[PART I – FINANCIAL INFORMATION](index=3&type=section&id=PART%20I%20%E2%80%93FINANCIAL%20INFORMATION) [Item 1. Financial Statements (Unaudited)](index=3&type=section&id=Item%201.%20Financial%20Statements%20(Unaudited)) Presents unaudited condensed financial statements for Q1 2021, showing a net loss of **$23.3 million** and total assets decreasing to **$250.2 million** Condensed Balance Sheet Highlights (Amounts in thousands) | Metric | March 31, 2021 | December 31, 2020 | | :----------------------------------- | :------------- | :---------------- | | Total Assets | $250,228 | $271,157 | | Total Current Assets | $188,351 | $195,065 | | Cash and Cash Equivalents | $22,519 | $31,683 | | Marketable Securities (Current) | $149,063 | $149,242 | | Total Liabilities | $19,769 | $22,156 | | Total Stockholders' Equity | $230,459 | $249,001 | Condensed Statements of Comprehensive Loss Highlights (Amounts in thousands) | Metric | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Total Revenue | $1,935 | $8,093 | | Research and Development Expenses | $19,131 | $33,536 | | General and Administrative Expenses | $6,365 | $4,558 | | Operating Loss | $(23,561) | $(30,001) | | Net Loss | $(23,301) | $(28,922) | | Net Loss per Share (Basic and Diluted) | $(0.47) | $(0.62) | Condensed Statements of Cash Flows Highlights (Amounts in thousands) | Metric | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Net Cash Used in Operating Activities | $(23,721) | $(38,303) | | Net Cash Provided by Investing Activities | $13,869 | $36,959 | | Net Cash Provided by Financing Activities | $688 | $75 | | Net Decrease in Cash, Cash Equivalents and Restricted Cash | $(9,164) | $(1,269) | | Cash, Cash Equivalents and Restricted Cash at End of Period | $22,927 | $17,444 | [Notes to Condensed Financial Statements](index=8&type=section&id=Notes%20to%20Condensed%20Financial%20Statements) Provides detailed notes on accounting policies, marketable securities, collaboration agreements, and revenue recognition for the unaudited financial statements - Cara Therapeutics is a clinical-stage biopharmaceutical corporation focused on developing and commercializing new chemical entities designed to alleviate pruritus by selectively targeting peripheral kappa opioid receptors[20](index=20&type=chunk) - As of March 31, 2021, the Company had raised approximately **$519.6 million** from equity financing and earned **$203.8 million** under license agreements[21](index=21&type=chunk) - The Company adopted ASU 2019-12 on January 1, 2021, which did not have a material effect on its financial statements due to a full valuation allowance[33](index=33&type=chunk) [1. Business](index=8&type=section&id=1.%20Business) Cara Therapeutics is a clinical-stage biopharmaceutical company focused on developing new chemical entities for pruritus - Cara Therapeutics, Inc. is a clinical-stage biopharmaceutical company focused on developing and commercializing new chemical entities targeting peripheral kappa opioid receptors to alleviate pruritus[20](index=20&type=chunk) - The company has incurred substantial net losses and negative cash flows from operating activities since inception, with net losses of **$23.3 million** and **$28.9 million** for the three months ended March 31, 2021 and 2020, respectively[22](index=22&type=chunk) [2. Basis of Presentation](index=8&type=section&id=2.%20Basis%20of%20Presentation) Details the preparation of unaudited interim financial statements in accordance with SEC rules and GAAP, including ASU 2019-12 adoption - The unaudited interim condensed financial statements are prepared in accordance with SEC rules and GAAP, reflecting all necessary adjustments for fair presentation[24](index=24&type=chunk) - The Company adopted ASU 2019-12 on January 1, 2021, which simplifies income tax accounting, but it did not materially affect financial results due to a full valuation allowance[31](index=31&type=chunk)[33](index=33&type=chunk) [3. Available-for-Sale Marketable Securities](index=12&type=section&id=3.%20Available-for-Sale%20Marketable%20Securities) Describes the composition and fair value of available-for-sale marketable securities, including realized gains from sales - Available-for-sale marketable securities consist of debt securities from U.S. Treasury, government-sponsored entities, investment grade institutions, and municipal bonds[34](index=34&type=chunk) Available-for-Sale Marketable Securities (Amounts in thousands) | Type of Security | Amortized Cost (Mar 31, 2021) | Fair Value (Mar 31, 2021) | Amortized Cost (Dec 31, 2020) | Fair Value (Dec 31, 2020) | | :----------------------------------- | :---------------------------- | :------------------------ | :---------------------------- | :------------------------ | | U.S. Treasury securities | $15,164 | $15,167 | $20,710 | $20,750 | | U.S. government agency obligations | $22,099 | $22,097 | $22,125 | $22,128 | | Corporate bonds | $41,674 | $41,652 | $49,080 | $49,118 | | Commercial paper | $115,179 | $115,187 | $116,139 | $116,127 | | Municipal bonds | $11,663 | $11,688 | $11,680 | $11,684 | | Total | $205,779 | $205,791 | $219,734 | $219,807 | - During the three months ended March 31, 2021, the Company sold available-for-sale debt securities with a fair value of **$8,029 thousand**, resulting in realized gains of **$39 thousand**[47](index=47&type=chunk) [4. Accumulated Other Comprehensive Income (Loss)](index=17&type=section&id=4.%20Accumulated%20Other%20Comprehensive%20Income%20(Loss)) Presents changes in accumulated other comprehensive income (loss), including reclassified realized gains on security sales Changes in Accumulated Other Comprehensive Income (Loss) (Amounts in thousands) | Metric | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Balance, December 31 / 2019 | $73 | $170 | | Other comprehensive loss before reclassifications | $(22) | $(238) | | Amount reclassified from accumulated other comprehensive income | $(39) | — | | Net current period other comprehensive loss | $(61) | $(238) | | Balance, March 31 | $12 | $(68) | - Realized gains on sales of securities of **$39 thousand** were reclassified from accumulated other comprehensive income (loss) into net loss for the three months ended March 31, 2021[50](index=50&type=chunk) [5. Fair Value Measurements](index=17&type=section&id=5.%20Fair%20Value%20Measurements) Outlines the fair value hierarchy for financial instruments, with most assets categorized as Level 2 - The Company classifies financial instruments into a fair value hierarchy (Level 1, 2, 3) based on the observability of inputs[54](index=54&type=chunk)[55](index=55&type=chunk) - Most financial assets, including U.S. Treasury securities, government agency obligations, corporate bonds, commercial paper, and municipal bonds, are categorized as **Level 2**, with fair values estimated using third-party pricing services[56](index=56&type=chunk)[60](index=60&type=chunk)[61](index=61&type=chunk) [6. Restricted Cash](index=20&type=section&id=6.%20Restricted%20Cash) Details the **$408 thousand** in restricted cash held as collateral for the Stamford office lease - The Company maintains **$408 thousand** in restricted cash as collateral for a standby letter of credit related to its Stamford office lease, consistent across March 31, 2021, and December 31, 2020[62](index=62&type=chunk)[63](index=63&type=chunk)[65](index=65&type=chunk) [7. Prepaid expenses](index=21&type=section&id=7.%20Prepaid%20expenses) Summarizes the composition of prepaid expenses, including R&D clinical costs and insurance Prepaid Expenses (Amounts in thousands) | Category | March 31, 2021 | December 31, 2020 | | :----------------------------------- | :------------- | :---------------- | | Prepaid R&D clinical costs | $10,557 | $11,286 | | Prepaid insurance | $2,007 | $223 | | Other prepaid costs | $454 | $567 | | Total Prepaid Expenses | $13,018 | $12,076 | [8. Accounts Payable and Accrued Expenses](index=21&type=section&id=8.%20Accounts%20Payable%20and%20Accrued%20Expenses) Provides a breakdown of accounts payable and accrued expenses, including research projects and compensation Accounts Payable and Accrued Expenses (Amounts in thousands) | Category | March 31, 2021 | December 31, 2020 | | :----------------------------------- | :------------- | :---------------- | | Accounts payable | $4,765 | $4,893 | | Accrued research projects | $7,190 | $6,194 | | Accrued compensation and benefits | $2,336 | $4,955 | | Accrued professional fees and other | $589 | $839 | | Total | $14,880 | $16,881 | [9. Stockholders' Equity](index=21&type=section&id=9.