CytoSorbents Issues Stockholder Letter and Reports Preliminary Fourth Quarter and Full Year 2022 Revenue
CytoSorbents Corporation (CTSO) reported a total revenue of approximately $34.7 million in 2022, down from $43.2 million in 2021. Cumulative CytoSorb treatments exceeded 195,000, marking a 20% increase year-over-year. Q4 2022 product sales reached approximately $7.6 million, up 18% sequentially from Q3 2022 but lower than Q4 2021 due to COVID-related sales. The company aims to complete the pivotal STAR-T trial for its DrugSorb-ATR product in 2023, targeting the U.S. and Canadian markets, with a significant addressable market estimated at $300-350 million. The firm ended 2022 with a solid cash balance of $23.8 million and a grant backlog of $11.5 million.
- Cumulative CytoSorb treatments surpassed 195,000, up 20% from 2021.
- Q4 2022 product sales increased by 18% sequentially from Q3 2022.
- Core non-COVID product sales in Q4 2022 were approximately $7.6 million, a 6% increase on a constant currency basis compared to Q4 2021.
- Company anticipates completion of the STAR-T trial in 2023, opening significant U.S. and Canadian markets.
- Solid cash balance of $23.8 million at the end of 2022.
- Total revenue declined to $34.7 million in 2022 from $43.2 million in 2021.
- Overall preliminary product sales were approximately $29.4 million in 2022, down from $40.1 million in 2021.
- Core (non-COVID) product sales dropped to $29.1 million in 2022 from $33.8 million in 2021.
- Currency exchange headwinds with an 11% drop in Euro against the U.S. dollar affected sales.
Cumulative CytoSorb treatments surpassed 195,000. Q4 2022 product sales rebounded from Q3 2022 low. Adjusted for constant currency, Core non-COVID 2022 product sales were within
Preliminary Unaudited Full Year 2022 Results
- Cumulative CytoSorb treatments delivered exceeded 195,000 at the end of 2022, up
20% from the end of 2021, and marking the 10th year of CytoSorb commercialization - Preliminary unaudited 2022 Total Revenue, which includes Product Sales and Grant Revenue, was approximately
versus$34.7 million in 2021, and$43.2 million in pre-pandemic 2019$24.9 million - Overall preliminary unaudited 2022 Product Sales were approximately
versus$29.4 million in 2021, which included$40.1 million and$0.3 million in COVID-19 related Product Sales, respectively, and versus$6.3 million in pre-pandemic 2019$22.8 million - 2022 Core (non-COVID-19) Product Sales were approximately
versus$29.1 million in 2021. This reflects an$33.8 million 11% drop in the average Euro to dollar exchange rate from 1.18 in 2021 to 1.05 in 2022. On a constant currency basis, Core Product Sales would have been approximately versus$32.2 million in 2021, a decrease of$33.8 million 4.6% - Solid cash balance at the end of 2022 of approximately
$23.8 million
Preliminary Unaudited Q4 2022 Results
- Q4 2022 Total Revenue was approximately
versus$9.4 million in Q4 2021, and versus$10.8 million in pre-pandemic Q4 2019$7.4 million - Q4 2022 Product Sales were approximately
, which rose$7.6 million 18% sequentially from in Q3 2022, but were lower than the$6.5 million in Q4 2021, which benefitted from$9.7 million in COVID-related sales. Pre-pandemic Q4 2019 Product Sales were$1.7 million .$6.6 million - Core (non-COVID-19) Product Sales in Q4 2022 were approximately
, compared to approximately$7.6 million in Q4 2021. On a constant currency basis, core Q4 2022 product sales would have been$8.0 million , a$8.5 million 6% increase over in Q4 2021$8.0 million
The Company expects to report fully-audited financial results for Q4 2022 and full year 2022 on
Dear Stockholders and Friends,
Before I begin, I thought it would be helpful to pause and take stock of where
We believe our value proposition is unique and compelling, particularly in light of the major unmet medical needs that our products address globally, our high margin "razorblade" business model, the validation of our technology by our customers, strategic partners, and government funding agencies, and the potential proximity of opening and driving sales in the
1. Opening the
Antithrombotic, or "blood thinning," medications are among the most widely prescribed drugs in the world, with millions of people on these agents to reduce the risk of heart attack and stroke. However, patients taking these medications have a higher tendency to bleed, sometimes fatally, particularly when undergoing urgent surgery, suffering an acute injury, or developing a spontaneous bleeding event such as a hemorrhagic stroke or gastrointestinal bleed.
