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A: 'I have, and it's all pending because it's a new drug.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.6, "extraction": { "at": "2026-07-16 23:10:19.749259+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 368, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "Emotional Appeal", "slug": "emotional-appeal", "status": "active", "bestFor": null, "canonId": "019dd956-bde9-7668-8be7-0097678fec59", "version": 1, "bodyDocId": null, "description": "Connecting to audience feelings rather than just logic", "familyLabel": null, "categoryName": "Slide", "categorySlug": "slide" }, "agent": "Storyteller", "layer": "slide", "agents": [ "Storyteller" ], "matchId": "f2887078-017f-4cdb-bf2d-25d64540454c", "evidence": "Little enthusiasm about Vykat from doctors; coming mostly from patients being pushed by a Prader Willi association", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.5, "extraction": { "at": "2026-07-16 23:10:19.88227+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 370, "whyItWorks": null, "antipattern": null, "cardinality": null, "narrativePurpose": null }, { "tool": { "name": "CEO quote contradiction", "slug": "ceo-quote-contradiction", "status": "active", "bestFor": "When management credibility is the lever", "canonId": "019dd9e1-52e9-717f-8454-93e627563ed6", "version": 1, "bodyDocId": "019dd9a1-8296-720d-8f51-da76937f9415", "description": "You reproduce management's own words — verbatim, with source and date — and\nthen place them next to the outcome that contradicts them. 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"frameworkName": "fraud-exposure" }, { "matchId": "cbeded24-57af-472f-b8ab-4f1397630104", "evidence": "Uses expert consultation transcripts to validate the thesis.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:14:38.393+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 414, "frameworkName": "authority-citation" } ], "patterns": [] }, "storymakers": null, "score": null, "review": null, "activistThesis": { "tone": "litigious", "notes": "Scorpion Capital's first short report on Soleno Therapeutics (SLNO1) targeting VYKAT XR (extended-release diazoxide choline) for Prader-Willi Syndrome. Signature Scorpion format: 415-page slide-style report with text-heavy black body, red call-out headlines and section dividers, abundant Facebook screenshots and AE-table screenshots, no original data visualization. Argument is built from >30 interviews (trial PIs, KOLs, ex-employees) and parent posts in two PWS Facebook groups suggesting pediatric hospitalizations for pulmonary edema / heart failure within weeks of launch. Headline rhetorical move is 'Russian Roulette With Prader-Willi Children' — unusually emotive even for a short report. Author is the firm; no individual signatory. Closing ask is operational (FDA Citizen Petition + crowdsourced AE evidence at contact@scorpioncapital.com), not a price target per se, though cover argues round-trip to ~$9 cash floor. Notable rhetorical features: explicit Zafgen analogue, naming Jennifer Miller as the 'invisible hand' fueling start forms (\"the drug may as well be called MILLER XR\"), and a side-by-side label-vs-publication AE table comparison framed as evidence of data fabrication. No sum-of-parts, no peer-gap chart in the conventional sense — this is an investigative-fraud report, not a valuation deck.", "kpisCited": [ { "detail": "~$500,000 per patient per year for a tablet form of a 50-year-old generic (diazoxide)", "metric": "Annual price of VYKAT XR" }, { "detail": "FDA label medication guide: 27% VYKAT vs 12% placebo; Phase 3 paper: 20.2% vs 9.5% — inconsistency flagged as potential misconduct", "metric": "Edema prevalence in label vs. paper" }, { "detail": "17% VYKAT vs 5% placebo, includes type 2 diabetes mellitus", "metric": "Hyperglycemia (label)" }, { "detail": "n=84 DCCR vs n=42 placebo; 13-week trial failed primary endpoint", "metric": "Phase 3 trial size" }, { "detail": "n=77, 16 weeks, single-site skewed, unpublished as of report date", "metric": "Withdrawal (pivotal) study size" }, { "detail": "8 of 9 interviewed investigators disavow VYKAT XR; one quoted: 'I didn't see $500,000 worth of — or $5,000 worth of benefit'", "metric": "Trial investigator rebuke" }, { "detail": "Inferred ~16 lb steady linear increase over 3 years; recent parent reports of 10-15 lb fluid gain in weeks", "metric": "Lean body mass increase on drug" }, { "detail": "Best-case 10-15% of PWS patients per ex-employee; small niche between pediatric and institutionalized populations", "metric": "Estimated TAM" }, { "detail": "~600 start forms, with one physician (Jennifer Miller) suspected as the dominant driver", "metric": "Start forms to date" }, { "detail": "Multiple parent-reported cases of pulmonary edema / heart failure within 6–12 weeks of starting VYKAT XR", "metric": "Pediatric hospitalizations" }, { "detail": "Per ex-Soleno medical affairs: ~50% of PWS physicians already trying GLP-1s for weight loss", "metric": "GLP-1 substitution risk" }, { "detail": "Trades near cash at ~$9 floor; was 90 cents 2.5 years ago", "metric": "Stock price round-trip risk" }, { "detail": "Core composition patent on tablet expires 2026, opening generic substitution", "metric": "Patent expiry" } ], "closingAsk": "Scorpion will file an emergency FDA Citizen Petition asking the FDA to request a voluntary recall of VYKAT XR, and is soliciting parents and physicians to share serious adverse events as supplementary evidence.", "extraction": { "at": "2026-04-22 22:31:03+00", "model": "unknown-legacy", "runId": null, "seconds": 177.08167, "promptVersion": null }, "scqaReward": "If the drug is recalled or new prescriptions plunge, SLNO — a zombie biotech with no pipeline trading near cash — round-trips back toward ~$9, near the penny-stock levels it traded at 2.5 years ago.", "thesisTypes": [ "fraud_exposure", "undervaluation" ], "top3Reasons": [ "VYKAT XR is a $500K/year repackaged 50-year-old generic (diazoxide) with no real PK advantage", "Children are being hospitalized for fluid overload and potential heart failure within weeks of launch", "8 of 9 trial investigators disavow the drug; data discrepancies suggest scientific misconduct" ], "scqaSituation": "Soleno Therapeutics is a one-product biotech selling VYKAT XR — an extended-release tablet of diazoxide, a generic compound used in hospitals for 50 years — at $500,000 per year for hyperphagia in Prader-Willi Syndrome.", "thesisSummary": "Scorpion Capital is short Soleno Therapeutics, alleging that VYKAT XR — a $500K/year extended-release tablet of diazoxide, a 50-year-old generic — is a worthless and dangerous knockoff that fleeced the FDA via sham clinical trials. The 13-week Phase 3 failed; approval rested on an unpublished, single-site-skewed 16-week withdrawal study whose data inconsistencies, per the report, suggest scientific misconduct. Eight of nine trial investigators interviewed allegedly disavow the drug; ex-employees describe pressure to downplay adverse events. Within months of launch, parents in Facebook groups are reporting pediatric hospitalizations for pulmonary edema, fluid overload, and potential heart failure — Scorpion sees the makings of a Zafgen-style debacle. Commercial prospects are torched by GLP-1 substitution, a 10-15% TAM, and dependence on a single physician (Jennifer Miller). Scorpion intends to file an emergency FDA Citizen Petition demanding a voluntary recall.", "primaryDemands": [ "FDA should request Soleno to conduct a voluntary recall of VYKAT XR", "Parents and physicians should report serious adverse events to Scorpion / FDA", "Investors and physicians should treat VYKAT XR as a launch failure and safety hazard" ], "scqaResolution": "Scorpion will submit an emergency FDA Citizen Petition requesting a voluntary recall of VYKAT XR, and is soliciting parents and physicians for additional adverse-event evidence to bolster the filing.", "thesisOneLiner": "Scorpion shorts Soleno (SLNO), arguing VYKAT XR — a $500K/year repackaged 50-year-old generic — is causing pediatric heart-failure hospitalizations and was approved on sham trial data; the launch will collapse.", "precedentsCited": [ "Zafgen (ZFGN) Prader-Willi debacle — high-flier extinct after two trial fatalities", "Sarepta (DKA / heart failure analogue cited by an interviewed investigator)" ], "scqaComplication": "VYKAT XR's Phase 3 failed; FDA approval rested on an unpublished, irregular withdrawal study, and within weeks of launch parents are reporting children hospitalized for fluid overload, pulmonary edema, and potential heart failure.", "narrativeInterest": 4, "notableSlidePages": [ 1, 7, 12, 54, 140, 259 ], "peerCompaniesCited": [ "Zafgen (ZFGN)", "Sarepta", "Aardvark Therapeutics (competing PWS GLP-1 program)", "Proglycem (branded diazoxide suspension)" ], "valuationFrameworks": [ "asset_value", "other" ], "visualCraftInterest": 2 }, "pitchdeck": { "metadata": null, "profile": null }, "slides": [ { "page": 1, "type": "setup", "title": "This is a classic activist short-seller cover page, utilizing aggressive, emotionally charged language to frame the thesis.", "function": "front_matter", "imagePath": "https://imgproxy.kitesheet.com/BoBE_uzE-1OWuuwvbP4TR3UeB4RoSL4F4pUN2_GkobI/rs:fit:1200:1200:0/q:82/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy9mMDZiMGI1ZDIwNzkvcDAwMS5wbmc", "rawType": "cover", "block": null, "metadata": { "slideType": "cover", "slideTypeCanon": { "name": "Cover", "slug": "cover", "status": "active", "canonId": "019de52d-05f2-729d-9f93-e0504f0a2410", "version": 1, "description": null }, "function": "front_matter", "functionCanon": { "name": "Front matter", "slug": "front_matter", "status": "active", "canonId": "019de52d-133d-73f0-9e26-201eda96b098", "version": 1, "description": null }, "density": "dense", "densityScore": 51, "componentCount": 5, "textChars": 2567, "nDataPoints": 0, "notes": "This is a classic activist short-seller cover page, utilizing aggressive, emotionally charged language to frame the thesis.", "elementsJson": [ "headline_text", "subtitle_text", "bullet_list", "callout_box" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:10.74+00", "seconds": 8.207, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/1", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-1", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.81 }, "kind": "callout", "text": "We intend to shortly submit an emergency Citizen Petition asking the FDA to request Soleno to conduct a voluntary recall of VYKAT XR from the market. If you are a parent or physician aware of serious adverse events which we can include as supplementary evidence, please email contact@scorpioncapital.com or anonymously via the contact form on our site.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:10.74+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4837f82a-29dd-450e-ae5d-e211c60cc81e", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We intend to shortly submit an emergency Citizen Petition asking the FDA to request Soleno to conduct a voluntary recall of VYKAT XR from the market.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acaa-aaf8dd84aa70", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.46 }, "kind": "list", "text": "The rapid pile-up of reports of children hospitalized for potential heart failure in recent weeks, shortly after starting VYKAT XR, leads us to conclude the drug may be at risk of being withdrawn from market; or that new prescriptions may plunge. SLNO is a replay of the Zafgen (ZFGN) debacle, the last Prader-Willi high-flier stock, which went extinct after two fatalities during its trial circa 2015 - the current fiasco appears to be unfolding at a more devastating pace. SLNO is at high risk of fading back into obscurity as a zombie biotech that trades near cash - $9/share - round-tripping back to single-digit or penny stock status, as it was a mere ~2.5 years ago when it hit 90 cents. SLNO is a one-trick pony with no meaningful assets, pipeline or scientific program, and its only drug is an inferior tablet version of a half-century-old suspension, with its core patent expiring in 2026, placing it at risk of demise if VYKAT XR bombs. SLNO’s launch metrics are hocus-pocus, obscuring its high dependence on a controversial physician in Gainesville, FL – the lead investigator/author on key trials/papers - whom we suspect to be the invisible hand fueling initial start forms. The investigator has a history of association with failed PWS treatments, such as ZFGN’s (principal investigator); and partnered with an Australian microcap stock promotion peddling a psychedelic for PWS, where the FDA halted its P2 trial. 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(\"SLNO\") (possibly along with or through its principals, members, partners, affiliates, employees, consultants, clients, investors, and/or related party entities or vehicles) and therefore stands to realize significant gains in the event that the price of its stock, bonds, options, and/or other securities decline or change.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acaa-e6b050161269", "parentComponentId": null }, { "bbox": { "h": 0.83, "w": 0.854, "x": 0.073, "y": 0.095 }, "kind": "disclaimer", "text": "THIS REPORT REPRESENTS THE CURRENT OPINIONS OF SCORPION CAPITAL LLC CONCERNING SOLENO THERAPEUTICS INC. 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We have been in the hospital since Friday!!! Retained fluid all over especially his lungs with potential heart failure. Stopping Vykat aka diazoxide choline for good!!!", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-0c1fe228f228", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.4, "x": 0.27, "y": 0.58 }, "kind": "paragraph", "text": "-A parent's post in the largest Facebook group dedicated to VYKAT XR discussion", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.613+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7f2e4b5c-8bdd-471d-a2a5-92a7577ddbd5", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.45, "x": 0.27, "y": 0.37 }, "kind": "quote", "text": "Not good at all!!! We have been in the hospital since Friday!!! Retained fluid all over especially his lungs with potential heart failure. Stopping Vykat aka diazoxide choline for good!!!", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.613+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "56e4ebd2-b591-4f31-bdaa-149633d8dada", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Not good at all!!! We have been in the hospital since Friday!!! Retained fluid all over especially his lungs with potential heart failure. 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We did as well. Our son is 11 and spent 7 weeks in the hospital this summer due to respiratory failure from fluid overload. He ended up on a vent for a week. Only change/new thing was the vykat...", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:14.703+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "555cf26a-7a32-44a9-aaf7-5f8fb3f6c82c", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Facebook group post - “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Massive fluid overload cause fluid around my sons heart and lungs. Weve been working a month now to get the fluid off with lasix and pt.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c2-f467f07e67f8", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.4, "x": 0.267, "y": 0.605 }, "kind": "paragraph", "text": "-A third parent's post in the largest Facebook group dedicated to VYKAT XR discussion, last Friday", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:15.232+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6d95b66c-dc05-472c-ab11-ff24ee4be34d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.46, "x": 0.267, "y": 0.348 }, "kind": "quote", "text": "this was our experience too! Massive fluid overload cause fluid around my sons heart and lungs. Weve been working a month now to get the fluid off with lasix and pt.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:15.232+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c4bc1633-a4e2-40d1-bbf9-ced06ae586dc", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "this was our experience too! Massive fluid overload cause fluid around my sons heart and lungs. 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Thus, the patient was filled VYKAT XR within about a month of commercial availability, when n=?.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.162+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "81638e44-bfc6-4ba1-b388-7120bd39d808", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Not good at all!!! We have been in the hospital since Friday!!! Retained fluid all over especially his lungs with potential heart failure. Stopping Vykat aka diazoxide choline for good!!! — Facebook User", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-be7b3803b12e", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.78, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group”...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.162+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "95db92e1-7266-4b3e-b1e3-cccd9d536667", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Fluid retention is a mechanistic feature of VYKAT XR, not a bug.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.162+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8f6f9c84-ee1c-4ae4-bf70-1a540b80c32f", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "d3d80ae9-ab64-4cd2-80db-a79e2036a76b", "evidence": "Contrasts company claims (implied) with patient reports of adverse events.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:13:17.162+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 12, "frameworkName": "expose_contradiction" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 13, "type": "tension", "title": "Uses anecdotal evidence from Facebook groups to build a case for systemic safety issues.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 54, "componentCount": 5, "textChars": 1675, "nDataPoints": 4, "notes": "Uses anecdotal evidence from Facebook groups to build a case for systemic safety issues.", "elementsJson": [ "paragraph", "screenshot" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:16.905+00", "seconds": 3.008, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/13", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-13", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "A general rule of thumb is that only 10% of adverse events are reported. The actual number of hospitalizations may be much larger.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-3b2a8c394780", "parentComponentId": null }, { "bbox": { "h": 0.32, "w": 0.86, "x": 0.07, "y": 0.59 }, "kind": "list", "text": "Post on Aug 8 – still trying to reduce fluid a month after hospitalization; Second post (excerpt) by the same parent – 5 days in hospital, now “weekly cardiology visits”; edema was missed by the provider", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Comparison list", "slug": "comparison", "status": "active", "canonId": "019de52c-fce7-733e-99d3-030a104727bf", "version": 1, "description": null }, "framework": null }, "subkind": "comparison", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:16.905+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5100a17d-3362-404c-86ad-99702a2252cd", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "That parent posted on July 20. Another parent replied to this post on July 28, indicating her 11-year-old spent 7 weeks in the hospital and had been on drug for 6 weeks. Working backward, we infer that the child began VYKAT XR a week or two after commercial availability, when n=?. A third parent chimed in on Aug 8th to report her son spent 5 days in the hospital – “now we make weekly cardiology visits.” The parent indicates “weve [sic] been working a month now to get the fluid off” – which implies he was admitted no later than end of June. Working backward, we infer that this patient also started VYKAT XR in the first few weeks after availability, when n=?. A general rule of thumb is that only 10% of adverse events are reported. The actual number of hospitalizations may be much larger. We note that it took the second parent a week to notice the first post and report the same scenario; and it took the third parent 12 days after that. Thus, we are alarmed at the possibility of unreported kids in the ICU as we speak.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:16.905+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "aa63276b-86c7-4c08-a23b-0b2eb6ce10bd", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "weve [sic] been working a month now to get the fluid off — Source: Facebook group post", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-3c46cbe55e04", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.6, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/groups/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/groups/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The online reports began to emerge in late July, which would represent only the initial cohort from the first few weeks of patient starts. The larger bolus of starts from June and July, we suspect, could begin to report similar outcomes in the coming weeks – as the previous reports suggest 6-8 weeks before fluid retention accumulates to a tipping point. Thus far, we have only talked about hospitalizations for potential heart failure. We see another report of hospitalization, which indicated the patient was admitted 4 days prior for an unspecified allergic reaction, which the parent stated resulted in drug discontinuation – we see no follow up post stating the outcome or length of hospitalization. The post is dated June 14, which leads us to infer the patient was in the cohort of starts in the first 8 weeks of launch, when n=?", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:20.128+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b7290d33-5535-451e-aad6-bc16daa4018a", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.45, "x": 0.12, "y": 0.6 }, "kind": "quote", "text": "My son had allergic reaction and has been in hospital 4 days so we won't be continuing it. But I know he's an exception and I pray it helps others. I did hear that AARDVARK therapeutics has trials going on for a similar drug that doesn't promote excessive hair growth.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:20.128+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4814de43-2c64-42d4-9eb5-d3428c88a761", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Prader-Willi Support” https://www.facebook.com/groups/1ApAMfpAHo/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We don't think they realize the danger nor the speed with which the presentation they are sharing publicly can cascade into pulmonary edema and potential calamity. Glancing at their public FB feeds, we have doubts about the quality of medical care they may have access to. One of the most commented upon posts in the last week concerns a patient on week 1 of drug who is \"getting psychotic and very confused...I'm afraid we may not able to do this...not sure where things go from here...his blood pressure is 139/89 and heart rate stating irregular heart beat.\" High blood pressure is consistent with fluid backing up into tissue prior to the onset of pulmonary edema, while irregular heartbeat can indicate fluid has begun to enter the lungs, prior to full crisis. Investigators told us of two cases of psychosis in the trials; at least one allegedly required hospitalization.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:16.893+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "77b54d56-3946-4a03-80bb-c1bc142b41a0", "parentComponentId": null }, { "bbox": { "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/groups/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/groups/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The blood sugar spike to 256 and heavy breathing is textbook, but follow-up posts say he’s just fine: “has been very sleepy, increased blood sugar levels, and respiratory problems when asleep...these symptoms are new since he double [sic] his dose...I’ve reported it to panther [Soleno’s specialty pharmacy] and keeping a close eye out if things persist we will unfortunately have to stop...safety first.” A few days later she indicated his blood glucose is already far above the prediabetes cutoff of 100; we note >125 indicates diabetes: “we are approaching week 5...[he] is 110-114 range!...when we entered week 3 and doubled his dose he had a spike to 256 and was very sleepy and was breathing heavily.” We repeat that this page concerns a 5-year-old.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.903+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cb8c2af3-22da-4ab7-b6ef-e84e2362d014", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The prominent placement of diabetic ketoacidosis in the Medication Guide in the FDA label is telling.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6216967d-f855-4b2a-8353-1d8a33443601", "parentComponentId": null }, { "bbox": { "x": 0.07, "y": 0.18 }, "kind": "paragraph", "text": "Both are life-threatening complications. 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Given that diazoxide suppresses insulin by >50%, DKA is a mechanistically-inherent extreme risk.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dbdb8fd0-e7bc-4aa0-a8a5-a144073592f3", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "one subject in Study 3 experienced a serious adverse reaction of diabetic ketoacidosis — FDA Label", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-5706a6051dcb", "parentComponentId": null }, { "bbox": { "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC1218186/pdf/nihms-2090141.pdf", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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It's two hits. That increases your risk. 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Q&A transcript follows.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.979+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b1aeb4e8-8925-4be7-bbd8-7eef22a4e881", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.85, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "As an example, we quote the Division Chief for pediatric endocrinology at a major academic center who treats 20 PWS patients – \"it's a two-hit...that increases your risk...absolutely\"- citing multiple fatalities he has seen from DKA, coma, and hyperosmolar...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.979+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "68cf9cc9-cd79-48ac-8481-31259093c9c3", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"if you got somebody on diazoxide and you've got somebody on growth hormone... that also is increasing your risk of diabetes...in DKA in overweight people, you also can get type 2 diabetes and wind up in a different type of ketoacidosis with hyperosmolar problems and coma...we've had a couple of deaths from DKA, but we've actually had two from hyperosmolar, type 2's...you're on a second medication that is increasing your sugar while you're on a medication that may be decreasing your insulin...and if you get DKA in type 2, there's a subset that gets something called hyperosmolar...it's bad and very, very difficult to treat...it has a relatively high mortality rate....\" — Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-1e8584342a49", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Our population-", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.501+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "05731e39-a776-4a61-97d5-7b40cbe4410a", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.32, "x": 0.07, "y": 0.62 }, "kind": "paragraph", "text": "Pulmonary hypertension (PH) is a major serious adverse event recently identified with diazoxide use in infants. After the reported cases illustrating the severity of drug-dependent PH, the FDA issued a black box warning for diazoxide use and advised close monitoring in infants at risk of PH; mainly neonates with meconium aspiration syndrome, respiratory distress syndrome, transient tachypnea, pneumonia, sepsis, congenital diaphragmatic hernia or congenital cardiac disease.13,18 Since then, evidence in the literature describing severe pulmonary and cardiac adverse effects of diazoxide has been growing, indicating the incidence of PH is more common than previously thought. However, the supportive published studies are mainly institutional case series and case reports.11 In our study, there were more", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.501+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6f6ebb73-036b-45c5-88cc-032f438a270f", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Ten minutes on PubMed/PubChem is all it takes to realize that unleashing diazoxide from a hospital setting into the general population is asking for trouble – in other words, don’t try this at home. VYKAT XR is merely a tablet version of diazoxide – an IP ploy - even more reckless for reasons we’ll get to. We examine the 2021 paper on the previous page, which reviewed safety outcomes over a 5-year period at a regional Midwest hospital. They used diazoxide for 15 infants with persistent hypoglycemia – 53% had an adverse outcome requiring diazoxide discontinuation; “40% of our patients deteriorated and then required mechanical ventilation”; “six of eight patients required intubation…five out of eight developed pulmonary hypertension.” The authors clearly wrote the paper because they think the literature is sparse and vastly understates the danger, indicating pulmonary hypertension in 2-7% of cases vs. their experience of 33% with PH and 40% with respiratory failure.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.501+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "711b9d68-545d-4677-95a4-ceeeeaf506f0", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“40% of our patients deteriorated and then required mechanical ventilation”; “six of eight patients required intubation…five out of eight developed pulmonary hypertension.” — 2021 paper on diazoxide safety outcomes", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-8d1c9256b111", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.07, "y": 0.94 }, "kind": "source-note", "text": "Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC8135194/pdf/10.1177_20420986211011338.pdf", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/21", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-21", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The problem for Soleno: a combination trial of its tablet and diuretics would have made the risk of PH/CHF obvious and killed its chances, not to mention scaring off physicians and parents.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, 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The problem for Soleno: a combination trial of its tablet and diuretics would have made the risk of PH/CHF obvious and killed its chances, not to mention scaring off physicians and parents.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.944+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "07ad5ea0-177c-43c9-91b4-dfbd165ec59e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "We strongly recommend that a thiazide diuretic be started concomitantly with the initiation of diazoxide due to risk of fluid retention and PH. — Pediatric Endocrine Society practice guidelines (2020)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:11+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-731f8765e7b7", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.36 }, "kind": "source-note", "text": "PES practice guidelines (2020)", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Fluid restriction: We suggest limiting fluid rate...", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.944+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8aa8c823-90aa-4a3b-ab4d-c3c686146f9a", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.5, "x": 0.07, "y": 0.41 }, "kind": "title", "text": "Management and Appropriate Use of Diazoxide in Infants and Children with Hyperinsulinism", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.944+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0a7619da-6057-4ca5-86f6-9646baba46b1", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "51a6b9b2-2ed2-40bd-9843-a3dddafd5286", "evidence": "The slide explicitly contrasts medical guidelines with company trial design to imply intentional omission of risk.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:13:17.944+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 21, "frameworkName": "fraud-exposure" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 22, "type": "tension", "title": "The slide uses a direct quote from a medical paper to expose the ineffectiveness of the company's recommended treatment.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 71, "componentCount": 7, "textChars": 2110, "nDataPoints": 2, "notes": "The slide uses a direct quote from a medical paper to expose the ineffectiveness of the company's recommended treatment.", "elementsJson": [ "paragraph", "callout_box", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:18.233+00", "seconds": 3.107, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/22", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-22", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Diuretics failed to stop diazoxide-induced fluid retention", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-01de5a4d20c1", "parentComponentId": null }, { "bbox": { "h": 0.33, "w": 0.42, "x": 0.07, "y": 0.59 }, "kind": "paragraph", "text": "fluid restriction. Experts recommend the use of a diuretic in every patient who receives diazoxide to prevent the effects of cardiorespiratory fluid overload;15 however, the use of diuretics was selective involving only four of our patients. In the group of patients who developed SAEs, three of eight patients received diuretics throughout the period of time that they developed respiratory deterioration and fluid overload. However, they did not show any signs of improvement until the diazoxide was discontinued. In addition, similar to findings from the existing literature, the development of edema was not dose dependent.15", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.233+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5831e48f-067c-4aaf-a150-def37499792d", "parentComponentId": null }, { "bbox": { "h": 0.42, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Soleno may have fleeced the FDA into a label that doesn't require concomitant diuretics, but its drug reps are being more transparent in sales meetings in recent weeks. Physicians we interviewed indicate being shocked, having thought that edema may be a transient feature, when reps suggested permanent diuretic therapy and gave them handouts for families to take home to recognize warning signs of edema. Unfortunately, diuretics are insufficient and cause severe secondary risks of their own. We again quote the previous paper: “three of eight patients received diuretics throughout the period of time that they developed respiratory deterioration and fluid overload...however, they did not show any signs of improvement until the diazoxide was discontinued...in addition, similar to findings from the existing literature, the development of edema was not dose dependent.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.233+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "76f82a44-2983-4250-83d8-d5b7a69f0ce4", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "three of eight patients received diuretics throughout the period of time that they developed respiratory deterioration and fluid overload...however, they did not show any signs of improvement until the diazoxide was discontinued...in addition, similar to findings from the existing literature, the development of edema was not dose dependent.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-043ee1e19bc2", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC8135194/pdf/10.1177_20420986211011338.pdf", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Q: \"So, you think this could potentially present cardiac risk in a quarter of patients?\" A: \"Cardiac is a big muscle, isn't it? It can. Right? Potassium, yeah...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.889+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4986298e-31b7-42e9-9eef-69a84d57084a", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.64 }, "kind": "paragraph", "text": "Concern about edema, compounded by diuretics; \"heart arrhythmia, muscle spasms, and seizures\" \"Therefore, it's going to certainly impact how you regulate your sodium, potassium, and magnesium in your body...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:17.889+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "63cf9a22-013c-4b6a-96a2-6743e164aa2e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“...interference with potassium, sodium, calcium, magnesium – all these...keep the heart functioning normally...that’s why I said I wanted to hold off [on Vykat]...and see what happens”; “low magnesium can cause seizures or muscle spasms or heart irregularity...I can see that could be a problem...when you’re on a diuretic...you’re losing your potassium... yes. I’m concerned about the edema...heart arrhythmia, muscle spasms, and seizures.” — Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-edfbb4d8c489", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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In particular, diuretics are well-known in worsening hyperglycemia – creating synergistic risk as diazoxide mechanistically induces hyperglycemia as well. Moreover, PWS patients are on growth hormone (82%) and often on psychiatric medications like risperidone, both also diabetogenic – thus creating a mind-boggling cocktail of 4 diabetogenic drugs in PWS patients already prone to obesity.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.58+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a59fbc78-29ae-46df-ba20-127d795bd7fc", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.35, "x": 0.07, "y": 0.58 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"019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Photo", "slug": "photo", "status": "active", "canonId": "019de52c-fd37-757f-b4a8-ca26d4888875", "version": 1, "description": null }, "framework": null }, "subkind": "photo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.805+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "569319be-04fe-4255-8655-e0df52bae074", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.78, "x": 0.07, "y": 0.44 }, "kind": "legend", "text": "Left: patient who we think was recently hospitalized for potential heart failure", "attrs": null, "canon": { "kind": { "name": "Legend", "slug": "legend", "status": "active", "canonId": "31361933-3d22-4c70-bbad-0801e9fffc0c", "version": 1, "description": "Color/symbol decoder placed adjacent to a chart or diagram." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.805+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0515923d-3b83-4fd9-b815-d6d837129479", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "It is unrealistic for parents to discern fluid retention before it is too late – thus, we think tragedy will ensue as long as VYKAT XR remains on market. PWS patients typically present with severe obesity – if they have hyperphagia they will over-eat. The obesity is indistinguishable from edema – parents are reporting kids putting on 10-15 lbs of fluid in a week. One of the patients we think was hospitalized for potential heart failure is bottom left; the other two PWS profiles are from Wikipedia. What you see below is obesity, not edema which is rare in PWS – but who can tell? Fluid retention can tip into pulmonary crisis rapidly – a parent from the opening pages: “started with wheezing hard to breathe...then just boom...man I want my son here with me...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.805+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "94de9a4f-52d8-4417-a5b1-47e9471e0ec6", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.63, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: First pic is from a parent's public Facebook profile/feed; https://en.wikipedia.org/wiki/Prader%E2%80%93Willi_syndrome; https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000100005", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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It was gradual for us...like waking up with swollen eyes...then not being able to put his socks on...next thing we know he’s up 16 pounds — Vykat discussion group member. My daughter is on week 4...her legs are so swollen she can’t wear sneakers...we are keeping her legs raised when possible — Vykat discussion group member. My child’s legs, feet and hands were swollen...she couldn’t fit her feet in tennis shoes and had trouble walking — Vykat discussion group member.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-30be30e0793a", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group”...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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to any of you...my son...started Vykat 7 weeks ago...he was going alright (no appetite change though), but a week and a half ago his legs and feet started to swollen [sic] rapidly, to the point it was hard to walk...he was given a week of diuretics and we stop Vykat...his legs and feet are fine now...has it happened to any of you?”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-d1fc8042b708", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "image", "text": "Screenshots of Facebook group posts and comments discussing Vykat side effects.", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.888+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b32f26c9-5f2d-4005-a7c1-9b70013e6a36", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“We have this going on now”; “we are on week 5...she had some edema too...did your kiddo have swelling as well?”; “each time the dose goes up she has swelling worse”; “water’s heavy...that is a lot...a gallon of water is roughly 8 lbs so 5 lbs would be more than half a gallon of retained fluids....” — Parents in Vykat discussion groups", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acab-d60ede561d9f", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.888+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "12320977-fa02-4666-af58-1aa969cc26ef", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Parents appear to be sounding the alarm to warn other parents – “I just wanted to share, and I hope this is not happening to any of you...my son...started Vykat 7 weeks ago...he was going alright (no appetite change though), but a week and a half ago his legs and feet started to swollen [sic] rapidly, to the point it was hard to walk...he was given a week of diuretics and we stop Vykat...his legs and feet are fine now...has it happened to any of you?” Other parents are chiming in: “We have this going on now”; “we are on week 5...she had some edema too...did your kiddo have swelling as well?”; “each time the dose goes up she has swelling worse”; “water’s heavy...that is a lot...a gallon of water is roughly 8 lbs so 5 lbs would be more than half a gallon of retained fluids....”", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:18.888+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bcabeebc-2e41-445f-9820-4ac90ac5eca3", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 28, "type": "tension", "title": "The slide uses screenshots of Facebook group posts as primary evidence of adverse drug reactions.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 52, "componentCount": 5, "textChars": 1465, "nDataPoints": 3, "notes": "The slide uses screenshots of Facebook group posts as primary evidence of adverse drug reactions.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:19.024+00", "seconds": 2.675, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/28", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-28", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The saga ended 3 weeks later when they discontinued the drug. The parent indicated the child lost 10 lbs of fluid (1.2 gallons) in the week after.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-46620086dd0d", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "image", "text": "Three Facebook post screenshots showing chronological updates on the child's condition.", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.024+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0537237b-5178-4f9c-a628-a4a2192fed54", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "So we have decided to stop the VYKAT. Even on a lower dose and lasix she still seemed to have some fluid retention. Her last dose was Monday and today her weight was back down to 171. McKenzie has been pretty vocal about wanting to stop the Vykat because the swelling hurt her.legs. she wants to do the HERO study. So after getting some info on the study we spoke with the study site and she has made the decision to go through with the intake appointment. Altho I am very saddened that the VYKAT resulted in these side effects, I hope it continues to help some and I understand it's not for everyone. Time to be apart of some more solutions!", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-491e1988a3e2", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.091 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/groups/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/groups/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.024+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e53a3251-3a28-4d08-8f44-e3c4b7254208", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Over the last few weeks, we followed a series of rolling updates by a worried parent – beginning on June 30, their 5th week of Vykat - on a potentially catastrophic build-up of fluid and failed attempts to manage it. The saga ended 3 weeks later when they discontinued the drug. The parent indicated the child lost 10 lbs of fluid (1.2 gallons) in the week after.