TRVI Trevi Therapeutics, Inc.
$15.31
Trevi Therapeutics, Inc. Q3 F2026 Earnings Call Transcript
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Operator
Good afternoon and welcome to the Trevi Therapeutics Third Quarter 2026 Financial Results and Corporate Update Conference Call. At this time, all participants are in listen-only mode. After today's presentation, there will be opportunity to ask questions. To ask a question during a session, you will need to press star 1-1 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 1-1 again. Please revise that today's conference is being recorded. Various remarks that management makes during this conference call about the company's future expectations, plan, and prospects constitute forward-looking statements for purposes of the state hardware provisions under the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including those discussed in the risk factors section of the company's most recent annual report on Form 10-K, which the company filed with the SEC on March 17, 2026, as updated by our subsequent filings with the SEC. In addition, any forward-looking statements represents the company's views only as of today and should be not be replied upon as representing the company's views as of any subsequent date. While the companies may elect to update these forward-looking statements, at some point in the future, the company specifically disclaims any obligation to do so, even if views change. I'd like to turn the conference call over to Jennifer Good, Trevis President and CEO. Please go ahead.
Jennifer Good
President and Chief Executive Officer
Good afternoon, and thank you for joining us for our third quarter 2026 earnings call and business update. Joining me today on this call are my colleagues, Dr. James Cassella, our Chief Development Officer, Farrell Simon, our Chief Commercial Officer, and David Hastings, our Chief Financial Officer. Dave and I will make some initial comments and then the team is happy to answer any questions you may have. 2026 is a busy year of execution for the company and the team is heads down on initiating and executing clinical trials in each of our programs. This includes activating sites globally, focusing on ensuring enrollment stays on track, all while staying aligned with the regulatory authorities. It has been fast-paced, but this is the fun part of what we do. Let me provide a brief update on each of our programs. First, our lead program in IPF-related chronic costs. We have initiated both Ocean 1 and Ocean 2 trials. We are now approved by all regulatory authorities in each of the countries in which we are conducting clinical trials, and the clinical team is focused on getting all the sites activated and screening patients. We will give an update once we reach 50% of the patients randomized in each of these trials. The trials are in early stages and progressing and we continue to believe we are on track with our previously stated guidance for Ocean 2, the 12-week study reading out in the second half of 2027 and Ocean 1, the 24-week efficacy endpoint with 52 weeks of safety reading out in the first half of 2028. In October, we took an important step forward in our non-IPF ILD cough program by aligning with the FDA on the development plan and next study. The pulmonary division has been very helpful and supportive as we think about how to get the first chronic cough drug approved in the U.S. The discussions have been collaborative and clear. Following this meeting with the FDA, our plan is to conduct a phase two dose ranging study with approximately 120 non-IPF ILD patients to confirm the optimal dose or doses to take forward into phase three. The protocol is written and will be submitted back to the FDA for any comments. We also have the wheels in motion identifying sites and working with our CRO partner to prepare for study initiation. Recall that these clinical centers will overlap directly with the same sites we are using in our North American IPF Phase III program. When we signed a contract and negotiated budgets for our ocean trials, we planned for the fact that we likely would conduct an ILD trial. We are planning to initiate this trial in the first quarter of 2027. We will study two doses of Heduvio for 12 weeks of fixed dosing in patients with interstitial lung disease, excluding patients with IPF. We anticipate top-line data to be available in the first half of 2028. Remember, the ILD opportunity more than doubles the IPF potential, and we continue to hear about the high unmet need in this population from doctors. In parallel to the clinical work, we are looking at prevalence and epi data to help refine our estimates of the commercial opportunity in non-IPF-related chronic costs. Turning now to refractory chronic costs, or RCC, and our late Phase IIb trial. With the two competitive drug failures this summer, I have talked more about this program over the past few months than I thought was humanly possible. Let me try to briefly summarize where things stand in the RCC space and explain