We are in the midst of the pivotal
In 2023, our goal is to successfully complete the STAR-T trial, finalize our data analysis, and file for
- Enrolled the first third of a total of 120 patients in the STAR-T trial in
November 2022 , achieving the first of three major milestones in the study - Received the recommendation by the independent Data and Safety Monitoring Board (DSMB) to continue the trial without modification in
December 2022 , following an unblinded data review of the first 40 patients - Obtained
Health Canada approval of our STAR-T protocol this month, clearing the way for us to initiate new high volume Brilinta-using centers in the country, which is expected to speed enrollment and completion of the study, while also supporting aHealth Canada regulatory submission - Welcomed Dr.
Irina Kulinets , PhD as Senior Vice President of Global Regulatory Affairs and the newest member of the executive management team, to lead the regulatory approval of DrugSorb-ATR for anti-thrombotic removal. Previously, she was the SVP of Regulatory Affairs, Clinical Research, and Quality atMicrovention , a global leader in advanced neuroendovascular surgical products. Irina is highly experienced in all aspects ofU.S. and international medical device regulatory affairs and has an outstanding track record of successful device approvals across the gamut of low to high-risk medical devices.
Patient enrollment in STAR-T continues to meet expectations. We expect to reach the second milestone of 80 patients enrolled this spring, which will trigger the next unblinded data review by the DSMB, and to complete enrollment of all 120 patients this summer, with database lock and topline data expected shortly thereafter. If positive, FDA and
Preparing for Commercialization of DrugSorb-ATR
Meanwhile, we have developed a detailed launch and commercialization strategy for DrugSorb-ATR and are pursuing our pre-commercial development in parallel to the clinical study. A key area of focus is how DrugSorb-ATR will be funded. Based upon a number of health economic analyses done in the
Although we feel very comfortable with the conventional path to obtain reimbursement for DrugSorb-ATR, interestingly, there may soon be another alternative avenue to obtain CMS reimbursement that will only be available to a select group of FDA-approved Breakthrough Devices. We have previously discussed how in
Thankfully, there is broad bipartisan support of the MCIT rule, and a modified version of it is included in the proposed CURES 2.0 Act legislation. In addition, in early 2022, CMS announced a new initiative called "Transitional Coverage for Emerging Technologies (TCET)" as a potential replacement for MCIT. TCET is supported by AdvaMed (
In an article entitled, "A Vision of Medicare Coverage for New and Emerging Technologies – A Consistent Process to Foster Innovation and Promote Value" published in the
At a
In a press release and open letter to CMS Administrator
Again, we believe DrugSorb-ATR, as an FDA Breakthrough Device whose target population comprises many patients 65 years of age and older in the Medicare population, could be well-suited to a proposed CMS TCET policy. We are encouraged by the continued prioritization of this program by CMS and will continue to follow the progress closely. If it becomes a reality, we will investigate this as an alternate path for CMS coverage. Meanwhile, we continue to be laser-focused on driving DrugSorb-ATR to the finish line.