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:19.024+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f9a171ba-9b93-4542-b737-369189a5eec0", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "416abfcc-fcaf-462e-adac-24499f0f7610", "evidence": "Uses anecdotal social media evidence to contradict safety claims of the drug.", "framework": 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"dense", "densityScore": 50, "componentCount": 5, "textChars": 1345, "nDataPoints": 3, "notes": "Uses patient testimonials as primary evidence to challenge the safety profile of the drug.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:21.397+00", "seconds": 4.965, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/29", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-29", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The critical part of the narrative: diuretics were insufficient to manage the crisis, indicating Vykat-induced edema is a feature not a bug – and by inference, so is the risk of pulmonary involvement and heart failure.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-60c3e6b7a4a9", "parentComponentId": null }, { "bbox": { "h": 0.42, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "image", "text": "Screenshots of Facebook discussion group posts detailing the patient's experience with Vykat and Lasix.", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.397+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "451a9287-3feb-4156-abe6-d1edd1f1f87e", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The family paused Vykat for two days for an emergency course of Lasix (furosemide), typically IV-administered in an urgent care setting for rapid fluid removal in case of pulmonary edema or congestive heart failure. It is an extremely potent diuretic that requires close monitoring for electrolyte and kidney-related complications. After then re-starting Vykat, the child re-gained 5 lbs of fluid – “I was a bit shocked at a 5lb gain!” Ten days later, the family gave up and stopped the drug: “even on a lower dose and Lasix she still seemed to have some fluid retention...[she] has been pretty vocal about wanting to stop the Vykat because the swelling hurt her legs.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.397+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7a23f6c9-cf52-4c07-91f6-ff005b9f52d9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I was a bit shocked at a 5lb gain! — Patient/Caregiver in Vykat discussion group. \"even on a lower dose and Lasix she still seemed to have some fluid retention...[she] has been pretty vocal about wanting to stop the Vykat because the swelling hurt her legs.\" — Patient/Caregiver in Vykat discussion group.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:12+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-6506c3a75010", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group”", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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my daughter is 14 and we are week 7...we hit a speed bump...her ankles are swollen and glucose has been slowly creeping up; we have the fluid retention going on...[our son] started a diuretic yesterday...we stopped Vykat; per doctor we stopped Vykat to do Lasix...I’m waiting to hear from the Vykat people...a mess. — Facebook group members", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acad-0335b19677a6", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.78, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; 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The game may be over for Soleno before it has even begun...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:20.115+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9cb1b4c5-08cd-44fe-8394-e2e78cec6540", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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So there are no new safety signals.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-ae5507197536", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "We infer early signs from Soleno that something may already be amiss with its launch – it declined to provide start form figures for July on the Aug 6 call, after providing them for April (May 7 Q1 release) and June (July 10 release for equity raise).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.725+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4da75e62-432d-4b41-802d-b898d6809a60", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "The first figure was 268 forms from FDA approval in March to May 6; the second figure was 646 forms cumulatively through June 30. We note that reports of hospitalizations began to appear in July, the same time we see an inflection in the main VYKAT FB forum – which indicates people are already starting to discontinue due to blood sugar spiking to prediabetic or diabetic level within weeks of starting drug, fluid retention, increase in hyperphagia and behavioral problems, and so forth.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.725+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "58d464aa-c2ee-46a8-9084-e2a61c342a51", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.49 }, "kind": "quote", "text": "Thanks for the question. So on the safety side, as many of you, I'm sure know, monitoring for safety data in the post-marketing setting is quite different from clinical trial settings. So one typically relies on reports from caregivers or health care providers and the patients that you're treating are also often not as controlled and may have more comorbidities, et cetera. So we are pretty early in the launch. But that said, I can tell you that we have not seen anything in the post-marketing setting that is different from the clinical trial setting. So there are no new safety signals. And once again, just to reiterate, what we have seen with the discontinuation rates at this time are substantially lower than what we have seen in the clinical trials. And Jim, I'll let you take the revenue question.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.725+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2dfa4e96-f6a9-4e84-a5ef-80a3569f9042", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Thanks for the question. So on the safety side, as many of you, I'm sure know, monitoring for safety data in the post-marketing setting is quite different from clinical trial settings. So one typically relies on reports from caregivers or health care providers and the patients that you're treating are also often not as controlled and may have more comorbidities, et cetera. So we are pretty early in the launch. But that said, I can tell you that we have not seen anything in the post-marketing setting that is different from the clinical trial setting. So there are no new safety signals. And once again, just to reiterate, what we have seen with the discontinuation rates at this time are substantially lower than what we have seen in the clinical trials. And Jim, I'll let you take the revenue question.” — Soleno CEO Anish Bhatnagar, Aug 6, 2025 earnings call", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acac-b0cfeb1041a1", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.35, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Capital IQ earnings call transcript; Soleno press releases", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Of these, ~60 appear to be patients converting from the withdrawal study per management comments, implying significant attrition of patients on drug from the trials.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.314+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cee697f5-8fa0-4799-9793-5540dde2052a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.25 }, "kind": "paragraph", "text": "The 13-week Phase 3 with 127 ITT patients dwindled to 83 by the end of the 52-week open-label extension, to 77 in the 16-week withdrawal study, to 60 start forms – leading us to infer a >50% discontinuation rate.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.314+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f79e8076-8a1e-4269-a627-c1ba0fa0cbe2", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/static-files/48405466-3bcb-41d8-ae9e-76f388652c12", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Now the drug is in the real world with nowhere to hide, versus a tiny rare-disease trial.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-b8792a913c4a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.85, "x": 0.07, "y": 0.15 }, "kind": "paragraph", "text": "Now the drug is in the real world with nowhere to hide, versus a tiny rare-disease trial. An ex-employee indicated that two patients in the phase 3 trial were hospitalized with potential heart failure; that in one case “admitted because of fluid overload,” which is consistent with Vykat-induced edema; that “it is not reflected” in the paper because “it was not attributed to the drug,” and questioned whether this was appropriate as the patients were young and “didn’t have underlying cardiac disease or renal disease” and “you can’t exclude a causal relationship” – “I believe one of the cases may have been in Harvard and the other one must have been in the UK…but MGH had a patient who was admitted for fluid overload and potential heart failure”; “if you have hyperglycemia and diabetes, and you have edema and heart failure, and I do believe there were a couple of patients hospitalized with heart failure just to reduce appetite, it may not be a risk worth taking…”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.5+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7e66fd58-8e32-4977-94c5-1c40d8d68ddf", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.85, "x": 0.07, "y": 0.55 }, "kind": "quote", "text": "“Couple of patients hospitalized with heart failure” during trials; lacked underlying factors for cardiac risk; A: “...if you have hyperglycemia and diabetes, and you have edema and heart failure, and I do believe there were a couple of patients hospitalized with heart failure just to reduce appetite, it may not be a risk worth taking.” Q: “There were a couple of patients that were hospitalized for heart failure?” A: “I do believe so. In the earlier trials. The Phase 3, the negative trials.” Q: “And did they reflect that in the adverse events table? Hold on. Let me pull up the adverse events table for that.” A: “It is not reflected because I think it was not attributed to the drug. They said there were other factors.” Q: “And did you agree with that assessment?” A: “Well, you can never tell 100%, right, when somebody is on an experimental drug, unless they are popping in and out of the hospital with heart failure every two or three months. When somebody develops it on the drug, there’s always a feeling at the back of your mind that you can’t exclude a causal relationship.” Q: “Were there things there that made you wonder if there might be a causal relationship, like lack of other factors that predispose them to heart disease? This is for younger patients, so it is very surprising. 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Fluid overload, fluid imbalance.”\nQ: “And how old were these patients?”\nA: “They were all young. The oldest patients in the trial were under 40...I think people are highly incentivized to downplay things that could be on the fence...when you have a causal relationship, uncertain or not known, then they decide to not include those type of things in publications.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.071+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c9563900-a5b3-410e-9796-8b7269388bd1", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "paragraph", "text": "Q: “Were there people at the company arguing for the inclusion of those two adverse events, cardiac adverse events in the paper? 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Releasing a drug that mechanistically induces edema and hyperglycemia - in a vulnerable population with a mean age of death of 29.5 and already at risk of pulmonary hypertension, cardiovascular risk, diabetes, and OSA – defies common sense. We give the FDA some credit: they were poised to reject the drug after the phase 3 trial failed. They relented after a high-pressure petition campaign organized by the two key PWS associations. An integral part of the rare-disease playbook is throwing money at patient groups and stacking FDA hearings with desperate families. The petition lacks credibility, claiming “more than 26,000 comments from PWS families and supporters” - exceeding the number of patients in the US; we wonder how many may have been bots. 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A: “Jennifer Miller was the biggest enroller... Q: “And do you remember roughly how many patients the top three had? ... 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We therefore presume the paper wouldn't pass peer review, or that Soleno wishes to conceal the data from the public.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:22.309+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "aab5d788-8bff-4c7b-9939-21e44f0c8166", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.37 }, "kind": "paragraph", "text": "“Miller was the biggest enroller...I think Eric Felner was number 2”; “other than the top three, the rest of them had three or fewer”; “I think Felner and Miller probably had, out of the 77 that were in the withdrawal study, I think they probably had between 20 to 30 of them.” In the failed phase 3 study, the ex-employee estimated that the same top enrollers had “probably in the 40 to 50 ballpark between the three of them” out of ~127 total.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:22.309+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dc6d9463-c242-4905-aaa0-f88a258f3059", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Jennifer Miller was the biggest enroller. 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Now, if I look at that withdrawal study, the increase in the HQ-CT score for the placebo patients was so sharp, rapid, and extreme, it actually strains credibility, to be candid with you.”\nA: “I know. I hear you, because that was a conversation that was had internally. But it was the data that it was, and they moved forward with it.”\nQ: “What was the conversation internally? They didn’t believe the data? They thought it was too good to be true?”\nA: “They were just surprised to see that it was so extreme, especially given the fact that it seemed to happen so quickly after they came off the drugs. They didn’t expect that. They expected it to be a slower withdrawal [...].”\nQ: “Were there people inside the company when they saw the randomized withdrawal data, did they really believe it? But they’re like, whatever, it’s the data, we’ve got to take it?”\nA: “Well, so much of the data is subjective. 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Thus, the VYKAT XR rollout is an unprecedented science experiment. PWS families posting in the primary FB forum for Vykat discussion indicate the drug is backfiring and *increasing* hyperphagia and sleepiness – the inevitable, mechanistic effect of insulin suppression per the last two pages. The commentary is devastating, indicating that the purported hyperphagia benefit in the pivotal withdrawal study was a cruel deception. The post with the most comments and engagement in the last few weeks is about VYKAT XR increasing hunger. We show the replies in a later chapter on this FB group - families are reporting the worst hunger and food-seeking they’ve ever seen in their kids. In the last week, one of the posts with the most engagement is about increased sleepiness. Parents report kids so tired they look like they’ve been “hit by a bus” and sleeping in 6 hours longer than usual.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:21.327+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "60cbf498-7e83-4b8c-80ea-5711d130ac92", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Parents report kids so tired they look like they’ve been “hit by a bus” and sleeping in 6 hours longer than usual.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acad-c1a22d25fe7a", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Facebook – Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The agency was poised to do the sensible thing and reject it after the phase 3 failed, relenting after a high-pressure, orchestrated petition campaign to allow Soleno to proceed with a highly unusual 16-week randomized withdrawal study. We presume the purported safety data tipped the balance, and therein lies the rub: the safety data obscured the risks in a manner we find to be nefarious. Let’s start with the risk of fluid retention. The key data is contained in a May 2025 paper. Jennifer Miller is the lead author. 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"promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/49", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-49", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": { "h": 0.1, "w": 0.4, "x": 0.53, "y": 0.53 }, "kind": "callout", "text": "DEXA “LBM” dataset suggests to us that DCCR linearly increases fluid retention over time, with no signs of plateau = 7.3 kg/16 lbs of fluid in 3 years", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:28.414+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3f4028e1-3819-4456-8c5a-326a75284eb7", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.45, "x": 0.07, "y": 0.44 }, "kind": "image", "text": "Chart from Soleno paper – May 25, 2025", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:28.414+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": 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Diazoxide causes mechanism-based fluid retention, but Soleno has provided no plausible mechanism for diazoxide’s purported increased muscle mass. No exercise program or activity monitoring. If so, no attenuation of linear increase in fluid retention is observed out to 3 years, suggesting serious and progressive fluid retention. In a 130 kg patient, 7.3 Kg of fluid accumulation is a significant risk (5.6% fluid gain) for chronic organ stress (kidneys & heart), hypertension, and worsening insulin resistance.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:28.414+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b6c2f208-c1c2-4645-bb86-ae99de19aaed", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "fluid retention: 16 lb", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-3651ace4ccb1", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.16 }, "kind": "paragraph", "text": "Soleno used DEXA scans to assess LBM, but DEXA cannot distinguish between LBM and edema. We later discuss why we think that purported body composition improvements are simply illusions caused by fluid. DEXA artifact is well-known in this context, and Soleno’s omission of this obvious issue is, we believe, part of the cover-up. Thus, we think the paper buries a shocking 16 lb steady, linear increase in fluid over 3 years on drug – sufficient to drive chronic stress on the heart and kidneys, hypertension, and insulin resistance.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:28.414+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b11a286c-f492-4cd7-9869-e1faa90d98cd", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/static-files/946b0269-ce30-4c6f-943c-8fa4ed54f44a; Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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In case Soleno deletes the papers, we took a screenshot and provide cached pdf links. Perhaps someone forgot to remove the original paper.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:13+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-1b48339d355f", "parentComponentId": null }, { "bbox": { "h": 0.38, "w": 0.43, "x": 0.07, "y": 0.52 }, "kind": "image", "text": null, "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:22.187+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fb0e6ab6-3cef-4f00-9b92-368b0f123a1b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.41, "x": 0.52, "y": 0.63 }, "kind": "list", "text": "https://scorpionreports.s3.us-east-2.amazonaws.com/Shoemaker+et+al_ENDO+2025+glycemic+outcomes+oral+presentation+FINAL.pdf\nhttps://scorpionreports.s3.us-east-2.amazonaws.com/Soleno+PWS+Poster+PES+2024+Final.pdf", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:22.187+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "569d3ae1-cff5-4cc2-ab8a-86425711fc25", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.16 }, "kind": "paragraph", "text": "Soleno conceals key HbA1c and fasting glucose level data, obscuring the danger and speed of onset. Thus, the first HbA1c and fasting glucose time series we found was from a May 16, 2024 publication by Gevers, Miller et al. It shows baseline levels, but fails to separate HbA1c by treatment group vs. placebo at the end of the 13-week phase 3 trial, providing a pooled average instead. A later chapter goes more in-depth, but for now the key point is that a new, second version of the same data was posted to Soleno’s site on July 14, 2025 (Shoemaker et al) – while we were mid-research. The data do not match. In case Soleno deletes the papers, we took a screenshot and provide cached pdf links. Perhaps someone forgot to remove the original paper.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:22.187+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e895389b-9eff-495c-be69-7653d22593fb", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.4, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/presentations/scientific-posters-presentations", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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This makes the SEM's appear more like the original graph in relative perspective", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "494cac12-23dc-4edb-befc-b549df9c8dd2", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.35, "x": 0.55, "y": 0.55 }, "kind": "callout", "text": "The mean HbA1c line is moved upward, thereby moving the population into pre-diabetic range (HbA1c > 5.7%). We added a red line to show pre-T2D cut off.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e19219bf-3079-46d3-863f-0af62375c267", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Thus, we conclude it is fabricated data – a sloppy, amateur cut-and-paste job.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-4d895b144a6b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.45, "x": 0.07, "y": 0.75 }, "kind": "chart", "text": "Bottom chart: Figure 1: Mean Hemoglobin A1C (%) by Week of DCCR Administration", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2f70cdd7-25ae-4a72-a57c-534635f18c48", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.45, "x": 0.07, "y": 0.55 }, "kind": "chart", "text": "Top chart: Mean (SE) HbA1c over time", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8d9d2d0d-0e6e-4cd4-ae3f-13300ac26813", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "HbA1c levels: 5.7%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-555d0b85b013", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.15 }, "kind": "paragraph", "text": "The original graph showed baseline HbA1c levels well below pre-diabetes range, at the start of the phase 3 trial. The second graph moves the line up, thus shifting the population's baseline HbA1c levels into pre-diabetic zone.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d3c58267-96bf-4a41-ac01-edc2d3378207", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "The reason, we infer, is subtle but nefarious, as we cover in a later chapter: we think the best way to hide that your drug made a substantial portion of Phase 3 patients pre-diabetic or diabetic over 13 weeks is by claiming they were pre-diabetic to begin with.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-520bc43e9756", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/presentations/scientific-posters-presentations; https://investors.soleno.life/static-files/7c732b67-56dc-4959-ac2f-31543a7c0ca3", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We did not cherry-pick investigators and spoke to all who were willing – encompassing a significant portion of the total PI’s, especially the most influential and respected leaders in the field who we sought out keenly, and who collectively enrolled a large percentage of the patients. We tried contacting each investigator multiple times to interview as many as possible, including the authors on the two published study papers and those in the acknowledgements, for the phase 3, open-label extension, and the randomized withdrawal studies – the latter is the “pivotal” as it was the basis of FDA approval after the P3 failed. 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I won't use it.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-a0f0c43062c9", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "list", "text": "Indicated the trials were just statistical artifacts with no observable difference in patients whether hyperphagia or weight; would advise other physicians to avoid using the drug: “I would say hold off...”; “I just didn’t think it worked...”; “they got a statistician who did all this remarkable testing and, oh, we came up with something...I think they played with the data until they finally got something that worked.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.223+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f1af532-8890-4134-9f6c-f6fcbc7671d0", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.75 }, "kind": "list", "text": "Indicated widespread skepticism in the field of Vykat by other trial investigators and PWS specialists who collectively manage a large percentage of the patients; expects it to be a dud within 3 to 6 months as failures and safety issues mount; “I don’t think anyone would say ‘Whoa, we got to get these patients on this drug...look what it can do...a lot of people are taking a hands-off, let’s just see...I haven’t heard from people with much enthusiasm”; “those who are the most experienced are probably not as excited about it than those that are newer...”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.223+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f914abc-6f34-405d-ba03-21f3494a3a9e", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "list", "text": "Stated that he’s working on a paper about cardiac risk from Vykat: “I have more than concern about it...in fact, I’m writing an article on it...I’ve been asked to write my opinion on this trial in the medical literature”; “yeah, lots of different issues...we still don’t have a clear understanding, even though the drug has been around since 1976.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.223+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "243d7160-310e-465f-bbd2-4a1ea2f95de0", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "list", "text": "Thinks that Vykat is a failure and has no effect on hyperphagia or weight; that it is dangerous and at risk of an existential Zafgen-type safety debacle; has no plans to put any patients on it; thinks that Soleno played games with the data; and that it should never have been approved by the FDA, which he believes was due to pressure from desperate families: “I didn’t see $500,000 worth of – or $5,000 worth of benefit”; “I’ve been around a long time. I won’t use it.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.223+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5d8c3746-7e94-41b6-bfea-dd105c36f34c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I didn't see $500,000 worth of – or $5,000 worth of benefit; I've been around a long time. I won't use it. — Trial investigator #1", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:14+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cd-733b-acae-a43dfe4a703d", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Skeptical of Soleno with no interest in prescribing Vykat, to the point of exhibiting anger and alarm at the drug.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.684+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1fe4b018-dff9-4006-9e88-76522752c499", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 59, "type": "tension", "function": "expose_contradiction", "rawType": "quote_slide", "block": null, "metadata": { "slideType": "quote_slide", "slideTypeCanon": { "name": "Quote slide", "slug": "quote_slide", "status": "active", "canonId": "019de52d-098e-7555-a9fd-4f0af7e80bc2", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "balanced", "densityScore": 47, "componentCount": 5, "textChars": 1584, "nDataPoints": 0, "notes": null, "elementsJson": [ "headline_text", "bullet_list" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:23.955+00", "seconds": 2.617, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/59", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-59", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Speculated that Soleno removed critical investigators as authors on papers and buried them under acknowledgments, and played hardball by keeping them in the dark about the status of the papers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29a-19f17ba61bfa", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.85, "x": 0.07, "y": 0.17 }, "kind": "quote", "text": "Speculated that Soleno removed critical investigators as authors on papers and buried them under acknowledgments, and played hardball by keeping them in the dark about the status of the papers: “I was very critical, and they didn't want to talk about the side effects, which I insisted on...they didn't even tell us that those papers were being prepared or published...there were complications...they develop hairiness...they develop diabetes...they develop edema...we had to give diuretics”; “co-authors were not even informed about the existence of this papers”; “it’s bizarre...[redacted] would have recruited a big number, yet [redacted's] name is not on the paper...very odd...it was very odd...”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:23.955+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "756f4b66-7fcc-41b0-80ed-91fcf6d68b62", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I was very critical, and they didn't want to talk about the side effects, which I insisted on...they didn't even tell us that those papers were being prepared or published...there were complications...they develop hairiness...they develop diabetes...they develop edema...we had to give diuretics; co-authors were not even informed about the existence of this papers; it's bizarre...[redacted] would have recruited a big number, yet [redacted's] name is not on the paper...very odd...it was very odd... — Trial investigator #2", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29a-1d3ee7db80b5", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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He expressed surprise that the FDA approved it, attributing it to families’ desperation and “hype” and “not on the basis of effectiveness”; indicated that other investigators and PWS KOL’s in general share his skepticism; and he “would struggle with” the risk of diabetes and other serious adverse effects – “I would very surprised if it’s a blockbuster”; “others who clearly feel closer to how I have felt about it”; “I feel that a treatment is possible, but I don’t think it’s this treatment…Vykat doesn’t do that.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.982+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a370b3f7-34b7-4497-a5a5-d1b1403304e8", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.61 }, "kind": "list", "text": "Stated that none of his patients improved and in fact tended to keep gaining weight, and that other patients just dropped out. He further indicated that the trial was functionally unblinded due to obvious side effects – “to be frank, my feeling was I don’t think anyone improved”; “so, I have been very skeptical about it”; “we knew he was on DCCR – and he put on a lot of weight...so clearly, this was not effective”; “then another person on the trial, she was putting on weight”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.982+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "da142eff-19a8-4c94-b509-c315184481c6", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.86, "x": 0.07, "y": 0.77 }, "kind": "list", "text": "Expressed strong concerns about the validity and conduct of the trials, in particular the withdrawal study which was the basis of FDA approval. He replied “yes, yes, yes” when we stated that the withdrawal study data seemed too good to be true – “I actually thought it probably wouldn’t be approved...I thought they would be much tougher...and I think there was a very powerful campaign [by associations/families]...families are desperate to see treatment.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.982+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ed416fa6-867b-41d5-811b-c361d1d03cee", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "list", "text": "The investigator thoroughly trashed Vykat and the clinical trials, stating he saw no benefit in any of his enrollees; that he “encouraged them not to continue” into the open-label extension; that only one patient remains on drug, for a discontinuation rate of ~80%; and that he is skeptical of the mother’s perception of benefit in the one remaining patient on the drug.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.982+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f0337ff5-c6af-46ac-ba2c-508deed31efe", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“publishing in this area for 20 or 30 years” — Trial investigator #3; “very much involved with Soleno over the years” — Trial investigator #3; “I’m asked to speak to parents, but quite often I speak to clinicians.” — Trial investigator #3; “encouraged them not to continue” — Trial investigator #3; “not on the basis of effectiveness” — Trial investigator #3; “would struggle with” — Trial investigator #3; “I would very surprised if it’s a blockbuster” — Trial investigator #3; “others who clearly feel closer to how I have felt about it” — Trial investigator #3; “I feel that a treatment is possible, but I don’t think it’s this treatment...Vykat doesn’t that.” — Trial investigator #3; “to be frank, my feeling was I don’t think anyone improved” — Trial investigator #3; “so, I have been very skeptical about it” — Trial investigator #3; “we knew he was on DCCR - and he put on a lot of weight...so clearly, this was not effective” — Trial investigator #3; “then another person on the trial, she was putting on weight” — Trial investigator #3; “yes, yes, yes” — Trial investigator #3; “I actually thought it probably wouldn’t be approved...I thought they would be much tougher...and I think there was a very powerful campaign [by associations/families]...families are desperate to see treatment.” — Trial investigator #3", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29a-f5e365975954", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Highly skeptical of Soleno’s trials and overall conduct... 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He indicated treating about a dozen PWS patients with GLP-1’s and seeing reductions in hyperphagia and weight when he felt Vykat showed neither. Moreover, he tracked HQ-CT hyperphagia scores and thought the results were far more promising than Soleno’s – “the GLP-1’s, if I was going to bet, will probably be more effective than this drug...[from] the limited data I’ve got on the GLP-1’s...I see reductions in hyperphagia...and I’m seeing weight loss in a way that wasn’t seen in the DCCR...I’ll be using GLP-1’s before I would be using this...from my experience with GLP-1’s to date, I’m quite hopeful...the HQ-CT score came down...I’m more encouraged by that than by the DCCR.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:25.243+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "23d8d591-b679-4af4-a24c-a2df76320098", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.16 }, "kind": "list", "text": "Zeroed in on the lack of reporting on insulin resistance as particularly troubling – “insulin resistance should be improving...I’m just really surprised they haven’t reported either the HOMA-B, the insulin production rate and the insulin resistance...I don’t know why they haven’t...I would like to have seen some effect in insulin resistance....they just didn’t report those...that was very odd to me...are they hiding something...it’s really weird....it’s such an obvious thing...that’s very odd...I don’t quite know what was going on there.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:25.243+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "63c65709-9c43-47d5-b6d9-89e0d8a5dc8c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“insulin resistance should be improving...I’m just really surprised they haven’t reported either the HOMA-B, the insulin production rate and the insulin resistance...I don’t know why they haven’t...I would like to have seen some effect in insulin resistance....they just didn’t report those...that was very odd to me...are they hiding something...it’s really weird....it’s such an obvious thing...that’s very odd...I don’t quite know what was going on there.” — Trial investigator #4", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:15+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29a-92488a498cf0", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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slide uses direct quotes from an expert to undermine the commercial viability and clinical efficacy of the drug.", "elementsJson": [ "headline_text", "bullet_list" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:26.896+00", "seconds": 5.138, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/64", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-64", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Lack of patient enthusiasm since Vykat FDA approval, with only 3 families calling out of >40 total: \"I got three calls...so no, it wasn't a floodgate that opened.\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": 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“effect” was observed after the patient “must been on it at least a year and a half by that point” - a dubious response given the highly subjective and unreliable hyperphagia questionnaire.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.896+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "07099df6-13f8-4985-8a0a-c9a393cbf612", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "list", "text": "Involved in the 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"kind": "list", "text": "Stated Vykat is not a blockbuster drug and is only “trying it” here and there because “we have nothing else.” The investigator indicated that other physicians “who are in town are, I think, very unlikely to go prescribing on their own...they're probably going to ask me to do it.” We note the investigator is in a large metro area in a major state.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.896+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, 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“there certainly was potential for unblinding...no question.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:31.669+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "40d21410-6852-4499-a2ba-760c2e59fd4c", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.85, "x": 0.07, "y": 0.49 }, "kind": "list", "text": "Noted significant adverse effects like edema, hyperglycemia, and hairiness, stating that Vykat raised patients’ fasting glucose levels and caused concern about a diabetes safety signal: “I’ll probably be quite cautious in the population that’s already got blood glucose intolerance.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:31.669+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4543f05d-c383-4e72-b60d-97aa37f3b8a8", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.85, "x": 0.07, "y": 0.27 }, "kind": "list", "text": "Even more telling, the investigator elaborated upon a Vykat patient who “probably put on 50 pounds during the 13-week C-601 [pivotal phase 3] trial and then rolled over [to open label] and continued to put on weight...the family withdrew her in order to hospitalize her” due to the uncontrolled weight gain.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:31.669+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5be372ab-d30a-4dca-8a4b-cb37ade28d62", "parentComponentId": null }, { "bbox": { "h": 0.14, "w": 0.85, "x": 0.07, "y": 0.6 }, "kind": "list", "text": "Stated that the Vykat tablet was too large for some patients and that they had to use several of the smaller dose tablets instead; 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Full interviews in appendix.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:24.155+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5c662a05-592f-466b-93ef-60733d2e8729", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 73, "type": "setup", "title": "The slide emphasizes the credibility and breadth of the expert sample to validate the subsequent findings.", "function": "summarize", "rawType": "appendix_methodology", "block": null, "metadata": { "slideType": "appendix_methodology", "slideTypeCanon": { "name": "Appendix methodology", "slug": "appendix_methodology", "status": "active", "canonId": "019de52d-07d9-726c-8599-167f2d2ffaa7", "version": 1, "description": null }, "function": "summarize", "functionCanon": { "name": "Summarize", "slug": "summarize", "status": "active", "canonId": "019de52d-1541-704f-b86f-bf7b75056373", "version": 1, "description": null }, "density": "balanced", "densityScore": 42, "componentCount": 3, "textChars": 1448, "nDataPoints": 1, "notes": "The slide emphasizes the credibility and breadth of the expert sample to validate the subsequent findings.", "elementsJson": [ "paragraph", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:13:25.921+00", "seconds": 3.241, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/73", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-73", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Our sample is broad across geography and practice settings, representative, and captures the prevalent mood in the field toward Vykat, as the physicians we interviewed are highly-networked within the small world of PWS specialists and clinics.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29b-0dd4e12de673", "parentComponentId": null }, { "bbox": { "h": 0.65, "w": 0.85, "x": 0.075, "y": 0.07 }, "kind": "paragraph", "text": "In addition to key trial investigators, we interviewed twelve PWS specialists; most are endocrinologists, either adult, pediatric or both, and one is a nephrologist on a team of endocrinologists. Our sample is broad across geography and practice settings, representative, and captures the prevalent mood in the field toward Vykat, as the physicians we interviewed are highly-networked within the small world of PWS specialists and clinics, including: two Division Chiefs in endocrinology at well-known academic centers, who appear to know most of the investigators; endocrinologists at large, pre-eminent centers like Children’s Hospital of Philadelphia (CHOP), Massachusetts General/Harvard, Univ of Michigan; many of whom attended the recent Pediatric Endocrine Society annual conference, the key meeting for Soleno’s space and barometer of the drug’s chances, including one who played a leadership role at the society; as well as several physicians in private practice and community settings, which see a small fraction of PWS patients versus academic centers but whose in-depth knowledge of Vykat and extreme skepticism was nonetheless telling.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:25.921+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ba76ec7-c73a-490b-b6b7-d41935d2cc30", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.075, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts;", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29b-c6186c73cd73", "parentComponentId": null }, { "bbox": { "h": 0.23, "w": 0.86, "x": 0.07, "y": 0.71 }, "kind": "list", "text": "Intensely skeptical of the trial data – “that’s rubbish” – and bewildered and surprised that Vykat even got approved; endocrinology field doubted “that this was likely to happen...me and my colleagues were surprised that all of a sudden we have an approval with this label right now – “I wasn't anticipating this particular piece of news...I wasn't expecting to see this — I don't think there was a perspective that this was likely to happen”; “it's been an erratic performer in trials, and I think I was comparatively unimpressed by — and somewhat inattentive as a result — to the journey of diazoxide through the trials... not particularly exciting and therefore kind of lost interest... when I saw this approval, I was like, \"What the hell?