the upcoming sample size re-estimation, or SSRE. First, there are no active competitive programs left in RCC or any of our targeted chronic cough indications for that matter. Peripheral-only mechanisms have not been able to withstand the complexity and heterogeneity of cough triggers. It was always our hypothesis that while the peripheral mechanism plays a role in settling signaling, the central mechanism is critical in mitigating the hypersensitivity related to cough. and I've been asked about the differences in market dynamics between RCC and IPF and non-IPF related chronic costs. The reality is that RCC is a significant unmet need in which patients' quality of life is deeply affected. We believe that if our drug can offer relief to these patients, we can figure out the commercial dynamics. We are working on various options around targeting the most refractory patient group, potentially with lower doses, et cetera. In a world where it all starts with the patient, RCC is a severe chronic cough condition with no good treatment options. There have been numerous examples of brands such as Dupixent successfully navigating payer dynamics in larger follow-on indications. Finally, as you know, drug development has been very challenging in RCC because of the heterogeneity of patients with chronic cough as well as the placebo effect. We believe we have distinct advantages with our dual central and peripheral mechanism and the demonstrated evidence that our drug works broadly across cost counts. However, we are mindful that there have been very few positive trials. So, as we designed the Phase IIb Lake Study, we built in a sample size re-estimation or SSRE to account for variability in the patient population, placebo effect, et cetera. Let's just recap the analysis. Once 50% or 50 patients complete the trial, an independent STATS team outside of Trevi will look at the unblinded data and confirm powering assumptions at that point in the study. Essentially, we will get one of three answers back with no corresponding data so as not to unblind the trial. The three potential answers are one, the trial to date has at least 80% power, and we should continue with the original plan of enrolling 100 patients. Two, the trial is showing a conditional power range of 40% to 80%. This means the drug is working, but there is either more variability or less of an effect size than our original assumptions. We then will upsize accordingly up to a maximum of 152 patients. It is not all or nothing with the upsize. It is a proportional upsize from 4 to 52 patients meant to restore at least 80% conditional power. A little color on what that means. The effect size in this conditional power range represents an effect size of approximately low 20% range to 30%. Just to be clear, effect size is defined as drug effect less placebo. A 20% to 30% effect size is clinically meaningful and could have a significant impact in a world where there are no good options. And finally, the third option for the SSRE is futility. The conditional power at the time of analysis for the trial would be below 40% and suggest futility for the fully completed trial. In light of the fact that the study will likely be close to fully enrolled and there are no competitive programs left, We would plan to finish enrollment based on the original sample size of 100 and look at the data. So to wrap up this SSRE discussion, the SSRE design means that a non-feudal result is a clinically meaningful benefit in cough reduction. And upsizing the trial slightly is to ensure that clinical meaningfulness is statistically significant at the end of the study. We estimate we will have the results of the SSRE in the early part of the first quarter. and have reconfirmed our guidance for full trial results in the second half of 2027. Finally, last month, a number of chronic cough patient advocacy organizations teamed up to hold an externally led patient-focused drug development or PFDD meeting with the FDA to discuss the disease burden of chronic cough. Patients told their stories of the impact on their lives and their experiences exemplified the burden of chronic cough across IPF, ILDs, and RCC patients. One ILD patient stated, cough is the single greatest thief of my quality of life. This meeting represents a meaningful engagement with the FDA in raising the need for effective and safe therapies. The results will be released in 2027 in a voice of the patient report. We are pleased by the focus of the FDA on this significant unmet need. In closing, we are focused on executing against our plan of becoming the leader in chronic cough. With the recent competitive failures in RCC, we are alone in all three of our cough indications and have the potential to be a first-in-class therapy in very big markets. We believe if we are able to execute against our current plan, we can create meaningful value for patients and in turn significant value for our shareholders. I will now turn it over to Dave for his remarks, and then we are happy to answer your questions. Dave?