%20Stockholders'%20Equity) Reports on the vesting and settlement of performance-based and time-based restricted stock units in Q1 2021 - In February and March 2021, **76,750** performance-based restricted stock units and **32,669** time-based restricted stock units vested and were settled in common stock[68](index=68&type=chunk)[69](index=69&type=chunk) [10. Collaboration and Licensing Agreements](index=22&type=section&id=10.%20Collaboration%20and%20Licensing%20Agreements) Details key collaboration and licensing agreements with Vifor, VFMCRP, Maruishi, and CKDP for CR845/difelikefalin - Vifor Agreement (October 2020) granted Vifor exclusive U.S. license for CR845/difelikefalin injection for pruritus in hemodialysis and peritoneal dialysis patients, with **$100 million** upfront, **$50 million** from common stock purchase, eligibility for **$50 million** additional common stock investment upon U.S. regulatory approval, up to **$240 million** in sales-based milestones, and a **60%** net profit-sharing arrangement (excluding FMCNA sales)[72](index=72&type=chunk)[73](index=73&type=chunk)[74](index=74&type=chunk)[75](index=75&type=chunk) - VFMCRP Agreement (May 2018) granted VFMCRP exclusive license for CR845/difelikefalin injection worldwide (excluding U.S., Japan, South Korea), receiving **$50 million** upfront and **$20 million** from common stock purchase, with eligibility for up to **$470 million** in regulatory and commercial milestones and tiered double-digit royalties on net sales, and a profit-sharing arrangement with VFMCRP for FMCNA dialysis clinics in the U.S.[81](index=81&type=chunk)[82](index=82&type=chunk)[83](index=83&type=chunk) - Maruishi Agreement (April 2013) granted Maruishi exclusive license for CR845/difelikefalin in Japan for acute pain and uremic pruritus, with eligibility for clinical/regulatory milestones (up to **$10.5 million**), a one-time sales milestone, sub-license fees, and tiered low double-digit to low twenties royalties on net sales, and earned a **$2.0 million** milestone in January 2021 for Phase 3 trial initiation[88](index=88&type=chunk)[89](index=89&type=chunk)[253](index=253&type=chunk) - CKDP Agreement (April 2012) granted CKDP exclusive license for CR845/difelikefalin in South Korea, with eligibility for development/regulatory milestones (up to **$3.8 million**), sub-license fees, and tiered high single-digit to high teens royalties on net sales[91](index=91&type=chunk)[92](index=92&type=chunk)[255](index=255&type=chunk) [11. Revenue Recognition](index=26&type=section&id=11.%20Revenue%20Recognition) Explains revenue recognition policies for upfront and milestone payments from collaboration agreements under ASC Topic 606 - Revenue is recognized in accordance with ASC Topic 606. Upfront payments and milestone payments are recognized, with future milestone and royalty payments considered variable consideration and constrained at inception due to uncertainty[93](index=93&type=chunk)[111](index=111&type=chunk)[113](index=113&type=chunk) - For the Vifor Agreement, the entire transaction price of **$111.6 million** was recognized as license and milestone fees revenue in 2020 upon license grant[103](index=103&type=chunk)[114](index=114&type=chunk) - For the VFMCRP Agreement, the **$55.4 million** transaction price was recognized as revenue as R&D services were performed, completed by December 31, 2020[104](index=104&type=chunk)[115](index=115&type=chunk)[127](index=127&type=chunk) - For the Maruishi Agreement, **$9.6 million** was allocated to the license (recognized immediately) and **$5.7 million** to R&D services (recognized over time until July 2015). In January 2021, a milestone event resulted in **$1.2 million** license and milestone fees revenue and **$0.7 million** collaborative revenue[120](index=120&type=chunk)[132](index=132&type=chunk) [12. Net Loss Per Share](index=35&type=section&id=12.%20Net%20Loss%20Per%20Share) Presents net loss per share calculations, excluding potentially dilutive shares due to net losses Net Loss Per Share (Basic and Diluted) | Metric | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Net loss | $(23,301) | $(28,922) | | Weighted-average common shares outstanding | 49,917,990 | 46,724,951 | | Net loss per share | $(0.47) | $(0.62) | - Potentially dilutive shares (stock options and restricted stock units) were excluded from diluted net loss per share calculations for both periods due to the Company's net losses, making their inclusion anti-dilutive[138](index=138&type=chunk)[141](index=141&type=chunk)[143](index=143&type=chunk) [13. Stock-Based Compensation](index=37&type=section&id=13.%20Stock-Based%20Compensation) Outlines stock plans, RSU grants to executives, and a breakdown of stock-based compensation expenses - The Company has two stock plans: the **2019 Inducement Plan** for new employees and the **2014 Equity Incentive Plan** for various equity compensation awards[144](index=144&type=chunk)[145](index=145&type=chunk) - In March 2021, **176,000** performance-based and **100,000** time-based restricted stock units were granted to executive officers. Compensation expense for performance-based RSUs is recognized upon achievement of performance targets[149](index=149&type=chunk)[150](index=150&type=chunk) Stock-Based Compensation Expense (Amounts in thousands) | Category | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Research and development (Stock Options) | $1,590 | $1,609 | | General and administrative (Stock Options) | $1,014 | $1,070 | | Total Stock Option Expense | $2,604 | $2,679 | | R&D (RSUs) | $568 | $14 | | G&A (RSUs) | $822 | $153 | | Total RSU Expense | $1,390 | $167 | [14. Income Taxes](index=44&type=section&id=14.%20Income%20Taxes) Discusses pre-tax losses and the full tax valuation allowance, with no income tax benefit recognized for Q1 2021 - The Company recognized pre-tax losses of **$23.3 million** and **$29.0 million** for the three months ended March 31, 2021 and 2020, respectively[164](index=164&type=chunk) - A full tax valuation allowance was recognized against deferred tax assets. No benefit from income taxes was recognized for Q1 2021 because the Company's 2020 revenue exceeded **$70 million**, making it ineligible for the Connecticut R&D Tax Credit Exchange Program[164](index=164&type=chunk)[165](index=165&type=chunk) [15. Commitments and Contingencies](index=46&type=section&id=15.%20Commitments%20and%20Contingencies) Details contractual obligations including the Enteris License Agreement, manufacturing agreements, and operating leases - Enteris License Agreement (August 2019) granted non-exclusive license for Peptelligence® technology for oral delivery of peptide APIs, with **$8.0 million** upfront paid (**$4.0 million** cash, **$4.0 million** common stock), obligations for milestone payments and low-single digit royalties, and an expected **$10.0 million** milestone payment in Q2 2021[171](index=171&type=chunk)[172](index=172&type=chunk)[173](index=173&type=chunk)[260](index=260&type=chunk) - Manufacturing Agreement (July 2019): Master Manufacturing Services Agreement (MSA) with Patheon UK Limited and Patheon Manufacturing Services LLC for commercial supplies of CR845/difelikefalin injection[174](index=174&type=chunk)[175](index=175&type=chunk) - Leases: Operating lease for Stamford office space (Stamford Lease, December 2015, amended June 2020). Lease expense recognized on a straight-line basis. Operating lease cost was **$406 thousand** for Q1 2021, up from **$234 thousand** in Q1 2020[177](index=177&type=chunk)[181](index=181&type=chunk)[183](index=183&type=chunk) [Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations.](index=50&type=section&id=Item%202.