\" I wasn't expecting that”; “I do remember looking at one of the — I think it was an investor deck...where they were talking about why this works. And I was like, \"That's rubbish.\"", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:27.495+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "821241d3-3de3-49cd-acb7-a1b7b6930bcf", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.23 }, "kind": "list", "text": "Surprised Vykat received FDA approval and indicated no enthusiasm for Vykat among physicians or patients – “it’s pretty quiet overall... what I'm not hearing people say, when can I get my hands on Vykat? Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless. I'll put it this way...this somewhat surprising and out of the blue approval that I don't think any of us were quite expecting.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:27.495+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ab69c31a-6df7-4b96-9625-2581661db560", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.42 }, "kind": "list", "text": "Zero emails from PWS patients inquiring about Vykat; if Vykat were theoretically useful, he would quickly put them on generic diazoxide suspension anyway; questions “whether this is all hoopla and bluster”; is “furious” about the price and finds it “outrageous” – “it bothers me, it makes me mad” as appetite suppression can be obtained for “pennies” with other medications – “I haven't had emails from my patients or patients' families, which is very interesting, even though this is a pretty active community. So, that's just interesting, but I haven't, and that's maybe telling”; “a lot will come off the branded version onto generic if it works”; “appetite suppression could be readily achieved with sedating medications like Haldol and other antipsychotics, for example, which have their own diabetogenic risk for the cost of pennies.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:27.495+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f62b3555-364d-4706-a868-7d10c3a5c524", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"it's pretty quiet overall... what I'm not hearing people say, when can I get my hands on Vykat? Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless. I'll put it this way...this somewhat surprising and out of the blue approval that I don't think any of us were quite expecting.\" — PWS endocrinologist #1; \"that's rubbish\" — PWS endocrinologist #1", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:16+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29b-c814029cc0d4", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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instantly persuaded and amused when he asked ChatGPT for a conversion table", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.354+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3b552dda-f7ed-475d-b512-26ef5c209f3e", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.85, "x": 0.07, "y": 0.65 }, "kind": "list", "text": "Thinks that Vykat tablet formulation is problematic due to swallowing difficulties in pediatric and PWS patients and that oral formulation of generic diazoxide suspension is superior", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.354+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9ae8e79d-ed2b-4e9f-a6a3-c31155281c81", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.13 }, "kind": "list", "text": "Skeptical of Soleno's marketing messages and is concerned that Soleno's own trial investigators are similarly skeptical; thinks that comments by these investigators \"in a public fora\" are \"going to torpedo the launch program for Soleno\"", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.354+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dfdfd44c-4c4a-4d20-b469-08de3a9ec889", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“these are not well-recognized journals or high-quality data points...find it very interesting that there may be some internal inconsistencies...” — PWS endocrinologist #1. “I predict that I can achieve similar plasma levels and clinical efficacy with both an oral formulation and at low cost, even if it requires off-label prescribing. I'm totally in. 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potentially fatal side effects from DKA; prevalence of diabetes in PWS patients shrinks the TAM – “the downside...is hyperglycemia and maybe some of the peripheral edema, fluid retention, maybe exacerbating some heart failure”; “doesn't take much to make them diabetic...no surprise, given this mechanism of action...no surprise...and importantly, some patients get ketoacidotic because the insulin suppression is so potent at these doses that you essentially render the patient to be type-one diabetic...which could be potentially lethal in wide use”; “probably 40% of my patients with Prader-Willi, even at this young age, already have diabetes...I'll be especially leery about introducing diazoxide into a diabetic patient...important limitation on the overall kind of access to an already rare disease.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:26.974+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8cfce4ea-cc37-4a9e-bd95-ff79ae8f47eb", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“the downside...is hyperglycemia and maybe some of the peripheral edema, fluid retention, maybe exacerbating some heart failure”; 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We’ll have a discussion about it. And, of course, we’ll have to learn more; “say that slowly again, the cost...oh my God.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:27.645+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "404df19f-fef9-465d-b52d-41260d189942", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "list", "text": "Thinks that there may a small, initial bolus of physicians who trial any newly-approved drug “but I don’t think it will last that long” – “you get someone on it and you don’t notice the big difference, and it costs so much. 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Put it this way, no one talked about it and said wow, we’re really excited for this new indication. 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I’ve not had anyone call up at all. There’s been no push to do this drug. 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I appreciate your input...you brought up factors that I think maybe you are unique in bringing them up...no, I appreciate it.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.512+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "38323a4c-6ae1-4c5b-974d-ffffbee88988", "parentComponentId": null }, { "bbox": { "h": 0.23, "w": 0.85, "x": 0.07, "y": 0.71 }, "kind": "paragraph", "text": "The endocrinologist indicated significant concern about edema-induced cardiac risk, as well as diabetes, to the point that he has asked Soleno for an answer; and plans baseline cardiac evaluations, which we presume would involved an echocardiogram - \"I'm more concerned about the edema than the hyperglycemia...it's easier to monitor for the hyperglycemia than for the edema...that's been a question I've asked them: how do they clinically evaluate for edema if you're not going to be seeing the patient all the time?...I think 30% of drug patients, treated patients actually developed edema... I'm more worried about the edema\"; \"I personally am doing baseline cardiac evaluations on these patients...in case they do develop edema, which can put strain on the cardiac function... the proof is going to be when we start treating these patients and seeing what happens...we just have to wait and see what happens.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.512+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5f4cf006-8879-4dc8-8fca-5b442e2adbe5", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.85, "x": 0.07, "y": 0.42 }, "kind": "paragraph", "text": "Stated he had jumped to submit a few start forms only because he had been told by a study investigator - who we believe to be Jennifer Miller, based on his coy response - that the drug takes 4 to 6 months to show a response. He himself noted that was highly unusual, as the phase 3 and withdrawal studies were only 13 week and 16 weeks, respectively, and purportedly showed efficacy within that period - and then appeared to wonder if he had been played: \"Talking to some of the study people, they really only see the effects of the 4 to 6 months on the drug...that's what I was told just to really see the effects, which is a little unusual compared to the data\"; \"an important person in the study...it was a little unusual, I must say, based on when you look at the data...the question for me is, when am I going to see that response?\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:29.512+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9cebd912-62f2-4b5d-9394-5e9923a3353f", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"You're right...you're definitely right about that...you're definitely right about that...a lot of it's coming from — Soleno definitely has quite an involvement in this...and definitely a lot of it, I'm sure who's supporting the study people being supported by Soleno, they are communicating on the same message...maybe we are being naïve to rely on it...now I'm just — you're making me question a lot of things... I appreciate your input...you brought up factors that I think maybe you are unique in bringing them up...no, I appreciate it.\" — Endocrinologist #5", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:17+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29c-8a560b48cfb8", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:06.865+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e499ab2a-d1a3-4b2a-b232-187ff00b14dd", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I would say that many of my patients are on Facebook groups and so on...they've been excited for it...they've been wanting to start it as soon as it was released...but people positioned like me are probably prescribing it, but with some question about how successful it's going to be — Endocrinologist #6. 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Thinks generic diazoxide is no different than Vykat and questions the necessity of the tablet formulation. Stated that other physicians are asking the same question.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:28.571+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e8008b10-2102-4713-a69d-097ac7bfb3a6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I would be most concerned about starting this medicine in someone that was pre-diabetic...the people that I'm the most concerned about are those borderline A1c patients that are obese and pre-diabetic...and I hesitate to start this medicine, and if I am, then I'm having a conversation about stopping it if they develop diabetes. — Endocrinologist #6", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:18+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29d-31339f942371", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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and that he would “switch everybody over to the generic anyway” if he thought it had any benefit in PWS: “it’s not particularly powerful...diazoxide is not, in and of itself, a brand-new medication...it’s a drug that we’ve used in other disease states for years...the actual drug has been approved for many years to be used in other diseases...many people have been put on it previously...we actually know this stuff pretty well because it’s a drug that’s been out for a while....”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:30.788+00", "model": 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"text": "Slammed Vykat on all counts, stating the studies were “a little underwhelming” and failed to show weight reduction or a proper endpoint – and that he wouldn’t push it patients: “if the goal here is largely appetite, weight, that sort of zone, at least show a benefit in BMI or something...those are the typical endpoints that we use...in this space”; “the data is not so strong with this medication that we’re going to push hard”; “while the medicine is approved and there are not a lot of options in PWS, it’s not like the data was like so strong...the drug had to fight hard to get approved...it failed at initial trial and had to get a second bite at the apple...it’s not some world-changingly powerful medication.”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", 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and unsupported by robust evidence.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-b22b84526f21", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.46 }, "kind": "list", "text": "Diazoxide binds SUR1 subunit to open KATP channel → primary effects = vasodilation and ↓ insulin\nForm (route): indication\n- Hyperstat, sodium salt (IV solution): emergency hypertension\n- Proglycem, non-salt base (oral suspension): hyperinsulinemia (congenital & insulinoma) to normalize insulin levels and attenuate hypoglycemia\n- VYKAT XR (DCCR), choline salt (oral tablet 50, 100 and 150 mg): Prader-Willi Syndrome suppress hyperphagia by blocking CNS-mediated starvation response\n- Commonly prescribed T2D medication bind to SUR1 to close KATP channels (opposite of diazoxide). 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Sulfonylureas are a class of medications used to treat diabetes by stimulating the pancreas to release more insulin. Diazoxide OPENS the channel while sulfonylureas CLOSES it. Therefore, it is logical to assume that diazoxide may cause diabetes in norm-insulin PWS patients. 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"kind": "paragraph", "text": "The adverse events table in the Phase 3 double-blind study manuscript never even uses the word diabetes, burying and conflated it with “hyperglycemia.” The table then has a second row for “blood glucose increased.” Both terms are undefined with no threshold or cut-off for HbA1c, fasting glucose, or glucose tolerance.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:31.697+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": 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Summary of treatment-emergent adverse events", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:31.697+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "53a90e93-a79b-45b7-b8e4-7b05ecc4c7d3", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.85, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Soleno’s inept efforts to conceal the diabetes signal indicate the magnitude of the problem.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", 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complications. DKA involves a severe lack of insulin, leading to high blood sugar and the buildup of ketones. Given that diazoxide suppresses insulin by >50%, DKA is a mechanistically-inherent extreme risk of DCCR therapy. The FDA label mentions diabetic ketoacidosis 8 times - “one subject in Study 3 experienced a serious adverse reaction of diabetic ketoacidosis” - yet we see no mention or discussion of DKA in the phase 3 or open-label manuscripts. DKA always requires hospitalization, yet the only hospitalizations referenced in the OLE study (“study 3” in the label) are vague with no indication of DKA. 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physician is under the impression that Soleno is sending glucose monitors", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29e-6dd242ce649f", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.85, "x": 0.07, "y": 0.16 }, "kind": "paragraph", "text": "An endocrinologist at an academic center and 8 colleagues, with ~50 PWS patients, all met the rep: “they’re going to basically prescribe the medication with a glucometer...a process where the glucometer gets sent to the family with the medication.” He stated that measures to control Vykat-induced hyperglycemia – titrating slowly or taking the patient off drug – may not work as it may already have tipped into diabetes; and that dose reductions in PWS patients are mechanistically different than lowering diazoxide in infants with hyperinsulinism – “if you’re hyperglycemic, I don’t know how it’s going to get better by going up more slowly on the dose or then you hold it a lower dose...is that okay?...somebody did bring that up, and they were like, oh, we just go up more slowly...I’m not sure...by that point, it may be too late...because if you already have type 2 diabetes and you’re making it worse, are you really helping the problem?”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:32.981+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "be2f48f1-ffc6-4f86-8402-f74ca6b92d6f", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.85, "x": 0.07, "y": 0.76 }, "kind": "quote", "text": "“And they suggested insulin resistance. But if you’re hyperglycemic, I don’t know how it’s going to get better by going up more slowly on the dose or then you hold it a lower dose. Is that okay? Somebody did bring that up, and they were like, oh, we just go up more slowly. I’m not sure. With the mechanism of action of what it’s doing. It’s not like a GLP-1 where your body gets used to it. When they first started designing this and thinking about it, but it is in a group of people that you’re very worried about, and you could probably make the argument, too, that a lot of those people, if they’re more hyperphagic, if they get type 2 diabetes, they’re probably the people that would benefit the most from it. But by that point, it may be too late. Because if you already have type 2 diabetes and you’re making it worse, are you really helping the problem?” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:32.981+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c4a60013-176e-4ed8-90c5-70da5e760114", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.57 }, "kind": "quote", "text": "“All the things about diabetes and the blood sugar risk, they’re going to basically prescribe the medication with a glucometer. They’re going to actually — I think they’re going to have a process where the glucometer gets sent to the family with the medication. And using one medication to treat the other —. I saw lots of babies that were put on diazoxide, and the dose was too high, and they had hyperglycemia, so, we decreased it. But there’s not really a good — in the babies with hyperinsulinism, we’re adjusting it because of hyperinsulinism. 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I do know at least two families that dropped out of the Vykat study, and both of their kids got diabetes, and they were not pre-diabetic. That’s concerning to me. And both of them are still now struggling with controlling diabetes. I think that people who take this drug —you now have another problem that you have to treat, that’s a bigger problem —” Q: “These are patients who were not pre-diabetic and then got full-blown diabetes. Is that what you said?” A: “Yep.” Q: “And how old were these patients?” A: “Early 20s.” Q: “And how long were they on the drug?” A: “I think one was on it for four months, and the other was right around the same time. Both dropped out.” Q: “So, four months. And when did the diabetes develop?” A: “I think somewhere within a couple of months of starting the drug.” Q: “And how long have they been trying to get the diabetes under control? Does it sound like they’re stuck with it after being on the drug? 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And they've been told, like they're pretty quiet about it. FYI, they don't feel really comfortable telling other people about it because they don't want to scare anybody. Just this idea that they feel uncomfortable in the community talking about it.” Q: “And were they obese — I get all these kids are at risk for diabetes.” A: “Sure. Just a little something. If you look at them on the street, they would not stand out as somebody who was obese. 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Hemoglobin A1c (HbA1c) Test\n- Reflects the average blood glucose over the prior 2 to 3 months, based on the glycation of red blood cell hemoglobin.\n- Prediabetes range: 5.7% to 6.4%\n- Diabetes range: >6.4%\n2. Fasting Plasma Glucose (FPG) Test\n- Measures blood glucose after at least 8 hours of fasting, typically overnight.\n- Prediabetes range: 100 to 125 mg/dL (5.6 to 6.9 mmol/L)\n- Diabetes range: >125 mg/dL\n3. Oral Glucose Tolerance Test (OGTT)\n- After fasting, the individual drinks a 75g glucose solution and blood glucose is measured 2 hours later.\n- Prediabetes range: 140 to 199 mg/dL (7.8 to 11.0 mmol/L) at the 2-hour mark\n- Diabetes range: >199 mg/dL", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:33.081+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b7257795-3d75-40b3-a997-25f3a2508692", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Our analysis of the data buried in Soleno’s papers indicates an alarming spike in prediabetes and diabetes within 13 weeks of starting Vykat – and a linear increase over 3 years with no signs of a plateau. The papers obfuscate the danger and exhibit troubling irregularities. Only two Soleno publications contain meaningful data for prediabetes and diabetes-related (T2D) markers – we shortly examine each. Three primary tests are typically used for diagnosis: 1) hemoglobin A1C (HbA1c), with a prediabetes range of 5.7% to 6.4% and >6.4% for diabetes; 2) fasting plasma glucose (FPG) test, with a prediabetes range of 100-125 mg/dL (5.6-6.9 mmol/L) and >125 mg/dL for diabetes; and 3) oral glucose tolerance test (OGTT) with a prediabetes range of 140-199 mg/dL and >199 mg/dL for diabetes.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:33.081+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "beaee378-ac2f-4cbf-b9f1-759f9b6590a6", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: ADA/NIH publications", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"eab4e681-c66b-46f5-a25f-f67158027bb7", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.05 }, "kind": "paragraph", "text": "The first publication that we can locate with analyzable HbA1c and fasting glucose data is a May 4, 2024 poster by Gevers, Miller et al. with Soleno's Bhatnagar and Cowen.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:32.314+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cf82ebac-7567-47bb-9e56-3c5f24efef8a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Long-Term Safety of Diazoxide Choline Extended-Release (DCCR) Tablets in Participants with Prader-Willi Syndrome from the Completed C601 Randomized Double-Blind Placebo-Controlled Study (DESTINY PWS) and C602 Open Label Extension (OLE) Study — Poster Title", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-475ec0611e0a", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/static-files/27318113-e299-408f-ba14-0b05114f37bc", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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As an initial red flag, the mean hbA1c at week 13 – the end of the Phase 3 double-blind portion – is shown only as pooled average mixed population.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29e-bd0b690fb37d", "parentComponentId": null }, { "bbox": { "h": 0.38, "w": 0.86, "x": 0.07, "y": 0.51 }, "kind": "chart", "text": "Mean Hemoglobin A1C (%) by Week of DCCR Administration", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:32.747+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5d92fa3c-ac58-4ba2-aace-9421acf23695", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "HbA1c", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29e-c6169ea094c9", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "We excerpt the HbA1c graph below – the data at the heart of Soleno’s diabetes-related obfuscation. The poster has almost no discussion of this critical chart, glossing over it with one sentence: “Longitudinal mean fasting glucose (FG) and HbA1c increased slightly over the initial 6-9 months but stabilized or returned to near-baseline levels upon continued DCCR dosing (Figure 1 and Figure 2).” Close observation of the chart indicates the claim is dubious. As an initial red flag, the mean hbA1c at week 13 – the end of the Phase 3 double-blind portion – is shown only as pooled average mixed population. 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We know that at week 0, n=85 DCCR and n=42 placebo, so n=127 (randomized, 125 after removing two patients didn't receive any drug). 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Conclusion: the same exact data clearly shows an increase in the proportion of patients in pre-diabetes range compared with naïve controls. In the control group there is no crossover. The SD increases dramatically in all treatment groups. One SD = 68% of the population as can be seen in the original graph on the previous page. 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Devastating impact observed as early as 3 months post-treatment. HbA1c separation between treatment group vs. placebo clearly visible at week 13. Progressive deterioration of glycemic control over time", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.067+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3a76286b-e0ac-40ee-ba95-5112a14a3459", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Soleno conceals the exact change in treatment group vs. placebo by showing only a pooled HbA1c average.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-760ce85c5c85", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.65, "x": 0.07, "y": 0.46 }, "kind": "chart", "text": "Stacked bar chart showing HbA1c distribution (Normal, Pre-diabetes, T2D) from W0 to W156.", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Stacked bar chart", "slug": "bar-stacked", "status": "active", "canonId": "019de52c-feec-74bf-9028-15b74f84f0a7", "version": 1, "description": null }, "framework": null }, "subkind": "bar-stacked", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.067+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fb295bff-f6ba-4c60-97c6-71029d7a81bc", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "HbA1c", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:19+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-79d42bd48e84", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "We use the same data (Figure 1 from the 2024 poster) to estimate the distribution of prediabetes (orange) and T2D (red) over time – every single timepoint shows highly significant increase in pre-T2D and T2D vs. baseline. We repeat - every timepoint. A devastating impact is observed as early as 13 weeks post-treatment; and a progressive deterioration of glycemic control as shown in red for increasing T2D. Soleno conceals the exact change in treatment group vs. placebo by showing only a pooled HbA1c average. 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null, "extraction": { "at": "2026-05-02 20:13:34.771+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "141cff5c-c45a-48f7-9ced-755c0941b802", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.18 }, "kind": "paragraph", "text": "The astounding assertion is made in the Miller et al (2024) publication for the Phase 3 open-label extension. The HbA1c and fasting glucose figures explicitly cited in the paper to support this claim appear to be pulled from thin air, as we analyze on the next page – and that HbA1c and fasting glucose stay elevated, do not return to baseline, and spin out of control. We highlight the key figures in the paper, and then analyze them on the next page.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.771+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5f34f9d1-5321-4fc2-8be0-2d1c661e4988", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "paragraph", "text": "Consistent with the observation of hyperglycemia as an adverse event, fasting glucose rose through Week 26 (Change from baseline mean±SD 0.35±0.81 mmol/L) and had returned nearly to baseline by 65 weeks of treatment (Baseline mean±SD 4.997±0.635 mmol/L; 65 weeks 5.126±0.692 mmol/L). HbA1c followed a similar pattern, being elevated at 26 Weeks (Change from Baseline mean±SD 0.19±0.50%) and returned nearly to baseline by 65 Weeks (Baseline mean±SD 5.547%±0.4069%; 65 weeks 5.572% ±0.5103%).", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.771+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "65046a97-eeae-4c2e-86d4-c0a619a3ef89", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.62, "x": 0.07, "y": 0.58 }, "kind": "paragraph", "text": "Jennifer L Miller 1, Evelien Gevers 2, Nicola Bridges 3, Jack A Yanovski 4, Parisa Salehi 5,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.771+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d6bb3a4d-94fe-4903-86fc-7cb6318e8f3f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "In addition to obfuscating diabetes risk by burying HbA1c data for treatment vs. placebo groups, Soleno claims that HbA1c and fasting glucose rose initially through week 26 but “returned nearly to baseline by 65 weeks.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.771+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f3f324b1-1f90-4832-84d6-0700f3916317", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Consistent with the observation of hyperglycemia as an adverse event, fasting glucose rose through Week 26 (Change from baseline mean±SD 0.35±0.81 mmol/L) and had returned nearly to baseline by 65 weeks of treatment (Baseline mean±SD 4.997±0.635 mmol/L; 65 weeks 5.126±0.692 mmol/L). HbA1c followed a similar pattern, being elevated at 26 Weeks (Change from Baseline mean±SD 0.19±0.50%) and returned nearly to baseline by 65 Weeks (Baseline mean±SD 5.547%±0.4069%; 65 weeks 5.572% ±0.5103%).” — Miller et al (2024)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a0-6b035180ebc3", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.47, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: https://pubmed.ncbi.nlm.nih.gov/37919617/; Scorpion Capital estimates and analysis", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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20:13:34.793+00", "seconds": 3.7, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/122", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-122", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The two data HbA1c data points - highlighted again in red/yellow – are above all of the points in their own time series.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-c54c73de46c2", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.45, "x": 0.05, "y": 0.45 }, "kind": "chart", "text": "FIGURE 1: Mean Hemoglobin A1C (%) by Week of DCCR Administration", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.793+00", "model": 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"bbox": { "h": 0.2, "w": 0.45, "x": 0.5, "y": 0.5 }, "kind": "list", "text": "Figure 1: HbA1c (%) Baseline (~Week 0): ~4.9–5.0% Peaks at Week 13 & 26: ~5.2–5.25% Lowest at Week 78: ~5.0% Never returns to baseline Week 156: HbA1c remains elevated (~5.2%)", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.793+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c72ff38b-8e30-49ee-b501-b3f9fc3d572e", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "HbA1c levels", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-cdf8f0ed9f40", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.2 }, "kind": "paragraph", "text": "The HbA1c data set cited here is published in the May 4, 2024 poster by Gevers, Miller et al, analyzed earlier in this section. The two data HbA1c data points - highlighted again in red/yellow – are above all of the points in their own time series.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:34.793+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "45a284f5-91d7-4e4c-93d2-469c4737c0a8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"HbA1c followed a similar pattern, being elevated at 26 Weeks (Change from Baseline mean±SD 0.19±0.50%) and returned nearly to baseline by 65 Weeks (Baseline mean±SD 5.547%±0.4069%; 65 weeks 5.572%±0.5103%).\" — Phase 3 open-label study paper - Miller et al (2024), excerpt", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b29f-cbb69cfdf76b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.8, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: https://pubmed.ncbi.nlm.nih.gov/37919617/; https://investors.soleno.life/static-files/27318113-e299-408f-ba14-0b05114f37bc; Scorpion Capital estimates and analysis", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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the single timepoint they cited is an outlier favoring their reversal narrative but not representative of the entire dataset and the progressive nature of glucose dysregulation by DCCR.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-4c93f02bf6b7", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.48, "x": 0.075, "y": 0.44 }, "kind": "chart", "text": "Linear Correlation Between Week and HbA1c Variance", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Scatter plot", "slug": "scatter", "status": "active", "canonId": "019de52d-007d-72ec-8689-c79fb78e21a2", "version": 1, "description": null }, "framework": null }, "subkind": "scatter", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:33.993+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bfeba4f5-1d17-4d49-bee5-fab7a6f2dec8", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "HbA1c variance: p<0.01", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-56d86c65cabb", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.45, "x": 0.53, "y": 0.44 }, "kind": "paragraph", "text": "HbA1c variance (SD) increase linearly with DCCR treatment duration (p=0.011)\nThis means that DCCR causes a steady decline in glucose homeostasis and increase in pre-T2D and T2D\nSoleno claimed normalization of DCCR-driven HbA1c elevation after 65 weeks of treatment; the single timepoint they cited is an outlier favoring their reversal narrative but not representative of the entire dataset and the progressive nature of glucose dysregulation by DCCR.\nSoleno later (July 2025 Shoemaker et al presentation) shortens the standard deviations (variance) of the entire treatment timecourse making them equivalent to hide the existence of DCCR-driven metabolic toxicity as well as its progressive nature.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:33.993+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "23707593-c16c-449a-8de5-e65d3b48d157", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Soleno later (July 2025 Shoemaker et al presentation) shortens the standard deviations (variance) of the entire treatment timecourse making them equivalent to hide the existence of DCCR-driven metabolic toxicity as well as its progressive nature.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-52ecb51e684c", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.28, "x": 0.075, "y": 0.945 }, "kind": "source-note", "text": "Source: Scorpion Capital estimates and analysis", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Efficacy was measured using HQ-CT scores and safety was assessed by hyperglycemia-related laboratory values and adverse events (AEs). Efficacy outcomes at Week 156 (p<0.0001) were similar for the PD/DM and normoglycemic groups.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.646+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "90aeb604-8d13-415b-b17d-1ac8d88d1be5", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "At baseline, 60% of study participants were identified as having evidence of PD/DM.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:20+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a0-4dc64845fd5f", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "SOLENO THERAPEUTICS HIGHLIGHTS NEW DATA ON VYKAT(TM) XR AT THE 2025 UNITED IN HOPE: INTERNATIONAL PRADER-WILLI SYNDROME CONFERENCE", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.646+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1960b925-9fdd-4bda-885a-4b3a7104a20f", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.86, "x": 0.07, "y": 0.81 }, "kind": "paragraph", "text": "As expected, a greater proportion of hyperglycemia-related AEs were reported for participants with PD/DM as compared to those without (42.7% vs 24.0%, respectively), however these events were generally manageable. Treatment-emergent adverse event-related discontinuations rates were similarly low (4.0% in PD/DM individuals vs. 6.0% in normoglycemic individuals) regardless of baseline PD/DM status.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.646+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5248ef8c-de10-43ad-9603-d9bd3b316de6", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "paragraph", "text": "Safety and Efficacy of Diazoxide Choline Extended-Release in Patients with PWS who Have Pre-Diabetes or Diabetes\nThis poster summarizes an analysis of the safety and efficacy of VYKAT XR in individuals in Soleno’s Phase 3 clinical trials who had evidence of pre-diabetes or diabetes (PD/DM) at baseline versus those who were normoglycemic.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.646+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "69b41829-7dcc-481a-bd3f-09adb1945901", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.55, "x": 0.07, "y": 0.44 }, "kind": "paragraph", "text": "June 20 and 25, 2025 press releases – excerpts of poster presentation", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.646+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c27e17b9-5962-4586-bf95-81b0edbedf44", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Thus, Soleno's own data – by our analysis - shows significant increase in pre-T2D and T2D within 13 weeks of treatment, and increasing linearly thereafter. Although the data is obscured in a manner that conceals this risk, we think the company – in recent weeks – has resorted to a more concerning maneuver, by publishing a “new” version of the same HbA1c chart, which makes it even more difficult to discern the T2D ticking time bomb lurking in its own chart. We sensed something irregular was afoot when Soleno announced supplemental Phase 3 data at a June 25, 2025 conference: a presentation by J. 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"text": "Source: https://investors.soleno.life/presentations/scientific-posters-presentations; https://investors.soleno.life/static-files/7c732b67-56dc-4959-ac2f-31543a7c0ca3; Scorpion Capital analysis and estimates", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Since fasting plasma glucose relates directly to HbA1c, we can calculate the corresponding HbA1c for the fasting glucose timepoints presented to see which HbA1c graph is correct. 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which suggests to us that the new HbA1c numbers are simply made up to fit a misleading narrative that entry ITT were already prediabetic.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-14fb460a6377", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.3 }, "kind": "chart", "text": "MEAN (SE) FASTING GLUCOSE OVER TIME", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.309+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a8f73949-9132-43b2-82ad-aaafd1a5f598", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Fasting Glucose", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-1e23ac656f3d", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.8 }, "kind": "paragraph", "text": "HbA1c = (FG+46.7)/28.7. The HbA1c values in red were calculated from the fasting glucose values in the new Shoemaker et al (2025) presentation, which are identical to the fasting glucose values in the original Miller et al (2024) poster. Soleno also split up the figure and placed another slide in between which makes the changes less obvious.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:35.309+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "22a90e33-4549-4f82-aafd-4433906fc726", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "HbA1c = (FG+46.7)/28.7. The HbA1c values in red were calculated from the fasting glucose values in the new Shoemaker et al (2025) presentation, which are identical to the fasting glucose values in the original Miller et al (2024) poster.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:21+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a1-190a9359df45", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.94 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/presentations/scientific-posters-presentations; https://investors.soleno.life/static-files/7c732b67-56dc-4959-ac2f-31543a7c0ca3; Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Metabolic action of GH occurs in multiple tissues including the liver, muscle, fat and pancreas either directly or indirectly through insulin-like growth factor 1. The diabetogenic action of GH has been well-described in previous in vivo studies. In this paper, we review the metabolic effects of GH on peripheral tissues focusing on glucose metabolism and insulin resistance, and discuss results from human studies on the long-term effects of GH administration on insulin resistance and hyperglycemia. determined yet. International cohort studies indicate that GH therapy may increase the incidence of type 2 diabetes mellitus in children and adolescents with predisposing risk factors, therefore it is prudent to monitor possible negative consequences on glucose metabolism during and after GH administration. 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Diabetes, type 1 diabetes, You're on a second medication that is increasing your sugar while you're on a medication that may be decreasing your insulin...'", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.349+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ffa98994-748d-4f61-b618-59627db430e6", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "quote", "text": "The other thing you have to realize is if you got somebody on diazoxide and you've got somebody on growth hormone... that also is increasing your risk of diabetes. 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The safety discussion mentions pulmonary edema once but is vague and appears to conflate it with peripheral edema – “Six participants experienced serious AEs in the study, all occurring in the DCCR group, which in only one participant was considered drug related (peripheral and pulmonary edema in the setting of an unrelated concurrent pneumonia).” Based upon color from an ex-employee and a trial investigator, we suspect this participant may have been hospitalized in the UK for pulmonary edema with cardiac involvement.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.91+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "85bc5392-4499-4aee-b662-c6e63cf97310", "parentComponentId": null }, { "bbox": { "h": 0.4, "w": 0.5, "x": 0.42, "y": 0.51 }, "kind": "paragraph", "text": "Safety Patients with PWS experience frequent complications and co-morbidities. 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"kind": "image", "text": "Periorbital edema", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Photo", "slug": "photo", "status": "active", "canonId": "019de52c-fd37-757f-b4a8-ca26d4888875", "version": 1, "description": null }, "framework": null }, "subkind": "photo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.795+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b312953e-6068-4572-aeb3-5e59750489c3", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.25, "x": 0.7, "y": 0.55 }, "kind": "image", "text": "Facial edema", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Photo", "slug": "photo", "status": "active", "canonId": "019de52c-fd37-757f-b4a8-ca26d4888875", "version": 1, "description": null }, "framework": null }, "subkind": "photo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.795+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cc1d1fb0-87a8-4364-9dc6-b97488f803a7", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.6, "x": 0.07, "y": 0.38 }, "kind": "list", "text": "Peripheral edema – the swelling of tissues usually in the legs, ankles and feet caused by the accumulation of fluid in the interstitial space\nFacial edema – the swelling of the face due to excess fluid accumulation under the skin\nPeriorbital edema – swelling around the eyes, especially the eye sockets due to fluid accumulation under the skin. The eyes have loose connective tissue making them especially prone\nImpaired cardiac function that may lead to pulmonary edema\nOver time this can lead to hypertension and cardiac tissue remodeling in patients with PWS → congestive heart failure\nPeripheral edema, facial edema, periorbital edema and pulmonary edema reported in clinical trials conducted by Soleno with DCCR", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.795+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ca2c2fb0-8334-4a57-8355-97f25f228eeb", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.6, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Pulmonary edema is the accumulation of fluid in the lung tissue and air spaces (alveoli), typically due to left heart failure or fluid overload, causing increased hydrostatic pressure that forces fluid out of the pulmonary capillaries into the lungs. When fluid overload exceeds the heart’s capacity to pump, left heart strain or pre-existing cardiac issues tip the balance toward pulmonary edema.