David Hastings
Chief Financial Officer
Thanks, Jennifer, and good afternoon, everybody. My remarks today will focus on our most important financial metric, which is our cash position and the runway it provides. We ended the third quarter of 2026 with approximately $299 million in cash, cash equivalents, and marketable securities. Importantly, we are well capitalized to execute on our development plans as our cash runway extends into 2030. This allows us to fund our clinical trials to key value inflection points, including our lead program in IPF-related chronic cough through potential FDA approval. As Jennifer mentioned, we recently completed a positive FDA meeting where we got clarity on the clinical trial pathway for our non-IPF-ILD-related chronic cough program. So with that feedback, our current cash runway includes funding that program through top-line data in our upcoming Phase II trial. Additionally, our current cash resources will fully fund our ongoing Phase IIb leg trial for the treatment of patients with RCC. The planned spending of these cash resources also includes pre-commercial Thank you. Thank you. Thank you.
Conference Operator
Operator
Thank you. We will now conduct the question and answer session. As a reminder to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1-1 again. At this time, we will pause momentarily to assemble our roster. And our first question comes from the line of Rona Reeves of Link Partners. Your line is now open.
Rona Rees
Analyst, Leerink Partners
Great. Hi, everyone. So I was curious, can you give me more color on your ILD chronic cough meeting with the FDA? Did you achieve all your goals going in? And are there any trial design features that we should think about for the phase two dose ranging study that are particularly important for setting up the value proposition in the syndication?
James Cassella, MD
Chief Development Officer
Hi, Rowana. This is Jim. Thanks for the question. So we had a very positive and very supportive meeting with the FDA. I think the key takeaways are really around the design of the phase two dose ranging trial, which will look very much like the choral study that we did to really launch the IPF program. One difference being that this will be a longer trial that will really support a more fully phase three program. So I think the dose ranging part of this is really to understand in this other ILD population that we have the same parameters for dosing and dose selection. So I think we had really nice alignment on what we need to do there and nothing out of the ordinary. I think just basic, you know, show me the data and show me the doses that are really working in this particular population.
Rona Rees
Analyst, Leerink Partners
Makes sense. And then thinking ahead to a potential Phase III program in ILD chronic cough, Any ideas on where you might land? Would it be a single phase three or any insights coming out of your interactions with the FDA?
James Cassella, MD
Chief Development Officer
I think there's another thing that we had some dialogue on. I think because we want to take into account the fact that this is a follow-on to the IPF program. This will be an SMDA regulatory submission pathway. will be building on the data that we have from the IPF-ILD population to support the non-IPF-ILD population and that program going forward. The beauty of our approach here and the alignment we have with the FDA is to take this stepwise to help them understand what's needed here and for us to understand what they're looking for. So the Phase II dose-ranging study is really to identify the doses, get experience in this patient population, build that on top of our findings and our observations with the IPF population and then design the most efficient, hopefully, and I think realistically, one phase three trial that will bring us to support the SMDA for non-IPF ILD.
Devon Chatterji
Analyst, JonesTrading
Sounds good. Thanks a lot.
Conference Operator
Operator
Thank you. We'll move on to our next question. Our next question, question line of Annabelle Samimi of State Folio Line is now open.
Annabel Samimy
Analyst, Stifel
Hi, thanks for taking my question. So just to follow on the ILD study, obviously it looks very much like the IPF study. I'm wondering if the FDA has asked you to do anything more or have you baked in any other subgroup analyses with this population given that it's a little bit maybe more variable than the IPF population? Are you looking to identify different subgroups with your trial, or is it just not possible at this stage?
James Cassella, MD
Chief Development Officer
Jim, again, thanks. It's a great question and one that we had a really good dialogue with a number of the KOLs in this space because it is a diverse population. It's more heterogeneous than IPF. IPF is that part of the ILD world that is really a more unified type of population, but when we get into non-IPF, there's really over 100 different conditions that are involved there. But the underlying condition, the fibrotic lung disease, is a common thread among all of these patient groups. So we're going to capitalize on the fact that they have this underlying lung condition, a certain amount of fibrosis, as well as the cough. So I think that is the common thread for all of these populations. We've had a good dialogue with the KOLs, and I think that's the approach we're taking because it's really hard when you look at all the different subgroups. Some of them are smaller, some of them are larger, but really we're going to go to the fundamental of the disease here where the belief is that the lung fibrosis is really a significant underlying condition for the cough, and that's going to tie all this together.
