Press Releases
CytoSorbents Reports Fourth Quarter and Full Year 2021 Results and Provides 2022 Outlook
Full Year 2021 Financial Results
- 2021 Total revenue, including product sales and grant income, was
$43.2 million , up 5% compared to$41.0 million in 2020. - 2021 Product sales were
$40.1 million , up 2% from$39.5 million in 2020. - Core non-COVID-19 product sales in 2021 were
$33.8 . million, an approximate 13% increase from$30.0 million in 2020. - Direct sales in
Germany grew to$21.0 million in 2021, a 4% increase from$20.3 million in 2020. - Estimated COVID-19 related sales in 2021 were
$6.3 million , versus$9.4 million in 2020. - 2021 product gross margin was approximately 80%, compared to 76% in 2020.
- The Company remains well-capitalized with cash and cash equivalents of
$53.8 million , including$1.7 million in restricted cash atDecember 31, 2021 , and no debt. - Received approval for the sale of our 2020 New Jersey NOL and R&D tax credits, expected to generate cash proceeds of approximately
$0.7M , to be received in first half 2022.
Fourth Quarter 2021 Financial Results
- Total revenue, including product sales and grant income, for Q4 2021 was
$10.8 million , a decrease of 10% compared to$12.0 million in Q4 2020. - Q4 2021 product sales were
$9.7 million , rose 9% sequentially from$8.9 million in Q3 2021, but down 16% compared to$11.5 million in Q4 2020. - Q4 2021 direct sales in
Germany were$5.3 million , up 45% from$3.7 million in Q3 2021, but lower than sales of$6.0 million inGermany in Q4 2020. - Core non-COVID-19 product sales for Q4 2021 were approximately
$8.0 million , or 82% of product sales, versus approximately$8.9 million , or 77% of product sales in Q4 2020. - Estimated Q4 2021 COVID-19 related sales were
$1.7 million , compared to an estimated$2.6 million in Q4 2020. - Q4 2021 product gross margin was 78%, down slightly from 81% in Q4 2020, due mainly to a scheduled manufacturing plant shut down for planned maintenance and year-end inventory count.
2021 Operating Highlights
- More than 162,000 cumulative CytoSorb devices have been utilized worldwide as of
December 31, 2021 , an increase of 34% compared to more than 121,000 devices utilized as of the end of 2020. More than 7,600 COVID-19 patients have been treated globally since the pandemic began. CytoSorb is now commercialized in more than 70 countries around the world, following the addition ofKorea ,Singapore , andThailand , among others in 2021. - Significant progress was made in pursuit of
U.S. FDA marketing approval of DrugSorb™-ATR for the intraoperative removal of antithrombotic drugs during urgent cardiothoracic surgery. - Initiation of two pivotal double-blind, randomized controlled trials, the STAR-T (Safe and Timely Antithrombotic Removal – Ticagrelor) and STAR-D (Safe and Timely Antithrombotic Removal – Direct Oral Anticoagulants) trials, following FDA IDE approval for both trials and receipt of a second FDA Breakthrough Device Designation for DrugSorb-ATR.
- Advanced the scientific body of knowledge and understanding of the benefits of CytoSorb use worldwide with 50 new peer-reviewed publications and 36 separate Cases of the Week in 2021 highlighting retrospective and prospective analyses of CytoSorb use in critical care, cardiac surgery, organ failure and other uses. Some highlights include:
- Topline results from the
U.S. CTC Registry demonstrating high survival in 52 critically ill patients with refractory respiratory failure on CytoSorb with ECMO (extracorporeal membrane oxygenation) from 5 U.S. ECMO centers were presented at both a dedicated webinar and at the International Symposium on Intensive Care & Emergency Medicine conference inBelgium , which were subsequently published in Frontiers in Medicine. - Multiple large cases series from the international community highlighting the use of CytoSorb in more than 110 critically ill COVID-19 patients with severe or refractory respiratory failure requiring ECMO or CRRT, and high observed survival, published in multiple peer reviewed journals such as Artificial Organs,
American Journal of Respiratory and Critical Care Medicine , Artificial Organs,Journal of Cardiac Surgery , and theInternational Journal of Artificial Organs - Results from two large investigator-initiated studies evaluating the intraoperative use of CytoSorb in a total of 337 patients with infective endocarditis, with both supporting the safety of CytoSorb in this application, and one demonstrating a significant reduction in sepsis-related mortality.