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:36.795+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5ad579ac-3f77-4ce2-a463-520bdab706d6", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.6, "x": 0.07, "y": 0.92 }, "kind": "source-note", "text": "Source: Scorpion Capital analysis and estimates; https://en.wikipedia.org/wiki/Edema; https://doi.org/10.3390/reports4030022; https://en.wikipedia.org/wiki/Periorbital_puffiness", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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In the kidney (1st mechanism): Diazoxide may directly open KATP SUR1/SUR2 in kidney collecting ducts attenuating urinary excretion of sodium (Na+) and water. Since diazoxide is 90% excreted by kidney, 50% as unmetabolized active drug, concentrations of active diazoxide in the renal collecting ducts → 100-fold higher than the circulation making it active against both SUR1 and SUR2 KATP subunits in collecting ducts. 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In the capillaries (3rd mechanism): Diazoxide causes vasodilation and increased capillary hydrostatic pressure favoring fluid movement out of the capillaries into the interstitial space.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:37.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9102f3a6-1735-40a9-a42a-0244a3ffae43", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.48 }, "kind": "list", "text": "2. In the arteriole blood vessels (2nd mechanism): Diazoxide's mechanism-based action on vascular KATP channels in smooth muscle lowers systemic vascular resistance and reduces renal perfusion pressure. This reduces renal perfusion pressure → ↓ GFR. In response the renin-angiotensin-aldosterone system (a hormonal cascade crucial for regulating fluid balance) is activated further promoting sodium retention, volume overload and edema.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:37.037+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d7e57578-db77-4a4d-b57a-37c1ff2b2095", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The heart must work harder to pump the excess venous volume leading to thickened walls of the ventricles called cardiac hypertrophy. The heart cannot effectively pump the extra volume of blood (reduced ejection fraction). DCCR is indicated for long-term treatment in PWS leading to chronic fluid retention that could lead to heart failure (particularly congestive heart failure). 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LS Mean (± SE) Increase in Lean Mass (kg) from Baseline", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:37.751+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8ebefa69-7eb4-4c52-a3b6-1f71036477f2", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.45, "x": 0.07, "y": 0.44 }, "kind": "image", "text": "Long-term Administration of Diazoxide Choline Extended-Release (DCCR) Tablets in People with Prader-Willi Syndrome", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:37.751+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e9a11dcb-7f5b-48ef-9d69-d0d504d03913", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.4, "x": 0.53, "y": 0.67 }, "kind": "list", "text": "DEXA cannot distinguish between edema and LBM. Diazoxide causes mechanism-based fluid retention... If so, no attenuation of linear increase... In a 130 kg patient, 7.3 Kg of fluid accumulation is a significant risk...", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:13:37.751+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3b10fa21-c063-40eb-8428-a388ee3f59c3", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Lean Body Mass: 7.3 kg", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-466228e83a19", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "A May 2025 paper by lead investigator Jennifer Miller and Soleno’s Neal Cowen shows a shocking 16 lb steady and linear increase over 3 years of Vykat – brazenly asserted to be LBM but which we think is clearly fluid.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-4335d977cb40", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.55, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/static-files/946b0269-ce30-4c6f-943c-8fa4ed54f44a; Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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DEXA cannot distinguish muscle from water... Reported increases in LBM (2-7 kg)... Temporal pattern aligns... Fat mass decreases were short-lived... 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Endocrinologists who attended drug rep presentations in recent weeks at their respective clinics said they were taken aback at the suggestion of permanent edema requiring continuous diuretic therapy. One, at an academic center who attended the meeting with 8 endocrinology colleagues, indicated skepticism of the rep’s answers - \"it’s a known side effect...I was a little bit surprised that they were talking about treating kids with diuretics as a standard of care with this medication - that was one of the things that the rep said...I was surprised about that because if I have somebody with congenital hyperinsulinism that has a mutation that responds to diazoxide...I would not treat that kid with a diuretic.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.94+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ce0d0186-6d97-4df0-8695-fd112c82e5b6", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "quote", "text": "“Every baby less than a year old, we put on diuretics, so it's a known side effect. When they get older, we actually stop it. Most of the time they don't still need it, which I was a little bit surprised that they were talking about treating kids with diuretics as a standard of care with this medication — that was one of the things that the rep said. I was surprised about that because if I have somebody with congenital hyperinsulinism that has a mutation that responds to diazoxide, and we continue to treat them, and there's a couple later on in life, I would not treat that kid with a diuretic. Usually, they're old enough and they do fine. 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When they get older, we actually stop it. Most of the time they don't still need it, which I was a little bit surprised that they were talking about treating kids with diuretics as a standard of care with this medication — that was one of the things that the rep said. I was surprised about that because if I have somebody with congenital hyperinsulinism that has a mutation that responds to diazoxide, and we continue to treat them, and there's a couple later on in life, I would not treat that kid with a diuretic. Usually, they're old enough and they're old enough and they do fine. 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If that's okay, we don't do them every two weeks or consistently unless we're always talking about changes in respiration or things like that. As far as serious cardiac events, we did talk about pulmonary edema at the visit, and she even said something about giving people a handout and how to recognize edema. And I was just like, \"huh!\" I would expect something transient, but I wouldn't expect a permanent edema, to be honest...\" - Pediatric endocrinologist at an academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:08.874+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "19e8b2d4-91c2-40ca-9229-8f1a057ca457", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.15 }, "kind": "paragraph", "text": "\"as far as serious cardiac events, we did talk about pulmonary edema at the visit, and she even said something about giving people a handout and how to recognize edema...and I was just like, \"huh!\" I would expect something transient, but I wouldn't expect a permanent edema, to be honest\"; \"they said something about...teaching people how to recognize the edema at home, which, I'm an endocrinologist, and I can certainly do that, pitting versus not...but that's not something we're typically do.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:08.874+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "acce162a-bb44-4292-83d8-ae8cf2dd37fe", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.68 }, "kind": "paragraph", "text": "Q: \"Is that what the rep hinted at? They were worried enough about edema that they gave a handout?\"\nA: \"Yes. They said something about the families are very good and teaching people how to recognize the edema at home, which, I'm an endocrinologist, and I can certainly do that, pitting versus not. But that's not something we're typically do.\" - Pediatric endocrinologist at an academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:08.874+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e2c7d5fc-8255-4db4-9544-58f13ef050a7", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“as far as serious cardiac events, we did talk about pulmonary edema at the visit, and she even said something about giving people a handout and how to recognize edema...and I was just like, \"huh!\" I would expect something transient, but I wouldn't expect a permanent edema, to be honest” — Pediatric endocrinologist at an academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-2dc2d3a3f17d", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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“heart arrhythmia, muscle spasms, and seizures”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:10.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c45ce96a-0233-4099-9680-374d8edc5aed", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "paragraph", "text": "“Therefore, it’s going to certainly impact how you regulate your sodium, potassium, and magnesium in your body. When your magnesium is not working, guess what happens? If you’re a doctor, the patient comes in with unexplained seizures and can’t talk to you. They’re in a seizure. No one else knows. You got the EMT’s brought them in. You have no history, right? First thing, you give that patient a bolus of magnesium. Because sometimes, low magnesium can cause seizures or muscle spasms or heart irregularity. I suspect it’s probably related to the magnesium transportation. And 1 in 4 —those genes involved making transporter proteins for iron and selenium and magnesium that keeps all equilibrium in our body so our electrolytes are normalized. But I can see that could be a problem. One in 4, particularly when they’re restricting their diet for some reason or other, maybe they’re on a diuretic. When you’re on a diuretic, you’re losing your fluid, you’re losing your potassium. To avoid potassium problems, you have to overload them with potassium pills or eat bananas. More information than you need to know. But yes, I’m concerned about the edema that is a risk. Those 1 in 4 that may have the ATP-sensitive potassium channel, which this drug works in that channel and that regulates our electrolytes in our body, particularly magnesium, and therefore, it can interfere. Without magnesium, you get heart arrhythmia, muscle spasms, and seizures.” - Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:10.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7aaa5430-1841-4b3c-9c8b-df759db04cb4", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "whose interview in a separate chapter highlighted severe channelopathy defect risks in PWS genetic subtypes – “...interference with potassium, sodium, calcium, magnesium – all these...keep the heart functioning normally...that’s why I said I wanted to hold off [on Vykat]...and see what happens”; “low magnesium can cause seizures or muscle spasms or heart irregularity...I can see that could be a problem...when you’re on a diuretic...you’re losing your potassium... yes. I’m concerned about the edema...heart arrhythmia, muscle spasms, and seizures.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:10.016+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ee8b452e-3ed5-4925-871f-af16d28a165b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "Q: “So, you think this could potentially present cardiac risk in a quarter of patients?”\nA: “Cardiac is a big muscle, isn’t it? It can. Right? Potassium, yeah. It can be in edema itself. It might be related to not [being] able to keep the right amount of salt and water in your bloodstream, and therefore you’re leaking out your liquid into your lower legs because your cell membranes aren’t pliable enough because of the interference with potassium, sodium, calcium, magnesium — all these make your muscle work and keep the heart functioning normally. It’s a big player. 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"slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:08.525+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "826f5461-5b2e-4b58-a703-e7e609fa4544", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.5, "x": 0.07, "y": 0.48 }, "kind": "list", "text": "Studies on diabetogenic effects of chronic diuretic use\nHow Do Diuretics Cause Hyperglycemia?\nThiazide-Induced Dysglycemia", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:08.525+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7a116d27-9d6e-42a5-bb9c-0babee94c6d4", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "electrolyte imbalances like hypokalemia (low potassium), hyponatremia (low sodium), and hypomagnesemia (low magnesium), all three of which can cause arrhythmia, QT prolongation, and worsened hypotonia, which is already present in PWS; and renal stress, as chronic diuretic therapy can cause pre-renal azotemia and acute kidney injury. In particular, diuretics are well-known in worsening hyperglycemia – creating synergistic risk as diazoxide mechanistically induces hyperglycemia as well. 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null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "75bfdc17-8afc-4b5e-821d-bf676c229f2b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.78 }, "kind": "quote", "text": "Well, this is the thing.— what we know with Prader-Willi is they're likely to have problems with their left ventricular function, probably as a result of obesity and blood pressure trending higher and things like that.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "165c080f-a241-49db-ae46-6cdb941d42eb", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.86, "x": 0.07, "y": 0.55 }, "kind": "quote", "text": "Certainly, in the other condition we use diazoxide for, pulmonary edema is a massive concern of ours. We use it in babies, and we need to make sure that the children have all had echos before they go on it and at regular intervals afterwards.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ada5166c-99fe-4a34-ab7d-895900866943", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Certainly, in the other condition we use diazoxide for, pulmonary edema is a massive concern of ours. 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The pulmonary edema.”\nA: “We probably treat about 20 to 30 infants a year. And it maybe only happens in 1 in 100 or something. It’s not that often, but it can be devastating. It can cause a real problem. So, that would be my worry. 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Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.473+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c4bc9de3-66d1-474b-837a-5a633e41b518", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Trial investigator #6 stated that diazoxide can be fatal and is contraindicated in patients with elevated pulmonary pressures - common in PWS patients due to obesity and diabetes, both of which greatly increase risk of increased pulmonary hypertension - “that’s why they have to stop using diazoxide...it can be devastating...that would be my worry.” The investigator indicated that ongoing echocardiograms are mandatory if using Vykat - “an echo before you can start it...and you measure pulmonary pressures...and then we tend to do it every couple of months...with Prader-Willi, I would be wanting an echo before and then two weeks after...and then to be honest...because we’re still not sure how this will go...I would probably do them six months to annually.”", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.473+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6719cf15-9a56-4607-b830-1744735b2825", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 156, "type": "tension", "title": "This appears to be a slide from a larger activist deck, likely part of a list of grievances or evidence against a company.", "function": "name_villain", "rawType": "villain_critique", "block": null, "metadata": { "slideType": "villain_critique", "slideTypeCanon": { "name": "Villain critique", "slug": "villain_critique", "status": "active", "canonId": "019de52d-10bc-7136-bf20-09de59d17447", "version": 1, "description": null }, "function": "name_villain", "functionCanon": { "name": "Name villain", "slug": "name_villain", "status": "active", "canonId": "019de52d-1746-70d6-bc58-5eeaf5865526", "version": 1, "description": null }, "density": "sparse", "densityScore": 2, "componentCount": 1, "textChars": 95, "nDataPoints": 0, "notes": "This appears to be a slide from a larger activist deck, likely part of a list of grievances or evidence against a company.", "elementsJson": [ "headline_text" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:07.549+00", "seconds": 1.643, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/156", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-156", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "6. Largest Facebook group for VYKAT XR discussion suggests a safety crisis and patient backlash", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:07.549+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7347a2f3-5576-43f6-9716-68bec4f55c32", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 157, "type": "tension", "title": "Uses social media follower counts as a proxy for community size to highlight the lack of engagement with the drug.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "balanced", "densityScore": 46, "componentCount": 5, "textChars": 1067, "nDataPoints": 2, "notes": "Uses social media follower counts as a proxy for community size to highlight the lack of engagement with the drug.", "elementsJson": [ "paragraph", "headline_text", "screenshot", "footnote" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:09.806+00", "seconds": 3.258, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/157", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-157", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "VYKAT XR is barely discussed in these two groups, relative to their size – an ominous signal that indicated the drug is generally off the radar and certainly not viewed as a game-changing medication.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-5ce4498b9621", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "image", "text": "Screenshots of Facebook group pages for FPWR and PWSA USA", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9612de44-79ca-4fa7-b70f-356a1285a6ee", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Facebook posts by PWS parents in two support groups indicate tepid interest in VYKAT XR as well as concern/reluctance due to lack of efficacy and adverse effects – which in recent weeks appear to have tipped into a rising backlash as reports of hospitalizations have begun to appear. FB groups play an integral role in the PWS community for discussing clinical trials, treatments, and personal experiences. The two key PWS associations have the largest groups: The Foundation for Prader-Willi Research (20K) and Prader-Willi Syndrome Association USA (15K). VYKAT XR is barely discussed in these two groups, relative to their size – an ominous signal that indicated the drug is generally off the radar and certainly not viewed as a game-changing medication.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a15e694f-863d-46ad-a560-afb5502aaec6", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Facebook groups", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"2026-05-02 21:26:09.806+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "967b7e95-5dda-43b2-be0e-d49adb64ff60", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 158, "type": "tension", "title": "The slide highlights the discrepancy between the expected community interest and the actual low membership/activity numbers.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 67, "componentCount": 7, "textChars": 1326, "nDataPoints": 4, "notes": "The slide highlights the discrepancy between the expected community interest and the actual low membership/activity numbers.", "elementsJson": [ "paragraph", "screenshot" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:09.985+00", "seconds": 3.37, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/158", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-158", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "We note the Vykat group has 1,056 members (as of 8/15) – a tiny number relative to the 20K/15K in the two key ones and a key indicator of VYKAT’s “buzz” in the PWS community.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-ab81bc8fe641", "parentComponentId": null }, { "bbox": { "h": 0.38, "w": 0.42, "x": 0.51, "y": 0.52 }, "kind": "image", "text": "Screenshot of Vykat for PWS group", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.985+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3650702b-d869-4e9a-a2db-bdf87abbde51", "parentComponentId": null }, { "bbox": { "h": 0.38, "w": 0.42, "x": 0.07, "y": 0.52 }, "kind": "image", "text": "Screenshot of Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.985+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cc729741-3114-4e69-ba38-524841a3379a", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Facebook group membership: 1,056", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-ac0111dc4c73", "parentComponentId": null }, { "bbox": { "h": 0.42, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The primary FB forum for VYKAT XR discussion among PWS parents is a group created on May 20th – “Vykat discussion group.” We note the Vykat group has 1,056 members (as of 8/15) – a tiny number relative to the 20K/15K in the two key ones and a key indicator of VYKAT’s “buzz” in the PWS community. In recent weeks, we have closely monitored the group. The vast majority of members appear to be curious lurkers vs. parents of patients on VYKAT. The rate of new members has slowed to a trickle – a few more members every week; and the level of activity indicates little and rapidly slowing traction for VYKAT with only 40 new posts in the last month. A smaller group – “Vykat for PWS” – was created on June 25th but has only 234 members and is basically dormant vs. the other group.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.985+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9b720841-f09a-48d5-81d7-fbec0c820dc4", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The general ratio of negative/ambivalent comments to positive ones suggests to us that Soleno’s launch may already be close to hitting a wall, as the initial bolus of desperate parents willing to try anything dries up. The sporadic positive comments strike us as tepid with clear placebo bias – parents reporting a “positive” hyperphagia effect are prone to sentiments like it took 18 months before they noticed benefit and that they still have to keep the food locked up. The key, devastating takeaway from the FB group: in the last few weeks, the 4 posts with the most engagement and largest number of comments – by orders of magnitude – are sharply negative. Shockingly, the post where we see the most comments – 61 as of late last week – is about VYKAT *increasing* hyperphagia, with parents piling on to complain.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.228+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5045dc03-f73b-43f2-ae40-909cb209ccf8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "My son is 9 and we're on week 12 of VYKAT. We're seeing a huge increase in hyperphasia. Anyone else?", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:22+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a2-dd8fc4f300b0", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.228+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5736a7cc-83eb-4e41-bb9d-adb970608d74", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 160, "type": "tension", "title": "The slide uses screenshots of Facebook comments to build a case against the drug's efficacy and safety profile.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "balanced", "densityScore": 44, "componentCount": 5, "textChars": 1243, "nDataPoints": 0, "notes": "The slide uses screenshots of Facebook comments to build a case against the drug's efficacy and safety profile.", "elementsJson": [ "paragraph", "screenshot" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:09.531+00", "seconds": 2.647, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/160", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-160", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The scathing replies to the post suggest that the game may already be over for Soleno before it has even begun – with some parents saying the hyperphagia is the worst they have ever experienced; “hyperphagia was never as bad as it is now on this drug”; “I’m scared this is activating it more” – to which another parent replied “exactly us” with another chiming in with “that’s so scary.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-59d63015ef6e", "parentComponentId": null }, { "bbox": { "h": 0.62, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "image", "text": "Facebook discussion group thread", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.531+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "26c6a505-c7a0-4af8-b135-bb4ea413c527", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“hyperphagia was never as bad as it is now on this drug” — Anonymous Parent. “I’m scared this is activating it more” — Anonymous Parent. “exactly us” — Anonymous Parent. “that’s so scary.” — Anonymous Parent.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-5cf051391a6a", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.531+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c10ead6e-1712-400e-b163-72684b4da218", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The scathing replies to the post suggest that the game may already be over for Soleno before it has even begun – with some parents saying the hyperphagia is the worst they have ever experienced; “hyperphagia was never as bad as it is now on this drug”; “I’m scared this is activating it more” – to which another parent replied “exactly us” with another chiming in with “that’s so scary.”", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:09.531+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "23a02ed0-716d-4609-af10-0c0e0870d2e4", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "f254403e-3004-42f3-9070-9a5d72b3ecaf", "evidence": "Uses user testimonials to contradict the company's narrative of drug efficacy.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 21:26:09.531+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 160, "frameworkName": "expose_contradiction" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 161, "type": "evidence", "title": "The slide uses anecdotal evidence from Facebook groups to highlight negative side effects (hyperphagia, behavioral changes) associated with the drug VYKAT.", "function": "illustrate_case", "rawType": "testimonial", "block": null, "metadata": { "slideType": "testimonial", "slideTypeCanon": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52d-0a2d-7782-8a48-7e84df92cc97", "version": 1, "description": null }, "function": "illustrate_case", "functionCanon": { "name": "Illustrate case", "slug": "illustrate_case", "status": "active", "canonId": "019de52d-13b4-772c-bb73-1873612a7463", "version": 1, "description": null }, "density": "balanced", "densityScore": 40, "componentCount": 5, "textChars": 1030, "nDataPoints": 0, "notes": "The slide uses anecdotal evidence from Facebook groups to highlight negative side effects (hyperphagia, behavioral changes) associated with the drug VYKAT.", "elementsJson": [ "headline_text", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:10.064+00", "seconds": 3.041, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/161", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-161", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "More comments to the same post – “a roller coaster ride over here…some days the hyperphagia is the worst it’s ever been”; “this is worrisome with more people saying this”; “the food seeking has now reached a level I didn’t think was possible.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-43144e1e5f85", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.86, "x": 0.07, "y": 0.24 }, "kind": "paragraph", "text": "Collection of five user comments from Facebook groups regarding VYKAT experiences.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:10.064+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "534cd83c-26ef-491d-b1b3-15dda09dfa42", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“a roller coaster ride over here…some days the hyperphagia is the worst it’s ever been”; “this is worrisome with more people saying this”; “the food seeking has now reached a level I didn’t think was possible.” — Facebook group users", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-4727f6f629ca", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 53, "componentCount": 5, "textChars": 1572, "nDataPoints": 4, "notes": "The slide uses screenshots of Facebook posts to provide qualitative evidence of patient dissatisfaction and safety concerns.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:14.511+00", "seconds": 7.309, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/162", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-162", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Each post is devastating, the adverse effects one particularly so: “today marks week 6...we have seen zero improvements...his behavior has actually worsened significantly...he generally appears to feel ‘unwell’...like he’s been hit by a bus every morning...I’m just so frustrated and worried for him...”: “behaviors have been off the charts...the medication just isn’t going to work.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-8a3d234d6a87", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.9, "x": 0.05, "y": 0.45 }, "kind": "image", "text": "Four Facebook post screenshots", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:14.511+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3f62853b-dac2-439b-9668-0412ae9d9af1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“making me think twice about even starting the med.” — Anonymous parent in Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-8f1952e5916b", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.05, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Hyperglycemia, behavioral issues, and an INCREASE in hyperphagia”; “it sounds like a lot of people are experiencing an increase in behavioral issues while starting the meds”; “we’re seeing way more obsessive behaviors…he’s still hyper focused on food”; “we’re on week 3 and I’m convinced it’s the medicine, only because of the severity/difference in behaviors…behaviors we’ve experienced mildly before seem to extremely exaggerated”; “my daughter…is having more tantrums and fixations”; “week3…the food seeking has now reached a level I didn’t think was possible.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-71307dc069e8", "parentComponentId": null }, { "bbox": { "h": 0.42, "w": 0.86, "x": 0.07, "y": 0.47 }, "kind": "image", "text": "Screenshots of Facebook posts", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:15.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7d02b99f-f8aa-416e-b566-d2ad9c95d4ee", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "“we haven’t started Vykat yet we are seeing quite a few parents comment about edema. Hyperglycemia, behavioral issues, and an INCREASE in hyperphagia”; “it sounds like a lot of people are experiencing an increase in behavioral issues while starting the meds”; “we’re seeing way more obsessive behaviors...he’s still hyper focused on food”; “we’re on week 3 and I’m convinced it’s the medicine, only because of the severity/difference in behaviors...behaviors we’ve experienced mildly before seem to extremely exaggerated”; “my daughter...is having more tantrums and fixations”; “week3...the food seeking has now reached a level I didn’t think was possible.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:15.405+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e82dee2-3bb3-4a5b-a4cd-ecfdfeb49f77", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“we haven’t started Vykat yet we are seeing quite a few parents comment about edema. Hyperglycemia, behavioral issues, and an INCREASE in hyperphagia” — Facebook user, Vykat for PWS: Evidence, Experience & Encouragement group. “it sounds like a lot of people are experiencing an increase in behavioral issues while starting the meds” — Facebook user, Vykat discussion group. “we’re on week 3 and I’m convinced it’s the medicine, only because of the severity/difference in behaviors…behaviors we’ve experienced mildly before seem to extremely exaggerated” — Facebook user, Vykat discussion group.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-75429d6e1950", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.75, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” [URL]; “Vykat for PWS: Evidence, Experience & Encouragement” [URL]", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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null, "at": "2026-05-02 21:26:12.639+00", "seconds": 4.915, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/164", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-164", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The negative Vykat commentary is so obvious that parents are commenting on its prevalence, while a few die-hards are exasperated trying to defend", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to 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"2026-05-02 21:26:12.639+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "534c1a77-334b-483b-ae92-1e7c984088fc", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "people are more likely to complain than to talk about the good things...we’re 8 weeks in with no changes, good or bad; it’s totally understandable this would be a forum where people are mostly raising concerns; I have invested well over 6 years of our lives into this study, so I apologize if I come off a little rude...this medication is not going to work for everyone...it is NOT a cure...there are SO MANY reasons why one would withdraw...ugh.... — Facebook group users", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": 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others indicate periorbital edema around the eyes.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a3-bb2d23745fdc", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.9, "x": 0.05, "y": 0.45 }, "kind": "image", "text": "Three screenshots of Facebook group posts from 'Vykat discussion group'", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.066+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5b7c154c-db2b-47c3-b23e-0249d12d3dc3", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.9, "x": 0.05, "y": 0.22 }, "kind": "paragraph", "text": "Peripheral swelling is so extreme that numerous posts indicate their kids can no longer walk or put on their socks or shoes; others indicate periorbital edema around the eyes: “I’m noticing several people experience edema as a potentially serious side effect”; “it was gradual for us...like waking up with swollen eyes...then not being able to put his socks on...next thing we know he’s up 16 pounds”; “my daughter is on week 4...her legs are so swollen she can’t wear sneakers...we are keeping her legs raised when possible”; “my child’s legs, feet and hands were swollen...she couldn’t fit her feet in tennis shoes and has trouble walking.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.066+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "978fbcaa-a164-45e1-a62d-494125d3cfbf", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I’m noticing several people experience edema as a potentially serious side effect — Vykat discussion group member. It was gradual for us...like waking up with swollen eyes...then not being able to put his socks on...next thing we know he’s up 16 pounds — Vykat discussion group member. My daughter is on week 4...her legs are so swollen she can’t wear sneakers...we are keeping her legs raised when possible — Vykat discussion group member. 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"019de52d-13b4-772c-bb73-1873612a7463", "version": 1, "description": null }, "density": "dense", "densityScore": 57, "componentCount": 6, "textChars": 1928, "nDataPoints": 0, "notes": "The slide uses anecdotal evidence from Facebook discussion groups to highlight potential adverse drug reactions.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:11.58+00", "seconds": 3.31, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/166", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-166", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Parents appear to be sounding the alarm to warn other parents – “I just wanted to share, and I hope this is not happening to any of you...my son...started Vykat 7 weeks ago...he was going alright (no appetite change though), but a week and a half ago his legs and feet started to swollen [sic] rapidly, to the point it was hard to walk...he was given a week of diuretics and we stop Vykat...his legs and feet are fine now...has it happened to any of you?”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": 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"parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.15 }, "kind": "paragraph", "text": "“I just wanted to share, and I hope this is not happening to any of you...my son...started Vykat 7 weeks ago...he was going alright (no appetite change though), but a week and a half ago his legs and feet started to swollen [sic] rapidly, to the point it was hard to walk...he was given a week of diuretics and we stop Vykat...his legs and feet are fine now...has it happened to any of you?” Other parents are chiming in: “We have this going on now”; “we are on week 5...she had some edema too...did your kiddo have swelling as well?”; “each time the dose goes up she has swelling worse”; “water’s heavy...that is a lot...a gallon of water is roughly 8 lbs so 5 lbs would be more than half a gallon of retained fluids....”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.58+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e352657-f9b1-4895-b84f-0802bbe4d571", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I just wanted to share, and I hope this is not happening to any of you...my son...started Vykat 7 weeks ago...he was going alright (no appetite change though), but a week and a half ago his legs and feet started to swollen [sic] rapidly, to the point it was hard to walk...he was given a week of diuretics and we stop Vykat...his legs and feet are fine now...has it happened to any of you?” — Parent in Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-3ed1ca41487a", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Even on a lower dose and lasix she still seemed to have some fluid retention. Her last dose was Monday and today her weight was back down to 171. McKenzie has been pretty vocal about wanting to stop the Vykat because the swelling hurt her.legs. she wants to do the HERO study. 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After then re-starting Vykat, the child re-gained 5 lbs of fluid – “I was a bit shocked at a 5lb gain!” Ten days later, the family gave up and stopped the drug: “even on a lower dose and Lasix she still seemed to have some fluid retention...[she] has been pretty vocal about wanting to stop the Vykat because the swelling hurt her legs.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:11.719+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "30882463-7c46-4376-a4bf-f1f250c678fd", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I was a bit shocked at a 5lb gain! — Vykat discussion group member. even on a lower dose and Lasix she still seemed to have some fluid retention...[she] has been pretty vocal about wanting to stop the Vykat because the swelling hurt her legs. — Vykat discussion group member.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-22396cc0a28f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group”", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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}, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:12.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f7183adb-a181-4736-88bd-22ad1d0c992c", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Not surprisingly, families indicate they are already discontinuing VYKAT due to fluid retention and failure with Lasix and other diuretics – or that they are passing on VYKAT after reading about edema and other issues", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", 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"019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:24+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-91061c9c3818", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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“my son can’t tell me if he’s in pain or not but his legs looks bigger to me”; “I’m noticing several people experiencing edema as a potentially serious side effect…my kiddo struggles with expressive language and I’m not confident he will communicate or notice if he is uncomfortable…he has severe OSA…so I absolutely do not want any extra strain on his heart/lungs from fluid retention.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:14.925+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "749fde83-8a49-466b-a097-181998b2d7b4", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I’m watching out for that...[she] already has quite big ankles”; “my son can’t tell me if he’s in pain or not but his legs looks bigger to me”; “I’m noticing several people experiencing edema as a potentially serious side effect...my kiddo struggles with expressive language and I’m not confident he will communicate or notice if he is uncomfortable...he has severe OSA...so I absolutely do not want any extra strain on his heart/lungs from fluid retention.” — Anonymous parents in Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:23+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-5a213c4b0db7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.401+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "caaaba38-0e6c-431c-8e51-16595505417f", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "One indicates that fasting glucose jumped from normal to far past the diabetes threshold in week 1 – and remains deep into hyperglycemic range in week 3: “my daughter is 5 we stopped due to her blood sugar going up, they said it ‘likely’ would level out...I don’t want to take that risk”: “we are seeing blood sugars very high due to vykat...diet is very good no sweets...any one else seeing blood sugar spikes?”; “his starting level was 85...he spiked at the end of the first week as high as 133...we are back down to 112 on the third week”; “we were at 87 before starting and did touch low 100s a couple of weeks ago...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.401+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0548dcc2-cd5b-4d76-97a5-72ebaa1b75a9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "my daughter is 5 we stopped due to her blood sugar going up, they said it 'likely' would level out...I don't want to take that risk — Anonymous Parent. we are seeing blood sugars very high due to vykat...diet is very good no sweets...any one else seeing blood sugar spikes? — Anonymous Parent. his starting level was 85...he spiked at the end of the first week as high as 133...we are back down to 112 on the third week — Anonymous Parent. we were at 87 before starting and did touch low 100s a couple of weeks ago... — Anonymous Parent.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 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One of the most prolific and positive parents – whose son has been on Vykat for 6 years – defended it against the deluge of negative comments: “I just wanted to say, it’s not a cure…it’s an aide…this is just a tool that helps your loved one turn down the food noise……the drug isn’t going to help if you don’t work and keep your kid off sweeteners, sugars, sodas…in fact when we started months in I was doubting.” Other parents: “have been on it for about six weeks now and it’s working great!!…we do keep everything locked up”; “my son doesn’t food seek per se, however the interest is there and…he will eat it…whether it’s on a plate or on the ground.