Jennifer Good
President and Chief Executive Officer
And the FDA did not focus on subgroups, right? They really, Annabelle, were focused on the fibrotic lungs.
Annabel Samimy
Analyst, Stifel
So, yeah. All right, that's helpful. And just one question on that. RCC. I guess the SSRE slipped just a little bit to the first quarter, so I'm just wondering with enrollment speed, I'm surprised. Is it just slightly slower enrollment because of—I didn't expect it to be slower enrollment because of some of the failures out there. And are there any options to increase powering beyond the 150 to if you seem to be falling at the low end of the range. Is there any possibility there in terms of clinical effect size?
Jennifer Good
President and Chief Executive Officer
I'm going to start, and Jim, you can add it. I think, Annabelle, this was always going to be our timelines always showed December. When you say slip to Q1, it's early Q1. We're sort of talking about weeks here with the holidays. So just to put it in context, it was always a little tricky because it was December. So, you know, it didn't take much and you sort of fell into January. As far as is there any opportunity to go above 152, and Jim, you can comment on this, but we won't know in the 40 to 80% range. We'll only know that it's X and you should upsize Y. I mean, we always over-enroll a little bit, but no, we're not going to try to chase efficacy here. We're going to follow the recommendation.
James Cassella, MD
Chief Development Officer
Yeah, and Ambella, I think that, you know, we went in with powering assumptions. This is our first parallel arm study in RCC. We learned a lot from the river study, which was the crossover in RCC, and we learned a lot from the coral study in terms of the IPF parallel arm study. I think the key here is that, you know, we are powering sufficiently. This is a little bit of a statistical adjustment given the effect sizes that we saw previously. So we'll take it with 80% power, which is appropriate for a Phase II study. So if we can get back up there, that's the end we'll go with.
Jennifer Good
President and Chief Executive Officer
Okay.
Conference Operator
Operator
Got it. Thank you.
Jennifer Good
President and Chief Executive Officer
Thanks, Annabelle.
Conference Operator
Operator
Thank you, Wilma, for our next question. Our next question comes from the line of Maxwell Score of Morgan Stanley. Your line is now open.
Maxwell Skor
Analyst, Morgan Stanley
Great. Thank you very much. So beyond confirming powering, would the SSRE outcome change how you plan for RCC overall? For example, the target patient segment, phase three sizing, or whether to partner the program? Thank you very much.
Jennifer Good
President and Chief Executive Officer
We'll wait to look at the full data set. We don't really get much, Maxwell, from the interim other than sort of to confirm powering in the end. So we'll wait for the full data set. I think what's changed here is we're in a world where there's nobody else. And so I think before we were trying to be mindful of making sort of superiority around any competitive programs, but that's changed. So I think we'll take a good look at the data. will talk to the agency and we'll figure out sort of what our phase three program needs to look like. I think much like Jim described on non-IPFILD, we believe this is also an SNDA and may only require one phase three study. As for partnering, I don't think that's probably on the table because we're a single asset company. We're going to want to retain sort of global rights. Now, whether commercially we look at, you can jump in, co-promote or anything, I think certainly all those options are on the table. But Our intent today is to retain commercial rights for our own program.
Maxwell Skor
Analyst, Morgan Stanley
Great, thank you.
Jennifer Good
President and Chief Executive Officer
Yeah, thank you.
Conference Operator
Operator
Thank you, Wilma, for our next question. Our next question comes from Glenn Gershow of Oppenheimer. Your line is now open.