2. Return to Sales Growth
CytoSorb is a
CytoSorb targets a global multi-billion dollar total addressable market each year. To date, among dozens of different applications, nearly half of all CytoSorb treatments were related to sepsis and septic shock. But other applications are expected to gain momentum, particularly:
- Treatment of severe ARDS (acute respiratory distress syndrome) with new exciting survival data in 100 patients from 5 major
U.S. ECMO centers, combining CytoSorb with ECMO (extracorporeal membrane oxygenation) in the setting of COVID-19 to achieve "enhanced lung rest" under FDA Emergency Use Authorization - Treatment of acute liver disease where CytoSorb demonstrated superiority to the leading liver dialysis platform in terms of liver toxin and cytokine removal, and importantly, ease-of-use
- Antithrombotic drug removal with strong adoption by cardiothoracic surgeons in
Europe and the pending completion of the STAR-T randomized controlled trial - Staph aureus endocarditis, driven by the risk of infection of aging implanted prosthetic heart valves as well as the opiate crisis and use of dirty needles
CytoSorb, DrugSorb-ATR, ECOS-300CY® and VetResQ® are now being manufactured at our new, certified, state-of-the-art production facility and headquarters in
We believe the fundamentals of our business and sales model are sound. However, in 2022, we experienced a perfect storm of many geopolitical, economic, post-pandemic, and company-specific factors that contributed to lower-than-expected sales and product gross margins, and higher capital expenditures and operating costs, that made it a challenging year. Some of these factors included:
- Significant weakness in the acute care hospital segment worldwide. As widely reported, the toll of the protracted pandemic led to an exodus of healthcare professionals, particularly nurses, and a shortfall in revenues due to fewer hospital beds, patients, and procedures, coupled with the additional financial strain from inflation and energy costs. Many hospitals in many countries are experiencing major deficits and are facing significant financial hardship
- The
11% drop of the Euro against theU.S. dollar resulting in major currency exchange headwinds as a majority of our sales are based in Euros and converted into dollars - The impact of high inflation and rapidly rising interest rates that threatened global recession, cascading down into all aspects of our business
- The
Russia -Ukraine war that drove both political and economic instability, and fueled skyrocketing energy costs throughoutEurope - The plunge of the stock market that triggered a bear market in many sectors, impacted our stock, and iced new investments and funding
- "Pandemic inflation" resulting in higher-than-expected construction costs to open our new manufacturing facility
- A temporary decline in product gross margin due to the transition to our new
Princeton, New Jersey manufacturing facility - The unusually competitive labor market, resulting in higher labor costs and employee turnover, and
- The simultaneous launch of the two pivotal STAR-T and STAR-D trials that increased our clinical spend
Given these challenges, we still managed to achieve approximately
As we look ahead to 2023, many of the factors that we faced last year still remain, but importantly, we believe a number of these have abated, and we believe our own situation has improved significantly. This year, we expect:
- Increased Visibility on the Likelihood of DrugSorb-ATR Contributing to Future Sales
As we discussed above, every month that goes by, we get closer to the completion of the STAR-T randomized controlled trial, expected this year. High quality clinical efficacy and health economics data from this study, if positive, are expected to support FDA andHealth Canada regulatory approval, demonstrate cost savings to the healthcare system to justify reimbursement, and support consideration for inclusion into patient care guidelines. Should these come to pass, we believe DrugSorb-ATR adoption could be swift with it becoming a significant contributor to overall product sales, capturing a portion of the estimated initial total addressableU.S. and Canadian markets of annually$300 -350M - Rebound of International Product Sales Growth
Core product sales for the year, when adjusted for currency exchange differences, were within5% of that achieved in 2021. In addition, Q4 2022 core product sales were18% sequentially higher than Q3 2022, and actually6% higher than core product sales in Q4 2021 on a constant currency basis. We believe this was primarily related to our efforts and ability as a company to get back to selling and marketing our products in person, rather than any significant improvement of the hospital markets. Although too early to draw broad conclusions, we are encouraged by the continued market enthusiasm for our therapy and are projecting stronger product sales this year based upon numerous growth opportunities and initiatives. We expect gains from key programs such as our standalone blood pump initiative, our global marketing agreement with Fresenius Medical Care, our therapy area focus in critical care, cardiac surgery, and liver & kidney diseases, and our preferred supplier agreements with the top two largest private hospital networks inGermany , Asklepios and Helios. We also expect to launch several new sales and marketing initiatives in 2023 that we believe have the potential to drive increased sales of CytoSorb throughout the world. We will have more detail on these programs as the year progresses. Our goal is to more than double our annual ex-U.S. product sales to at least in the next three years$80M - Restoration of Product Gross Margins – In 2022, product gross margins were lower due to scheduled pauses in device production, the combined overhead of two manufacturing facilities, one-time manufacturing issues, and decreased production due to inventory and lower than expected product sales. As most of these issues were non-recurring, we believe product gross margins will return to historic ranges between 75