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.284+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "32b8d522-42d1-4e27-9f63-86d52e473b79", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I just wanted to say, it’s not a cure...it’s an aide...this is just a tool that helps your loved one turn down the food noise......the drug isn’t going to help if you don’t work and keep your kid off sweeteners, sugars, sodas...in fact when we started months in I was doubting. — Parent on Vykat for 6 years", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:24+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a4-f4f8bb143c33", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.05, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” ...; “Vykat for PWS: Evidence, Experience, & Encouragement” ...", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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of a key proponent (Dr. Miller) by showing her own followers are skeptical of the product.", "function": "expose_contradiction", "rawType": "testimonial", "block": null, "metadata": { "slideType": "testimonial", "slideTypeCanon": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52d-0a2d-7782-8a48-7e84df92cc97", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "balanced", "densityScore": 45, "componentCount": 5, "textChars": 1332, "nDataPoints": 0, "notes": "The slide uses social media screenshots to undermine the credibility of a key proponent (Dr. Miller) by showing her own followers are skeptical of the product.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:13.64+00", "seconds": 3.168, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/176", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-176", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "we see Dr Miller and we have ZERO plans on giving our 10 year old son this medication for many reasons...the side effects are very concerning to us...we might consider it but only at a point of desperation when we have exhausted other options.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", 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"019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.64+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "94ec9f2b-8557-4c82-a6ef-926f2d4e789d", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Ominously, even some parents who are Jennifer Miller devotees indicate they have no interest in Vykat – “we see Dr Miller and we have ZERO plans on giving our 10 year old son this medication for many reasons...the side effects are very concerning to us...we might consider it but only at a point of desperation when we have exhausted other options.” Another parent: “we see Dr Miller and also a local endo...VYKAT is not something we’d consider after speaking with our local endo and other doctors...the risk is just not worth it for us...it will be the last resort.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.64+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "71d4705e-77da-40d3-a18f-9f40d18384db", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "we see Dr Miller and we have ZERO plans on giving our 10 year old son this medication for many reasons...the side effects are very concerning to us...we might consider it but only at a point of desperation when we have exhausted other options. — Anonymous member 654", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:24+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-1b0e4ed7c2fc", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/q/17JomVRPoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/groups/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We are seriously considering it...it’s week 3 for us and she’s still chewing pills...it’s just not working...I’m noticing swelling in her ankles and some hair growth...the cons are outweighing the pros for us at this point”; “we had to discontinue but have our eyes on the Hero study and pray it is approved”; “we just opted out of Vykat for several reasons...”; “we are officially out of the trial now...the effect on hyperphagia was minimal...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:16.708+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "833c9de4-3a32-47e2-83e3-4a21ee6294f4", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“we have been on Vykat 5 weeks...we tried titrating up but behavior was worse...I am so tempted to just quit”; “has anyone stopped taking this medication? We are seriously considering it...it’s week 3 for us and she’s still chewing pills...it’s just not working...I’m noticing swelling in her ankles and some hair growth...the cons are outweighing the pros for us at this point”; “we had to discontinue but have our eyes on the Hero study and pray it is approved”; “we just opted out of Vykat for several reasons...”; “we are officially out of the trial now...the effect on hyperphagia was minimal...” — Facebook users in Vykat discussion groups.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-69aed4bbe21d", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups - “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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“I know some parents are excited...but we are not convinced [sic] is the solution for hyperphagia”; “we heard from some parents that it took a few months to a few YEARS to see a difference”; “I am on the fence on giving the medication...my gut tells me, no...but the guilt of the potential for her future is gnawing at me too”; “my son is 25...we discussed it...I figure we will revisit...in a year when more data and family experiences have been shared...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.952+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eb32af43-617d-4088-b844-d3dc6917bc87", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Vykat is not a truly 'new' medication...my nephew was on it 20 years ago as an infant due to hypoglycemia — Anonymous member. I know some parents are excited...but we are not convinced [sic] is the solution for hyperphagia — Anonymous member 264. we heard from some parents that it took a few months to a few YEARS to see a difference — Top contributor. I am on the fence on giving the medication...my gut tells me, no...but the guilt of the potential for her future is gnawing at me too — Anonymous member. my son is 25...we discussed it...I figure we will revisit...in a year when more data and family experiences have been shared... — Anonymous member.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-dc7073faa325", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRPoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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contraindicated by the extended-release formulation - appear widespread, leading parents to try clearly dangerous methods, such as getting kids to suck tablets through large boba straws - creating risk of aspiration and choking - which the 4th leading cause of death in PWS patients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-98bf1eed019d", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.9, "x": 0.05, "y": 0.35 }, "kind": "image", "text": "Screenshots of Facebook discussion group posts", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Screenshot", "slug": "screenshot", "status": "active", "canonId": "019de52c-fd87-7509-8391-3d79fb339379", "version": 1, "description": null }, "framework": null }, "subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.82+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "517d2e27-7c14-4af9-bdd6-ed7ccf1fe6cd", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "she did gag a little at first but ended up swallowing it!; if she would swallow the pills whole...I may be more inclined to stay on it... — Anonymous parents from Vykat discussion groups.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-9ea7d9056582", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.8, "x": 0.05, "y": 0.92 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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\"I have noticed this on my daughter [sic] shoulder(s)...hang in there...we are in week 8.5...I considered stopping...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:13.451+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ef6641a6-0829-4eba-9c19-f2574e538805", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“my son had allergic reaction and has been in hospital 4 days so we don’t be continuing it.” — Parent in Vykat discussion group", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-4e05d0ee12d5", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.91 }, "kind": "source-note", "text": "Source: Facebook groups - \"Vykat discussion group\" https://www.facebook.com/groups/17JomVRpoV/?mibextid=wwXlfr; \"Vykat for PWS: Evidence, Experience, & Encouragement\" https://www.facebook.com/groups/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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They stated they had patients (I'm assuming in the trial?) that were shaving their foreheads from the excessive hair growth. Was this reported at all? I understand hirsutism is a side effect but was it on random body parts? — Anonymous member, Prader-Willi Support Facebook group", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a6-d4abdbf2e21f", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.75, "x": 0.07, "y": 0.093 }, "kind": "source-note", "text": "Source: Facebook groups – “Vykat discussion group” https://www.facebook.com/share/g/17JomVRpoV/?mibextid=wwXlfr; “Vykat for PWS: Evidence, Experience, & Encouragement” https://www.facebook.com/share/g/14HMwkfXhzm/?mibextid=wwXlfr", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Soleno investor presentation", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:19.888+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "96985a9d-8d18-414f-b0e8-86d70a87876d", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.45, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://investors.soleno.life/static-files/48405466-3bcb-41d8-ae9e-76f388652c12", "attrs": null, "canon": { "kind": { "name": "Source 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They didn't expect that. They expected it to be a slower withdrawal.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a5-f2ab25b7baf9", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "Q: \"I've heard from several investigators that the trial was functionally unblinded because 30% to 40% of patients have a side effect of rapid hair growth. Now, if I look at that withdrawal study, the increase in the HQ-CT score for the placebo patients was so sharp, rapid, and extreme, it actually strains credibility, to be candid with you.\"\nA: \"I know. I hear you, because that was a conversation that was had internally. But it was the data that it was, and they moved forward with it.\"\nQ: \"What was the conversation internally? They didn't believe the data? They thought it was too good to be true?\"\nA: \"They were just surprised to see that it was so extreme, especially given the fact that it seemed to happen so quickly after they came off the drugs. They didn't expect that. They expected it to be a slower withdrawal [...].\"\nQ: \"Were there people inside the company when they saw the randomized withdrawal data, did they really believe it? But they're like, whatever, it's the data, we've got to take it?\"\nA: \"Well, so much of the data is subjective. 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"/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/189", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-189", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "I think, in terms of senior leadership, I think they felt their hands were bound to some extent because she had enrolled so many patients.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, 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"subkind": "screenshot", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:32.6+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4f41f6f3-8fcd-4042-9058-89ec21cb7e6f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.2 }, "kind": "paragraph", "text": "The HQ-CT is a subjective 9-item, observer-reported outcome measure that assesses a range of hyperphagic and food-related behaviors during the prior 2 weeks. An item score of 0 indicates an absence of behaviors, with a score of 4 indicating the most frequent behaviors. The HQ-CT Total Score may range from 0 to 36, with higher scores indicating greater overall severity of food-related behaviors. We excerpt some questions below – the subjectivity is self-evident.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:32.6+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d65a3d10-c6f7-4129-afe6-9a1b0724f695", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.4, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://www.rtihs.org/sites/default/files/Brown_ISPOR.2015_Poster.pdf", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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baseline scores were unusually high and unclear if a “true genuine score”; questioning whether the decline from an inflated score is due to placebo effect", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:17.396+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8fc4a365-d265-49d1-a3c5-eac623b352ad", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "callout", "text": "HQ-CT score is not “very good”; hard to measure hyperphagia; “possible to manipulate it”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:17.396+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ba5ba45f-7414-4f3a-a413-0954616f51ad", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Soleno’s trial investigators broadly repudiated HQ-CT as an outcome measure, as detailed in interview chapters, indicating that: parents exaggerated scores to meet HQ-CT inclusion criteria, with scores clustering around the entry threshold.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a6-707d2fa16847", "parentComponentId": null }, { "bbox": { "h": 0.32, "w": 0.86, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "as detailed in interview chapters, indicating that: parents exaggerated scores to meet HQ-CT inclusion criteria, with scores clustering around the entry threshold; that the average baseline score (22.6 in phase 3) sharply exceeded the 10.3 average per PWS population studies (n=400); that scores could fluctuate >30% weekly based on which parent did the survey. We quote two investigators whose comments were representative: “any kind of score like that...possible to manipulate it”; “skewed if they have overexaggerated” baseline scores; “perception of hyperphagia is a tricky one to quantify”; “the HQ-CT score, it’s not a great marker...it’s a subjective score...whether it’s the mom, dad, or grandparents”; “the median score of 20, that’s a very high score...most of my patients are nowhere near that...is it just placebo effect goes down for the score from 23 down to 15...is that really the drug?”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:17.396+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1c70864a-5386-4ce0-a735-27c8f370596c", "parentComponentId": null }, { "bbox": { "h": 0.16, "w": 0.86, "x": 0.07, "y": 0.78 }, "kind": "quote", "text": "“The other fundamental issue is actually the HQ-CT score. It’s not a great marker. It’s the only tool that we have as validated. But it’s not perfect. You’re basing a lot of your study or your analysis on something that’s not perfect. It’s not like your HbA1c or your cholesterol level. It’s a subjective score. It’s not a hard and fast measurement...it will vary depending on who’s done it, whether it’s the mom, the dad, or grandparents. In terms of the median score of 20, that’s a very high score. And most of my patients are nowhere near that. Now, whether that’s a true genuine score or not, I don’t know...If they’ve got such a high score, is it just purely a placebo effect goes down for the score from 23 down to 15, is that really the drug? Is that placebo? Is that the fact that they’ve done a trial? I don’t know.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:17.396+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1caf122f-6a83-42dc-8941-bb87a13bfa2d", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "quote", "text": "“I don’t think the HQ-CT score is very good, if I’m honest, because I think sometimes the perception of appearance and the level of hyperphagia is different to, say, another caregiver with the same child. So, in a school setting and so on. And it’s hard to know because maybe the child is able to manage or maybe mask some of the hyperphagia. I wouldn’t have thought so in the Prader-Willi Syndrome population, that they should have the ability to do that. But maybe somehow they know in certain settings what they can get away with. But I would say maybe perception of hyperphagia; it is a tricky one to quantify. And I think that’s the difficulty with these studies is what is genuine hyperphagia...I think the problem with any kind of score like that is it is possible to manipulate it.” -Trial investigator, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:17.396+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "af9067bd-849d-4ba0-91f8-0fa85f2adbb8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I don't think the HQ-CT score is very good, if I'm honest, because I think sometimes the perception of appearance and the level of hyperphagia is different to, say, another caregiver with the same child... it is possible to manipulate it.\" — Trial investigator, pediatric endocrinologist; \"The other fundamental issue is actually the HQ-CT score. It's not a great marker... It's a subjective score... it will vary depending on who's done it, whether it's the mom, the dad, or grandparents... If they've got such a high score, is it just purely a placebo effect goes down for the score from 23 down to 15, is that really the drug?\" — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a6-756200726931", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"componentId": "21fc3427-9105-41f0-b4fc-3653d860f7e8", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Soleno has no meaningful intellectual property for Vykat XR as its core composition-of-matter patent for diazoxide choline expires in Dec 2026 – and thus any acquisition scenario is a mirage.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:25+00", "model": "unknown-legacy", "runId": null, 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Despite this IP ploy, Soleno has no meaningful intellectual property for Vykat XR as its core composition-of-matter patent for diazoxide choline expires in Dec 2026 – and thus any acquisition scenario is a mirage. As far as we can tell, Soleno’s Neal Cowen – via a predecessor entity called Essentialis, Inc. – scrounged for two decades to turn his patent from lead into gold, flinging it at every indication under the sun and failing, until at long last winning a PWS indication from the FDA – a pyrrhic victory, as the patent now only has a year left. The FDA Orange Book lists five applicable patents applicable. 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poster comparing DCCR to Proglycem oral suspension", "attrs": null, "canon": { "kind": { "name": "Legend", "slug": "legend", "status": "active", "canonId": "31361933-3d22-4c70-bbad-0801e9fffc0c", "version": 1, "description": "Color/symbol decoder placed adjacent to a chart or diagram." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4440bde5-44ea-49a1-95bd-7046e947ddc1", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.92, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Soleno’s entire existence as a public company is predicated on the purported PK superiority of its tablet in this single poster – that is, it has a lower C-max and thus prevents C-max related adverse events, although no such adverse events are ever explained. Despite this rather narrow and flimsy PK rationale, Soleno has a long history of making shrill and unsupported claims for the tablet. For example, in a 2020 conference video with Jennifer Miller, CEO Bhatnagar references the PK chart in the poster to imply that regular diazoxide rapidly spikes to unsafe levels in the blood; that it is “nearly impossible to use” for PWS; “it has a lot more side effects”; that “you have to repeatedly dose it during the day at these high levels and put the person at significant risk...DCCR was designed to get around these problems...allows us to not only have a better safety profile but also allows us to have efficacy with doses that are half to a third of what can be used with diazoxide today.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0181d694-02f8-418a-b248-849ce9a6a7eb", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“nearly impossible to use”; “it has a lot more side effects”; “you have to repeatedly dose it during the day at these high levels and put the person at significant risk...DCCR was designed to get around these problems...allows us to not only have a better safety profile but also allows us to have efficacy with doses that are half to a third of what can be used with diazoxide today.” — CEO Anish Bhatnagar", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:26+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a7-6a67cefc516b", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "b40452ec-953e-4bb4-bae1-300b0d1fb851", "evidence": "Contrasts CEO's verbal claims with the limited scope of the cited PK chart.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 21:26:21.783+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 203, "frameworkName": "ceo-quote-contradiction" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 204, "type": "tension", "title": "The slide uses a forensic approach to discredit clinical data, specifically targeting the validity of a poster presentation.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 83, "componentCount": 10, "textChars": 1904, "nDataPoints": 0, "notes": "The slide uses a forensic approach to discredit clinical data, specifically targeting the validity of a poster presentation.", "elementsJson": [ "paragraph", "bullet_list", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:03.989+00", "seconds": 12.901, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/204", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-204", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The poster does not provide credible evidence for improved PK properties of DCCR. Instead, it highlights a pattern of data manipulation, non-transparent methodology, and implausible pharmacologic claims, undermining the entire DCCR PK narrative.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:26+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a7-37a5ab4f5dc4", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.85, "x": 0.07, "y": 0.59 }, "kind": "list", "text": "Suspicious half-life claims: The poster describes a ~30-hour half-life, consistent with known diazoxide PK, however, the prescribing information claims a 106-hour half-life with no supporting data.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "051105c8-7bb5-4bcf-846d-5f9158c37f18", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.85, "x": 0.07, "y": 0.51 }, "kind": "list", "text": "Implausible time-concentration curve: The DCCR curve shows a flat 12-hour plateau with identical plasma concentrations (~8 µg/mL) across multiple timepoints — a biological impossibility under first-order kinetics.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "116cb332-2b78-4572-8e43-b675dd46398c", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.85, "x": 0.07, "y": 0.67 }, "kind": "list", "text": "Invalid Tmax shift argument: Cmax is markedly reduced (~40-50%), inconsistent with a pure delay in absorption. AUC appears lower, indicating possible reduced bioavailability, not increased circulating residency time.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7953a53c-8d15-4fb2-bb42-88faec183f74", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.85, "x": 0.07, "y": 0.31 }, "kind": "list", "text": "Only public PK data source: The only publicly available time-concentration data for DCCR we can locate comes from a single poster — not a peer-reviewed publication. This data appears internally inconsistent, methodologically implausible, and likely manipulated.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ad9f5a58-11e2-43a8-825d-189e564c46af", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.85, "x": 0.07, "y": 0.41 }, "kind": "list", "text": "Mismatch between graph and table: The Cmax, Tmax, and AUC values listed in the poster’s table do not match the plotted graph. Cmax and AUC for DCCR are artificially suppressed, yet the elimination phase is identical to that of Proglycem.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ade66f54-5ab4-41d6-93b0-5e3915106d22", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.85, "x": 0.07, "y": 0.77 }, "kind": "list", "text": "Conclusion: The poster does not provide credible evidence for improved PK properties of DCCR. Instead, it highlights a pattern of data manipulation, non-transparent methodology, and implausible pharmacologic claims.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c5bde164-34fa-4a92-a98b-79c0f2cbad5c", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.85, "x": 0.07, "y": 0.23 }, "kind": "paragraph", "text": "We hired a pharmacologist PhD with decades of experience in PK studies to analyze Soleno’s DCCR claims. The key takeaways from that analysis are below.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a025622f-a766-4384-a5c5-0ce6e7ef112d", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.2, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a266d9fb-aace-49a3-b7d8-25e31b3c884b", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The PK data in the poster and the CEO’s claims, in our view, are phony and designed to fabricate a pretense for its tablet", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0a41f1db-60de-4cb9-b2f8-660cf76e7f41", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "2a0340bf-96d2-4b08-aed2-d6f5badd0ce5", "evidence": "The slide systematically deconstructs clinical data to allege manipulation and fraud.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:14:03.989+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 204, "frameworkName": "fraud-exposure" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 205, "type": "tension", "title": "The slide uses annotated charts to highlight alleged data manipulation in a clinical study.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 58, "componentCount": 7, "textChars": 1053, "nDataPoints": 0, "notes": "The slide uses annotated charts to highlight alleged data manipulation in a clinical study.", "elementsJson": [ "headline_text", "paragraph", "line_chart", "callout_box", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:04.704+00", "seconds": 12.684, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/205", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-205", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The oral suspension curve is oddly pointy and the DCCR curve is flat with identical concentrations over 12 hours", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:26+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a7-99d8c5266067", "parentComponentId": null }, { "bbox": { "h": 0.23, "w": 0.32, "x": 0.07, "y": 0.068 }, "kind": "chart", "text": "Simulation of poster figure conforming to first order rules", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2cf85dc5-ab2a-4f0c-a938-ccca8ee47e40", "parentComponentId": null }, { "bbox": { "h": 0.23, "w": 0.32, "x": 0.07, "y": 0.38 }, "kind": "chart", "text": "Figure 1. Plasma concentration 0-120 hours in clinical study PK001", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5c4be049-6f46-4b62-9aad-0b27110c5a31", "parentComponentId": null }, { "bbox": { "h": 0.5, "w": 0.55, "x": 0.38, "y": 0.38 }, "kind": "list", "text": "The DCCR curve is flat with identical drug concentrations encompassing 6 timepoints over a 12-hour plateau. The half-life for DCCR throughout the poster is ~30 h. The elimination phase oddly spans Tmax to 96 h as a straight line. Lack of other publicly available DCCR data.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e15600b7-df2c-49ae-8ffe-deda8b6e3830", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.85, "x": 0.07, "y": 0.14 }, "kind": "paragraph", "text": "The blue curve shows DCCR plasma concentration, and is flat with identical drug concentrations over 6 timepoints over a 12-hour plateau – a fantasy that strains credibility, suggesting to us that the authors just chopped off the top of the blue curve to make it look less spiky than oral suspension - sloppy 7th grade-level data games.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7b62b772-b08e-4fc6-adb8-21363b4f83ca", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://abstracts.eurospe.org/hrp/0089/eposters/hrp0089lb-p8_eposter.pdf; Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Plasma concentration 0-120 hours in clinical study PK001 (mean±SEM)", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.003+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fd54a925-608a-4d0d-a69b-32b9c55c68b3", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "As the proverb goes, “to hide a lie a thousand lies are needed” – we find that the culprits invariably get sloppy. We note that the key data in the table - the Cmax, Tmax, and AUC for DCCR - do not match the graph even though they are placed adjacent to each other. 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Single dose non-transformed plasma pharmacokinetic parameters", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.003+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "57506b75-108b-4a73-99b7-052d33e27ed8", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "A reliable clue for potential scientific misconduct is when authors can't even keep their own numbers and values straight in the same paper", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.003+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0051bb1b-305c-4d0d-8032-b47a3dcab6a3", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.37 }, "kind": "title", "text": "2018 PK paper excerpts – the foundation for DCCR tablet formulation vs. diazoxide suspension", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.003+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1141b9a2-b9a9-4e7f-8af9-abf3837bb7aa", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "cddb2243-d405-4e7d-b94d-3b8ed63e81c5", "evidence": "The slide explicitly claims to expose scientific misconduct through data contradiction.", "framework": null, "confidence": 0.95, "extraction": { "at": "2026-05-02 20:14:09.003+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 206, "frameworkName": "fraud-exposure" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 207, "type": "tension", "title": "The slide presents a Q&A transcript excerpt highlighting potential fraud and competitive threats.", "function": "expose_contradiction", "rawType": "testimonial", "block": null, "metadata": { "slideType": "testimonial", "slideTypeCanon": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52d-0a2d-7782-8a48-7e84df92cc97", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 51, "componentCount": 5, "textChars": 2819, "nDataPoints": 0, "notes": "The slide presents a Q&A transcript excerpt highlighting potential fraud and competitive threats.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:05.51+00", "seconds": 12.918, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/207", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-207", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "I do believe it was slightly manipulated...Off-label, certainly people could use it...you’re completely right. If this is really such a good drug, people can use diazoxide and suspension exactly the same way for pennies on the dollar.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:27+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a8-196d9bfe5bdf", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "A former employee who played a key role in Soleno’s clinical trial program confirmed our view that the data in the PK paper was manipulated – the ex-employee diplomatically phrased it as “slightly manipulated” – and concurred that off-label substitution by generic diazoxide suspension is a key threat to Vykat – “I agree with you 100%, and I agree with your take on Neil Cowen’s PK paper...I do believe it was slightly manipulated...off-label, certainly people could use it...you’re completely right...if this is really such a good thing, people can use diazoxide and suspension exactly the same way for pennies on the dollar.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.51+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f5b80d29-6aba-468f-9a81-1be5e241841a", "parentComponentId": null }, { "bbox": { "h": 0.48, "w": 0.86, "x": 0.07, "y": 0.42 }, "kind": "quote", "text": "Soleno PK paper was manipulated; generic liquid suspension is perfectly substitutable with Vykat\nQ: “There's a PK paper from Neil Cowen a few years ago — you may have seen it — that compares the cMax, tMax, etc. of DCCR with oral suspension. I had a pharmacologist who looked at that data and said, look, these things are functionally identical. They manipulated the data for the oral suspension in the PK paper to make it look like it has a higher peak. All you need is a slightly different dose of oral suspension to achieve essentially the same steady state plasma concentration in a few days as with DCCR. The drug has a very long half-life. And it seems to me that aside from a safety signal coming out, the biggest threat to the company is that doctors are going to figure out that you can just prescribe generic diazoxide oral suspension off-label without all the problems of a tablet. What is your take on oral suspension, that formulation versus DCCR? It seems disingenuous to me.”\nA: “I agree with you 100%, and I agree with your on your take on Neil Cowen’s PK paper. I do believe it was slightly manipulated. Unfortunately, our system is such that if you didn't test diazoxide as such in Prader-Willi, you can't really have an indication for it. Off-label, certainly people could use it...you’re completely right. If this is really such a good drug, people can use diazoxide and suspension exactly the same way for pennies on the dollar.” – Ex-senior Soleno employee #1, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.51+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f9309876-fc64-4827-8fbc-950a49f4f72a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I agree with you 100%, and I agree with you on your take on Neil Cowen’s PK paper. I do believe it was slightly manipulated...Off-label, certainly people could use it...you’re completely right. 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Extends efficacious plasma levels over time: possible once daily dosing (QD); shift and flatten curve: ↑Tmax and ↓Cmax", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.799+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5242ee26-8163-44f5-9689-91571b4a616b", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.85, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "As shown in the example below, where the green line represents the ideal outcome for XR vs generic blue line. 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"bbox": { "h": 0.35, "w": 0.5, "x": 0.05, "y": 0.22 }, "kind": "chart", "text": "Comparison of Immediate Release vs Slow Release (XR) concentration over time.", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.093+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2ce27479-2358-4353-a242-af37104b5264", "parentComponentId": null }, { "bbox": { "h": 0.7, "w": 0.38, "x": 0.58, "y": 0.22 }, "kind": "list", "text": "Diazoxide is avidly bound to albumin (>90%) and eliminated in kidney extending its half-life to 30 h (XR form = minimal benefit – may decrease XR bioavailability). Diazoxide already has a slow absorption rate (Tmax of 4 to 6 hours) (XR minimal benefit). Why make a salt form? Proglycem is already >95% absorbed (XR likely to decrease XR bioavailability). Albumin-bound inactive drug is the body's slow-release form (10% circulating at any time) over a long period of time (proglycem half-life = 30 h) (XR minimal benefit). Limited decrease in plasma levels with XR. XR formulation may decrease bioavailability due to unabsorbed fraction reaching the colon (human transit time to colon ~ 10 h). 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Soleno claims that diazoxide choline salt is “more soluble” but with no comparator - more soluble than what? If increasing solubility would improve formulation it would make sense to use the Na salt form which is 25-50-fold more soluble than diazoxide choline. This form is only used for IV injection - why? Because the base form, Proglycem is hard to improve upon. 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Proglycem (many published sources) and DCCR (not disclosed)", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.617+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "43d54639-085e-470c-bffd-3efeda60f4be", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.4, "x": 0.53, "y": 0.26 }, "kind": "callout", "text": "Poster figure (manipulated, in our view) -> DCCR = low bioavailability", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.617+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f038412d-7a62-478b-9166-8170fde9bad0", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Therefore, our PK modeling leads us to conclude that Vykat is inferior from a PK standpoint vs. regular diazoxide – diazoxide has such a long half life that an extended-release version actually worsens its bioavailability profile.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:27+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a8-030c048879e3", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.4, "x": 0.07, "y": 0.38 }, "kind": "chart", "text": "Simulated Plasma Concentration Curves for Diazoxide", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.617+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5fd781f3-cef0-414e-8e6e-5bd637da303c", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.4, "x": 0.53, "y": 0.38 }, "kind": "chart", "text": "Figure 1. Plasma concentration 0-120 hours in clinical study PK001", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Line chart", "slug": "line", "status": "active", "canonId": "019de52c-ff62-778f-8f6c-a952ceae8677", "version": 1, "description": null }, "framework": null }, "subkind": "line", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.617+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a0495545-67d1-4f41-8571-1938d5a08d1a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Therefore, our PK modeling leads us to conclude that Vykat is inferior from a PK standpoint vs. regular diazoxide – diazoxide has such a long half life that an extended-release version actually worsens its bioavailability profile. We note that various endocrinologists we interviewed noted diazoxide’s long half life, questioning why Soleno’s extended-release tablet was necessary.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.617+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "789640a2-208a-4639-a933-3a5fba0adc67", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Incorrect: Biologically insignificant peak to trough ratios (modeled, ~1.75 vs 1.5) expected due to high protein binding of and resulting long circulating half-life.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1601e5a0-0727-4029-ac5c-f215fbb33f1b", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.7 }, "kind": "list", "text": "Proglycem can not be substituted for DCCR - Incorrect: it’s a math trick. DCCR mg dose includes the weight of the choline salt (unconventionally). Proglycem dose includes just the weight of the active diazoxide (conventionally). To equate DCCR dose with proglycem just multiply DCCR dose by 0.66 (since DCCR is ~66% diazoxide and 33% salt)", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "184b8ad6-504d-43f1-a89d-967e79314794", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.37 }, "kind": "list", "text": "DCCR XR will have an improved residency time vs proglycem to support QD - Incorrect: Diazoxide circulates tightly bound to plasma proteins (>90%). Plasma bound diazoxide slow released to interstitial space in circulation. DCCR’s slowed absorption likely decreases its bioavailability (some is excreted prior to absorption) but MRT should be similar for both forms.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "42cb610f-7f08-44db-bb29-7916c72be2d8", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "list", "text": "DCCR better than oral suspension – more convenient QD - Incorrect: liquid formulation is easily tailored to maintain uniform mg/kg dose in children/adults. Oral proglycem tablets are also available.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "574a7145-4ce1-4576-9385-14d38f7e9d81", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "list", "text": "Better peak to trough/smoother plasma levels - Incorrect: Low levels circulating DCCR (Cmin at steady state) likely due to decreased bioavailability (they hide PK data & manipulate those few data shared).", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5e42c37f-cb64-4833-a074-8732a060582a", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "list", "text": "Diazoxide XR (DCCR) supports QD vs proglycem BID - Incorrect: Both support QD. Proglycem PK characteristics already support QD dosing. BID proglycem: convention over decades and overabundance of caution in children & young adults.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7329ca75-78ba-4bf4-9880-461bc2ba28e1", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital analysis and estimates", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6bc954e9-16ce-4fd1-b53a-e46ba7be8fb4", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "We summarize our pharmacology consultant’s key takeaways, which indicate there is no pharmacokinetic rationale to use Vykat XR tablets vs. regular diazoxide suspension whether in inexpensive Proglycem form or an even cheaper generic. The suspension can also be dosed once daily, and can also be titrated more precisely.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9a80d69a-1e91-4c39-aba3-2ec141d01308", "parentComponentId": null } ], "metrics": [], "tools": [ { "tool": { "name": "List presentation", "slug": "list-presentation", "status": "active", "bestFor": null, "canonId": "019dd9e1-4ef7-777d-ba68-9074c2b3bcf1", "version": 1, "bodyDocId": null, "description": "Bulleted, numbered, or checklist enumerations.", "familyLabel": null, "categoryName": null, "categorySlug": null }, "agent": null, "layer": "slide", "agents": null, "matchId": "39613fbe-a3e1-4fa8-b9ed-ea3eb76f26c4", "evidence": "The slide presents a list of bullet points summarizing the pharmacology consultant's key takeaways.", "pageRefs": null, "priority": null, "whenToUse": null, "confidence": 0.7, "extraction": { "at": "2026-07-16 23:10:06.691118+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 213, "whyItWorks": null, "antipattern": null, "cardinality": "common", "narrativePurpose": null } ], "frameworks": [ { "matchId": "ac2a66bd-586e-456f-8989-873db1be009c", "evidence": "The slide systematically lists common arguments for a product and refutes them with 'Incorrect' labels and counter-evidence.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:14:07.659+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 213, "frameworkName": "preempt_rebuttal" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 214, "type": "tension", "title": "The slide uses molecular weight calculations to expose that DCCR is simply a salt form of diazoxide, implying the price premium is unjustified.", "function": "expose_contradiction", "rawType": "precedent_table", "block": null, "metadata": { "slideType": "precedent_table", "slideTypeCanon": { "name": "Precedent table", "slug": "precedent_table", "status": "active", "canonId": "019de52d-115e-757e-a38f-486981054171", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 74, "componentCount": 7, "textChars": 1652, "nDataPoints": 44, "notes": "The slide uses molecular weight calculations to expose that DCCR is simply a salt form of diazoxide, implying the price premium is unjustified.", "elementsJson": [ "paragraph", "data_table", "bullet_list" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 21:26:24.356+00", "seconds": 8.358, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/214", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-214", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "They are pharmacologically identical, but marketed with obfuscated dosing units and for price-gouging purposes only.