%20Management's%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations.) Management discusses financial condition, operations, product pipeline, and liquidity, highlighting KORSUVA's development and regulatory milestones - Cara Therapeutics is a clinical-stage biopharmaceutical company developing KORSUVA (CR845/difelikefalin), a first-in-class kappa opioid receptor agonist, for pruritus and pain[195](index=195&type=chunk) - The FDA accepted the NDA for KORSUVA injection for CKD-aP in February 2021 and granted Priority Review in March 2021, with a PDUFA target action date of **August 23, 2021**[198](index=198&type=chunk)[203](index=203&type=chunk) - The COVID-19 pandemic has impacted clinical trial initiation and patient enrollment for some trials, but no significant delays in clinical development or commercial timelines are currently expected[200](index=200&type=chunk)[202](index=202&type=chunk) [Overview](index=54&type=section&id=Overview) Introduces Cara Therapeutics as a clinical-stage biopharmaceutical company developing KORSUVA for pruritus - The company is a clinical-stage biopharmaceutical company developing KORSUVA (CR845/difelikefalin), a first-in-class KOR agonist, for pruritus by selectively targeting peripheral kappa opioid receptors[195](index=195&type=chunk) - KORSUVA injection has shown significant reductions in itch intensity and improved quality of life in hemodialysis patients with CKD-aP in Phase 3 trials[196](index=196&type=chunk) - The FDA accepted the NDA for KORSUVA injection for CKD-aP in February 2021 and granted Priority Review in March 2021, with a PDUFA target action date of **August 23, 2021**[198](index=198&type=chunk) [Recent Developments](index=54&type=section&id=Recent%20Developments) Highlights the FDA's Priority Review for KORSUVA injection and the EMA MAA submission, noting COVID-19 impacts - The COVID-19 pandemic has affected clinical trial initiation and patient enrollment for some trials, including Oral KORSUVA for NP and CLD-aP, but no significant delays in clinical development or commercial timelines are currently expected[200](index=200&type=chunk)[202](index=202&type=chunk) - The FDA accepted the NDA for KORSUVA (CR845/difelikefalin) injection for moderate-to-severe pruritus in hemodialysis patients in February 2021 and granted Priority Review in March 2021, with a PDUFA target action date of **August 23, 2021**[203](index=203&type=chunk) - VFMCRP submitted a Marketing Authorization Application (MAA) to the European Medicines Agency (EMA) in March 2021, with a decision expected in **Q2 2022**[204](index=204&type=chunk) [Overview of Our Product Candidates](index=56&type=section&id=Overview%20of%20Our%20Product%20Candidates) Presents CR845/difelikefalin as a selective kappa opioid receptor agonist with injectable and oral forms for various pruritus indications - CR845/difelikefalin is a new chemical entity designed to selectively stimulate peripheral kappa opioid receptors, avoiding CNS-related side effects of traditional opioids[205](index=205&type=chunk) - The product candidate pipeline includes KORSUVA injection for CKD-aP (NDA accepted, Priority Review granted) and Oral KORSUVA for NDD-CKD pruritus, Atopic Dermatitis, CLD-aP (ongoing Phase 2), and Notalgia Paresthetica (ongoing Phase 2)[209](index=209&type=chunk) - CR845/difelikefalin is available in injectable form for hospital/dialysis settings and oral form for outpatient treatment of pruritus or chronic pain[208](index=208&type=chunk) [KORSUVA (CR845/Difelikefalin) Injection for Treatment of Chronic Kidney Disease-Associated Pruritus (CKD-aP)](index=58&type=section&id=KORSUVA%20(CR845%2FDifelikefalin)%20Injection%20for%20Treatment%20of%20Chronic%20Kidney%20Disease-Associated%20Pruritus%20(CKD-aP)) Details the FDA's Priority Review for KORSUVA injection for CKD-aP and positive Phase 3 trial results - NDA for KORSUVA injection for moderate-to-severe pruritus in hemodialysis patients was accepted by the FDA in February 2021 and granted Priority Review in March 2021, with a PDUFA target action date of **August 23, 2021**[210](index=210&type=chunk) - KALM-2 Phase 3 trial met primary and key secondary endpoints, showing **54%** of KORSUVA patients achieved a **≥3-point improvement** in worst itching NRS score at week 12 (vs. **42%** placebo, **p=0.02**)[215](index=215&type=chunk) - KALM-1 Phase 3 trial also met primary and all secondary endpoints, with **51%** of KORSUVA patients achieving a **≥3-point improvement** in worst itching NRS score at week 12 (vs. **28%** placebo, **p=0.000019**)[217](index=217&type=chunk) [Oral KORSUVA (CR845/Difelikefalin) for Treatment of Non-Dialysis Dependent (NDD) Chronic Kidney Disease-Associated Pruritus (CKD-aP)](index=60&type=section&id=Oral%20KORSUVA%20(CR845%2FDifelikefalin)%20for%20Treatment%20of%20Non-Dialysis%20Dependent%20(NDD)%20Chronic%20Kidney%20Disease-Associated%20Pruritus%20(CKD-aP)) Reports positive Phase 2 results for Oral KORSUVA in NDD-CKD pruritus and plans for a Phase 3 program - Phase 2 trial of Oral KORSUVA (**1.0 mg**) for NDD-CKD patients achieved the primary endpoint of statistically significant reduction in weekly mean of daily worst itching NRS scores vs. placebo after **12 weeks** (**-4.4** KORSUVA vs. **-3.3** placebo, **p=0.018**)[219](index=219&type=chunk) - The FDA indicated acceptability of Stage 5 pre-dialysis CKD patients for a Phase 3 trial and potential to use existing KORSUVA injection data to support approval based on a single Phase 3 trial for Oral KORSUVA in this population[222](index=222&type=chunk) - The company plans to initiate its Phase 3 program for Oral KORSUVA in NDD-CKD by **year-end 2021**[222](index=222&type=chunk) [Oral KORSUVA (CR845/difelikefalin) for Treatment of Moderate-to-Severe Pruritus Associated with Atopic Dermatitis (AD)](index=62&type=section&id=Oral%20KORSUVA%20(CR845%2Fdifelikefalin)%20for%20Treatment%20of%20Moderate-to-Severe%20Pruritus%20Associated%20with%20Atopic%20Dermatitis%20(AD)) Discusses Phase 2 trial results for Oral KORSUVA in AD pruritus, noting primary endpoint not met but positive subgroup analysis - KARE Phase 2 trial for AD pruritus did not meet the primary efficacy endpoint (change from baseline in weekly mean of daily 24-hour Itch NRS score at week 12) for any dose group in the ITT population[224](index=224&type=chunk) - A prespecified analysis showed a statistically significant change in the primary endpoint for the mild-to-moderate (BSA<10%) patient population (**p=0.036**, All doses vs placebo)[225](index=225&type=chunk) - The company intends to request an End of Phase 2 Meeting with the FDA in **H2 2021** and aims to initiate a Phase 3 program by **year-end**[228](index=228&type=chunk) [Oral KORSUVA (CR845/Difelikefalin) for Treatment of Chronic Liver Disease-Associated Pruritus](index=64&type=section&id=Oral%20KORSUVA%20(CR845%2FDifelikefalin)%20for%20Treatment%20of%20Chronic%20Liver%20Disease-Associated%20Pruritus) Reports on the ongoing Phase 2 trial for Oral KORSUVA in CLD-associated pruritus, with top-line data expected in H2 2021 - A Phase 2 trial of Oral KORSUVA for pruritus in patients with hepatic impairment due to PBC is ongoing, with top-line data expected in the **second half of 2021**[231](index=231&type=chunk) - Previous Phase 1 safety and PK trial in CLD patients showed Oral KORSUVA was generally well-tolerated with dose-proportional PK parameters in mild-to-moderate CLD[232](index=232&type=chunk) [Oral KORSUVA (CR845/difelikefalin) for Treatment of Moderate-to-Severe Pruritus Associated with Notalgia Paresthetica (NP)](index=64&type=section&id=Oral%20KORSUVA%20(CR845%2Fdifelikefalin)%20for%20Treatment%20of%20Moderate-to-Severe%20Pruritus%20Associated%20with%20Notalgia%20Paresthetica%20(NP)) Announces the initiation of a Phase 2 trial for Oral KORSUVA in Notalgia Paresthetica in January 2021 - A Phase 2 randomized, double-blind, placebo-controlled trial for Oral KORSUVA in adult subjects with NP was initiated in **January 2021**, evaluating efficacy and safety over an **8-week** treatment period[233](index=233&type=chunk) [Intravenous CR845/Difelikefalin for Treatment of Acute Postoperative Pain](index=64&type=section&id=Intravenous%20CR845%2FDifelikefalin%20for%20Treatment%20of%20Acute%20Postoperative%20Pain) Reports positive Phase 2/3 study results for IV CR845 in postoperative pain and PONV, with next steps under evaluation - Adaptive Phase 2/3 study of CR845/difelikefalin in abdominal surgery patients showed statistical significance for pain relief (AUC 0-24 hours) with the **1.0 mcg/kg** dose (**p=0.032**)[235](index=235&type=chunk) - Both **0.5** and **1.0 mcg/kg** doses of CR845 injection showed statistically significant improvements in PONV impact