

Achieve entry to the entire market analysis and monetary analytics used within the preparation of this text plus unique content material and pharma, healthcare and biotech funding suggestions and analysis / analytics by subscribing to my channel,Ā Haggerston BioHealth.

Disclosure: I/we’ve no positions in any shares talked about, however could provoke an extended place in ADIL over the following 72 hours. I wrote this text myself, and it expresses my very own opinions. I’m not receiving compensation for it (apart from from In search of Alpha). I’ve no enterprise relationship with any firm whose inventory is talked about on this article.


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