Glenn Gershowitz / Brian Deschner
Analyst, Oppenheimer / Raymond James
Oh, great. Thanks for providing this update and taking our questions. Just one from us on the non-IPF-ILD. So it sounds like the doses that you'll be evaluating here just, you know, fall effectively in line with what you have looked at historically in cough. And I'm just wondering, maybe for Jim, you know, do you think that there is any biology that could lead to differences in response in that dose range versus IPF-ILD? Obviously, a lot of variability in the biology and the diseases. of the various other non-IPFILDs. Just kind of curious your thoughts there on kind of dose response in that non-IPFILD. Thanks.
James Cassella, MD
Chief Development Officer
Yeah, no, thanks, William. It's a great question and actually one that we were all very interested in, especially the FDA, because it's all about doing definitive dose ranging. I think you can imagine that we have IPF, which is a very severe and terminal population. This may be in the eyes of some a little different than that more IPF, more severe population. So there's a possibility that you could see something working maybe a little bit better at the 27 milligram dose trend. However, I think when we talk to the KOLs, their belief is that this is all being driven by the fibrotic lung. So this is really a study to demonstrate what we have. and probably see something along the lines of what we saw with IPF. But I think that really is the show-me stage to make sure that we have our doses right. So I don't think we have a different expectation for ILD, but I think we'll get some good answers out of this.
Brandon Folkes / Connor McKay
Analyst, Cantor Fitzgerald / Analyst, BMO Capital Markets
Great. Thank you.
Conference Operator
Operator
Thank you. Well, we'll move to our next question. Our next question comes from the line of Brian Deschner of Raymond James. Your line is now open.
Glenn Gershowitz / Brian Deschner
Analyst, Oppenheimer / Raymond James
Hey, thanks for the question, and congrats on the progress. I'm curious what you've been able to learn from the failure of GSK's Phase III program with camlapixin that could be helpful in the execution of the leg trial or in a subsequent Phase III program for RCC or impact how you're thinking about the upcoming FSRE update. Thanks.
Jennifer Good
President and Chief Executive Officer
Yeah, thanks, Brian, for the question. I think you know none of the data has been put out so it's all been sort of through the grapevine but there's been a lot of stuff drifting around. I would say what I have learned just from investigators and actually from the company itself is I don't think placebo was a big problem here which is really as you know has always been the only thing we really needed to care about. I also think that it sounds like their first trial worked reasonably well, and for whatever reason, their second trial, column two, fell apart. It was the longer trial, but that trial was also upsized twice. So a lot of kind of confounding factors in that. So I think as Jim has warned me about from the very beginning, we're better off to follow our own data because there was a lot of extenuating circumstances around those trials. I think they were trying to sort of enrich for this greater than 20 coffers. You know, they upsized the trial twice. They sort of took over the development program midstream. There was a lot of challenging aspects of that. So, you know, I think Ryan will run our Phase 2B, hopefully now the dose, and then I'm hoping that we don't need as big a trial as everybody else has had to run because our effect size will be bigger. So that's kind of what we know. I think there's also the NoCyan program out there some people are aware of. That drug just didn't work. I've seen all the data. It didn't work in 2A, and I think they sort of enrolled 400 patients to show it didn't work in phase 2B. So I don't think, I don't know, Jim, there wasn't anything I really learned out of that trial that was really all that enlightening either.
James Cassella, MD
Chief Development Officer
Yeah, I think the key, Ryan, is that we've designed the lake trial to really give us the information we need to have. I think, you know, given our experience with, you know, chronic cough, with IPF, and with the river data, Yeah, we can drive our program based on our own results and we know that we really need to keep the control over the centers we pick and the patients they pick and we're all over that. Thank you very much.
Jennifer Good
President and Chief Executive Officer
Thank you, Ryan.
Conference Operator
Operator
Thank you. One moment for our next question. Again, as a reminder to ask a question, you'll need to press star 1-1 on your telephone. Our next question comes from the line of Kaveri Pullman of Clear Street. Your line is now open.