scores and reduced anti-emetic medication use[237](index=237&type=chunk) - The company has completed an advisory meeting with the FDA regarding the regulatory path for PONV and is evaluating next steps[238](index=238&type=chunk) [Human Abuse Liability Trial of CR845/Difelikefalin Injection](index=66&type=section&id=Human%20Abuse%20Liability%20Trial%20of%20CR845%2FDifelikefalin%20Injection) Highlights the successful completion of a Human Abuse Liability trial, showing low 'drug liking' for CR845 injection - A Human Abuse Liability (HAL) trial of CR845/difelikefalin injection successfully completed in **Q4 2014**, demonstrating statistically significant lower 'drug liking' scores compared to pentazocine (**p <0.0001**)[239](index=239&type=chunk) - CR845/difelikefalin injection showed no 'drug liking' dose response and was not different from placebo, supporting its potential as a non-scheduled or low (Schedule V) scheduled peripheral kappa opioid[239](index=239&type=chunk) [Respiratory Safety Phase 1 Trial of CR845/Difelikefalin Injection](index=66&type=section&id=Respiratory%20Safety%20Phase%201%20Trial%20of%20CR845%2FDifelikefalin%20Injection) Confirms a favorable respiratory safety profile for CR845 injection based on Phase 1 trial results - A Phase 1 trial evaluating respiratory safety of CR845/difelikefalin injection in **April 2017** showed no statistically significant differences in respiratory measures between CR845 doses and placebo[240](index=240&type=chunk)[241](index=241&type=chunk) - All treatment-emergent adverse events were mild and resolved without intervention, indicating a favorable respiratory safety profile[241](index=241&type=chunk) [Collaboration and License Agreements](index=66&type=section&id=Collaboration%20and%20License%20Agreements) Summarizes key collaboration and license agreements for KORSUVA with Vifor, VFMCRP, Maruishi, and CKDP - Vifor Agreement (October 2020) granted Vifor exclusive U.S. license for KORSUVA injection in hemodialysis and peritoneal dialysis patients, receiving **$100 million** upfront and **$50 million** from common stock purchase, with eligibility for **$50 million** additional common stock investment upon U.S. regulatory approval, up to **$240 million** in sales-based milestones, and a **60%** net profit-sharing arrangement (excluding FMCNA sales)[242](index=242&type=chunk)[243](index=243&type=chunk)[244](index=244&type=chunk)[245](index=245&type=chunk)[246](index=246&type=chunk) - VFMCRP Agreement (May 2018) granted VFMCRP exclusive license for KORSUVA injection worldwide (excluding U.S., Japan, South Korea), receiving **$50 million** upfront and **$20 million** from common stock purchase, with eligibility for up to **$470 million** in regulatory and commercial milestones and tiered double-digit royalties on net sales, and a profit-sharing arrangement with VFMCRP for FMCNA dialysis clinics in the U.S.[248](index=248&type=chunk)[249](index=249&type=chunk) - Maruishi Agreement (April 2013) granted Maruishi exclusive license for CR845/difelikefalin in Japan for acute pain and uremic pruritus, receiving **$15.0 million** upfront, with eligibility for up to **$10.5 million** in clinical/regulatory milestones, a one-time sales milestone, sub-license fees, and tiered low double-digit to low twenties royalties, and earned a **$2.0 million** milestone in January 2021[250](index=250&type=chunk)[251](index=251&type=chunk)[252](index=252&type=chunk)[253](index=253&type=chunk) - CKDP Agreement (April 2012) granted CKDP exclusive license for CR845/difelikefalin in South Korea, receiving **$0.6 million** upfront, with eligibility for up to **$3.8 million** in development/regulatory milestones, sub-license fees, and tiered high single-digit to high teens royalties[254](index=254&type=chunk)[255](index=255&type=chunk) [Manufacturing and License Agreements](index=70&type=section&id=Manufacturing%20and%20License%20Agreements) Details the Enteris License Agreement for Peptelligence® technology and the MSA with Patheon for CR845/difelikefalin manufacturing - Enteris License Agreement (August 2019) granted a non-exclusive license for Peptelligence® technology for oral delivery of peptide APIs, with **$8.0 million** upfront paid (**$4.0 million** cash, **$4.0 million** common stock), obligations for milestone payments and low-single digit royalties, and an expected **$10.0 million** milestone payment in Q2 2021[257](index=257&type=chunk)[258](index=258&type=chunk)[259](index=259&type=chunk)[260](index=260&type=chunk) - Patheon UK Limited MSA (July 2019): Master Manufacturing Services Agreement with Patheon and Patheon Greenville for commercial supplies of CR845/difelikefalin injection at Monza, Italy and Greenville, North Carolina sites[262](index=262&type=chunk)[264](index=264&type=chunk) [Components of Operating Results](index=72&type=section&id=Components%20of%20Operating%20Results) Explains the components of revenue, R&D expenses, G&A expenses, and other income, including tax implications - Revenue primarily consists of upfront payments and milestone/sub-license payments from license agreements. No product sales revenue to date[265](index=265&type=chunk) - R&D expenses are primarily for CR845/difelikefalin development, including compensation, clinical trials, CRO fees, and stock-based compensation. R&D expenses for 2021 are expected to be consistent with 2020[266](index=266&type=chunk)[267](index=267&type=chunk)[270](index=270&type=chunk) - General and administrative expenses include salaries, stock-based compensation, facility costs, legal fees, and consulting services. Expected to be consistent with 2020, with potential increases for commercialization efforts[273](index=273&type=chunk)[274](index=274&type=chunk)[276](index=276&type=chunk) - Other income, net, includes interest/dividend income, realized gains/losses on securities, and accretion/amortization. Benefit from income taxes relates to state R&D tax credits, but no benefit for Q1 2021 due to revenue exceeding **$70 million**[277](index=277&type=chunk)[278](index=278&type=chunk) [Results of Operations](index=76&type=section&id=Results%20of%20Operations) Compares revenue, R&D, and G&A expenses for Q1 2021 and Q1 2020, highlighting significant changes Revenue Comparison (Amounts in thousands) | Revenue Type | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | % Change | | :----------------------------------- | :-------------------------------- | :-------------------------------- | :------- | | License and milestone fees | $1,192 | $8,021 | -85% | | Collaborative revenue | $706 | — | N/A | | Clinical compound revenue | $37 | $72 | -49% | | Total Revenue | $1,935 | $8,093 | -76% | R&D Expense Comparison (Amounts in thousands) | R&D Category | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | % Change | | :----------------------------------- | :-------------------------------- | :-------------------------------- | :------- | | Direct clinical trial costs | $10,000 | $25,738 | -61% | | Consultant services | $1,170 | $1,275 | -8% | | Stock-based compensation | $2,158 | $1,623 | 33% | | Other R&D operating expenses | $5,772 | $4,873 | 18% | | Total R&D Expense | $19,131 | $33,536 | -43% | G&A Expense Comparison (Amounts in thousands) | G&A Category | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | % Change | | :----------------------------------- | :-------------------------------- | :-------------------------------- | :------- | | Professional fees and public/investor relations | $877 | $1,131 | -22% | | Stock-based compensation | $1,974 | $1,223 | 61% | | Other G&A operating expenses | $3,483 | $2,183 | 60% | | Total G&A Expense | $6,365 | $4,558 | 40% | - Other income, net, decreased by **73%** to **$260 thousand** in Q1 2021 from **$957 thousand** in Q1 2020, primarily due to lower interest income and net accretion income from a lower yield on investments[289](index=289&type=chunk) - No benefit from income taxes was recognized in Q1 2021 (vs. **$122 thousand** in Q1 2020) due to ineligibility for the Connecticut R&D Tax Credit Exchange Program[290](index=290&type=chunk) [Liquidity and Capital Resources](index=79&type=section&id=Liquidity%20and%20Capital%20Resources) Discusses the company's funding history, current cash position, and future capital needs for KORSUVA development - Since inception, the