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:27+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a8-a79d91d0f503", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.4, "x": 0.07, "y": 0.55 }, "kind": "paragraph", "text": "DCCR (diazoxide choline controlled-release) is a salt form of diazoxide, specifically diazoxide choline, which combines diazoxide (the active drug) with choline (a counterion to form the salt). Molecular Weights: Diazoxide (C8H7ClN2O2S): ~230.67 g/mol Choline (C5H14NO): ~104.17 g/mol Diazoxide choline (1:1 salt): ~334.84 g/mol To find the % of diazoxide in diazoxide choline: [(230.67) x (104.17)] x 100 = 68.9% Approximately 69% of DCCR is actual diazoxide by weight; the remaining ~31% is the choline salt portion Proglycem is 100% diazoxide To calculate dose-equivalents for Proglycem: [(mg dose DCCR) x (0.689)] = mg dose Proglycem", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.356+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "038ec1f1-d603-4968-bc7a-1b1bc1d3fe28", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "Circulating DCCR and Proglycem deliver identical molecular forms of diazoxide. They are pharmacologically identical, but marketed with obfuscated dosing units and for price-gouging purposes only. There is no difference in the circulating form, and no meaningful difference in pharmacokinetics (AUC, half-life, or mean residence time) when bioavailability is held constant. Simply put, only 69% of DCCR’s stated weight is diazoxide. 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"status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.008+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fcacb86c-0665-42df-ae64-5ddcef566568", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "An endocrinologist at Massachusetts General who treats PWS stated that most physicians are familiar with MDCalc.com - used by 80% - which provides dosage conversions – and that a conversion equation or table posted there would hasten Vykat substitution via off-label oral suspension", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.008+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f2724530-5011-4ea1-91e0-113a1ce62e2c", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "quote", "text": "of course...that’s probably what it will come to...I think that’s what it’s going to come to; kids like drinking liquids; if there’s an equation, we’ll find it; if it's on MDCalc, I think we'll feel good about it", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.008+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "750ebee1-5884-4c6c-a74c-331c1de7275c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“of course...that’s probably what it will come to...I think that’s what it’s going to come to”; “kids like drinking liquids”; “if there’s an equation, we’ll find it”; “if it’s on MDCalc, I 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As examples, we paste comments from the two different endocrinologists below, from the chapters on investigator and physician interviews – one was a study investigator.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.31+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2da70012-e07e-4fc3-9313-c178766d7eac", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.69 }, "kind": "quote", "text": "Extensive experience with generic diazoxide; unconvinced that Vykat extended release formulation adds any value. Diazoxide I use regularly... I'm not convinced whether it's the actual choline... or whether, is it really just the diazoxide?", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.31+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9010c9c0-8590-4ded-a9c9-52a5303d3670", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "quote", "text": "No reason to not use generic diazoxide suspension vs. Vykat; highly skeptical of arguments for Vykat vs. generic. ...this is the thing that is really a big question in my mind... Why wouldn't I just be prescribing diazoxide?", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.31+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a42e8d5f-431c-4e1c-a562-b1f990154453", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“...this is the thing that is really a big question in my mind, because I don't really understand why — I haven't gotten a good answer, I don't feel like — why extended-release is necessary for this mechanism of action. And I feel cynically or realistically, that they're marketing an extended-release to get a different drug so they can get the patent. Why wouldn't I just be prescribing diazoxide?” — Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center. “Diazoxide I use regularly...I am familiar with diazoxide, and I have been using it for many years. I normally give 2-3 times a day, and there is a liquid preparation. There are capsules. Although the liquid preparation, which is more stable...I suppose the question — is it worth the difference? [...] it's probably just the diazoxide, where the extended release probably makes no difference at all [...] I'm not convinced whether it's the actual choline, the extended choline release that makes a big difference, or whether, is it really just the diazoxide?” — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:28+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a9-ef5a7c5d740e", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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no need to give liquid 2-3X a day for PWS", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.626+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dc5fa2b6-efa1-47a2-ae88-fe67f87851ae", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.69 }, "kind": "quote", "text": "“I don't really know why a drug that's targeted at children would ever be a tablet because it's a nightmare. [...] I don't know why they've picked a tablet over a suspension.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.626+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "08c84736-790b-43b6-b54a-e52d5ee78701", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.49 }, "kind": "quote", "text": "“Yeah, a suspension is always going to be better. And I didn't appreciate it was going to be so expensive.” ... “Yeah, they should be. For Prader-Willi, I don't think you'd need to worry so much about titrating it...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.626+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "62ba7f5f-3121-4450-b74f-a6e2d14ab4f1", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.88 }, "kind": "quote", "text": "“...it does last. I know it's got a long half-life... Could we just use diazoxide instead of this very expensive Vykat? That's probably true.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:03.626+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8ccfbce1-6af6-4510-a0e9-bcb73d60d5d9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Yeah, a suspension is always going to be better. And I didn't appreciate it was going to be so expensive. [...] I think even if, say, they were on the same oral suspension and you were worried about peak levels or whatever, you still wouldn't really need to give it two to three times daily, I don't think, because it's a different. — Trial investigator, pediatric endocrinologist; I don't really know why a drug that's targeted at children would ever be a tablet because it's a nightmare. [...] I don't know why they've picked a tablet over a suspension. And I guess they say it's because you need to give the suspension two to three times daily. But again, I think they're referring to what we do in hyperinsulinism, which is a very different condition. And we're giving that medicine because we want the sugars to be kept within a certain range, whereas in Prader-Willi Syndrome, managing the hyperphagia, it doesn't need to be done in that similar way. — Trial investigator, pediatric endocrinologist; ...it does last. I know it's got a long half-life, although we routinely prescribe it 2-3 times a day, I know as a child is older — the babies need more but as a child is older, once a day and even when they come off it, it takes a week or even two weeks before you see the kind of effects of diazoxide wearing off. I know it's got a long half-life. Could we just use diazoxide instead of this very expensive Vykat? That's probably true. My management will ask, \"Well, fine. You have no other drug? Okay. 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Do not split, crush, or chew the extended-release tablets because doing so may compromise the extended-release characteristics, efficacy, or safety of VYKAT XR.\n17 PATIENT COUNSELING INFORMATION\nAdvise the patient to read the FDA-approved patient labeling (Medication Guide).\nAdministration Instructions\nAdvise patients to swallow tablets whole and not to split, crush, or chew VYKAT XR [see Dosage and Administration (2.2)].\nHow should I take VYKAT XR?\n• Take VYKAT XR exactly as your healthcare provider tells you to take it. Your healthcare provider will decide how much VYKAT XR you will take and may slowly increase your dose when you first start taking VYKAT XR.\n• Take VYKAT XR by mouth 1 time per day with or without food.\n• Swallow VYKAT XR tablets whole. Do not split, crush, or chew the tablets.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.62+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cf7cf121-2d40-43c6-a010-9d13e5e34c7e", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "In addition to zero pharmacokinetic, clinical, or dosing benefit, Vykat’s tablet formulation is reckless and dangerous versus oral suspension: prescribing tablets to children 4 and up per the label defies common sense, as liquids are the standard of care in pediatrics; choking/aspiration is the third-leading cause of death in PWS patients; numerous investigators told us kids had difficulty swallowing the tablet and were chewing it instead, which is contraindicated in the label and defeats the purpose of an extended-release tablet. Moreover, chewing turns Soleno’s only argument about Vykat’s purported PK superiority on its head, since it releases the entire dose at once, and thus the CEO shoots himself with his own arrow by claiming that “high levels...put the person at significant risk.” The FDA label warns three different times against chewing or cutting the tablets.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.62+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f01173d4-a974-4c25-9b66-4e8305bd99a4", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“high levels...put the person at significant risk.” — Soleno CEO", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:27+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a8-78b7985c7df8", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.4, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/216665s000lbl.pdf", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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One of the investigators called it a horse pill. I don’t know if the pill is really that large. I don’t know if he was exaggerating, but he said, these kids were chewing it anyway. The label says you’re not supposed to chew it or cut it, because then it’s no longer extended release.”\nA: “There were definitely kids not able to swallow it...for a small child, any pill is difficult to take.”\nQ: “The standard of care for pediatrics is a liquid suspension. Did you guys see issues with kids swallowing it? One of the investigators said, choking is a fourth leading cause of death for these kids.”\nA: “It is. It is a very serious issue in these patients. I think the oral suspension would make more sense for delivery. 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“they’re going to chew it”; “I was concerned because the fourth most common cause of death...is choking...they can’t swallow...they have dry mouth...their suck reflex is poor...their choking reflex is poor...it’s a problem...I saw that...they would chew, those that I witnessed...concerns with that big pill....make sure your child doesn’t choke...after I saw the size of that pill and said, oh my God, they’re never going to swallow this...I guess if you chew it, you swallow it in smaller pieces.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:20.211+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "643f2690-a3b4-4e5f-93b0-e93506e31efa", "parentComponentId": null }, { "bbox": { "h": 0.42, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "paragraph", "text": "Q: “What did you observe about the formulation? Because it seems to me like, how do you get a four-year-old kid to swallow an extended-release tablet? Because extended release, you can’t cut it or chew it?”\nA: “Well. You can’t. That was a concern I had, too, when I first came in. It’s like a horse pill. But what happens? I don’t know if you’ve ever seen Prader Willi patients, but you put something in their mouth what they do, they’re going to chew it and swallow it, probably people that are constantly eating anything and everything. And I was concerned because the fourth most common cause of death, in Prader-Willi Syndrome is choking. For a four-year-old, the most common cause of death in a four-year-old Prader-Willi is choking on a hot dog...they can’t swallow, they have poor teeth, they have dry mouth, they swallowing difficulties, their suck reflex is poor, their choking reflex is poor. It’s a problem. I saw that. I said, that’s it. You can’t ever get this — they’re never going to swallow this pill. But what they do, they chew it...you can’t chew because you’ll destroy the drug; it has to stay intact —”\nQ: “[Redacted number] patients that you enrolled in the trial, were they all chewing the pill?”\nA: “Pretty much. They would chew, those I witnessed. Once every three months, I’d see them and they would.”\nQ: “They’re not supposed to chew it. That ruins the extended release.”\nA: “Well, but some of them do. They chew it, but they’ll chew it into maybe a half a piece, but it’s still opened up. So, it’s an issue....the big pill, I was concerned about that because the swallowing difficulties...That was something I addressed with them. About concerns with that big pill: we got to make sure that your child doesn’t choke because we’re concerned about the dry mouth, the poor dentition, poor enamel, and the swallowing difficulties...because after I saw the size of that pill and said, oh my God, they’re never going to swallow this. But then I said, well, they’re chewing it. Okay. 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Ex-Soleno employees and others close to the trials corroborate safety and other concerns", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:05.258+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b0611a28-c56c-4fc6-b9d8-e07651458503", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 224, "type": "tension", "title": "The slide uses a Q&A transcript format to highlight negative sentiment from former employees.", "function": "expose_contradiction", "rawType": "testimonial", "block": null, "metadata": { "slideType": "testimonial", "slideTypeCanon": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52d-0a2d-7782-8a48-7e84df92cc97", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "dense", "densityScore": 59, "componentCount": 6, "textChars": 3022, "nDataPoints": 0, "notes": "The slide uses a Q&A transcript format to highlight negative sentiment from former employees.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:08.876+00", "seconds": 14.122, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/224", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-224", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": { "x": 0.93, "y": 0.62 }, "kind": "callout", "text": "\"Substantial number\" of trial investigators are skeptical of the drug; potentially devastating adverse events", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.876+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ac44327-caf2-407c-a169-73a83d4d5ec7", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "I fail to see how any third-party payor would accept this as a treatment...I just find it very hard to think that third-party payers are just going to do that. It’s a bit like the Sarepta drug or something. You have one devastating DKA and heart failure. I think they had some serious adverse effects where somebody was admitted to the ICU.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:28+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a9-18fcae1627fa", "parentComponentId": null }, { "bbox": { "x": 0.93, "y": 0.55 }, "kind": "paragraph", "text": "We interviewed three ex-employees of Soleno, in key roles involving the clinical trial program, engagement with study sites and investigators, as well as medical affairs. All three questioned Soleno's conduct and that of a key investigator; two stated they left as they doubted the drug's efficacy and safety profile - and all three opined that the Vykat launch is likely to be dead-on-arrival. We begin with the first ex-employee, who stated that Soleno's own trial investigators think the drug is a failure and are unlikely to prescribe it: “...other physicians are not so bullish about it...if you talk to some of the other investigators other than Jennifer Miller, you might get a different impression...I would say that you have a substantial number of investigators who are not so bullish about the drug”; “I fail to see how any third-party payor would accept this as a treatment...it’s a little bit like the Sarepta drug...you have one devastating DKA and heart failure...I think they had some serious adverse effects where somebody was admitted to the ICU.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.876+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7433fbff-476f-4c3e-a04a-92a64788724a", "parentComponentId": null }, { "bbox": { "x": 0.93, "y": 0.88 }, "kind": "quote", "text": "A: \"I fail to see how any third-party payer would accept this as a treatment...I just find it very hard to think that third-party payers are just going to do that. It's a bit like the Sarepta drug or something. You have one devastating DKA and heart failure. You might want to talk — Jennifer Miller is a big advocate of this drug, and she has put a large number of patients into the trial. But, tother physicians are not so bullish about it.\"\nQ: \"You mean the investigators?\"\nA: \"Yeah, if you talk to some of the other investigators other than Jennifer Miller, you might get a different opinion.\"\nQ: \"Do you think most investigators, would you say that they would be not enthusiastic about the drug? Is that your assessment, talking to them?\"\nA: \"I would say you have a substantial number of investigators who are not so bullish about the drug.\" - Ex-Soleno employee #1, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.876+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e98a8700-8d61-4a10-9a49-b17b08a852e6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“...other physicians are not so bullish about it...if you talk to some of the other investigators other than Jennifer Miller, you might get a different impression...I would say that you have a substantial number of investigators who are not so bullish about the drug”; “I fail to see how any third-party payor would accept this as a treatment...it’s a little bit like the Sarepta drug...you have one devastating DKA and heart failure...I think they had some serious adverse effects where somebody was admitted to the ICU.” — Ex-Soleno employee #1", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:28+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2a9-1dad6dc7b5b1", "parentComponentId": null }, { "bbox": { "x": 0.35, "y": 0.97 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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“with a completely soft endpoint, it’s very tricky and it’s very hard to blind yourself…just from the side effects, it’s pretty clear whether you’re on active drug or not.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eaf776de-d9da-44ce-8f41-3d418b766049", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "quote", "text": "“Surprised” at FDA approval; issues with largest trial site; trial was essentially unblinded\n“Very candidly…I’m kind of surprised that the FDA gave them an approval. And I don’t know if they audited Jennifer Miller’s site. But with a completely soft endpoint, it’s very tricky and it’s very hard to blind yourself to this drug. You can say I’m on placebo or whatever, but just from the side effects, it’s pretty clear whether you’re on active drug or not. It’s really challenging to blind.” – Ex-Soleno employee #1, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1e5b9a09-94cd-4673-9baa-7589e894bb31", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.66 }, "kind": "quote", "text": "Trials were functionally unblinded; won’t penetrate an already tiny market; “don’t think that data exists” to show it helps PWS\nQ: “Several investigators have said they thought the trial was functionally unblinded because the side effects — the hair growth, the edema — it seems like a lot of parents apparently were trading notes on like on some WhatsApp or Facebook group. They were saying that the DCCR smelled different than placebo. I don’t know if that’s accurate or not. I mean, even a little bit of functional unblinding in the context of a caregiver questionnaire can make a trial completely useless.”\nA: “Yes, completely. I agree with you. And I think that was the challenge with this compound all the way. And the stock has gone up astronomically since they got the last Phase 3 result and the and the approval from the FDA. But I find it difficult to think that they will be able to really penetrate even a limited market just because of the adverse effects, the need for very, very close monitoring…how that plays out in terms of the kids are not gaining weight over the next five years and having a more normal life, I just don’t know because I don’t think that data exists.” – Ex-Soleno employee #1, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.779+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "770196d3-7a22-4d4f-b08f-3555c4504c15", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Very candidly...I'm kind of surprised that the FDA gave them an approval. And I don't know if they audited Jennifer Miller's site. But with a completely soft endpoint, it's very tricky and it's very hard to blind yourself to this drug. You can say I'm on placebo or whatever, but just from the side effects, it's pretty clear whether you're on active drug or not. 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lack of objective endpoints in the label claims; lack of confirmatory behavioral changes; serious risk of diabetes and need for titration", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.347+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6dd0c2a7-0ea7-4c83-b494-cb334f684962", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.38 }, "kind": "quote", "text": "So, when you have a soft endpoint like this and it's not 100% backed up by some of the other objective endpoints... It boils down to a very soft hyperphagia questionnaire.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.347+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "75f36d9f-1a1b-4629-bbc6-1410f959878e", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.62 }, "kind": "quote", "text": "Phase 3 was a “cherry-picking exercise” with a post-hoc subgroup analysis, “quite underwhelming”; “big safety signal as well”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.347+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b25f97f9-bb2f-4598-924a-61d63934a52d", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.78 }, "kind": "quote", "text": "DEXA data was useless. You can also ask for the DEXA scan data because that for fat mass theoretically should not lie. I know that for one of the trials, they were not able to manage the data too well because they didn't set standards.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.347+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f96dfb30-54aa-4f73-992a-623f0f0a5b39", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“So, when you have a soft endpoint like this and it's not 100% backed up by some of the other objective endpoints, like, say, a DEXA scan to show improvement in fat and fat muscle ratio has changed or the HOMA-IR is overall trending downwards or unchanged for a metabolic signal. 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that in one case “admitted because of fluid overload,” which is consistent with Vykat-induced edema; that “it is not reflected” in the paper because “it was not attributed to the drug,” and questioned whether this was appropriate as the patients were young and “didn’t have underlying cardiac disease or renal disease” and “you can’t exclude a causal relationship” – “I believe one of the cases may have been in Harvard and the other one must have been in the UK...but MGH had a patient who was admitted for fluid overload and potential heart failure”; “if you have hyperglycemia and diabetes, and you have edema and heart failure, and I do believe there were a couple of patients hospitalized with heart failure just to reduce appetite, it may not be a risk worth taking”;", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:04.264+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "035d5b6f-0fae-4c89-9076-29cdbb9b3d98", "parentComponentId": null }, { "bbox": { "h": 0.5, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "“Couple of patients hospitalized with heart failure” during trials; lacked underlying factors for cardiac risk; Q: “The company has touted that it’s, 'a clean FDA label without any monitoring requirements.' On the other hand, it has this titration schedule. Those two things are pretty contradictory. You don’t have this kind of a titration schedule if you think your drug is really safe.” A: “No. I worked on many drugs with titration schedules...but if you have hyperglycemia and diabetes, and you have edema and heart failure, and I do believe there were a couple of patients hospitalized with heart failure just to reduce appetite, it may not be a risk worth taking.” Q: “There were a couple of patients that were hospitalized for heart failure?” A: “I do believe so. In the earlier trials. The Phase 3, the negative trials.” Q: “And did they reflect that in the adverse events table? Hold on. Let me pull up the adverse events table for that.” A: “It is not reflected because I think it was not attributed to the drug. They said there were other factors.” Q: “And did you agree with that assessment?” A: “Well, you can never tell 100%, right, when somebody is on an experimental drug, unless they are popping in and out of the hospital with heart failure every two or three months. When somebody develops it on the drug, there’s always a feeling at the back of your mind that you can’t exclude a causal relationship.” Q: “Were there things here that made you wonder if there might be a causal relationship, like lack of other factors that predispose them to heart disease? This is for younger patients, so it is very surprising. Were there things that put a question mark in your mind?” A: “Again, they didn’t have significant underlying cardiac disease or renal disease. I think they had some kind of intercurrent illness and were admitted because of fluid overload. And they were treated successfully. I believe one of the cases may have been in Harvard and the other one must have been in the UK. But MGH had a patient who was admitted for fluid overload and potential heart failure. 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Or they just couldn't really talk about it?\" A: \"There was a lot of pressure to not have the investigator assessment to be causally related to the study drug.\" – Ex-Soleno employee #1, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.439+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "18a1d35e-5f19-4c1b-a20c-138e08375a24", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.59 }, "kind": "paragraph", "text": "Q: \"Were there people at the company arguing for the inclusion of those two adverse events, cardiac adverse events in the paper? Or you just knew that you could get fired if you did that?\" A: \"The atmosphere at the company was very much to downplay the adverse effects [...] if you were to follow up with the company, I would really press on what were the hospitalizations of patients in the trials? And to just ignore the causality and just look at what the case -\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.439+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "24b8a0c5-7952-4b15-9b03-d9302c717971", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.71 }, "kind": "paragraph", "text": "Q: \"Were there hospitalizations beyond the cardiac situations, or is that what you're referring to?\" A: \"The cardiac the two big ones and, yeah, I think that was the two big ones.\" Q: \"Were there any other minor hospitalizations?\" A: \"They're just written in the label. But, the diabetes, there's a double asterisk footnote under the hyperglycemia. Edema, pulmonary edema. Pulmonary edema you can die from. Right. It's basically heart failure. 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Fluid overload, fluid imbalance.\" Q: \"And how old were these patients?\" A: \"They were all young. The oldest patients in the trial were under 40...I think people are highly incentivized to downplay things that could be on the fence...when you have a causal relationship, uncertain or not known, then they decide to not include those type of things in publications.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:08.439+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d08ef9f1-da69-45d3-8aae-7d9bac7f308d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "They were all young. The oldest patients in the trial were under 40...I think people are highly incentivized to downplay things that could be on the fence...when you have a causal relationship, uncertain or not known, then they decide to not include those type of things in publications. [...] The atmosphere at the company was very much to downplay the adverse effects [...] if you were to follow up with the company, I would really press on what were the hospitalizations of patients in the trials? 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generic liquid suspension is perfectly substitutable with Vykat", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.57+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "204b905c-8f2a-4384-aa0b-53f1aafafb9f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.43 }, "kind": "quote", "text": "A: \"I agree with you 100%, and I agree with your on your take on Neil Cowen's PK paper. I do believe it was slightly manipulated... Off-label, certainly people could use it... people can use diazoxide and suspension exactly the same way for pennies on the dollar.\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.57+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ae893157-995e-4866-8778-3ab9dbac4bdf", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.27 }, "kind": "quote", "text": "Q: \"There's a PK paper from Neil Cowen a few years ago... the biggest threat to the company is that doctors are going to figure out that you can just prescribe generic diazoxide oral suspension off-label...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.57+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d9329578-9c1f-4e5b-993e-abaf13cab18b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I agree with you 100%, and I agree with your take on Neil Cowen’s PK paper. I do believe it was slightly manipulated... Off-label, certainly people could use it...you’re completely right. 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If you're creating hyperglycemia by giving the drug then, really, what is the benefit...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.027+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0905d675-2914-4076-9ce2-77ec01327790", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I think fundamentally, if the goal is to reduce obesity and obesity-related disease, which is why hyperphagia is the primary focus of all these programs, even though it is a really multifactorial disease that affects a multitude of symptoms. The main side effects for this drug are hypertrichosis, peripheral edema, and hyperglycemia. If you're creating hyperglycemia by giving the drug then, really, what is the benefit if the long-term goal of reducing obesity is to prevent obesity complications like diabetes, hypertension, and cardiovascular disease. But if you're causing hyperglycemia, to me, that is the salient point. I do think if there are patients with extreme hyperphagia, there may be physicians who are willing to take that risk and put them on this drug. But I think there's so much variability within hyperphagia itself that, unless a patient has an extreme level of hyperphagia that is not under control through any other means, yeah, I think the value is minimal compared to what you're risking.\" — Ex-Soleno employee #2, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:29+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2aa-8edf877a9380", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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A: \"Diabetes is not an insignificant side effect...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:06.925+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b2f99033-c036-462c-83a8-09d898911437", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“diabetes is not an insignificant side effect...that is a very serious side effect in this patient population...and it’s very contrary to the articulated goal of therapy in the first place...we did see that as a side effect...clearly....and I think it is significant...I felt like it makes no sense to have this as one of your primary side effects for the drug, given its goal...it really did not make sense to me”; 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And a lot of people in that space would say, the HQ-CT probably doesn’t really reflect the behaviors of the Prader-Willi patient because of early diagnosis, intervention, and just a lot of regulation around food and behaviors around food. – Ex-Soleno employee #2, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:28:32.18+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "366aa6fa-8cc6-4b45-bdda-8d5b7d8966a7", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "paragraph", "text": "A: “The problem is there are no validated biomarkers. There’s no clear biomarker objective measure for any of the key symptoms, whether it’s hyperphagia or whatever. I think that’s the real —”\nQ: “Well, there actually is one: PP and PYY. Do you know for a fact if they collected that data?”\nA: “It was not collected.”\nQ: “That’s one of the most obvious biomarkers to capture for a trial like this. What did you make of the fact that that was not included?”\nA: “I think they expected to see really promising results on DEXA. They were really banking on that. Looking at body fat relative to lean muscle mass and changes over time.”\nQ: “And what happened with the DEXA data? It sounded like you weren’t enthusiastic about it.”\nA: “There were some challenges with collection, too, because this trial was wrapping up around Covid. There was missing data that just was not collected because patients couldn’t get in to get the test done. And then it just was not really significant. There’s also challenges with using DEXA and body fat percentage in the pediatric population. I have a number of concerns around the validity and value of DEXA data, not only in this type of trial, but just in general in assessing.” - Ex-Soleno employee #2, key role in clinical trial program", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-07-17 03:28:32.18+00", "model": "google/gemini-3.1-flash-lite-preview", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "81a2fed8-f156-469e-bf1c-b27e71585cec", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I think there are challenges with the HQ-CT as a primary endpoint. 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and who is highly networked and influential with key PWS physicians and patient associations: “I run clinical trials...I follow a lot of families...some of the families I’ve seen...since the early [decade redacted]...I have a really long track record with the families...I helped [Soleno] when they got their data...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.563+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1d96da3a-da94-4be8-920e-b35d2c4ed9c4", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "quote", "text": "KOL in the PWS space; involved with Vykat trial and FDA process\n“I'm at [redacted institution]...I've been working with people with PWS since [year redacted]. I've done [redacted - a large number] clinical trials in people with Prader-Willi Syndrome.I run clinical trials at this point...and so I follow a lot of families...some of the families I've seen, I've seen since the early [redacted], and continue to see them in the clinical trial space. I have a really long track record with the families. And even today, I saw several people for the [redacted] trial...this is pretty much what I do is just people with PWS... 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I've done [redacted – a large number] clinical trials in people with Prader-Willi Syndrome. I run clinical trials at this point...and so I follow a lot of families...some of the families I've seen, I've seen since the early [redacted], and continue to see them in the clinical space. I have a really long track record with the families. And even today, I saw several people for the [redacted] trial...this is pretty much what I do is just people with PWS... 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endocrinologist uncomfortable prescribing", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.92+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cfd5171b-1598-4cda-ac91-89cdeb923d63", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.83 }, "kind": "callout", "text": "Highly skeptical of real-world “fallout” as drug is introduced vs. minor statistical artifact in trial", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.92+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e4e8bb34-fd52-4adf-b9a9-be59e912cdce", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "The KOL characterized Vykat as a total flop and exhibited concern about a cover-up and misrepresentation of the drug’s toxicity profile – and fears a looming safety debacle as patients begin to trial it.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-169c16bfc495", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.32 }, "kind": "paragraph", "text": "Ominously, the KOL mentioned several leading PWS endocrinologists who are already refusing to use it – “a couple of endos who are telling me – it’s interesting – that they’re not comfortable prescribing it because of the side effect profile...I think that’s telling”; “five points [in the hyperphagia survey] is not a gigantic change...it’s going to be interesting when the fallout comes with people aren’t in the clinical trial...I think the jury’s definitely still out.” The KOL stated that “the side effect profile...that worries me...on multiple town halls and dissemination efforts by Soleno, a lot of side effects are not really being addressed...diabetic ketoacidosis, edema, fluid retention, peripheral and pulmonary edema, those are significant...I tell people, if your kid is already likely to have diabetes...we don’t know a ton about what this drug is going to do.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:07.92+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b4413928-f07b-4086-986b-93643489c329", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I do think the side effect profile is a little troubling. That worries me about some of the side effects and also the fact that, having been on multiple town halls and other dissemination efforts from Soleno, a lot of side effects are not really being addressed in a way — people are excited and there's obviously a lot of hype. And I tell people, if your kid is already likely to have diabetes...we don't know a ton about what this drug is going to do. And so I have talked to a couple of endos who are telling me — it's interesting — that they're not comfortable prescribing it because of the side effect profile. 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People are going to compare notes very rapidly as this rolls out. Among the people that really treat the big volumes of PWS patients, do they think this is a blockbuster? Are they cynical? How would you categorize the mood?” A: “I think cynical, in general, just because again, but really struggling because it is the only FDA-approved drug. The families are definitely excited. I’ve talked to several physicians who have written prescriptions. None of them have gotten approved yet. Like they said, I’m not really sure how that part’s going to work. They were throwing out a couple of test cases to see. But there’s definitely, from what I gather, at least three of the people that are endos, who see a lot of people with PWS, have all said the same thing: Well, if somebody is pre-diabetic or really overweight or fill in the blank, I’m going to treat that really aggressively with x, y, and z. And then I might consider after HbA1c is in the normal to pre-diabetic range, considering that treatment. But then the blood sugar monitoring, constant blood draws; it’s going to require a lot of follow-up. And so, what they were saying, it’s not one you can go, hey, here you go. And good luck to you. It’s going to require a lot of follow-up, and what they’re concerned about, and they’ve just said this, is they’re worried that mom-and-pop PCP’s and don’t know a ton about this are going to be prescribing it without maybe some of the safeguards in place that they’re going to be doing. 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I just think that’s interesting. And I just pulled it out because I thought it was so interesting. One paragraph in the labeling says people who discontinued the study dropped out due to treatment compared to placebo, not the randomized withdrawal, mind you, increased hyperphagia, type 2 diabetes, pulmonary edema, aggression, anger, labile effect, and hoarding and suicidal ideation. I don’t know. I find that to be pretty significant side effects. So, that was my issue is that —” - KOL in the PWS field; involved with Soleno’s clinical program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.664+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b7cc9d43-65b2-4b57-8022-7c831030153f", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.72 }, "kind": "quote", "text": "Q: “Is their diabetes data accurate? I’ve had a couple of promotional trial investigators say, oh, well, the blood sugar went up five points. It didn’t really concern me that much, fasting glucose. That seems to me to be really downplaying it, given the mechanism of action. Is that accurate? Or do you think it’s gone up more?” A: “People dropped out because they got diabetes, and they dropped out because they got blood sugar issues. The deal is, I’m sure that is probably minimizing what really happened. But again, I think what they didn’t say is just as interesting as what they did say. 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red flag that key info is missing in the label", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.013+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "51be6619-e09e-4a19-944d-992783465088", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "callout", "text": "Hyperphagia score reduction in HQ-CT survey is not compelling", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.013+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "642a1835-2ba1-4a0d-b6e9-79e5dbfc86d4", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "The KOL was skeptical of the randomized withdrawal study as well, noting that hyperphagia scores actually worsened in the drug arm", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-590f6078d504", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "“Investigators may have something to do with that Oh, I see your kid is like, oh my God, maybe they are. As an investigator, you can do a lot to move the needle, even if it’s not real movement...the data that is on their label is not nearly as compelling...so I’m just not entirely sure what to make of it. It’s got a modest effect on hyperphagia, which is better than nothing, but it’s not gigantic. And the FDA in the past has required eight points on the hyperphagia questionnaire to be considered clinically significant and meaningful data. Theirs isn’t there yet. It’s about five points difference between people on placebo and people on drugs. To me, that’s not a giant signal when I know the scale and it goes up to 36.” – KOL in the PWS field; involved with Soleno’s clinical program", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.013+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "51ba5f57-69c2-4ccc-a44c-c9813626d19c", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The KOL disputed both the failed phase 3 and the withdrawal study that was the basis of FDA approval, as the HQ-CT scores were easily manipulated – “as an investigator, you can do a lot to move the needle, even if it’s not real movement\" - and stated the 5-point HQ-CT reductions vs. placebo were meaningless on a 36-point scale vs. and questioned the FDA’s approval given past requirements – “the FDA in the past has required eight points on the hyperphagia questionnaire to be considered clinical significant and meaningful...theirs isn’t...not a giant signal.” The KOL was skeptical of the randomized withdrawal study as well, noting that hyperphagia scores actually worsened in the drug arm – “people who were on drug went up, I think, 2.6 points, which seems odd....people on placebo went up 7.8...about a five-point difference...in the original study [5 points] wasn’t statistically significant.