- The first documented use of CytoSorb to treat severe, refractory neurotoxicity after CAR T-cell immunotherapy for primary refractory high-grade B-cell lymphoma.
- The publication in the
Journal of Clinical Medicine of the largest case series of 109 critically ill liver disease patients with high baseline expected mortality, treated with CytoSorb, collected from the CytoSorb International Registry, demonstrating a significant reduction in bilirubin, a common toxin in these patients and an approved indication for CytoSorb - Continued to advance partnerships to increase availability and drive growth of
CytoSorbents' products worldwide. - Established a global co-marketing relationship with
B. Braun Avitum AG , one of the largest medical device companies in the world, to jointly market CytoSorb with the new OMNI® continuous blood purification platform and OMNIset® Plus bloodline set. - Announced the commercial launch in
Italy of the PerSorb™ adsorber, which is based on the ECOS-300CY™ sorbent technology to remove inflammatory mediators during ex vivo organ perfusion, in combination with Aferetica's PerLife™ Organ Perfusion System inAugust 2021 . - Began construction on the Company's new global headquarters and state-of-the-art manufacturing facility following the lease of a 48,500 square foot mixed-use facility in
Princeton, New Jersey . The new production facility was designed to support annual sales of up to$400 million while improving product gross margins and allowing space for future product line expansions. We expect to complete the certification audit in the first half of 2022, and commercial production of CytoSorb expected to commence in the second half of 2022.
2022 Outlook
- We expect continued and progressive improvement in our underlying core non-COVID-19 business in 2022, with growth of 20% or more in 2022 core product sales, compared to
$33.8 million in 2021 core sales. This expectation assumes: - A gradual recovery of normalized hospital activity and sales access in
Germany and other key countries - No major economic slowdowns caused by new variants of COVID-19
- Little to no contribution to sales from
Russia and neighboring countries that might be impacted by the war. In 2021, sales from these geographies represented less than 4% of total product sales - We expect limited COVID-19 related sales in 2022 compared to an estimated
$6.3 million in COVID-19 related product sales in 2021, as high rates of vaccination and natural immunity have reduced the severity of COVID-19 illness and need for hospitalization and ICU care, and with it the use of CytoSorb in these patients.
For a more detailed discussion of 2021 and our 2022 strategy, please refer to our annual stockholder letter, issued
Dr.
- Our main priority is to open the U.S. market by obtaining FDA Marketing approval for DrugSorb™-ATR to remove ticagrelor and/or direct oral anticoagulants (DOACs) during cardiothoracic surgery, a potential total addressable market of
$500M to$1 billion in theU.S. alone. To do so, we intend to complete enrollment of the 120-patientU.S. STAR-T pivotal, randomized, controlled trial (RCT) within 12 months from today, and the 120-patientU.S. STAR-D pivotal RCT within 12-18 months of first patient enrollment. If successful, these studies will support our marketing approval application to the FDA under FDA Breakthrough Device Designation. - Second, we are targeting growth of 20% or more in core CytoSorb sales for the entire year, driven by major investments in our sales infrastructure and key personnel, and by broad existing and new applications ranging from sepsis, trauma, liver failure, acute respiratory distress syndrome, antithrombotic drug removal, and inevitable surgical complications from the significant backlog of surgical procedures. This forecast takes into account the expected evolution of the COVID-19 pandemic and the potential impact of the
Russia –Ukraine war. - Third, we expect to complete and begin CytoSorb production later this year from our new manufacturing facility, which will become our headquarters in
Princeton, New Jersey , currently under construction. This facility is expected to help expand product gross margins while supplying enough product to support future annual product sales of up to$400 million . - Finally, we plan to expand our strategic partnerships, both new and existing, to maximize the synergy between our technology and those of our partners, while creating new global opportunities for growth.