Company has raised approximately **$776.4 million**, primarily from equity sales (**$446.3 million**), convertible preferred stock/debt (**$73.3 million**), and license agreements (**$203.8 million**)[292](index=292&type=chunk) - As of March 31, 2021, unrestricted cash, cash equivalents, and marketable securities totaled **$228.3 million**, expected to fund operations into **2023**[296](index=296&type=chunk)[312](index=312&type=chunk) - The Company expects to continue incurring significant expenses and operating losses as it develops KORSUVA and seeks marketing approval, with future funding needs to be met through equity/debt financings and collaboration arrangements[304](index=304&type=chunk)[310](index=310&type=chunk)[311](index=311&type=chunk) [Cash Flows](index=87&type=section&id=Cash%20Flows) Analyzes changes in net cash used in operating, investing, and financing activities for Q1 2021 versus Q1 2020 Summary of Cash Flows (Amounts in thousands) | Activity | Three Months Ended March 31, 2021 | Three Months Ended March 31, 2020 | | :----------------------------------- | :-------------------------------- | :-------------------------------- | | Net cash used in operating activities | $(23,721) | $(38,303) | | Net cash provided by investing activities | $13,869 | $36,959 | | Net cash provided by financing activities | $688 | $75 | | Net decrease in cash, cash equivalents and restricted cash | $(9,164) | $(1,269) | - Net cash used in operating activities decreased from **$38.3 million** in Q1 2020 to **$23.7 million** in Q1 2021, primarily due to a lower net loss and changes in operating assets and liabilities[315](index=315&type=chunk)[316](index=316&type=chunk) - Net cash provided by investing activities decreased from **$37.0 million** in Q1 2020 to **$13.9 million** in Q1 2021, mainly due to changes in maturities, redemptions, and purchases of marketable securities[317](index=317&type=chunk)[318](index=318&type=chunk) [Contractual Obligations and Commitments](index=87&type=section&id=Contractual%20Obligations%20and%20Commitments) Outlines the company's contractual obligations, including operating leases and license agreements - Contractual obligations include operating lease obligations for the Stamford office, the Enteris License Agreement, and the MSA with Patheon[321](index=321&type=chunk) - The Company has no material non-cancelable purchase commitments with contract manufacturers or service providers[322](index=322&type=chunk) [Discussion of Critical Accounting Policies](index=89&type=section&id=Discussion%20of%20Critical%20Accounting%20Policies) Confirms no significant changes to critical accounting policies from the prior annual report - No significant changes to critical accounting policies were made during the three months ended March 31, 2021, from those described in the Annual Report on Form 10-K for 2020[328](index=328&type=chunk) [Item 3. Quantitative and Qualitative Disclosures About Market Risk.](index=89&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk.) Discusses market risks, primarily interest rate and credit quality, related to the investment portfolio, noting immaterial exposure to interest rate changes - The Company invests a majority of its cash reserves in available-for-sale marketable securities, including investment-grade debt instruments, U.S. government obligations, corporate bonds, commercial paper, and municipal bonds[329](index=329&type=chunk) Marketable Securities Investment (Amounts in millions) | Metric | March 31, 2021 | December 31, 2020 | | :----------------------------------- | :------------- | :---------------- | | Invested in marketable securities | $205.8 | $219.8 | | Yield | 0.26% | 0.32% | | Maturities | Through January 2024 | Through December 2023 | - A hypothetical **100 basis point** increase in interest rates would result in immaterial decreases in the fair values of the marketable securities portfolio[334](index=334&type=chunk) - No charges to credit loss expense were recorded for available-for-sale securities for the three months ended March 31, 2021 and 2020[335](index=335&type=chunk) [Item 4. Controls and Procedures.](index=91&type=section&id=Item%204.%20Controls%20and%20Procedures.) Management assessed disclosure controls and procedures as effective, with no material changes to internal control over financial reporting during Q1 2021 - Disclosure controls and procedures were evaluated as effective as of **March 31, 2021**, providing reasonable assurance that required information is recorded, processed, summarized, and reported timely[337](index=337&type=chunk) - No material changes in internal control over financial reporting occurred during the quarter ended **March 31, 2021**[338](index=338&type=chunk) [PART II – OTHER INFORMATION](index=94&type=section&id=PART%20II%20%E2%80%93%20OTHER%20INFORMATION) [Item 1. Legal Proceedings](index=94&type=section&id=Item%201.%20Legal%20Proceedings) The company is not currently involved in any material legal proceedings that would adversely affect its business or financial condition - The Company is not currently involved in any material arbitration, litigation, or claims that would adversely affect its business, operating results, or financial condition[344](index=344&type=chunk) [Item 1A. Risk Factors.](index=94&type=section&id=Item%201A.%20Risk%20Factors.) No material changes to risk factors were reported compared to the Annual Report on Form 10-K for 2020 - No material changes in risk factors were reported compared to the Annual Report on Form 10-K for the year ended December 31, 2020[345](index=345&type=chunk) [Item 6. Exhibits](index=95&type=section&id=Item%206.%20Exhibits) Lists exhibits filed with Form 10-Q, including certifications, XBRL taxonomy extensions, and corporate governance documents - The exhibits include certifications from the CEO and CFO, Inline XBRL Taxonomy Extension documents, and corporate organizational documents[356](index=356&type=chunk)[357](index=357&type=chunk)

Targeting Pruritus with First-In-Class Therapeutics February, 2021 Forward Looking Statements 2 This presentation contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. In some cases, you can identify forward-looking statements by the words "anticipate," "believe," "continue," "estimate," "expect," "objective," "ongoing," "plan," "propose," "potential," "projected", or "up-coming" and/or the negative of these terms, or other comparable termino ...

Cara Therapeutics, Inc. (NASDAQ:CARA) Q4 2020 Earnings Conference Call February 25, 2021 4:30 PM ET Company Participants Jack Hildick-Smith - Stern IR Derek Chalmers - Chief Executive Officer Thomas Reilly - Chief Financial Officer Conference Call Participants Avatar Jones - Stifel Financial Corp. Brian Mills - Jefferies Jason Gerberry - Bank of America Merrill Lynch Joseph Stringer - Needham & Company David Amsellem - Piper Sandler Benedict Shim - Canaccord Genuity LLC Operator Good afternoon and welcome t ...

Table of Contents UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 10-K ☒ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED DECEMBER 31, 2020 OR ☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 COMMISSION FILE NUMBER: 001-36279 CARA THERAPEUTICS, INC. (Exact name of registrant as specified in its charter) Delaware 75-3175693 (State or other jurisdiction of incorporation or organ ...

Targeting Pruritus with First-In-Class Therapeutics January, 2021 Forward Looking Statements 2 This presentation contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. In some cases, you can identify forward-looking statements by the words "anticipate," "believe," "continue," "estimate," "expect," "objective," "ongoing," "plan," "propose," "potential," "projected", or "up-coming" and/or the negative of these terms, or other comparable terminol ...

Cara Therapeutics, Inc. (NASDAQ:CARA) Q3 2020 Earnings Conference Call November 9, 2020 4:30 PM ET Company Participants Jack Hildick-Smith - Stern IR Derek Chalmers - President and CEO Thomas Reilly - CFO Conference Call Participants Zach Sachar - Piper Sandler Nick Rubino - Stifel Chi Meng Fong - BAnk of America Alan Carr - Needham & Company Ben Shim - Canaccord Operator Good afternoon and welcome to Cara Therapeutics' Third Quarter 2020 Financial Results Conference Call. All participants are now in list ...