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.013+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "98ba8a44-e22b-46ed-af97-a515a8924689", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.71 }, "kind": "paragraph", "text": "Q: “When you say it was a five-point change in the HQ-CT score, are you talking about the phase 3 subgroup analysis or overall result?” A: “Well, the overall results aren’t anywhere you can find. Like I looked at the label. I spent several hours going through the labeling information, so everything we know about the drug. The Vykat group, the only information that’s in labeling is the people who were in the randomized withdrawal part of the study: 38 were on drugs, 39 were switched to placebo during that time. Those changes over, I think, it’s four months, people who were on drug went up to, I think, it said 2.6 points, which seems odd. And people on placebo went up 7.6. It’s about a five-point difference between the two groups on people in that randomized withdrawal. In the original study, it wasn’t statistically significant, the change between placebo and people on drug, which I guess is why they’re not using label. I think that what people don’t say sometimes, is just as interesting as what people do say...” – KOL in the PWS field; involved with Soleno’s clinical program", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.013+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cebb801c-6aea-47d1-9382-3e1adc4d8d85", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "As an investigator, you can do a lot to move the needle, even if it’s not real movement...the FDA in the past has required eight points on the hyperphagia questionnaire to be considered clinical significant and meaningful...theirs isn’t...not a giant signal. — KOL in the PWS field; involved with Soleno's clinical program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-5ebbd541b443", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:09.068+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2f45aec2-787c-45f7-93b4-d086050eafb9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"Again, there's a lot that's not really in there...77 people, that's such a small thing...I'm just so surprised the FDA didn't question that, that almost half of the people dropped out before the randomized withdrawal study...when I finally read the final-final, I was just kind of, huh...that is just so few people...the data...just really isn't compelling enough.\" — KOL in the PWS field; involved with Soleno's clinical program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or 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patients taking a “wait and see” attitude; “we don’t really know” side effects", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:10.864+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "984d65ad-2a65-4c29-9f9e-52e3458fbcb2", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "The reluctance, despite Soleno’s over-the-top bombardment of patients and prescribers, indicates significant challenges for Vykat", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-71493825861e", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The KOL cast doubt on the success of Vykat’s launch, indicating significant reluctance on the part of PWS families – we note that the KOL is a longtime, highly-networked, go-to resource for families around the country with a prominent profile in the PWS patient community. The KOL indicated families are already wary of Vykat’s diabetes risk, given 30-40% of PWS patients are diabetic and the rest are obese, pre-diabetic, and generally at extreme risk of developing the condition – “people with diabetes probably wouldn’t be an option...prediabetes, it wouldn’t be an option...you’re going to have a lot of people say, and I have had several people say...they’re going to kind of wait and see...that’s probably a pretty smart move, to be honest...” The reluctance, despite Soleno’s over-the-top bombardment of patients and prescribers, indicates significant challenges for Vykat – “I myself am getting emails from Soleno...they’re sending out lots of mass promotional things to try to get people to prescribe, for sure.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:10.864+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7f3bdd0c-9b2e-4d1f-98ed-533fea840e31", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.8 }, "kind": "quote", "text": "I will say that there’s several patient or parent forums that are getting —one family said, \"Oh, there’s a couple of forums.\" I’m like, \"Is Soleno running them?\" And they’re like, \"I don’t know.\" It’s interesting that people are not sure where the data is coming from or where the information is coming from. I myself am getting emails from Soleno, so they’re sending out lots of mass kinds of promotional things to try to get people to prescribe, for sure...there was a big —.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:10.864+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6c51c9ae-8c8f-48a5-8223-95bf452320f8", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "quote", "text": "People with diabetes probably wouldn’t be an option. For people in prediabetes, it wouldn’t be an option. So I think you’re going to have a lot of people say, and I have had several people say, I’m going to kind of wait till it’s been out for a little bit longer so that I can kind of like, determine for myself whether this would be something that I could do. I think for some people, that’s kind of the thing is they’re going to kind of wait and see. I think that’s probably a pretty smart move, to be honest with you, because we don’t really know.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:10.864+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "745f0962-4db6-43d4-9ba3-edd7163f7a6b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "People with diabetes probably wouldn't be an option. For people in prediabetes, it wouldn't be an option. So I think you're going to have a lot of people say, and I have had several people say, I'm going to kind of wait till it's been out for a little bit longer so that I can kind of like, determine for myself whether this would be something that I could do. I think for some people, that's kind of the thing they're going to kind of wait and see. 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She was the lead investigator and, we have been told, the largest enroller in its studies; the lead author on its papers; its evangelist to patients and endocrinologists around the country; and, through these efforts, we suspect that she is the invisible hand fueling Soleno’s ~600 start forms to date – her profile page states she follows “over 500” PWS patients. The few endocrinologists we found willing to submit a meaningful number of start forms indicated they had been influenced by outreach from or conversations with Miller. 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We can locate no peer-reviewed publication for the withdrawal study – a troubling and unusual fact – but Miller’s name is once again on the title page of its slide deck.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:14.923+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8e7dca7b-ea1f-4367-8c03-015ec17e3de6", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.92 }, "kind": "source-note", "text": "Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC10271219/; https://pubmed.ncbi.nlm.nih.gov/37919617/; https://investors.soleno.life/static-files/dae000f3-5c9a-450f-be0a-1b6c32d13fed", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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And I’ve had two or three parents who said that she's reached out to them personally to tell them about this drug. And thankfully, they are very savvy parents. 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And I’ve had two or three parents who said that she's reached out to them personally to tell them about this drug. And thankfully, they are very savvy parents...and they said, but the risk of diabetes...she definitely is invested in a way I’ve never seen physicians invested, to be honest with you.” — KOL in the PWS field; involved with Soleno’s clinical program", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:31+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ac-4dba4087fbe2", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"componentCount": 6, "textChars": 1165, "nDataPoints": 0, "notes": "The slide uses emotional imagery and anecdotal evidence to undermine the credibility of a key figure in the PWS space.", "elementsJson": [ "paragraph", "screenshot", "footnote" ], "confidence": 0.95, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:10.469+00", "seconds": 2.69, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/262", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-262", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "we note that several endocrinologists used the term \"cult.\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-b96b15159aa7", "parentComponentId": null }, { "bbox": { "h": 0.38, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "image", "text": "Three screenshots from a UF Health Facebook video showing Dr. Miller with patients.", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, 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Virtually every trial investigator and endocrinologist we interviewed mentioned her outsized influence with a swath of PWS families across the US – these families tend to use their in-state PWS specialist, but with Miller involved behind the scenes from Florida. We see countless Miller videos on YouTube and social media, with PWS families talking her up in a highly adulatory manner - we note that several endocrinologists used the term “cult.” A ritual in this group of followers appears to be an annual pilgrimage to Gainesville. One family’s emotional video tribute - on a Univ. of Florida FB page, which leads us to wonder who wrote it: “Jennifer Miller...shines brightly as an inspiration...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:10.469+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "048d5658-4b2e-45fe-b0f4-c765e74eef0e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Jennifer Miller...shines brightly as an inspiration... — Univ. of Florida FB page", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:30+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ab-bf419dc769ca", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.35, "x": 0.07, "y": 0.94 }, "kind": "source-note", "text": "Source: https://www.facebook.com/watch/?v=461757416522042", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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She walked in to our appointment and gave us a BIG hug. Then her attention turned all to Kimber, who was acting a little shy and nervous...after trying to coax a few words out of her she simply turned to us and announced 'We're going for a walk. You guys stay here.' They were gone for about 10 min. 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We found one anecdote striking: 'Dr Miller is AMAZING! She walked in to our appointment and gave us a BIG hug. Then her attention turned all to Kimber, who was acting a little shy and nervous...after trying to coax a few words out of her she simply turned to us and announced 'We're going for a walk. You guys stay here.' They were gone for about 10 min. When they came back Kimber had bubbles and a puzzle and was just chatting away with her new bestie.'", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.55+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "be9001a6-4356-45a1-b19b-94c020836ae8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"Yes, at 30 weeks pregnant we scraped together the money, packed up our very busy two year old and flew across the country to see a doctor...this decision has had many of our family and friends scratching their heads...we have such wonderful care here in state...so why did we feel the need to go see someone over 2,000 miles away?\" — One family's blog post", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-09d28004bc0e", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: https://www.growingupwithpws.com/blogs/news/why-dr-miller#:~:text=She%20was%20able%20to%20fill,her%20whole%", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I mean, she was saying that was the most marvelous drug out there, oxytocin. Then she switched over to this…But she’s a politician, too, and she’s the one that was the spokesman. There’s nothing ever going to replace oxytocin for treating Prader-Willi Syndrome. 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I’ve been at meetings on the oxytocin trial where she had the family members in national meetings, almost in tears because they were so joyful to hear her talk so positively about oxytocin. And then the next drug comes up, and it’s the best thing that ever happened. It’s the same scenario. She has a lot of energy…sometimes, she’s driven to the point of maybe she’s not seeing what’s in front of her. So, what you’re telling me is not a surprise. I wouldn’t deny that…she’s very driven to be successful…but, yeah, I’ve been in those settings before where she was just like, there’s nothing better out there than oxytocin. This is going to solve all our problems. And the moms in the audience were just crying. That was, I don’t know, ten years ago with oxytocin. And then the next trial comes up, and it’s the best thing out there. 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One of the most published, and influential authorities in the field - who has a long history with Soleno, played a key role in its trials, and was one of her manuscript co-authors – painted her as fanning false hopes and promoting prior PWS drugs that flopped - “she was a very big proponent of the oxytocin…the most marvelous drug out there…then she switched over to this…she’s a politician”; “I’ve been at meetings…where she had the family members in national meetings…almost in tears because they were so joyful to hear her talk so positively about oxytocin…she was just like, there’s nothing better out there than oxytocin…this is going to solve all our problems…and the moms in the audience were just crying.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.644+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "08c50828-4ca6-4ef4-87b3-ffa042573e0b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“She was a very big proponent of the oxytocin. 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Halts Eating Disorder Study. Tryp Therapeutics Readies First Trial of TRP-8802 for Excessive Appetite...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:12.028+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "805c2087-21d1-4974-8a12-ca4f0992ff8b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"We are pleased to announce the involvement of Dr. Miller, a leading expert in treating patients with rare eating disorders, in the planning for a clinical trial evaluating the safety, pharmacokinetics and efficacy of TRP-8802, Jim Kuo, Tryp's CEO, said in a press release.\" — Jim Kuo", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:32+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ac-f0157355d34c", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.65, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: https://www.youtube.com/watch?v=-UoH5V-oN6c; https://www.biospace.com/fda-slaps-clinical-hold-on-tryp-s-eating-disorder-trial; https://praderwillinews.com/news/tryp-therapeutics-launch-first-trial-trp-8802-excessive-appetite-pws-prader-willi-syndrome/", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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As I've been taking care of these patients over the last ten years, there's other interventions that are not evidence-based that she promotes. She promotes these things as really important. And so, patients will go see her, and come back and want to start these non-evidence-based supplements. And some of it has some data, and it's all pretty benign and cheap, to be honest. So, a lot of us are pretty agnostic about these interventions that it's just like whatever. But she's a proponent of these loosely evidence-based interventions for Prader-Willi Syndrome. And I feel like patients come back with a lot of requests, oftentimes, that are a little bit maybe out there that they're asking me to co-sign as their doctor that they see throughout the year. And most of the time, I do because they're generally benign things that they're convinced are going to be helpful. 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I don't see it. 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insurers providing initial coverage will eventually why not use generic", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:32+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2ad-3c43ebc2f876", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "quote", "text": "...they may get away with it initially, but eventually, people are going to catch up to it... that kind of information usually spreads pretty rapidly... through the compounding pharmacies themselves, they'll send out letters, and saying, hey, by the way, we have this available.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.818+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "23bdd982-cd2d-4fa7-9bf1-6129983adad6", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "quote", "text": "Compounding pharmacies, that's their business. They have a vested interest in using that for this... it would be a simple email to our head of pharmacy. Tell me why we can't use a compounding pharmacy to do the same thing here.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:11.818+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2fb39cca-7953-496f-a5f0-b93c2f613ca4", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Compounding pharmacies, that’s their business. 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We have tried to be very mindful of not saying things that we would not feel good about saying. We really didn't want to lead the community astray. We are very loyal to the science. And have been really careful to be very honest with the community about what the findings are and the ways that it can help. We really wanted to make sure that there were certainly no one from our organization going out there saying this was a cure and everyone should be on it. We were very careful to say that's a decision for your family and to discuss with your physician. Like we've tried to hold the line in that regard. And my sense is — I hear that there's been some pushing, but then when we've had our boundary, they've been respectful.”\nQ: “What did they try to push on?”\nA: “Maybe wanting us to say something a little more strongly than we want than we felt comfortable saying from the science perspective.”\nQ: “What were you guys planning to say? 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It's not...it's a nice little product as many rare disease products are. 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Soleno lacks rare disease commercialization experience – “the chief commercial officer had no experience in rare disease...does that tell you anything?”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:18.825+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a7af79c1-f52d-451b-9203-dfd17ebc5ef2", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.37 }, "kind": "paragraph", "text": "“everybody looks at 1 in 100,000 and says oh well, that’s still a pretty good subset if we get 50% of it...but when you really look at the data and fully understand what subset of that you may get, it just becomes a much smaller number”; “so yeah, maybe as much 10% to 15% but I don’t think it’s beyond that.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:18.825+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dbbcf409-9661-4e10-b772-ae70b5b661d6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“the chief commercial officer had no experience in rare disease...does that tell you anything?”; “everybody looks at 1 in 100,000 and says oh well, that’s still a pretty good subset if we get 50% of it...but when you really look at the data and fully understand what subset of that you may get, it just becomes a much smaller number”; 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Here's the problem. A lot of physicians and families are so focused on weight loss for good health reasons that when they look at the study and don't see the weight loss, it causes them pause because of the expense with this...So, once the GLP-1 became available, a lot of physicians targeted that way to help with weight loss. 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Here's the problem. A lot of physicians and families are so focused on weight loss for good health reasons that when they look at the study and don't see the weight loss, it causes them pause because of the expense with this...So, once the GLP-1 became available, a lot of physicians targeted that way to help with weight loss. 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And I’ve been concerned about this in those with the type I deletion. And they account for about 1 of every 4 Prader-Willi patients — there are 7 different genetic subtypes. But one out of four of all the subtypes, 25% is actually is 6x4, which is 24%. We’ll have the type I deletion where the magnesium, iron, potassium channels will be altered because the transporter gene in this region is not making a transporter if we have problems maintaining your electrolyte balance. Electrolyte balance, what happens? Put your hands in salt water, what happens to your hands? They get all wrinkled, don’t they? Because you’re pulling water out of your hand. Imagine you got electrolyte balance in your body. You’re taking liquid out of your blood. Your blood becomes sluggish, more prone to blood clots. Or maybe putting too much liquid back into your blood, it’s getting too thin. Imagine if you have disturbances in your iron or magnesium and ATP — Vykat actually is an ATP-sensitive potassium channel. 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I’m concerned about the edema...heart arrhythmia, muscle spasms, and seizures.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:15.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "016889e4-5db7-4f6d-8427-bc4c3acc23fa", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.69 }, "kind": "paragraph", "text": "“Therefore, it’s going to certainly impact how you regulate your sodium, potassium, and magnesium in your body. When your magnesium is not working, guess what happens? If you’re a doctor, the patient comes in with unexplained seizures and can’t talk to you. They’re in a seizure. No one else knows. You got the EMT’s brought them in. You have no history, right? First thing, you give that patient a bolus of magnesium. Because sometimes, low magnesium can cause seizures or muscle spasms or heart irregularity. I suspect it’s probably related to the magnesium transportation. And 1 in 4 —those genes involved making transporter proteins for iron and selenium and magnesium that keeps all equilibrium in our body so our electrolytes are normalized. But I can see that could be a problem. One in 4, particularly when they’re restricting their diet for some reason or other, maybe they’re on a diuretic. When you’re on a diuretic, you’re losing your fluid, you’re losing your potassium. To avoid potassium problems, you have to overload them with potassium pills or eat bananas. More information than you need to know. But yes, I’m concerned about the edema that is a risk. Those 1 in 4 that may have the ATP-sensitive potassium channel, which this drug works in that channel and that regulates our electrolytes in our body, particularly magnesium, and therefore, it can interfere. 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It can. Right? Potassium, yeah. It can be in edema itself. It might be related to not [being] able to keep the right amount of salt and water in your bloodstream, and therefore you’re leaking out your liquid into your lower legs because your cell membranes aren’t pliable enough because of the interference with potassium, sodium, calcium, magnesium — all these make your muscle work and keep the heart functioning normally. It’s a big player. 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[Q&A transcript excerpts]", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:14.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f73d7a1a-d1de-4028-b206-c49d5d90203c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I was kind of surprised...a lot of that’s driven by the young families that have Facebook. 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parental assessments were in conflict and unreliable", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.361+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3d6c00d1-1c1f-483e-9e42-3e405fa3e3b7", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "quote", "text": "“I think we found out that, in my opinion, some of the people coming in knew what they should be looking for as far as the scores on the questionnaire form. So, they come in 13, 13, 13, after you get three or four 13s, I said, well, why are we all getting 13? Somewhere along, I'm thinking, my opinion, because these are young families are on Facebook, they probably knew they had a certain score that the child had to have before they could enter the trial. Everyone had run that score. I thought that was so strange. It's got what? Zero, three, six, and then 13 is a cutoff. And they're 13, 13, 13. . It's human nature, right? You're a parent. You're desperate. You want to do anything for your child, and you want to make sure the child. But when you do that, then you're stuck with that trial. 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So, they come in 13, 13, 13, after you get three or four 13s, I said, well, why are we all getting 13? ... You're desperate. You want to do anything for your child... 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I think so many times they had the weight as the objective measurement, but not hyperphagia, which is subjective. So, they’re basing so much on subjectivity. And that can vary from month to month, year to year. Your objectivity, you can’t artificially change your weight. It’s there, you know, BMI”\nQ: “When I looked at the BMI outcome, they said it was statistically significant, but it was trivial. It looked like not even a one kilogram reduction in the trial group. Like, am I reading that right? Was that the extent of the weight reduction?”\nA: “Yes, not that remarkable”\nQ: “That was literally the weight reduction that they said gave him stat sig?”\nA: “Yeah. it didn’t really change the weight. But there was more impact on that than the hyperphagia which was negative until they got into the square measures, and they got a statistician who did all this remarkable testing and, oh, we came up with something. 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This is my opinion.” - Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.597+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b0626057-f1e7-4b1c-a75e-49ba629fa27a", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.35 }, "kind": "paragraph", "text": "Slammed the trial: drug doesn’t work; didn’t change hyperphagia nor weight; statistical games to come up “with something”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.597+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e7c96bf4-b2e7-43c5-83df-02f56335521c", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I just didn’t think it worked...they’re basing so much on subjectivity.” Regarding the negligible BMI outcomes: “yes, not that remarkable...it didn’t really change the weight...they got a statistician who did all this remarkable testing and, oh, we came up with something...so I think they played with the data until they finally got something that worked.” — Trial investigator and physician; one of the leading KOL’s in the PWS field", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:34+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2af-6e4629c5af53", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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field toward Vykat, given long history of PWS drug failures", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:19.259+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "564a070d-e024-41a5-9eb0-df67f1e38054", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "When we asked if the launch is a dud, he stated that he expects to rapidly hear skepticism in the field within 3 to 6 months, toward the drug; and that it will be the next in a long line of duds in the PWS field – “I wasn’t seeing a lot of success with the drug”; I don’t think anyone would say ‘Whoa, we got to get these patients on this drug…look what it can do…a lot of people are taking a hands-off, let’s just see…I haven’t heard from people with much enthusiasm.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:19.259+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": 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Because it seems to me like, how do you get a four-year-old kid to swallow an extended-release tablet? Because extended release, you can’t cut it or chew it?” A: “Well. You can’t. That was a concern I had, too, when I first came in. It’s like a horse pill. But what happens? I don’t know if you’ve ever seen Prader Willi patients, but you put something in their mouth what they do, they’re going to chew it and swallow it, probably people that are constantly eating anything and everything. And I was concerned because the fourth most common cause of death, in Prader-Willi Syndrome is choking. For a four-year-old, the most common cause of death in a four-year-old Prader-Willi is choking on a hot dog...they can’t swallow, they have poor teeth, they have dry mouth, they swallowing difficulties, their suck reflex is poor, their choking reflex is poor. It’s a problem. I saw that. I said, that’s it. You can’t ever get this — they’re never going to swallow this pill. But what they do, they chew it...you can’t chew because you’ll destroy the drug; it has to stay intact —” Q: “The [redacted number] patients that you enrolled in the trial, were they all chewing the pill?” A: “Pretty much. They would chew, those I witnessed. Once every three months, I’d see them and they would.” Q: “They’re not supposed to chew it. That ruins the extended release.” A: “Well, but some of them do. They chew it, but they’ll chew it into maybe a half a piece, but it’s still opened up. So, it’s an issue....the big pill, I was concerned about that because the swallowing difficulties...That was something I addressed with them. About concerns with that big pill: we got to make sure that your child doesn’t choke because we’re concerned about the dry mouth, the poor dentition, poor enamel, and the swallowing difficulties...because after I saw the size of that pill and said, oh My God, they’re never going to swallow this. But then I said, well, they’re chewing it. Okay. 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I'm concerned about choking, particularly younger patients. 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It could happen. That’s a problem [for Soleno]. This drug has been around since 1976. 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And I have been taking care of Prader-Willi patients for more than two decades. I initiated several Prader-Willi clinics. Right now, my colleagues take care of the actual clinic patients, and I focus mainly on the research patients. We’re conducting two trials right now. Of course, one of them is ending with Vykat being approved. I’m in an academic institution. I see patients in the clinic, and I do research both clinical and in the lab.”\nQ: “How many patients does your clinic see? I presume your colleagues are consulting with you, and you’re aware of what’s going on.’\nA: “Yeah, I would say close to a hundred at [hospital name redacted], and I would say probably 20 or so patients at [redacted]. They’re mainly adult patients.” – Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.674+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1463f05a-2337-47ac-b488-e2bd0f5ded73", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.9, "x": 0.05, "y": 0.68 }, "kind": "paragraph", "text": "Key investigator and author on Vykat paper – little discussion since approval; other endocrinologists not reporting improvement\nQ: “Obviously, people know that you’re an authority on the drug. Was there enthusiasm when the drug was improved? Do you sense a lot of excitement and enthusiasm for people to put their patients on Vykat when you talk to colleagues?”\nA: “I have not really talked to colleagues except for a very few. And one endocrinologist said she did not see a big difference. She just said a lot of her patients didn’t respond….” – Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.674+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "605fa927-539a-4476-a2cc-f7cdd9824b7a", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.9, "x": 0.05, "y": 0.82 }, "kind": "paragraph", "text": "Only one patient on Vykat despite being one of the largest centers; disinterested to date in pursuing and no discussion yet\nQ: “How many patients do you think you and your colleagues might put on it in the next three to six months? Like, what do you hear from them? Are they excited? Are they cautious and taking a wait-and-see attitude? What are you hearing?”\nA: “I don’t know how difficult it’s going to be…you know, I have not had that discussion with them yet.. I will reach out to them, but I haven’t done that as yet. But thank you for reminding me…” – Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:21.674+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b2cc99ff-6e36-4793-82c9-d008431ab9b9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I have not really talked to colleagues...and one endocrinologist said she did not see a big difference...she just said a lot of her patients didn't respond” — Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:35+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2af-e2bf039a9665", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I don't know if you're aware of that.” A: “Oh, I know that. And I think it's disgusting, but — I've asked them, how did they justify — ” Q: “If you could prescribe an oral solution once or twice a day versus a tablet — which one would you prescribe?” A: “Well, I actually asked the question because I was horrified when I saw it was $400,000. It's not like it's gene therapy or a new enzyme that's being developed. It's diazoxide, for Christ's sake, you know. And I'm still waiting for an answer.” Q: “Is that going to change your prescribing behavior?” A: “Well, it makes me not so interested in supporting this drug. I don't see $400,000 of benefit because two of my patients developed diabetes. Two out of 15 developed diabetes and others developed hyperglycemia, which is what it's supposed to do. I mean, it's not surprising that it causes that because that's the role of the drug...I'm just not sure how they justify charging $400,000. That, to me, I still find it mind-boggling...I don't really understand that, can you just pull a number out of the air and charge it for your drug?” – Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.142+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6d4e533f-ec54-4eac-9102-6d692a38075a", "parentComponentId": null }, { "bbox": { "h": 0.13, "w": 0.85, "x": 0.07, "y": 0.83 }, "kind": "paragraph", "text": "Q: “I don't get the sense you're going to put many patients on the drug. Do you think your colleagues are going to put many patients on the drug ? If they ask you what you think, what would you tell them? They're obviously going to ask because you're well-known.” A: “Yeah, they would. My big problem is the price. I just don't think there's any justification. I think if it's ten times less than that, that would be enough of a profit for them. And if it was like a newfangled drug, I would understand, but it's just packaged diazoxide. Right? Which is a cheap drug. How they can charge — even ten times would still make them a big profit...it's outrageous. And I'm disgusted, quite frankly. And if they weren't pricing, I would be more sympathetic to recommending it.” – Physician, KOL, and Vykat trial investigator", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.142+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "722f8293-41a7-468e-b5f7-0dc485201fa1", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "In particular, the investigator exhibited resentment that “two of my patients developed diabetes...and others developed hyperglycemia” while on the drug. The investigator stated that diabetic risk is inherent to Vykat’s mechanism of action: “hyperglycemia...which it’s supposed to do. I mean, it’s not surprising that it causes that because that’s the role of the drug.” The investigator stated that Vykat is just old, cheap diazoxide: “it’s not like it’s gene therapy...it’s diazoxide for Christ’s sake”; “I just don’t think there’s any justification”; “it’s just packaged diazoxide...which is a cheap drug...it’s outrageous...I’m disgusted”; “mind-boggling...I don’t really understand...”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.142+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7af643c0-7bb6-4be7-bcba-e08aa485f46e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I was horrified” — Trial investigator #2. “Well, I actually asked the question because I was horrified when I saw it was $400,000. 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To me, it’s bizarre. She would have recruited a big number, yet her name is not on the paper.”\nQ: “So, she’s at [redacted university].”\nA: “Very odd.”\nQ: “So, you’re saying they excluded trial investigators off the paper?”\nA: “Many, yeah. Many got excluded. Yeah, there were a few things that were not good...if you’re a PI of this study at a site, you’re not just in the acknowledgements; you should be a co-author.... 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Involved with key Soleno trials as PI, high discontinuation rate with only one patient left on drug... No benefit in approximately 5 enrollees; PI didn't want to encourage families to continue on drug; skeptical of one parent", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.06+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8623372d-a3b0-48e1-aa4c-813d1559951e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.22 }, "kind": "paragraph", "text": "The investigator thoroughly trashed Vykat and the clinical trials, stating he saw no benefit in any of his enrollees; that he \"encouraged them not to continue\" into the open-label extension; that only one patient remains on drug, for a discontinuation rate of ~80%; and that he is skeptical of the mother’s perception of benefit in the one remaining patient on the drug.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.06+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "00522f90-9fb4-46b8-b010-7a13893566a5", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I have been publishing in this area for 20 or 30 years. The first study we did in the 1980's. I've been involved in providing second opinions to many people with Prader-Willi Syndrome over the years, and have seen many as part of the research projects. Our research projects have been focused on hyperphagia. And I've been an advisor to the [Prader-Willi association name redacted] and, at the present time, [title redacted] of the [Prader-Willi organization name redacted]. Through the PWS, associations, I'm asked to speak to parents, but quite often I speak to clinicians, and we work through the issues of what might be the most appropriate medication or the most appropriate course of action in any given situation.\" — Trial investigator, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:36+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b1-3d7a9df695ea", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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any potential is based on desperation not effectiveness; other PI's share same opinion; concerned about hyperglycemia", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f8fae924-40f5-42a7-b929-3f877e3c10b4", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "quote", "text": "“I would be very surprised if it's a blockbuster, and if it was, it would be on the back of the hype and the sense of need, not on the basis of effectiveness...there have been others who clearly feel closer to how I have felt about it. I haven't had a sense of an absolutely glowing endorsement...it's not going to remove the need for controlling access to food....the risk of elevated blood sugars or worth the risk of hair growth or whatever it is — that I would struggle with.” - Trial investigator, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2ae5e19b-9332-4a90-ab21-6fab98f68eb1", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.6 }, "kind": "quote", "text": "“My own feeling and from our own research, I feel that a treatment is possible, but I don’t think it’s this treatment...it’s just that the satiety system in people with Prader-Willi Syndrome is very inefficient. What you’ve got to do is find something that makes it more efficient. You can bring about satiety in people with Prader-Willi Syndrome if you allow them to have enough food. That just happens to be far too much. You’ve got to try and improve efficiency. And I think Vykat doesn’t do that.” - Trial investigator, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e0faa85-aa3e-4234-a8ed-f6f2b31427e0", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I would be very surprised if it's a blockbuster, and if it was, it would be on the back of the hype and the sense of need, not on the basis of effectiveness...there have been others who clearly feel closer to how I have felt about it. I haven't had a sense of an absolutely glowing endorsement...it's not going to remove the need for controlling access to food....the risk of elevated blood sugars or worth the risk of hair growth or whatever it is — that I would struggle with.\" — Trial investigator, key opinion leader for PWS; \"My own feeling and from our research, I feel that a treatment is possible, but I don't think it's this treatment...it's just that the satiety system in people with Prader-Willi Syndrome is very inefficient. What you've got to do is find something that makes it more efficient. You can bring about satiety in people with Prader-Willi Syndrome if you allow them to have enough food. That just happens to be far too much. You've got to try and improve efficiency. And I think Vykat doesn't do that.\" — Trial investigator, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:36+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b1-0cb0ffbc8f5b", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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He expressed surprise that the FDA approved it, attributing it to families’ desperation and “hype” and “not on the basis of effectiveness”; indicated that other investigators and PWS KOL’s in general share his skepticism; and he “would struggle with” the risk of diabetes and other serious adverse effects – “I would very surprised if it’s a blockbuster”; “others who clearly feel closer to how I have felt about it”; “I feel that a treatment is possible, but I don’t think it’s this treatment…Vykat doesn’t do that.”", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4ba94f14-27e1-4049-8d75-3aed25e99603", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "title", "text": "Vykat has no impact on hyperphagia or satiety", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Subtitle", "slug": "subtitle", "status": "active", "canonId": "019de52c-fb09-739d-900c-815b0d9ac526", "version": 1, "description": null }, "framework": null }, "subkind": "subtitle", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:17.494+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6e6d3235-8269-4379-b5cd-fac31d050322", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 306, "type": "tension", "title": "The slide uses a Q&A format to present qualitative evidence from a trial investigator.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "balanced", "densityScore": 49, "componentCount": 6, "textChars": 1087, "nDataPoints": 0, "notes": "The slide uses a Q&A format to present qualitative evidence from a trial investigator.