Wayne (for Kaveri Pohlman)
Analyst, Clear Street
Hi, Tim. This is Wayne for Kaveri. Congrats on all the progress this quarter, and thanks for taking our questions. So based on our conversation with some investors, there remain some concerns around ultimate size and durability of the RCC market. So how do you think about those concerns, and what commercial initiatives and market development efforts do you believe will be important to drive physician awareness patient identification, and successful uptake of Hadovio following approval. Thank you.
Farrell Simon
Chief Commercial Officer
Yeah, Wayne, this is Farrell. Thank you for the question. So when we look at the RCC market, right, I just want to go back. We're an IPF-ILD-led company, and so when we're focused on building the market, and we've already started those efforts with our unbranded campaign, we're We've approached, I think, 93% of pulmonologists that we've already touched talking about the burden of chronic cough and that disease. When we look at the future potential of the RCC market, we'll do our proper market sizing of that market, but we estimate the severe portion, those who have failed other therapies, and aligned with our inclusion-exclusion criteria of being diagnosed for greater than one year, that really narrows that market to around a million patients. And those are the patients that are going to be seen by pulmonologists primarily. So we're still focusing all of our efforts on pulmonology. And as we look at just further market development, that is further off in RCC, right? We are solely focused on developing that IPF and ILD market currently.
Wayne (for Kaveri Pohlman)
Analyst, Clear Street
Got it. Thank you so much.
Conference Operator
Operator
Thank you. One more for our next question. Our next question comes from the line of Debwajana Jatterji of Jones. Your line is now open.
Devon Chatterji
Analyst, JonesTrading
Hi, thanks for taking my question, and congrats on all the progress with all the programs. So I have a question on SSRE. If the data calls for the update, calls for upsizing, how long would it take to do the additional 52 patient enrollment, and how could that affect the top line readout? And I have a quick follow-up.
James Cassella, MD
Chief Development Officer
Yeah. Hi, David. This is Jim. We anticipate that if we have to go to the full increase in cohort, that we would still be able to read that out by the end of 27.
Jennifer Good
President and Chief Executive Officer
Sorry, guidance would remain the same. Second half 27, yep.
Devon Chatterji
Analyst, JonesTrading
Okay. And curious how low would the RCC approvable dose need to be for to allow you to launch that as a separate brand from the IPF program and to preserve differential pricing?
Farrell Simon
Chief Commercial Officer
Hey, Devon, John, and this is Farrell. So, you know, we'll get the dose from that study. It's part of the reason we're testing the 27 milligrams once a day. You know, if we end up in that range or lower, it doesn't necessarily even have to be a once a day, even if we get into really low doses in a twice-a-day delivery program. We could still do that. We have work to do there in order to refine what we get out of the trial and really understand how that could impact IPF and ILD because one of the things we don't want to do is cannibalize the pricing in those indications.
Devon Chatterji
Analyst, JonesTrading
I appreciate the color. Thank you.
Conference Operator
Operator
Thank you. One moment for our next question. Our next question comes from Serge Ballinger of Needham & Co. Your line is not open.
John (for Serge Belanger) / William Wood
Analyst, Needham & Company / Analyst, B. Riley Securities
Hi, good afternoon. This is John on for Surge today. Thanks for taking my question. Maybe just one for us today surrounding IP for Hadovio. Curious if there's been any updates to strengthen Hadovio's patent protection over the past few months and what some initiatives might be on that front as we head into 2027.
Jennifer Good
President and Chief Executive Officer
Yeah, John, thank you for that question. That's been a big effort and focus around the company this year. I mean, we've always thought about it, but there's been a concerted effort. You'll see in our earnings release we just put out that we actually did get another patent issued around dosing in hepatic impaired patients and non-IPF-ILD. That would take that protection out to 2041. So fundamentally, our patenting strategy is method of use patents, We're trying to get the base patents in place for each of our indications. That takes the protection through 2039. And then beyond that, we're filing essentially different dosing claims that have come up through the work Jim's doing and different claims in the label. And we're having good success getting those issued. So yeah, made some progress on that this quarter.
