Health is becoming more and more digital, as patients are now harnessing both data and treatment plans literally in the palm of their hands through common digital devices, like iPads, watches, and cell phones.
Now, one company is not just collecting patient data, but creating and commercializing digital software that serves as prescription medical treatments for people with unmet medical needs.
Click’s apps target disease and drive outcomes from multiple different angles, combining scientifically proven therapies with proprietary neuromodulatory mechanisms to deliver clinical interventions.
The company is currently developing software that's used in tandem with doctor-prescribed medication, including the first and only FDA-cleared app to help treat MDD. Their migraine treatment has also shown statistically significant reduction in monthly migraine days.
Click’s founder, David Benshoof Klein, connected with
MD+DI
to discuss the ever-evolving digital therapeutics landscape, and about the medtech applications that could change care for patients globally.
Click Therapeutics achieved a major milestone as the first FDA-cleared app for MDD treatment. What were the biggest regulatory and clinical hurdles you overcame, and how has this breakthrough positioned the company in the digital therapeutics landscape?
Klein:
That was a bit over a year ago in collaboration with our partner Otsuka. We had the first ever FDA-authorized app to treat depression, specifically as an adjunctive treatment for major depressive disorder symptoms. A tremendously exciting milestone for the company. We have been at this for a while, so our first real FDA clearance of an app to treat a disease was a monumental moment. Super excited about it. We also, relatively recently, had the first ever FDA-authorized app to treat migraines. That is specifically indicated for the preventative treatment of episodic migraines.
How do you work with physicians to integrate your apps into existing treatment protocols?
Klein:
The MDD app, Rejoin, is licensed to Otsuka. It is being prescribed by physicians to patients, probably as we speak. It is a new and fantastic tool for physicians and patients to have. We are preparing to launch our migraine program later this year.
What does the reimbursement landscape look like for digital therapeutics? Are payers recognizing the value proposition, and how do you demonstrate cost-effectiveness compared to traditional treatments?
Klein:
There is a misnomer that payers won't reimburse for this. It is always challenging when you have a new modality of medicine, to scale it into our complex healthcare system. The first group of digital therapeutic companies that tried to enter the system really had lackluster clinical outcomes. If there were drugs with those clinical outcomes, they never would have been commercialized.
We are very deliberate in the programs we develop, and work with payers even before pivotal trials to understand what outcomes they need for reimbursement. We start working with payers really early in the process. We are getting terrific feedback on our migraine program. We showed in our pivotal trial a reduction of three monthly migraine days. The average patient in our study’s intervention group went from seven and a half monthly migraine days to about four. That is greater than the control. That is meaningful in lost productivity alone, let alone savings in all of the other ways. That is thousands of dollars a year for patients.
We also hit some outcomes in that study that drugs do not necessarily address as well as we do. That's migraine specific quality of life. We showed a statistically significant outcome over the control. Also, the migraine disability score, the MIDAS. That migraine specific quality of life scale directly translates into health economics outcomes. The scale asks patients how many days they missed work over the last two weeks, and these types of things that are directly translatable into economics. We are getting positive feedback from payers, and that is not a surprise because we were very collaborative in our design process, so when we hit our endpoints we were pretty confident we could get coverage.
What's your vision for the digital therapeutics space over the next 5 years? Which therapeutic areas do you see as the biggest opportunities for software-based interventions?
Klein:
We want to expand access to digital therapeutics. That also includes partnering with tech companies, whether it's wearables or phone makers. We are seeing a revolution in healthcare right now where the power is moving to consumers. When my wife gets a lab test back, the first thing she does is put it in our AI system. That is new and different. When we wake up, the first thing we do is we look at our sleep data. All of this data is consumer facing now. At the same time, you really do need FDA clearance if you want to make treatment claims or make certain recommendations to patients about what to actually do with their data. For the next five years, we would like to see digital medicine enter completely into standard of care in medicine.
There are very few drugs that should be prescribed without software as part of that treatment. FDA has set up robust draft guidance that shows if software as a medical device demonstrates additionally clinically meaningful benefits to a drug, that benefit can be incorporated directly into the drug label. That is very important. In the next five years, we envision many drugs, if not most, being combined with software and patients using software along with pharmacy treatment. And also being combined with wearables and sensor technology, and real-time biometric feedback to allow those technologies to go past tracking symptoms to really delivering guided and intentional cognitive and behavioral change.
What other therapeutic areas is Click Therapeutics targeting in the next 12 months?
Klein:
We have a very active type 2 diabetes and obesity program. We also just, with a partner company, announced topline data read out on our schizophrenia program. That data is extremely compelling and exciting. We successfully hit the primary endpoint of negative symptoms in schizophrenia, which is the holy grail of treatments. A dozen drugs or more have failed to hit that endpoint, but our app succeeded. It succeeded where many other drugs and treatments have failed. We are really excited about that program. It is currently an investigational device for the treatment of negative symptoms in schizophrenia. If authorized by FDA, it will be the first ever app, or first ever treatment of any kind, authorized by FDA to treat negative symptoms of schizophrenia.
Is there anything else you would like to expand on?
Klein:
We just launched an Ultrahuman partnership, which is our first time entering the wearables space. We partnered with Ultrahuman to leverage our migraine technology in their app, which is a wearable ring and biometric ecosystem. That will be deployed starting internationally first, and it goes to show the potential power and strategy of wearables plus digital therapeutics. Our digital therapeutics can potentially help patients manage migraines, but also leverage biometric data you are getting from a smart ring. You can understand a patient’s HRV, stress, activity level, sleep, menstrual cycle, all of these types of things, and provide insights to patients that are related to their migraines that really help them understand and potentially manage disease better.