We believe these initiatives will lead to sustainable and significant value creation for our Company and our shareholders."
Clinical Studies Update
Cardiac Surgery
- The
U.S. double-blind, randomized, controlled STAR-T (Safe and Timely Antithrombotic Removal – Ticagrelor) clinical study evaluating the removal of ticagrelor by DrugSorb-ATR in a cardiopulmonary bypass circuit to reduce the likelihood of serious perioperative bleeding during urgent cardiac surgery enrolled the first patient inOctober 2021 . The study is now actively recruiting patients at multiple sites and we expect the study to reach its first scheduled milestone of the first Data Safety Monitoring Board (DSMB) meeting after 33% of patients are enrolled this summer. Enrollment is expected to be complete within 12 months from today.
- The
U.S. double-blind, randomized controlled STAR-D (Safe and Timely Antithrombotic Removal – Direct Oral Anticoagulants) clinical study evaluating the removal of the Direct Oral Anticoagulants (DOACs) apixaban and rivaroxaban by DrugSorb-ATR in a cardiopulmonary bypass circuit to reduce the likelihood of serious perioperative bleeding during urgent cardiac surgery has activated its first sites. We expect the first patient to be enrolled in the first quarter of 2022 with target study enrollment completion in 12-18 months following the first patient enrolled.
- The international Safe and Timely Antithrombotic Removal (STAR) Registry is designed to capture real world clinical and health economic outcomes with intraoperative antithrombotic drug removal. The STAR Registry is actively enrolling in the
U.K. andGermany and is planned to expand to additional EU countries before the end of 2022. The intent of the Registry is to report outcomes at international conferences and submit the results for publication on a rolling basis as enrollment progresses.
- As previously announced, the decision was made in
January 2022 to stop the randomized, controlled, multi-center REFRESH 2-AKI study designed to evaluate intraoperative use of two CytoSorb devices as a therapy to reduce the incidence and severity of acute kidney injury following cardiac surgery. The study was stopped for business reasons to shift resource allocation to the prioritizedU.S. STAR-T and STAR-D trials discussed above. Importantly, there were no safety issues in the REFRESH 2-AKI trial.
- The single arm TISORB study executed in the
U.K. and the single arm CYTATION study inGermany evaluating ticagrelor removal during cardiac surgery were both stopped in 2021. The decision was made since the larger, far more rigorous double blind RCT STAR-T will generate much higher quality data on ticagrelor removal and is powered to also report clinical outcomes rendering these two single arm studies redundant. Once again, it is important to emphasize that this was a business decision to enhance the focus and resource allocation to the STAR programs and that there were no safety concerns in either of the two stopped studies as confirmed by the independent DSMBs of each study.
Critical Care
- Primary results from the CytoSorb Therapy in COVID-19 (CTC) Registry demonstrating high 90-day survival in critically ill COVID-19 patients with acute respiratory distress syndrome (ARDS) treated with both extracorporeal membrane oxygenation (ECMO) and CytoSorb under FDA Emergency Use Authorization were presented at the International Symposium of Intensive Care Medicine (ISICEM) conference at the end of
August 2021 inBrussels, Belgium , and have been published in the peer reviewed journal, Frontiers in Medicine. The CTC Registry has completed enrollment at 100 patients and the final results will also be submitted for publication.
- The German PROCYSS multicenter, randomized controlled trial evaluating the ability of CytoSorb to restore hemodynamic stability in patients with refractory septic shock is now actively enrolling. The speed of enrollment remains uncertain due to COVID-19, however, we estimate that the next important milestone of the interim analysis after 50% enrollment will occur in 2023.