Conference Operator
Operator
Great.
Wayne (for Kaveri Pohlman)
Analyst, Clear Street
Thanks for the added color.
Jennifer Good
President and Chief Executive Officer
Yeah, thank you.
Conference Operator
Operator
Thank you. One moment for our next question. Our next question comes from the line of Brandon Foulkes of 18 Where Am I? Your line is now open.
Brandon Folkes / Connor McKay
Analyst, Cantor Fitzgerald / Analyst, BMO Capital Markets
Hi, thanks for the questions and congrats on all the progress. Just maybe two from me on RCC. On the lake disemphasized re-estimation, can you just talk about how do you account for potentially different responses across the three active doses? Is the conditional power assessment on SSRE are driven by the 54 milligram arm or the three active arms. And then secondly, if an upsize is needed, do you get insight into if this is driven by sex size or variability? And if so, can you help us think about just variability, the scenario they're just giving you are testing lower doses? Thank you.
James Cassella, MD
Chief Development Officer
Yeah, hi, this is Jim. on the SSRE, it is based on the high dose only, the 54 milligram twice daily dose. So we will drive everything based on the analysis of that dose alone. We get very little information from the statisticians. We will know to stay at our current N or upsize by a certain number. We have no read on what the issues are or what may be driving any kind of an upsize. The whole idea here is to keep us unbiased, and that's what the purpose of this is. It really is a statistical adjustment, so in order not to bias the trial, we get very, very little information. We will know all that at the end of the day, obviously, when the study completes, but we don't get that information along the way.
Devon Chatterji
Analyst, JonesTrading
All right. Thank you very much.
Conference Operator
Operator
One moment for our next question. Our next question comes from the line of Connor McKay of BMO Capital Markets. Your line is now open.
Brandon Folkes / Connor McKay
Analyst, Cantor Fitzgerald / Analyst, BMO Capital Markets
Hi there. Thanks for taking my question, and congrats on all of the progress. I'm wondering if maybe you can speak to how enrollment is progressing for OCEAN 1 and 2 and how you would think about timing for eventual filing and IPF front-end costs. Would you be able to submit the filing with just the OCEAN 2 data and add OCEAN 1 at a later point, or do you need both data sets in hand before you can submit?
Jennifer Good
President and Chief Executive Officer
I'll comment on the first part of that, Jim. You add any. Things are going well. We have a plan. I think site activations are coming along nicely. We've got enrollment coming along nicely. It's early. We think we've reconfirmed our guidance, so we're comfortable with that as of now. I think I would just add a little color. I've gone to all the investigator meetings that Jim and his team have hosted. There's a lot of excitement and enthusiasm around this clinical trial, as you guys probably know there's been a lot of clinical work done in IPF, a lot of anti-fibrotic work. And I think there's a genuine excitement around having a cost option for people to enroll in. So yeah, I think we feel good about that. What was the second half of the question?
James Cassella, MD
Chief Development Officer
Really on the filing strategy is we would report out the trials for Ocean 2 and Ocean 1 separately. but we would do a comprehensive integrated NDA filing. So that involves the reporting of each of the individual trials but there's also integrated safety, integrated efficacy. So those will all come together at the end and be filed all as one piece for the clinical portion of the NDA.
Jennifer Good
President and Chief Executive Officer
Jim, if we were to get fast track though, we could file in pieces. I know they don't read it all until they get everything.
James Cassella, MD
Chief Development Officer
They don't read anything until the thing is filed. So, and it doesn't necessarily help us on any date because it's not until the last piece is in.
Conference Operator
Operator
I appreciate the additional follow-up. Thanks. Sure. Thank you. One moment for our next question. Our next question comes from the line of William Wood of B-Body Securities. Your line is now open.