PART I – FINANCIAL INFORMATION [Item 1. Financial Statements (Unaudited)](index=4&type=section&id=Item%201.%20Financial%20Statements%20%28Unaudited%29) This section presents Cara Therapeutics, Inc.'s unaudited condensed financial statements, detailing financial position, performance, and accounting policies [Condensed Financial Statements](index=4&type=section&id=Condensed%20Financial%20Statements) Condensed financial statements show total assets decreased to **$147.1 million** by September 2020, a **$70.5 million** net loss for nine months, and increased cash used in operations Condensed Balance Sheet Data (in thousands) | Account | Sep 30, 2020 | Dec 31, 2019 | | :--- | :--- | :--- | | **Assets** | | | | Cash and cash equivalents | $75,281 | $18,305 | | Marketable securities | $56,094 | $199,860 | | Total current assets | $132,837 | $165,656 | | Total assets | $147,136 | $232,959 | | **Liabilities & Equity** | | | | Total current liabilities | $16,598 | $42,894 | | Total liabilities | $19,289 | $46,246 | | Total stockholders' equity | $127,847 | $186,713 | | Accumulated deficit | ($471,226) | ($400,727) | Condensed Statements of Comprehensive Loss (in thousands, except per share data) | Metric | Three Months Ended Sep 30, 2020 | Three Months Ended Sep 30, 2019 | Nine Months Ended Sep 30, 2020 | Nine Months Ended Sep 30, 2019 | | :--- | :--- | :--- | :--- | :--- | | Total revenue | $9,266 | $5,785 | $22,993 | $15,375 | | Research and development | $21,067 | $35,992 | $80,711 | $83,956 | | General and administrative | $5,219 | $4,226 | $15,187 | $13,128 | | Operating loss | ($17,020) | ($34,433) | ($72,905) | ($81,709) | | Net loss | ($16,509) | ($32,842) | ($70,499) | ($77,762) | | Net loss per share (Basic & Diluted) | ($0.35) | ($0.74) | ($1.51) | ($1.88) | Condensed Statements of Cash Flows (in thousands) | Activity | Nine Months Ended Sep 30, 2020 | Nine Months Ended Sep 30, 2019 | | :--- | :--- | :--- | | Net cash used in operating activities | ($87,575) | ($78,059) | | Net cash provided by (used in) investing activities | $143,880 | ($45,254) | | Net cash provided by financing activities | $671 | $142,576 | | Net increase in cash, cash equivalents and restricted cash | $56,976 | $19,263 | [Notes to Condensed Financial Statements](index=9&type=section&id=Notes%20to%20Condensed%20Financial%20Statements) This subsection details the company's business, accounting policies, and financial statement items, including its clinical-stage status, collaboration agreements, and a **$150 million** Vifor license agreement - Cara Therapeutics is a clinical-stage biopharmaceutical company focused on developing new chemical entities to alleviate pruritus, having incurred **substantial net losses and negative cash flows** from operations since inception[23](index=23&type=chunk)[25](index=25&type=chunk) - The company has significant collaboration and licensing agreements with Vifor Fresenius Medical Care Renal Pharma Ltd (VFMCRP), Maruishi Pharmaceutical Co, Ltd, and Chong Kun Dang Pharmaceutical Corp (CKDP) for its lead product candidate, CR845/difelikefalin[97](index=97&type=chunk)[107](index=107&type=chunk)[112](index=112&type=chunk) - Revenue recognition is primarily tied to these licensing agreements, with **$21.8 million** recognized from the VFMCRP agreement and a **$0.6 million** milestone payment from the CKDP agreement for the nine months ended September 30, 2020[115](index=115&type=chunk)[123](index=123&type=chunk)[153](index=153&type=chunk) - Subsequent to the quarter's end in October 2020, the company entered a significant license agreement with Vifor (International) Ltd, receiving a **$100 million** upfront payment and an additional **$50 million** from common stock sale[26](index=26&type=chunk)[211](index=211&type=chunk)[214](index=214&type=chunk) [Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations](index=60&type=section&id=Item%202.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) This section analyzes the company's financial condition and operations, covering COVID-19 impact, the KORSUVA pipeline, operating results, liquidity, and capital resources, with **$150 million** from Vifor expected to fund operations into 2023 [Introduction & Recent Developments](index=63&type=section&id=Introduction%20%26%20Recent%20Developments) This section introduces the company's focus on pruritus treatments with KORSUVA, recent COVID-19 impacts, a **$150 million** Vifor license agreement, and the appointment of a new CFO - The COVID-19 pandemic has affected patient enrollment for Phase 2 clinical trials of Oral KORSUVA but is not expected to delay the New Drug Application (NDA) submission for KORSUVA injection, which remains on track for **Q4 2020**[236](index=236&type=chunk) - In October 2020, the company entered a license agreement with Vifor, receiving a **$100.0 million** upfront payment and an additional **$50.0 million** for common stock purchase, significantly strengthening its financial position[239](index=239&type=chunk) - Effective October 1, 2020, Thomas Reilly was appointed as the company's Chief Financial Officer[240](index=240&type=chunk) [Our Product Candidate Pipeline](index=65&type=section&id=Our%20Product%20Candidate%20Pipeline) The company's pipeline focuses on KORSUVA (CR845/difelikefalin) in injectable and oral forms, with NDA submission for injection in **Q4 2020** and oral form Phase 2 data expected in **2021** - The company's lead product, KORSUVA (CR845/difelikefalin) Injection for CKD-aP in hemodialysis patients, has completed two pivotal Phase 3 trials (KALM-1 and KALM-2), both meeting primary and key secondary endpoints[246](index=246&type=chunk)[250](index=250&type=chunk) - An NDA submission to the FDA for KORSUVA Injection is expected in the **fourth quarter of 2020**, with a Marketing Authorisation Application (MAA) to the EMA to follow shortly thereafter[245](index=245&type=chunk) - The Oral KORSUVA program is advancing with ongoing Phase 2 trials for pruritus in patients with Atopic Dermatitis (AD) and Chronic Liver Disease (CLD), with top-line data for both expected in the **first half of 2021**[259](index=259&type=chunk)[265](index=265&type=chunk) [Collaboration and License Agreements](index=75&type=section&id=Collaboration%20and%20License%20Agreements) This subsection details key strategic partnerships, including a recent Vifor agreement for KORSUVA injection U.S. commercialization with **$150 million** upfront, and existing agreements for global rights and milestones - In October 2020, the company granted Vifor an exclusive license for U.S. commercialization of KORSUVA injection in dialysis patients, including a **$100M** upfront payment, a **$50M** equity investment, up to **$240M** in sales-based milestones, and a **60/40 profit-sharing** arrangement in Cara's favor[275](index=275&type=chunk)[276](index=276&type=chunk)[277](index=277&type=chunk) - The May 2018 agreement with VFMCRP covers commercialization rights for KORSUVA injection in most territories outside the U.S., Japan, and South Korea, with Cara eligible for up to **$470 million** in regulatory and commercial milestones plus tiered double-digit royalties[283](index=283&type=chunk)[284](index=284&type=chunk) - The company has existing agreements with Maruishi for Japan and CKDP for South Korea, which include potential milestone payments and