- The German Hep-On-Fire multicenter, single-arm trial evaluating CytoSorb in patients suffering from acute liver failure due to alcoholic hepatitis received Ethics Committee approval in
October 2021 and study start-up activities are ongoing. We expect that the study will begin enrollment in the first half of 2022 and complete enrollment in 2023.
- The international COSMOS Registry was designed to capture real world outcomes and device utilization patterns across multiple critical care indications including but not limited to sepsis, acute respiratory failure, postoperative vasoplegia, acute liver failure, and acute pancreatitis. The Registry is undergoing start-up activities and scheduled to begin enrollment in the first half of 2022 with the goal of being active in multiple countries in 2023. The intent of the Registry is to report outcomes at international conferences and submit the results for publication on a rolling basis as enrollment progresses.
Results of Operations for the year ended
Revenues
Total revenue, including product revenue and grant income, for the year ended
Cost of Revenues
Cost of revenue for the year ended
Operating Expenses
Operating expenses for the year ended
Liquidity and Capital Resources
Since inception, our operations have been primarily financed through the private and public placement of our debt and equity securities. At
We believe that we have sufficient cash to fund our operations and clinical trial activities well into the future.
Results of Operations for the Quarter ended
Revenues
Total revenue, including product revenue and grant income, for the fourth quarter of 2021 was
Cost of Revenues
Cost of revenue for the fourth quarter of 2021 was
Operating Expenses
Operating expenses for the fourth quarter of 2021 amounted to
2022 Outlook
The macro environment in which we operate remains difficult to predict given the complex drivers of our business and global nature of our operations.
We expect COVID-19 cases and hospitalizations worldwide to continue to decline and expect to reach a more normalized operating environment as the year progresses, as high rates of vaccination and natural immunity have reduced the severity of COVID-19 illness and need for hospitalization and ICU care, and with it the use of CytoSorb in these patients. Our 2022 outlook assumes a gradual recovery of normalized hospital activity in
In addition, given our global presence, the
Assuming little, to no sales in 2022 from
For additional information, please see the Company's Form 10-K for the period ended
Conference Call
The company will conduct its fourth quarter and full year results call today at
Conference Call Details:
Toll free: 1-877-451-6152
International: 1-201-389-0879
Conference ID: 13726520
It is recommended that participants dial in approximately 10 minutes prior to the start of the call. There will be a simultaneous live webcast of the conference call that can be accessed through the following audio feed link: https://viavid.webcasts.com/starthere.jsp?ei=1525680&tp_key=7f828ec8e8
An archived recording of the conference call will be available under the Investor Relations section of the Company's website at http://cytosorbents.com/investor-relations/financial-results/.