John (for Serge Belanger) / William Wood
Analyst, Needham & Company / Analyst, B. Riley Securities
Thanks for taking our questions and congrats on another successful quarter. Two from us, one on IOD, one on Lake. For Lake, I was curious, could you provide any comment on how your site activation is ongoing and if that remains on track or if that's been completely activated and then also How many patients have you actually enrolled? I know we're expecting the SSRE to read out at 50% completion, but I was curious specifically on enrollment and then on ILD. Could you just remind us, you've had some discussions now with the FDA. We know this is not IPF, but is it still, what is being excluded from the trial in terms of sort of its basket enabling? and then in terms of your dosing, why not a 27-month daily dose? And is there a certain level degree of fibrosis or cough that will be needed in this trial? Thank you.
Jennifer Good
President and Chief Executive Officer
Thanks, William. I'll take the first part. I'll let Jim do ILD. Lake, our site activations are on track. Not every site's up and running, but we're a long ways there. That's gone very well. I think the enrollment percentage, our general policy is going to be we'll let you know when we hit 50% and we'll give updates after that. So we're obviously progressing nicely for having this come sort of early in the year. So when we hit that number, we'll let you know. I think, Jim, I'll turn it over to you on all the ILD questions.
James Cassella, MD
Chief Development Officer
And I may have missed the last one, so you can remind me. In terms of the strategy on patient selection, It will be based on a certain level of fibrosis. That's going to be the underlying condition here. And we're not looking at it in terms of their specific comorbidities. But the intention is that all of the various comorbidities are eligible for the most part with the underlying fibrosis and chronic cough. I think the last question was, sorry, you may have to remind me.
Jennifer Good
President and Chief Executive Officer
What is being excluded? Nobody's excluded at ICF.
James Cassella, MD
Chief Development Officer
Yeah. No, for the ILD, I mean, really nobody's being excluded unless they don't have the level of the fibrosis. Did you? Was there one more? Yes.
John (for Serge Belanger) / William Wood
Analyst, Needham & Company / Analyst, B. Riley Securities
Yeah, one follow-up there. What is the level of fibrosis? I'm just thinking in terms of is this a sort of like a moderate to severe cough trial that you have to have just fibrosis meet some bar, or is it there's a certain level of, you know, very specific fibrosis in the lungs versus just any that you have to sort of complete or meet? And then dosing specifically, why not a 27 QD once daily dose?
James Cassella, MD
Chief Development Officer
Yeah, so in terms of the level of fibrosis, the KOLs in this space generally have a floor of at least 10% fibrosis in the IPF, non-IPF world to really establish a sort of a reliable condition. And then they sort of break out based on the HRCT scan what type of ILD they may have. So we're thinking along the lines of that we would have a minimum of about 10%. lung fibrosis, and without any particular pattern. So that sets the floor for us, but that's pretty much what the experts agree would be establishment of an appropriate level of interstitial lung disease, whether it's IPF or not IPF. So nothing magical there other than setting the floor. Cough count, I mean, obviously they have to have chronic cough over the period of time. So why not go into a 27 QD dose Well, because in the IPF world, we saw that the 27BID dose was our less effective dose. We are making the assumption that this non-IPF ILD program will follow very closely to the IPF program. We just didn't think that once a day, 27 in the ILD space would be sufficient given the data that we have with IPF.
John (for Serge Belanger) / William Wood
Analyst, Needham & Company / Analyst, B. Riley Securities
Got it. Appreciate that. Thanks for the extra color.
Conference Operator
Operator
Sure. Thanks.
Jennifer Good
President and Chief Executive Officer
Thank you, William.
Conference Operator
Operator
Thank you. I'm showing no further questions at this time. This concludes our question and answer session. I'll now turn the conference back to Jennifer Good for closing remarks.
Jennifer Good
President and Chief Executive Officer
We appreciate you joining us for today's call. We will be at the Stifel Conference on Wednesday this week and hope to see many of you there. Thank you.
Conference Operator
Operator
This concludes today's conference call. Thank you for attending. You may now disconnect.