royalties, with a **$0.6 million** milestone achieved and received from CKDP in May 2020[285](index=285&type=chunk)[289](index=289&type=chunk)[290](index=290&type=chunk) [Results of Operations](index=85&type=section&id=Results%20of%20Operations) This subsection compares financial results for Q3 and nine months ended September 30, 2020, showing increased total revenue, a **41%** decrease in Q3 R&D expenses, and higher G&A expenses Revenue Comparison (in thousands) | Revenue Type | Q3 2020 | Q3 2019 | % Change | Nine Months 2020 | Nine Months 2019 | % Change | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | License and milestone fees | $9,257 | $5,785 | 60% | $22,377 | $15,235 | 47% | | Clinical compound revenue | $9 | $0 | N/A | $616 | $140 | 341% | | **Total Revenue** | **$9,266** | **$5,785** | **60%** | **$22,993** | **$15,375** | **50%** | R&D Expense Comparison (in thousands) | Period | R&D Expense 2020 | R&D Expense 2019 | % Change | | :--- | :--- | :--- | :--- | | Three Months Ended Sep 30 | $21,067 | $35,992 | -41% | | Nine Months Ended Sep 30 | $80,711 | $83,956 | -4% | - The decrease in R&D expenses for **Q3 2020** was primarily due to lower costs associated with the completed KALM-1 and KALM-2 Phase 3 trials for KORSUVA injection, partially offset by increased costs for the Phase 2 trial in Atopic Dermatitis and NDA submission preparation[320](index=320&type=chunk) G&A Expense Comparison (in thousands) | Period | G&A Expense 2020 | G&A Expense 2019 | % Change | | :--- | :--- | :--- | :--- | | Three Months Ended Sep 30 | $5,219 | $4,226 | 24% | | Nine Months Ended Sep 30 | $15,187 | $13,128 | 16% | [Liquidity and Capital Resources](index=89&type=section&id=Liquidity%20and%20Capital%20Resources) The company's liquidity is supported by **$131.4 million** in cash and securities as of September 2020, with an additional **$150 million** from Vifor expected to fund operations into **2023**, though significant losses are anticipated - As of September 30, 2020, the company had **$131.4 million** in unrestricted cash, cash equivalents, and available-for-sale marketable securities[334](index=334&type=chunk) - Including the **$150.0 million** in proceeds from the Vifor license agreement received in October 2020, the company believes its existing capital is sufficient to fund operating expenses and capital expenditures into **2023**[334](index=334&type=chunk) Cash Flow Summary (Nine Months Ended Sep 30, in thousands) | Cash Flow Activity | 2020 | 2019 | | :--- | :--- | :--- | | Net cash used in operating activities | ($87,575) | ($78,059) | | Net cash provided by (used in) investing activities | $143,880 | ($45,254) | | Net cash provided by financing activities | $671 | $142,576 | [Item 3. Quantitative and Qualitative Disclosures About Market Risk](index=98&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk) This section addresses market risks, primarily interest rate and credit quality risks on the company's investment portfolio, noting a conservative policy and immaterial impact from a hypothetical **1%** interest rate increase - The company's primary market risk exposure is to interest rate fluctuations on its portfolio of cash equivalents and marketable securities, which consist of investment-grade debt instruments[366](index=366&type=chunk) - Due to the conservative nature and short duration of its investments, the company believes its interest rate risk is mitigated, with a hypothetical **1%** increase in interest rates having an immaterial impact on the portfolio's fair value[368](index=368&type=chunk)[369](index=369&type=chunk) [Item 4. Controls and Procedures](index=98&type=section&id=Item%204.%20Controls%20and%20Procedures) Management concluded the company's disclosure controls and procedures were effective as of September 30, 2020, with only a non-material change related to ASU 2016-13 adoption - Management, including the Chief Executive Officer and Chief Financial Officer, concluded that the company's disclosure controls and procedures were effective as of September 30, 2020[371](index=371&type=chunk)[373](index=373&type=chunk) - A change was made to internal controls over financial reporting during the quarter to address the adoption of ASU 2016-13 (Financial Instruments—Credit Losses), but it did not have a material impact, and no other material changes were reported[374](index=374&type=chunk)[375](index=375&type=chunk) PART II – OTHER INFORMATION [Item 1. Legal Proceedings](index=101&type=section&id=Item%201.%20Legal%20Proceedings) The company is not currently a party to any legal proceedings that would materially adversely affect its business, operating results, or financial condition - As of the filing date, the company is not a party to any material legal proceedings[379](index=379&type=chunk) [Item 1A. Risk Factors](index=101&type=section&id=Item%201A.%20Risk%20Factors) This section details numerous business risks, including a history of losses, dependence on KORSUVA, regulatory uncertainties, competition, reliance on third parties, and the adverse impact of the COVID-19 pandemic - The company has a history of significant losses, with an accumulated deficit of **$471.2 million** as of September 30, 2020, and anticipates continued losses for the foreseeable future[381](index=381&type=chunk)[390](index=390&type=chunk) - The business is substantially dependent on the success of its lead product candidate, KORSUVA (CR845/difelikefalin) injection, with no guarantee of regulatory approval or successful commercialization[382](index=382&type=chunk)[401](index=401&type=chunk) - The COVID-19 pandemic poses a risk to business operations, clinical development, and regulatory timelines, potentially causing delays in trial site initiation and patient enrollment[388](index=388&type=chunk)[414](index=414&type=chunk) - The company relies on third parties for conducting clinical trials and manufacturing its product candidates, and any failure by these parties to perform satisfactorily could delay development and commercialization[387](index=387&type=chunk)[503](index=503&type=chunk)[510](index=510&type=chunk) [Other Items (Items 2, 3, 4, 5, 6)](index=186&type=section&id=Other%20Items%20%28Items%202%2C%203%2C%204%2C%205%2C%206%29) This section covers remaining standard disclosure items, reporting 'None' or 'Not applicable' for Items 2-5, and listing exhibits filed with the report, including corporate governance documents and officer certifications - There were no unregistered sales of equity securities, defaults upon senior securities, or other material information to report for the period[655](index=655&type=chunk) - The report includes a list of exhibits filed, such as the Amended and Restated Certificate of Incorporation, Bylaws, a new employment agreement, and required CEO/CFO certifications[658](index=658&type=chunk)

Cara Therapeutics, Inc. (NASDAQ:CARA) Q2 2020 Earnings Conference Call August 10, 2020 4:30 PM ET Company Participants Jack Hildick-Smith - Stern IR Derek Chalmers - President and CEO Rick Makara - VP and Head, Accounting Conference Call Participants Chris Howerton - Jefferies David Amsellem - Piper Sandler Annabel Samimy - Stifel Jason Gerberry - Bank of America Alan Carr - Needham & Company Operator Good afternoon and welcome to Cara Therapeutics' Second Quarter 2020 Financial Results Conference Call. All ...