About
Forward-Looking Statements
This press release includes forward-looking statements intended to qualify for the safe harbor from liability established by the Private Securities Litigation Reform Act of 1995. These forward-looking statements include, but are not limited to, statements about our plans, objectives, future targets and outlooks for our business, expectations regarding the future impacts of COVID-19 or the ongoing conflict between
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CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS |
||||||||||||||||
(amounts in thousands, except per share data) |
||||||||||||||||
Three months ended |
Year ended |
|||||||||||||||
2021 |
2020 |
2021 |
2020 |
|||||||||||||
Revenue: |
||||||||||||||||
CytoSorb sales |
$ |
9,592 |
$ |
11,489 |
$ |
39,997 |
$ |
39,342 |
||||||||
Other sales |
106 |
42 |
112 |
110 |
||||||||||||
Total product sales |
9,698 |
11,531 |
40,109 |
39,452 |
||||||||||||
Grant income |
1,084 |
425 |
3,057 |
1,552 |
||||||||||||
Total revenue |
10,782 |
11,956 |
43,166 |
41,004 |
||||||||||||
Cost of revenue |
3,123 |
2,527 |
11,048 |
11,052 |
||||||||||||
Gross profit |
7,659 |
9,429 |
32,118 |
29,952 |
||||||||||||
Other Expenses: |
||||||||||||||||
Research and development |
6,137 |
2,686 |
16,381 |
8,810 |
||||||||||||
Legal, financial and other consulting |
641 |
1,103 |
2,732 |
3,048 |
||||||||||||
Selling, general and administrative |
10,442 |
8,274 |
35,750 |
28,464 |
||||||||||||
Total expenses |
17,220 |
12,063 |
54,863 |
40,322 |
||||||||||||
Loss from operations |
(9,561) |
(2,634) |
(22,745) |
(10,370) |
||||||||||||
Other income/(expense): |
||||||||||||||||
Interest income (expense), net |
12 |
(361) |
28 |
(1,201) |
||||||||||||
Gain (loss) on foreign currency transactions |
(493) |
1,190 |
(2,578) |
2,607 |
||||||||||||
Total other income (expense), net |
(481) |
829 |
(2,550) |
1,406 |
||||||||||||
Loss before benefit from income taxes |
(10,043) |
(1,805) |
(25,295) |
(8,964) |
||||||||||||
Benefit from income taxes |
736 |
1,127 |
736 |
1,127 |
||||||||||||
Net loss |
$ |
(9,307) |
$ |
(678) |
$ |
(24,559) |
$ |
(7,837) |
||||||||
Basic and diluted net loss per common share |
$ |
(0.21) |
$ |
(0.02) |
$ |
(0.57) |
$ |
(0.20) |
||||||||
Weighted average number of shares of |
43,476,926 |
43,192,127 |
43,359,186 |
38,818,990 |
||||||||||||
Net loss |
$ |
(9,307) |
$ |
(678) |
$ |
(24,559) |
$ |
(7,837) |
||||||||
Other comprehensive income (loss): |
||||||||||||||||
Currency translation adjustment |
558 |
(1,217) |
2,260 |
(2,260) |
||||||||||||
Comprehensive loss |
$ |
(8,749) |
$ |
(1,895) |
$ |
(22,299) |
$ |
(10,097) |
|
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CONDENSED CONSOLIDATED BALANCE SHEETS |
||||||
(amounts in thousands) |
||||||
|
2020 |
|||||
ASSETS: |
||||||
Current Assets: |
||||||
Cash and cash equivalents |
$ |
52,138 |
$ |
71,422 |
||
Grants and accounts receivable, net |
4,523 |
5,159 |
||||
Inventories |
4,766 |
2,674 |
||||
Prepaid expenses and other current assets |
2,872 |
3,198 |
||||
Total current assets |
64,299 |
82,453 |
||||
Property and equipment, net |
5,151 |
2,120 |
||||
Restricted Cash |
1,687 |
– |
||||
Right of use asset |
13,423 |
1,029 |
||||
Other assets |
4,959 |
4,348 |
||||
TOTAL ASSETS |
$ |
89,519 |
$ |
89,950 |
||
LIABILITIES AND STOCKHOLDERS' EQUITY: |
||||||
Current Liabilities: |
||||||
Accounts payable |
$ |
2,805 |
$ |
1,835 |
||
Lease liability – current portion |
571 |
447 |
||||
Accrued expenses and other current liabilities |
10,314 |
7,871 |
||||
Total current liabilities |
13,690 |
10,153 |
||||
Lease liability, net of current portion |
13,251 |
582 |
||||
TOTAL LIABILITIES |
26,941 |
10,735 |
||||
Total stockholders' equity |
62,578 |
79,215 |
||||
TOTAL LIABILITIES AND STOCKHOLDERS' EQUITY |
$ |
89,519 |
$ |
89,950 |
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Investor Relations Contact:
and Corporate Communications
(732) 482-9984
[email protected]
Eric Kim
Rubenstein Public Relations
212-805-3052
[email protected]
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