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Protalix BioTherapeutics(PLX) - 2024 Q4 - Annual Report

Product Development and Commercialization - The company has successfully developed two commercial products: Elfabrio® for Fabry disease and Elelyso® for Gaucher disease, with Elfabrio generating 29.3millioninsalesin2024[42].Elelysoisapprovedin23marketsglobally,with29.3 million in sales in 2024[42]. - Elelyso is approved in 23 markets globally, with 12.6 million generated from sales to Pfizer and 11.0millionfromsalesinBrazilin2024[41].TheFDAapprovedElfabrioonMay9,2023,foradultpatientswithFabrydisease,coveringadosageof1mg/kgeverytwoweeks[22].ThecompanyhaslicensedElelysoscommercializationrightsworldwidetoPfizer,excludingBrazil,whereitismarketedasBioManguinhosalfataliglicerase[18].Thecompanysfirstcommercialproduct,Elelyso,isnowapprovedin23marketsincludingtheUnitedStates,Brazil,andIsrael[51].Thecompanyssecondcommercialproduct,Elfabrio,wasapprovedformarketingintheEUandtheUnitedStatesinMay2023foradultpatientswithFabrydisease[55].ClinicalTrialsandResearchThecompanyisdevelopingPRX115,aPEGylateduricaseforuncontrolledgout,withanestimated2511.0 million from sales in Brazil in 2024[41]. - The FDA approved Elfabrio on May 9, 2023, for adult patients with Fabry disease, covering a dosage of 1 mg/kg every two weeks[22]. - The company has licensed Elelyso's commercialization rights worldwide to Pfizer, excluding Brazil, where it is marketed as BioManguinhos alfataliglicerase[18]. - The company’s first commercial product, Elelyso, is now approved in 23 markets including the United States, Brazil, and Israel[51]. - The company’s second commercial product, Elfabrio, was approved for marketing in the EU and the United States in May 2023 for adult patients with Fabry disease[55]. Clinical Trials and Research - The company is developing PRX-115, a PEGylated uricase for uncontrolled gout, with an estimated 25% of the gout population in the US and Western Europe not having their condition controlled[44]. - PRX-119, a PEGylated recombinant human DNase I, is being designed for the treatment of NETs-related diseases, targeting the excessive formation of neutrophil extracellular traps[45]. - In May 2024, the company announced the expansion of its phase I First-in-Human clinical trial of PRX-115 by adding an eighth cohort with eight new patients and preparations for a phase II clinical trial[46]. - The phase I clinical trial of PRX-115 for uncontrolled gout included 64 randomized subjects, with 48 receiving PRX-115 and 16 receiving placebo[108]. - The company is conducting a clinical trial in Japan to evaluate the safety and efficacy of PRX-102 in Fabry disease patients, aiming to enroll approximately 18-20 patients[103]. - The BALANCE study demonstrated a favorable tolerability profile for PRX-102, with 90.4% of patients in the PRX-102 arm experiencing at least one treatment-emergent adverse event (TEAE) compared to 96.0% in the agalsidase beta arm[71]. - The BRIDGE study reported that 20 out of 22 patients completed the 12-month treatment duration, demonstrating high treatment adherence[80]. - The BRIGHT study reported that 75% of participants experienced improvement or no change in average pain severity at Week 52[92]. Financial Performance and Market Analysis - The global market for Gaucher disease was 1.7 billion in 2024 and is forecasted to grow at a compound annual growth rate (CAGR) of approximately -0.46% from 2024-2030[53]. - The global market for Fabry disease is forecasted to be approximately 2.3billionin2025,growingataCAGRof6.62.3 billion in 2025, growing at a CAGR of 6.6% from 2024-2030, reaching approximately 3.1 billion in annual sales by 2030[61]. - In September 2024, the company fully repaid all outstanding principal and interest under its 2024 Notes, financed entirely with available cash[49]. Regulatory and Compliance - The Biologics License Application for Elfabrio was resubmitted to the FDA on November 9, 2022, after an initial Complete Response Letter[21]. - The FDA requires substantial time and financial resources for regulatory approvals, with potential sanctions for non-compliance, including product recalls and clinical holds[160]. - The IND application must include preclinical test results, manufacturing information, and analytical data, becoming effective 30 days after submission unless placed on clinical hold by the FDA[161]. - The FDA review process for a BLA or NDA typically takes one to three years, with potential delays if additional data is required[172]. - The FDA may withdraw product approval if regulatory compliance is not maintained or if new problems arise post-approval[188]. Intellectual Property and Licensing - The company holds a robust patent portfolio of approximately 75 patents globally, with about 50 pending applications[125]. - New patents have been granted in the U.S., Australia, Chile, and Mexico for the treatment of Fabry disease using stabilized alpha-galactosidase[128]. - Protalix Ltd. has entered into two exclusive global licensing agreements with Chiesi for PRX-102, receiving 50millioninupfrontpaymentsanddevelopmentcostreimbursementsof50 million in upfront payments and development cost reimbursements of 45 million, with potential milestone payments exceeding 1billion[146].UndertheChiesiUSAgreement,ProtalixLtd.iseligibleforupto1 billion[146]. - Under the Chiesi US Agreement, Protalix Ltd. is eligible for up to 760 million in regulatory and commercial milestone payments, with tiered payments of 15% to 40% of net sales depending on annual sales[148]. Manufacturing and Supply Chain - The manufacturing facility in Carmiel, Israel, has approximately 14,700 sq/ft of clean rooms and has been approved by the FDA as a multi-product facility since 2017, capable of meeting all current and expected commercial and clinical needs[152][153]. - Protalix Ltd. relies on a single approved supplier for certain materials but has identified additional suppliers for most raw materials required for production[155]. - The company is committed to identifying alternative approved suppliers to ensure an uninterrupted supply of necessary raw materials for drug development[156]. Taxation and Financial Incentives - The corporate tax rate in Israel is 23% for income not derived from "Approved Enterprises" as of 2018[205]. - Under the Investment Law, an Approved Enterprise may be exempt from corporate tax for a period of 2 to 10 years depending on its geographic location[209]. - The company has an Approved Enterprise program, allowing for tax benefits for a 10-year period if it qualifies as a foreign investors' company[210]. - A foreign investors' company with over 25% foreign ownership can benefit from a reduced corporate tax rate ranging from 10% to 23%[211].