PART I – FINANCIAL INFORMATION [Financial Statements](index=4&type=section&id=Item%201.%20Financial%20Statements) Unaudited condensed financial statements for Q2 2020 show decreased assets, increased net loss, and higher cash used in operations [Condensed Balance Sheets](index=4&type=section&id=Condensed%20Balance%20Sheets) Total assets decreased to **$168.6 million** by June 30, 2020, driven by reduced marketable securities and increased accumulated deficit Condensed Balance Sheet Summary (in thousands) | Account | June 30, 2020 | December 31, 2019 | | :--- | :--- | :--- | | **Assets** | | | | Cash and cash equivalents | $56,967 | $18,305 | | Marketable securities | $96,079 | $199,860 | | Total current assets | $141,915 | $165,656 | | **Total assets** | **$168,613** | **$232,959** | | **Liabilities & Equity** | | | | Total current liabilities | $24,726 | $42,894 | | Total liabilities | $27,685 | $46,246 | | Accumulated deficit | ($454,717) | ($400,727) | | Total stockholders' equity | $140,928 | $186,713 | | **Total liabilities and stockholders' equity** | **$168,613** | **$232,959** | [Condensed Statements of Comprehensive Loss](index=5&type=section&id=Condensed%20Statements%20of%20Comprehensive%20Loss) Q2 2020 revenue slightly increased to **$5.6 million**, but net loss widened to **$25.1 million** due to higher R&D expenses Statement of Comprehensive Loss Summary (in thousands, except per share data) | Metric | Three Months Ended June 30, 2020 | Three Months Ended June 30, 2019 | Six Months Ended June 30, 2020 | Six Months Ended June 30, 2019 | | :--- | :--- | :--- | :--- | :--- | | Total revenue | $5,634 | $5,208 | $13,727 | $9,590 | | Research and development | $26,108 | $24,356 | $59,644 | $47,964 | | General and administrative | $5,410 | $4,994 | $9,968 | $8,902 | | Operating loss | ($25,884) | ($24,142) | ($55,885) | ($47,276) | | **Net loss** | **($25,068)** | **($22,960)** | **($53,990)** | **($44,920)** | | **Net loss per share (Basic and Diluted)** | **($0.54)** | **($0.58)** | **($1.15)** | **($1.13)** | [Condensed Statements of Cash Flows](index=7&type=section&id=Condensed%20Statements%20of%20Cash%20Flows) Net cash used in operating activities increased to **$66.0 million** for H1 2020, offset by **$104.3 million** from investing activities Cash Flow Summary for the Six Months Ended June 30 (in thousands) | Activity | 2020 | 2019 | | :--- | :--- | :--- | | Net cash used in operating activities | ($65,955) | ($52,422) | | Net cash provided by investing activities | $104,341 | $51,627 | | Net cash provided by financing activities | $276 | $4,208 | | **Net increase in cash, cash equivalents and restricted cash** | **$38,662** | **$3,413** | [Notes to Condensed Financial Statements](index=8&type=section&id=Notes%20to%20Condensed%20Financial%20Statements) Notes detail the company's biopharmaceutical business, significant accumulated deficit, reliance on financing, and key collaboration agreements - The company is a clinical-stage biopharmaceutical firm focused on developing and commercializing treatments for pruritus by targeting peripheral kappa opioid receptors[20](index=20&type=chunk) - As of June 30, 2020, the company had an accumulated deficit of **$454.7 million** and expects to incur substantial net losses for the foreseeable future[22](index=22&type=chunk) [Management's Discussion and Analysis of Financial Condition and Results of Operations (MD&A)](index=53&type=section&id=Item%202.%20Management%27s%20Discussion%20and%20Analysis%20of%20Financial%20Condition%20and%20Results%20of%20Operations) MD&A discusses KORSUVA's clinical progress, COVID-19 impact, increased R&D expenses, and liquidity sufficient into H2 2021 [Product Candidate Pipeline](index=58&type=section&id=Product%20Candidate%20Pipeline) The pipeline focuses on KORSUVA, with NDA submission for injection expected in Q4 2020 and oral formulation in Phase 2 trials - The company expects to submit a New Drug Application (NDA) to the FDA for KORSUVA (CR845/difelikefalin) injection for CKD-aP in the **fourth quarter of 2020**[223](index=223&type=chunk) - Positive top-line results from the pivotal KALM-2 Phase 3 trial were announced in April 2020, with the trial meeting its primary and key secondary endpoints[224](index=224&type=chunk) - The Phase 2 trial for Oral KORSUVA in Atopic Dermatitis was expanded to **410 patients** to maintain statistical power based on an IDMC recommendation following an interim analysis[239](index=239&type=chunk) [Collaboration and License Agreements](index=67&type=section&id=Collaboration%20and%20License%20Agreements) Key KORSUVA commercialization partnerships include VFMCRP (up to **$470 million** in milestones), Maruishi, and CKDP (received **$0.6 million** milestone) - The VFMCRP agreement provides for up to **$470 million** in regulatory and commercial milestone payments, plus tiered double-digit royalties[253](index=253&type=chunk) - In June 2020, the company received a **$0.6 million** milestone payment (net of tax) from CKDP for the completion of a Phase 3 trial for uremic pruritus in the U.S.[259](index=259&type=chunk) - The company entered into a Master Manufacturing Services Agreement (MSA) with Patheon in July 2019 to secure commercial supplies of CR845/difelikefalin injection[265](index=265&type=chunk)[269](index=269&type=chunk) [Results of Operations](index=74&type=section&id=Results%20of%20Operations) Q2 2020 revenue increased to **$5.6 million**, but R&D expenses rose to **$26.1 million**, contributing to a wider net loss Comparison of Results of Operations (in thousands) | Metric | Three Months Ended June 30, 2020 | Three Months Ended June 30, 2019 | Six Months Ended June 30, 2020 | Six Months Ended June 30, 2019 | | :--- | :--- | :--- | :--- | :--- | | Total revenue | $5,634 | $5,208 | $13,727 | $9,590 | | R&D expense | $26,108 | $24,356 | $59,644 | $47,964 | | G&A expense | $5,410 | $4,994 | $9,968 | $8,902 | - The increase in R&D expenses for the six months ended June 30, 2020 was primarily driven by activities related to the KALM-2 Phase 3 trial, the Phase 3 safety trial of KORSUVA injection, and the Phase 2 trial for pruritus associated with Atopic Dermatitis (AD)[291](index=291&type=chunk) [Liquidity and Capital Resources](index=78&type=section&id=Liquidity%20and%20Capital%20Resources) As of June 30, 2020, the company held **$153.0 million** in liquidity, sufficient to fund operations into H2 2021 - As of June 30, 2020, the company had **$153.0 million** in unrestricted cash, cash equivalents, and available-for-sale marketable securities[306](index=306&type=chunk) - The company believes its existing cash will be sufficient to fund currently anticipated operating expenses and capital expenditures into the **second half of 2021**[306](index=306&type=chunk)[321](index=321&type=chunk) - Net cash used in operating activities for the six months ended June 30, 2020 was **$66.0 million**, an increase from **$52.4 million** in the prior year period, primarily due to higher net loss and changes in operating assets and liabilities[323](index=323&type=chunk)[324](index=324&type=chunk) [Quantitative and Qualitative Disclosures About Market Risk](index=87&type=section&id=Item%203.%20Quantitative%20and%20Qualitative%20Disclosures%20About%20Market%20Risk) Market risk primarily stems from interest rate fluctuations on investment portfolio, mitigated by short-duration, high-quality debt instruments - The company's primary market risk exposure is interest rate risk on its investment portfolio of cash, cash equivalents, and marketable securities[336](index=336&type=chunk)[338](index=338&type=chunk) - As of June 30, 2020, the company had invested **$96.1 million** in marketable securities with a yield of approximately **1.70%** and maturities through December 2021[337](index=337&type=chunk) [Controls and Procedures](index=89&type=section&id=Item%204.%20Controls%20and%20Procedures) Management concluded disclosure controls and procedures were effective as of June 30, 2020, with minor revisions for ASU 2016-13 - Management concluded that the company's disclosure controls and procedures were effective as of June 30, 2020[342](index=342&type=chunk) PART II – OTHER INFORMATION [Legal Proceedings](index=90&type=section&id=Item%201.%20Legal%20Proceedings) The company is not currently involved in any legal proceedings that would materially impact its business or financial condition - The company is not currently a party to any material legal proceedings[348](index=348&type=chunk) [Risk Factors](index=90&type=section&id=Item%201A.%20Risk%20Factors) Significant risks include a history of losses, dependence on KORSUVA's success, clinical development challenges, and COVID-19 disruptions - The company has a history of significant losses, with an accumulated deficit of **$454.7 million** as of June 30, 2020, and anticipates continued losses for the foreseeable future[350](index=350&type=chunk)[351](index=351&type=chunk) - The business is substantially dependent on the success of its lead product candidate, KORSUVA (CR845/difelikefalin) injection, which may never receive regulatory approval or be successfully commercialized[365](index=365&type=chunk)[366](index=366&type=chunk) - The ongoing COVID-19 pandemic could adversely affect business operations, clinical development timelines, and patient enrollment in trials[374](index=374&type=chunk)[376](index=376&type=chunk) [Other Items (2, 3, 4, 5, 6)](index=172&type=section&id=Other%20Items) This section confirms no unregistered equity sales, no defaults on senior securities, and no other material disclosures for the period - There were no unregistered sales of equity securities, defaults upon senior securities, or other material information to report during the period[615](index=615&type=chunk)[617](index=617&type=chunk)[621](index=621&type=chunk)

Targeting Pruritus with Novel Peripherally-Restricted Kappa Agonist Therapeutics May 2020 Forward Looking Statements 2 This presentation contains certain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. In some cases, you can identify forward-looking statements by the words "anticipate," "believe," "continue," "estimate," "expect," "objective," "ongoing," "plan," "propose," "potential," "projected", or "up-coming" and/or the negative of these terms, or o ...