@mushroompanda I’m curious what the attendance was like at the meeting? 

From the Q&A (I was online) it didn’t sound like there were any fund representation and questions were pretty brief.

@Slew very minimal. Maybe just a handful of outsiders.

Encouraged by the recent meeting with Brad and the SM chatter I've spent a bit of time over the past few days catching up on Cogstate having previously owned it about 3 years ago.

I've been making my way through the Investor Insights Series which is on the Cogstate website and wanted to put down a couple of points mostly for myself but maybe there are others interested as well. @mushroompanda may have mentioned this already but if you are interested in the company the Investor Insights Series is excellent. I found the sencond one in particular, Unlocking Alzheimer’s Breakthroughs: Enabling better data-driven decisions to advance drug approvals, surprisingly insightful. It runs for an hour, is chaired by CEO Brad O'Conner and has a diverse and balanced panel of Kaycee Sink who is the Chief Medical Officer for Cogstate also a practicing geriatrician, Akash Tewari an Equity Analyst for Jefferies who covers Lilly and Rachel Colite who is the executive vice president of Clinical Trials at Cogstate. To me it feels like a rigorous scientific discussion.

Firstly Kaycee Sink spoke about a new drug being developed by Roche to treat Alzheimer's disease called Trontinemab that was presented at the recent Alzheimer's Association International Conference (AAIC) that took place in Toronto in July. This drug is important because it uses a novel new technology called Brainshuttle to transport the antibody across the notoriously impermeable blood brain barrier to the active sites inside the brain where it breaks down the amyloid. The amyloid is thought to be responsible for the development of Alzheimers disease. This Brainshuttle mechanism increases blood brain penetration of the drug by 50x. What the early data has shown is a reduction in amyloid by 90% after 6 months of treatment. Importantly the ARIA or Amyloid-related imaging abnormalities is also low at only 4% for the higher dose treatment arm. Roche is now heading to Phase 3 trials as @mushroompanda noted and this is work that will probably be won by Cogstate.

Secondly Akash Tewari discussed the Lilly Trial (Trailblazer-Alz-3) which is a current Phase 3 trial looking at a drug called donanemab in early stage Alzheimers disease and in some cases pre-symptomatic patients ie patients are identified on biochemical markers only. This trial is ongoing but Akash said Lilly, "have a sense of what the treatment arm is doing indirectly and the feeling is of some excitement in this population." So far the released data shows only 1/3 of the usual ARIA rate in this population and significantly it is looking like this drug will prevent Alzheimers progression. This is a big deal because the current drugs in clinical practice only slow the progression of Alzheimers disease by about 25-30%. It appears younger patients tolerate these drugs better because they have a lower amyloid burden. The initial read-out of date from this Phase 3 trial is expected in 12 months.

So big Pharma is shifting from treatment to prevention with promising looking drugs in the pipeline. If the initial read-out from the Trailblazer trial is positive as is expected this will be a catalyst for the Cogstate SP. Using these drugs for prevention massively increases the TAM. It is possible with a highly effective and safe drug like Trontinemab to have a once a year treatment, almost like having a vaccine, to flush out all the amyloid from your CNS. All of this presents a big opportunity for Cogstate. Their sophisticated and sensitive cognitive testing is well set up for the many pre-symptomatic trials that will follow as big Pharma move into the opportunity. But perhaps even bigger for Cogstate is the all end user cognitive testing that each of us will be doing on our phones to see if it is time to start another course of Trontinemab and go for another brain rinse!

Thanks for the tag @Shapeshifter. I haven't watched the second Investor Insights video - probably something I should get around to!

Some nice tidbits in your notes, especially around Roche's Trontinemab and the Lilly's TRAILBLAZER-ALZ 3 trial. My view on CGS winning the Trontinemab trials have cooled significantly. Given the start dates, I expected the contract wins to have been announced during the AGM update at the latest had they won. However Brad hasn't really changed his narrative around expecting more Phase 3 wins, so they mightn't have been in that specific race in the first place.

On a separate note, the AGM presentation did mention that the Cogstate x Clinical Ink partnership secured a preferred vendor selection with a new top 10 (by revenue) big pharma company. From Brad's social media interactions, and my own bit of LLM-ing - there's a good chance it could be Novo Nordisk.

Initial read outs for Novo's EVOKE and EVOKE+ trials are expected at the CTAD conference in early December. A positive readout might be a positive for CGS on two fronts:

1. If Novo Nordisk is the new customer, then the potential for follow on trials (e.g. combination or with a pre-symtomatic cohort) could follow on quickly with Cogstate in the prime postion to win them.
2. Eli Lilly, Cogstate's largest customer, also has GLP-1 drugs. It may encourage them to start their own trials.

Sounds like a Hail Mary from Noro Nordisk. They have failed to protect its GLP-1 patent in the US and their SP has been punished as a result. Personally I find the GLP-1 agonists to have limited efficacy for weight loss in the real world even factoring in cost and availability of the drug. Clearly a fishing expedition from Novo Nordisk and while Cogstate can ride the tailwinds of increasing CNS research spend (second to oncology I think Brad said) they do better when a trial has a positive outcome as this creates further work. This is perhaps one weakness of the Cogstate business model. Their fortunes are somewhat tied to the fortunes of the trial outcomes.