-80% in 2023 - Full CytoSorb Production from Princeton Facility
InDecember 2022 , we consolidated all of ourU.S. operations to ourPrinceton, New Jersey headquarters. The transition was smooth and we are currently beginning full production of CytoSorb out of the new manufacturing facility - More Normalized Year-over-Year Comparisons
In the past several years, our results have been skewed by two major items: large COVID-19 related product revenue from the first two years of the pandemic, and currency exchange volatility. Going forward, we expect more normalized year-over-year comparisons, with nominal COVID-19 related revenue to compare to last year, and what was a likely bottoming of the Euro in 2022 - Reduced Cash Burn with Tight Control Over Expenses, and No Major Capital Expenditures
In December, we strengthened our cash balance to with a non-dilutive$23.8M term-loan from$5M Bridge Bank . Meanwhile in Q4 2022, we reduced our cash burn significantly and expect our quarterly cash burn to be even lower in 2023 with achievement of budgeted sales. Many of the cost cutting efforts that we took in 2022 will become more apparent. For example, consolidation of ourU.S. facilities, where we exited our prior lease at the end of 2022, will save approximately this year. The postponement of STAR-D is expected to save$0.8M in 2023. And annualized savings from the$4M 10% headcount reduction made last year will begin to be realized, particularly inEurope now that mandatory employment notice periods have expired. In addition, we do not expect any major capital expenditures this year, after completing the build out of our manufacturing facility last year - Finally, We Expect More Economic Relief for Hospitals Throughout Europe
Healthcare is often cited as recession resistant, as there are always people getting sick. However, the pandemic initiated a global healthcare crisis, and eroded the infrastructure and buffer that protected hospitals as the backbone of the healthcare industry. This will likely result in a wave of hospital consolidations with weaker ones being assimilated or closed. But overall, we believe hospitals are such a core part of the economy and provide such a fundamental, basic human right that governments cannot afford, both economically and politically, to let them fail despite occasional rhetoric to the contrary. This is particularly true in most European countries where governments regulate and fund, or heavily subsidize, universal healthcare. For example,Germany pledged financial support for German hospitals to offset the cost of energy inOctober 2022 . In the same month,France announced a150M Euro relief fund for pediatric services, and earlier this month announced an overhaul to the French health system. At the same time, the U.K. Prime Minister called an emergency meeting in earlyJanuary 2023 on how to shore up the strugglingNational Health System (NHS ). Although not enough, it highlights the motivation of governments to address this crisis, which ultimately we believe would be good for us
Eyes on the Prize
With everything going on in the world today, it is easy to get distracted by short-term events and uninformed speculation, and to lose sight of the significant value that we have created in this Company, the expected proximity of some potentially game-changing events such as the completion of the STAR-T trial and submission for FDA and
Despite the significant challenges that we have faced this past year and their impact on our business, we believe we have successfully navigated through some of the most challenging times in our Company's history and believe we are in excellent shape and well-positioned to take the next step in our evolution. We believe we have been able to do so because of our strong fundamentals.
- An outstanding and passionate team of nearly 200 employees worldwide
- A strong network of dedicated users and healthcare professionals in 75 countries globally
- A portfolio of compelling products, including CytoSorb, DrugSorb-ATR, ECOS-300CY, VetResQ, HemoDefend-BGA, and others under commercialization and development that address pressing unmet medical needs, massive markets, and are driven by major trends in healthcare
- An attractive high margin "razorblade" business model
- World-class industry partners
- A solid balance sheet to fund our initiatives
- A new manufacturing facility that is expected to drive further product gross margin expansion while supplying product for years to come, and finally,
- The expected successful completion of the STAR-T trial this year, and if positive, submission for FDA and
Health Canada marketing approval, potentially opening up the massiveU.S. and Canadian markets – a potential watershed event for our Company
We are grateful to all of you who continue to support
Dr.
Chief Executive Officer
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, including our future sales goals and targets, expectations regarding the future impacts of COVID-19 or the ongoing conflict between
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CytoSorbents Contact:
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kbloch@cytosorbents.com
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