Fulcrum Therapeutics Inc (FULC) 2025 Conference Transcript

Fulcrum Therapeutics Inc (FULC) 2025 Conference Summary Company Overview - Fulcrum Therapeutics is a SMIDGAP biotech company focused on rare benign hematological conditions, with its lead program, Posiridir, targeting sickle cell disease currently in Phase 1b studies [4][2] Market Opportunity in Sickle Cell Disease - Sickle cell disease affects approximately 100,000 people in the U.S. and 4.4 million globally, with a significantly decreased life expectancy of 20 to 25 years [6][6] - Recent drug approvals have not met expectations; Voxelotor was pulled from the market, and Crizanlizumab failed to show significant efficacy in reducing vaso-occlusive crises [7][8] - The unmet need in the sickle cell market remains extremely high, creating an opportunity for Posiridir [8][8] Mechanism of Action - Posiridir induces fetal hemoglobin (HBF) expression, which can mitigate the effects of sickle hemoglobin by diluting it and preventing sickling under hypoxic conditions [10][12] - The drug works by inhibiting the PRC2 enzyme complex, leading to an altered gene expression profile that upregulates the HBG gene responsible for fetal hemoglobin production [11][12] Clinical Development and Regulatory Updates - A clinical hold was placed by the FDA in early 2023 due to preclinical findings of hematological malignancies, but the hold was lifted after redefining the patient population to include more severely affected patients [14][16][18] - The new inclusion criteria restrict concomitant use of hydroxyurea, which is labeled as a carcinogen, to ensure patient safety during early development [19][21] Patient Population and Enrollment - Approximately 10% of the 100,000 U.S. sickle cell patients meet the new inclusion criteria, equating to about 10,000 potential participants for the study [22][22] - The company anticipates that demonstrating the drug's efficacy in increasing fetal hemoglobin levels could lead to a relaxation of these criteria in future studies [24][24] Efficacy and Clinical Meaningfulness - There is a strong correlation between increased fetal hemoglobin levels and reduced vaso-occlusive crises, with a target of achieving a clinically meaningful reduction of at least 25% in these crises [29][30] - Initial cohorts showed dose-dependent increases in fetal hemoglobin, with higher doses leading to more significant increases [26][27] Competitive Landscape - Renewed interest in fetal hemoglobin as a treatment mechanism has emerged, with several competitors entering the field, including BMS, Novartis, and GSK, although they are at earlier stages of development compared to Fulcrum [33][34] Financial Position and Future Aspirations - Fulcrum has a cash position of approximately $226 million, with an annual burn rate of$55 to $65 million, providing a runway until at least 2027 [40][41] - The company aims to expand beyond sickle cell disease and become a leader in benign hematological rare conditions [41][42]