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:16.536+00", "seconds": 2.719, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/306", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-306", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "to be frank, my feeling was I don't think anyone improved", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:35+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b0-3be0b23f1fc4", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.35 }, "kind": "paragraph", "text": "PI doesn't think \"anyone improved\" and is \"very skeptical\"; patients still hyperphagic and gaining weight on drug; also aware who was on drug and therefore unblinded", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "571e187e-ad15-4e14-b0cb-37f4b24cc286", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "quote", "text": "Q: \"What was your impression of the [approximately 5] patients that you put in the trial? Did you think it worked? Did they stay on it? What are your observations?\" A: \"I'm happy to talk about that...to be frank, my feeling was that I don't think anyone improved...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:16.536+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "017a97e0-c612-4007-aa79-42bcb5bbcaa9", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“to be frank, my feeling was I don't think anyone improved”; “so, I have been very skeptical about it”; “we knew he was on DCCR – and he put on a lot of weight...so clearly, this was not effective”; “then another person on the trial, she was putting on weight” — Trial investigator, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:35+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b0-3e8ea5888b36", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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You have patients that have been on a drug for years, and just immediately after they go on placebo, the HQ-CT score spikes like a hockey stick. And these are not patients that are naive to the drug. And the most amazing thing there is they never published a paper for that randomized withdrawal study. They've buried it.”\nA: “Yes, yes, yes.”\nQ: “Did you take note of the fact that they never published that paper? The paper that is the basis of FDA approval.”\nA: “I actually thought it probably wouldn’t be approved. I thought they would be much tougher. And I think there was a very powerful campaign [by associations/families].”\nQ: “You mean using the patient support groups?”\nA: “Yes. I think one of the issues here is that families are desperate to see treatment for hyperphagia and also for some of the other problem behaviors...hopes have been raised in previous trials and then shattered, and then other trials, as I say, they've been stopped because either the funding ran out or there wasn't real convincing evidence of efficacy or whatever. An enormous amount was invested in this trial. And in a sense, it's the first trial that got to the stage, got close enough to being considered for FDA approval. And I think people felt, and understandably, felt that the treatment was needed. 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And what one is seeing is distortions because people know that —”\nQ: “Did you observe any distortions in the trial around unblinding, HQ-CT scores? An investigator I talked to said the score is not reliable.”\nA: “I think there’s been a lot of discussion about it. In fact, I think in reality, the [approximately five] patients that we saw turned out all to be on the active drug effect. Now, there was a story that the actual active drug smelled a bit, and it smelled differently from the placebo. And the message went around, and people could tell that it was the active drug. I don’t know whether the people involved, the parents in our case, knew, had guessed and guessed correctly that their son or daughter was on the active drug. That never actually came up in discussion. They never said, oh, I’m convinced my son or daughter is on the drug. 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75 PWS patients\nAround 10 patients in the trials; 100% discontinuation rate; “this isn’t a miracle drug, that’s for sure”\nPatients discontinued because “just didn’t see any benefit from it”; “still very obese”; didn’t feel it was worth it to even come in for trial assessments", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.37+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "60639176-a5c7-41d9-9cde-35d502ad137b", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.47 }, "kind": "paragraph", "text": "Q: “How many patients did you you enroll in the trial?”\nA: “Under 10. I have a pediatric colleague who I work with who comes to my clinic. She has more on. I’ve heard about her experience from it as well. I’ve got a little bit more feedback from it. It’s an allied institution.”\nQ: “Between you and the allied institution, was it under 10 or was it over 10?”\nA: “It was probably around just over ten, I think.”\nQ: “And so it sounds like you basically have a 100% discontinuation rate if nobody’s still on it?”\nA: “Yeah. None of mine continued on it either because they didn’t want to or not having much effect…overall, this isn’t a miracle drug, that’s for sure.” –Trial investigator; one of the most published authorities on PWS and hyperphagia\nQ: “Let’s talk about the discontinuation rate of the patients that you enrolled. What were their rough ages? How quickly did they start rolling off? How long did the longest one stay on it?”\nA: “They stopped because they just didn’t see any benefit from it….I’ve just actually just started them on GLP-1. 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And we didn’t see that in this study.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:19.183+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "062965cc-8e28-4910-9a79-c491c64c348d", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.74 }, "kind": "quote", "text": "“The hypertrichosis is likely to unblind people and peripheral edema will. Yes, I think there is a real risk of functional unblinding, for sure.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:19.183+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a786a076-a2d1-426a-96ae-55545a681567", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“And to then not have a harder endpoint. With a reduction in hyperphagia, that as an outcome is not really measurable...there's tons of problems with that score...I would have expected that if hyperphagia went down, we would see, as in the beloranib study...weight went down as well. And we didn't see that in this study. 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They never published it.\" A: \"All I've seen are the summary stats...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:18.651+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a52ebb3b-806a-46fc-a9dc-c239b7983cea", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“All I’ve seen are the summary stats. I haven’t seen anything on an individual basis. So yeah, it does worry me that things are not published, for sure. And, there are odd things like the papers don’t describe insulin resistance at all anywhere. They talk about glucose and insulin levels, but no one’s actually reported the insulin resistance because one would expect the insulin levels go down and the leptin really goes down. And there’s something very weird going on. Their leptin goes massively down despite there not being a huge change in fat mass. So, there’s something odd there. And then, mechanistically, they haven’t really shown that insulin resistance gets bigger. They don’t report. 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One would expect to see — supposedly leptin levels come way down, suggesting the fat biology is changing and there’s some reduction in fat mass and improvement in muscle. I think it was more improvement in muscle mass, if I remember rightly, than the fact that came down. But then the leptin really went down. That could be central control of peripheral fat metabolism through some pathway. But I would like to have seen the effect on insulin resistance. They just didn’t report those, and that was very odd to me. Then that seemed to again, are they hiding something? It’s really weird. It’s such an obvious thing. That a major reviewer didn’t ask for that to be done. So, that’s very odd. 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But I’m just really surprised they haven’t reported either the HOMA-B, the insulin production rate and the insulin resistance. 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sees better results for hyperphagia + weight reduction", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.031+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b15ff7f3-d45d-40f4-afbb-16b461ece66a", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "I think the GLP-1s, if I was going to bet, will probably be more effective than this drug from what I’ve seen about this drug so far, and the limited data I’ve got on the GLP-1s and the GLP-1s are likely to be cheaper", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:35+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b0-f09d9bbacbff", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.53 }, "kind": "paragraph", "text": "A: “I think there are potentially other drugs that are going to be more effective. I think the GLP-1 drugs; I’ve begun to use that in a few people…I can imagine that, I think the GLP-1s, if I was going to bet, will probably be more effective than this drug from what I’ve seen about this drug so far, and the limited data I’ve got on the GLP-1s and the GLP-1s are likely to be cheaper”\nQ: “How many patients have you tried GLP-1s in?”\nA: “I’ve treated about 11 or 12.”\nQ: “It’s the same number. And you thought the effect was much better?”\nA: “Yes.”\nQ: “Is there even an anecdotal paper out there on GLP-1s in PWS? It seems like it would just be the obvious thing to try.\nA: “There’s a case report. There’s about six case reports from about two or three papers. . . I see reductions in hyperphagia, which are not dissimilar to that seen on average with DCCR. And I’m seeing weight loss in a way that wasn’t seen in the DCCR. And again, the small numbers.” - Trial investigator; endocrinologist; one of the most published authorities on PWS and hyperphagia", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.031+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ad8a51b3-6768-4517-ac5e-290ca83c7965", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.82 }, "kind": "paragraph", "text": "“I suspect I’ll be using GLP-1s before I would be using this. From my experience with GLP-1’s to date, I’m quite hopeful…I had people who were weight stable and then lost weight when starting it or gaining weight, started it, and then leveled off. I’ve got HQ-CTs going back in time, and they were pretty constant. And then after starting, the HQ-CT came down. It could all be placebo. But I’ve got some estimate of the repeated measures. 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Moreover, he tracked HQ-CT hyperphagia scores and thought the results were far more promising than Soleno’s – “the GLP-1’s, if I was going to bet, will probably be more effective than this drug…[from] the limited data I’ve got on belonid the GLP-1’s…I see reductions in hyperphagia…and I’m seeing weight loss in a way that wasn’t seen in the DCCR…I’ll be using GLP-1’s before I would be using this…from my experience with GLP-1’s to date, I’m quite hopeful…the HQ-CT score came down…I’m more encouraged by that than by the DCCR.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.031+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c70820a7-b886-46a5-8491-581a0fc328e8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I think the GLP-1s, if I was going to bet, will probably be more effective than this drug from what I’ve seen about this drug so far, and the limited data I’ve got on the GLP-1s and the GLP-1s are likely to be cheaper — Trial investigator; endocrinologist; one of the most published authorities on PWS and hyperphagia", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:35+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b0-f77463f94bb1", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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“not a cure”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.706+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "80522064-e402-4436-9a87-1d6766a91fce", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "list", "text": "Lack of patient enthusiasm; only 3 patient calls out of >40 total", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.706+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bdbfa37a-172b-4e8d-90ec-efcbc85ea903", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "Q: 'How much excitement do you see? ... Did you get bombarded when this got approved?' A: 'No, I got three calls... And so, no, it wasn't a floodgate that opened.' Q: 'Is it fair to say it was relatively muted or would you use a different word?' 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A: 'I think most people are... cautiously optimistic, but I wouldn't say anybody is wildly over the moon... it's not like a miracle... I don't think anybody's used the term miraculous to describe what they're seeing.' Q: 'Do you think it's even a cure...?' 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Is it the two of you that would be the main prescribers? Is your colleague enthusiastic, or is it kind of more muted?”\nA: “Yeah, no, she’s looking forward to trying it, mainly because we have nothing else, so it’s nice to have something to offer. But for my group, pretty much everybody knows that I’m the Prader-Willi person. So, the other geneticists who are in town are, I think, very unlikely to go prescribing on their own. They’re probably going to ask me to do it.”\nQ: “Do you consider this a blockbuster drug or like a little addition to the toolkit?”\nA: “Exactly. It’s an addition to the toolkit, and it’s probably going to benefit the families who are already doing a good job. And it’s maybe not going to be helpful at all to the families who don’t have the ability to control the environment.” -Trial investigator, pediatrician/geneticist, professor", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:19.481+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7ac8df02-eae5-43b9-a4b6-330e5caee15b", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Trial investigator #5 stated that only 1 out of approximately 10 trial enrollees at the center even responded to Vykat and even that patient was barely a responder: “well, one [patient]...and I wouldn’t call it a wow response.” Even more damning, this “effect” was observed after the patient “must been on it at least a year and a half by that point” – a dubious response given the highly subjective and unreliable nature of the hyperphagia questionnaire. 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I want to say about 15% may have had the side effect of edema and maybe 20% the side effect of hyperglycemia and maybe 20% the side effect of hypertrichosis. There certainly was potential for unblinding. No question..\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "194c6b3f-3302-4d94-a004-4fb5cb41331d", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.66 }, "kind": "callout", "text": "A: “It does. It does. If you are waiting to use it until the patients are already massively obese and diabetic.,,my own personal experience was that...the folks who did have glucose elevations, it just bumped up their fasting glucose by five or ten points, but it didn't tip them over into diabetes. Now, again, I have a small n, but my sense is that it sort of reset your fasting blood sugar up ten points. 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Probably would monitor them really closely if I started this drug.” -Trial investigator, pediatrician/geneticist, professor", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "daa8b50b-3994-4a4a-9aad-25df19bedbef", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "There certainly was potential for unblinding...no question.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:36+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b1-b28f9f2ed41a", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "paragraph", "text": "Q: “What do you think about the diabetes issue? When I looked at the data for the pilot study, it looked like there were 13 patients. One got full-blown diabetes. A number of others appear to become pre-diabetic. It was artfully worded in the adverse events table. And I've seen different figures that maybe up to 40% of the PWS population is diabetic. Does that limit the commercial opportunity and applicability?”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f9e6f13-2b80-42d3-9f1f-c1fe78495dac", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.55 }, "kind": "paragraph", "text": "Cautious about diabetes risk; limits TAM; resets fasting glucose by 10 points per investigators personal observations", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "54e1f1ae-94f7-4d85-88a1-297ac46d16ee", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "Q: “The adverse events table says...20% have hypotrichosis? Even if it's 20%, that level of unblinding is enough to make the p-value completely unreliable.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8c600c42-67e8-47cb-8f96-85bed20346e8", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.67, "x": 0.07, "y": 0.35 }, "kind": "paragraph", "text": "Trial was essentially unblinded major adverse events like edema, hairiness, hyperglycemia", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "98daee88-c1d2-4337-94cb-c052e00340f5", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.86, "x": 0.07, "y": 0.75 }, "kind": "paragraph", "text": "Q: “Are you worried about risk of any kind of safety signal emerging?”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c090dfbc-ad49-4ba4-9fc1-137786226d5c", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.66, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "A: “Yeah, 20% would be enough to, yeah.” -Trial investigator, pediatrician/geneticist, professor", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.089+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cfe30219-5ad1-43f9-939a-10732175183e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“There were three main side effects which not everybody gets. I want to say about 15% may have had the side effect of edema and maybe 20% the side effect of hyperglycemia and maybe 20% the side effect of hypertrichosis. There certainly was potential for unblinding. 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How large is the tablet, first of all? This other investigator called it a horse pill. Is it large?”\nA: “Well, the 150 milligram one was big. And so there were some folks who couldn’t swallow that big a pill, so we had to use the 75 mg for them instead. So, yeah, the 150 mg is a big pill.”\nQ: “Like, how big is it?”\nA: “It’s for sure bigger than an Advil. Twice the size of Advil?”\nQ: “When I asked this other investigator about it, he said, well, what I observed, the patients are just chewing it, which undermines the entire extended release.”\nA: “Oh no, they can’t —”\nQ: “They’re not supposed to, but what are you going to do? It’s a kid”\nA: “Well, no. In order to get in the study, you had to be able to demonstrate that you could swallow a pill. I don’t know what to tell you.” -Trial investigator, pediatrician/geneticist, professor", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.758+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6fc9cad1-5197-4142-9bd0-6f213f5350c6", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "Trial investigator #5 stated that the Vykat tablet was too large for some trial patients and that they had to use several of the smaller dose tablets instead. When we asked why anyone would even use a tablet formulation for children, the investigator replied that “in order to get in the study, you had to be able to demonstrate that you could swallow a pill…I don’t know what to tell you” – “some folks couldn’t swallow that big a pill, so we had to use the 75 mg for them instead…so yeah, the 150 mg is a big pill.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:20.758+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "766cc7f3-7578-4c07-8f8a-0c80f0f44a9a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Well, the 150 milligram one was big. 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21:26:21.256+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7b713346-6b78-4212-bafa-8e6f92eb0fee", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.4 }, "kind": "quote", "text": "Q: “It sounds like you think that from a pharmacokinetic clinical standpoint, the oral and the DCCR are equivalent; it's the same ingredient, diazoxide, just a different formulation.”\nA: “Yeah, a suspension is always going to be better. And I didn't appreciate it was going to be so expensive.”\nQ: “But you think they're freely interchangeable, as a researcher?”\nA: “Yeah, they should be. And for Prader-Willi, I don't think you'd need to worry so much about titrating it to a certain level and things, because it's not the sugars we're worried about, it's just being able to dampen the hyperphagia response. I think even if, say, they were on the same oral suspension and you were worried about peak levels or whatever, you still wouldn't really need to give it two to three times daily, I don't think, because it's a different —”\nQ: “You think once a day oral suspension is probably sufficient?”\nA: “Yeah, I would have thought so. I'd say, you might need to take it to a dose and then do it. 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And for Prader-Willi, I don't think you'd need to worry so much about titrating it to a certain level and things, because it's not the sugars we're worried about, it's just being able to dampen the hyperphagia response. I think even if, say, they were on the same oral suspension and you were worried about peak levels or whatever, you still wouldn't really need to give it two to three times daily, I don't think, because it's a different —” “Yeah, I would have thought so. I'd say, you might need to take it to a dose and then do it. 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only 10-15% would even trial it", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.372+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ee86bb42-6f91-4e18-9d30-26123d56e164", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.86, "x": 0.07, "y": 0.5 }, "kind": "quote", "text": "“I am a pediatric endocrinologist. I have a multidisciplinary Prader-Willi clinic, and you probably already saw that I was a lead author, chair for developing the [redacted] guidance for children and young adults for Prader-Willi Syndrome...I see about 40 patients with Prader-Willi Syndrome...” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.372+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "01bc3a2e-0ba6-47e7-b68f-05bac1625111", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.79 }, "kind": "quote", "text": "Q: “How much enthusiasm do you sense from other doctors or patients? 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I will probably just trial normal diazoxide and see what happens.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.372+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1eb985e9-5655-48e0-bffa-11348513ce45", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "quote", "text": "Q: “Let’s say we’re two years, five years out. It sounds like you don’t like the price and aren’t sure if it works. What percentage of Prader-Willi patients, within two years, five years out, do you really think are going to be on this drug?”\nA: “I suppose 10% to 15% would probably trial it.”\nQ: “So, you think, at most, the total addressable market is about 10% of patients?”\nA: “At most.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.372+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "70f6b98b-b7b7-4c38-8914-2f047a477848", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I am a pediatric endocrinologist. I have a multidisciplinary Prader-Willi clinic, and you probably already saw that I was a lead author, chair for developing the [redacted] guidance for children and young adults for Prader-Willi Syndrome...I see about 40 patients with Prader-Willi Syndrome...I suppose 10% to 15% would probably trial it...At most...No. The day it got approved, I happened to have a clinic. A couple of patients said, oh, this is got news. It's got FDA approval. At that time, we weren't aware of the cost. I wouldn't say this is something that every child or every patient of mine with Prader-Willi syndrome should receive this treatment. This is still on a case-by-case patient basis. And again, some of the younger ones are managed very well and don't need it. However, would I be able to allow and be able to justify that cost? That's probably the biggest issue. And then, as physicians, all it's going to take is somebody to actually say, you know what? I can't afford that. 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I will probably just trial normal diazoxide and see what happens. — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-1d538375c2ea", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Stated the cost is unjustifiable given limited benefit, and that he would rather just use generic diazoxide suspension instead: “I wouldn’t say this is something...every patient of mine...should receive...this is still case-by-case...why don’t I just trial regular diazoxide...[it has] the same kind of pharmacological profile as DCCR...I will probably just trial normal diazoxide and see what happens.”", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.372+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "adb0097e-1628-4a8e-ab08-12926c57b17f", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 330, "type": "setup", "title": "Includes direct Q&A transcripts from a trial investigator/endocrinologist.", "function": "preempt_rebuttal", "rawType": "preempt_rebuttal", "block": null, "metadata": { "slideType": "preempt_rebuttal", "slideTypeCanon": { "name": "Preempt rebuttal", "slug": "preempt_rebuttal", "status": "active", "canonId": "019de52d-1225-7368-af32-6381fddabdb3", "version": 1, "description": null }, "function": "preempt_rebuttal", "functionCanon": { "name": "Preempt rebuttal", "slug": "preempt_rebuttal", "status": "active", "canonId": "019de52d-18ab-7479-9a7e-820a2f03586a", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 81, "componentCount": 8, "textChars": 3058, "nDataPoints": 3, "notes": "Includes direct Q&A transcripts from a trial investigator/endocrinologist.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:27.288+00", "seconds": 9.615, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/330", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-330", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "The problem with these trials and all trials of patients with rare conditions, and I suppose the Prader-Willi patient is the same when I've tried to recruit patients for other trials for Prader-Willi Syndrome, the ones who I think may benefit because they have got issues with weight gain and so on, are often the ones who are reluctant to participate in clinical trials.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-a216a6a53716", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.31 }, "kind": "paragraph", "text": "Not suitable for the 15 patients that could theoretically be prescribed the drug out of 40-50 total in the clinic; trial had inherent selection bias", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "28e130eb-930d-491a-be9b-93197fe66c50", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "paragraph", "text": "30-40% of older patients are diabetic; unsuitable for young patients as parents can manage the hyperphagia", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "74831140-d384-4f0c-8385-d910244773b8", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.37 }, "kind": "quote", "text": "Q: “What did you make of the quality of the trial?” A: “The problem with these trials... you've got patients who are motivated... they're also motivated in managing their underlying condition... it's not just about a drug... 10 to 15 or so patients I have that may benefit from it probably weren't suitable for the trial.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "76cf3e3f-5d55-47e3-956a-5e99302e13a9", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "quote", "text": "Q: “What percentage of PWS patients do you think are diabetic? What's your estimate, including the older ones?” A: “The older ones, probably about 30%, 40% because the older ones weren't managed as well... Q: “And what is your cut-off age?...” A: “Under ten, I don't think they need it because the parents are in control and their hyperphagia is managed.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a86fca37-2d50-4604-99ba-cf8948491dc6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "The problem with these trials and all trials of patients with rare conditions, and I suppose the Prader-Willi patient is the same when I've tried to recruit patients for other trials for Prader-Willi Syndrome, the ones who I think may benefit because they have got issues with weight gain and so on, are often the ones who are reluctant to participate in clinical trials. Whereas the ones who are already motivated are often keen to participate in trials. So, you have a kind of inherent selection bias. You've got patients who are motivated, who want to participate in trials, and because they're motivated, they're also motivated in managing their underlying condition. And as we've already mentioned, it's not just about a drug here for Prader-Willi Syndrome. There's lots of lifestyle, food security, etc., so your trial population is already biased to a certain degree. So, you've not got the maybe the most severe patients. I suppose that's where going back to my patient cohort, the 10 to 15 or so patients I have that may benefit from it probably weren't suitable for the trial. — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-a4517b89977b", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I looked at that chart in the corporate presentation. And you see the placebo arm HQ-CT scores go to the moon in the withdrawal phase. It’s a dramatic shift in HQ-CT score. How reliable were that data from the randomized withdrawal phase?”\nA: “I can only go by my patients, and n=[redacted, under 5] is not in any way a study or a trial. But n=[redacted, under 5], there was not a huge difference in my patients. They’re also transitioning from school or college placement, so behavior became more and more challenging. But there’s also other factors. And that’s what the trial does not necessarily take into account, because the hyperphagia is also triggered or made worse by anxiety and challenging behavior. So, really, what was the improvement? Because again, things may improve in terms of that patient’s caregiver, lifestyle, and stability. And because that’s improved, the hyperphagia and the HQ-CT changes.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:26.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7a771020-d848-45cc-a11e-9924410c8eef", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.35 }, "kind": "paragraph", "text": "Trial had a “strong placebo effect”; skeptical of the “unusual” withdrawal study\n“Now, my patients, one was on the placebo to start off with, and one was on — those patients, certainly, their hyperphagia did not get any worse, probably potentially got better. Now, I don't know whether that's — all these drugs also have a strong placebo effect. So, you could argue that it was placebo effect. I think that's the reason they had to do that placebo withdrawal, which is unusual in terms of trials. So, it was an unusual study plan that they had to get more data, but they had the fact that they had to do a placebo withdrawal. That's unusual.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:26.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e5092d16-8590-4629-b819-9e2375eb3b7a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Now, my patients, one was on the placebo to start off with, and one was on — those patients, certainly, their hyperphagia did not get any worse, probably potentially got better. Now, I don’t know whether that’s — all these drugs also have a strong placebo effect. So, you could argue that it was placebo effect. I think that’s the reason they had to do that placebo withdrawal, which is unusual in terms of trials. So, it was an unusual study plan that they had to get more data, but they had the fact that they had to do a placebo withdrawal. 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It's not a great marker. It's the only tool that we have as validated. But it's not perfect. 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It's not a great marker. It's the only tool that we have as validated. But it's not perfect. You're basing a lot of your study or your analysis on something that's not perfect. It's not like your HbA1c or your cholesterol level. It's a subjective score. It's not a hard and fast measurement..it will vary depending on who's done it, whether it's the mom, the dad, or grandparents. In terms of the median score of 20, that's a very high score. And most of my patients are nowhere near that. Now, whether that's a true genuine score or not, I don't know...If they've got such a high score, is it just purely a placebo effect goes down for the score from 23 down to 15, is that really the drug? Is that placebo? Is that the fact that they've done a trial? I don't know.\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:25.111+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a8449155-8a1c-4db2-87fe-9a3b8cf130a1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "the HQ-CT score, it’s not a great marker...it’s a subjective core...will vary depending on...whether it’s the mom, dad, or grandparents; the median score of 20, that’s a very high score...most of my patients are nowhere near that...is it just placebo effect goes down for the score from 23 down to 15...is that really the drug? — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-607325169b82", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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unconvinced that Vykat extended release formulation adds any value", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.914+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "48de05c9-9a16-4c68-9296-577c55204c5e", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "paragraph", "text": "Diazoxide already has a long half-life; only need once a day dosing for older kids with liquid; generic liquid is substitutable and expects hospital to ask him to use it instead", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.914+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "69a3d574-b5fa-4961-9073-7a8aadfd6ba2", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "quote", "text": "“Diazoxide I use regularly, and I use it in babies. My other interest, as well as Prader-Willi Syndrome, is hyperinsulinism. I am familiar with diazoxide, and I have been using it for many years. I normally give 2-3 times a day, and there is a liquid preparation. There are capsules. Although the liquid preparation, which is more stable...I suppose the question — is it worth the difference? Obviously, when we participated in the trial, we weren't aware of the costs and so on. I want to know whether that drug is more effective or not. Now, whether it's the extended coding that makes a difference, whether it's diazoxide, it's probably just the diazoxide, where the extended release probably makes no difference at all. And you could argue, why give something once a day, which is great compliance-wise, and it's great for the patient. But half to $1 million is a bit excessive for something that you could do for a year, for $1,000 at most. There is that issue. Is it really going to be effective? I'm not convinced whether it's the actual choline, the extended choline release that makes a big difference, or whether, is it really just the diazoxide?” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.914+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0f0da0d9-5880-47d6-bb2d-8bb26a5f6f84", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.7 }, "kind": "quote", "text": "“I'm not a pharmacologist, so I don't know the kind of pharmacokinetics, but, if it's diazoxide and certainly when I've used it for hyperinsulinism, it does last. I know it's got a long half-life, although we routinely prescribe it 2-3 times a day, I know as a child is older — the babies need more but as a child is older, once a day and even when they come off it, it takes a week or even two weeks before you see the kind of effects of diazoxide wearing off. I know it's got a long half-life. Could we just use diazoxide instead of this very expensive Vykat? That's probably true. My management will ask, \"Well, fine. You have no other drug? Okay. 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And if they are charging half a million to $1 million per person, that is very expensive for a drug that isn’t that novel ...it’s hard to justify the cost of the diazoxide, the normal formulation, which the Proglycem is about $800 a bottle.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-4ac9e116963e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.35 }, "kind": "list", "text": "Not worth the “absolutely outrageous” cost for Vykat versus cheap liquid diazoxide – “a drug that isn’t that novel”\n“The cost is absolutely outrageous…my concern is certainly, is this cost-effective? And if they are charging half a million to $1 million per person, that is very expensive for a drug that isn’t that novel …it’s hard to justify the cost of the diazoxide, the normal formulation, which the Proglycem is about $800 a bottle.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.588+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0b568d2c-dd2d-4b91-b19d-40c36e67a4e7", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "list", "text": "Prefer liquid formulation if PK is identical; easier to titrate; already uses generic diazoxide capsules in older kids\nQ: “if you had to pick one formulation, which one do you think checks off more boxes if they’re pharmaceutically identical?”\nA: “If it’s identical, then I would probably pick the liquid preparation because I can titrate it better and offer it to more patients. Going back to hyperinsulinism, most of my patients who are on diazoxide take the liquid preparation. There’s only a couple of patients who take the capsules, so the older ones take the capsules, but the majority —.” -Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:21.588+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2cc6b469-9465-46d4-b568-caf7c34bf92b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“The cost is absolutely outrageous...my concern is certainly, is this cost-effective? And if they are charging half a million to $1 million per person, that is very expensive for a drug that isn’t that novel ...it’s hard to justify the cost of the diazoxide, the normal formulation, which the Proglycem is about $800 a bottle.” — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-4d29f023a93a", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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also works with adult PWS clinic with 60-70 patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.015+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "995a5d25-080f-4414-899a-96793c1c6c64", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "paragraph", "text": "Almost all patients out of approximately 10 discontinued due to “drug reaction,” “side effects,” or just didn’t want to be on drug", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.015+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b63123e7-2b91-42e9-8b59-398167ae0f30", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "quote", "text": "“I'm a pediatric endocrinologist, so I only see children up until the age of 18. And I've got 35 patients in my caseload. And when patients are 18, I'll refer to an adult endocrinologist, and he looks after approximately 60 or maybe 70 patients with Prader-Willi Syndrome...we see our patients every four months, sometimes every five months, but ideally every four months. In a lot of other places, they're being seen only once a year.” -Trial investigator/author, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.015+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9a1d3410-a620-4443-a73d-a83b42220119", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.6 }, "kind": "quote", "text": "Q: “How many patients did you enroll in the Vykat trials, starting with maybe the Phase 3?”\nA: “And so, we had [slightly under 10] patients actively running. And I think we screened two more patients that then didn't fulfill criteria.”\nQ: “And then how many of them are still on it?”\nA: “And so, in the moment in my clinic, there are still two on it...one patient stopped because of drug reaction. One patient stopped because they didn't want to be in the trial anymore...one patient was transferred to adult, started working, so also didn't want to be involved anymore. One patient felt that they had side effects...and therefore didn't want to continue. I think that's probably it.” - Trial investigator/author, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.015+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c059260d-5110-47ab-bce7-6462166d3b59", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I'm a pediatric endocrinologist, so I only see children up until the age of 18. And I've got 35 patients in my caseload. And when patients are 18, I'll refer to an adult endocrinologist, and he looks after approximately 60 or maybe 70 patients with Prader-Willi Syndrome...we see our patients every four months, sometimes every five months, but ideally every four months. In a lot of other places, they're being seen only once a year.\" — Trial investigator/author, pediatric endocrinologist; \"And so, we had [slightly under 10] patients actively running. And I think we screened two more patients that then didn't fulfill criteria.\" — Trial investigator/author, pediatric endocrinologist; \"And so, in the moment in my clinic, there are still two on it...one patient stopped because of drug reaction. One patient stopped because they didn't want to be in the trial anymore...one patient was transferred to adult, started working, so also didn't want to be involved anymore. One patient felt that they had side effects...and therefore didn't want to continue. I think that's probably it.\" — Trial investigator/author, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-c0b4160753e0", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I will be careful with patients that have impaired glucose tolerance because then to type 2 diabetes, I think, is quite an issue.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "07bff6ef-ff19-4946-bf6d-dd1e8b3491ae", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.11 }, "kind": "paragraph", "text": "When we asked how many of the investigator's 35 PWS patients were likely to be prescribed the drug, the investigator evaded the question with an indirect but telling answer...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4f94d839-6aeb-4c2d-96ab-64f6de96966e", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.62 }, "kind": "paragraph", "text": "Q: \"What was the adverse effect that led the patient to discontinue?\" A: \"It was a drug reaction... we had suggested starting metformin...\" Q: \"You were worried enough about the blood sugar elevation to put the patient on metformin?\" A: \"I was worried about the glucose increase...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:22.932+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f12258c6-6144-400b-a768-5067cd1372f5", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I will be careful with patients that have impaired glucose tolerance because then type 2 diabetes, I think, is quite an issue.” — Trial investigator/author, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:37+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-7b238599c7a5", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.93 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/337", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-337", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Moreover, this investigator comments cast grave doubt on the validity of the withdrawal study, which showed an abrupt spike in HQ-CT scores in the placebo group for such a “slow drug.”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": 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So, sometimes people think, initially, in the first three months, that there isn’t a change, but then you will see their behavior change or their weight go up, either one.” Q: “How long do you think it takes to work, to kick in?” A: “I think it takes about 8 to 12 weeks to work, probably more towards 12 weeks. And that’s also what you see when you look at data. At 12 weeks, you start to see a significant difference between placebo and the drug. Then the effect is more clear by 16 weeks, and it only plateaus at about 35, 40 weeks. 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And over time, all the patients have developed hypertrichosis...the patients that I saw, most of them developed some degree of hypertrichosis. Yes.” -Trial investigator/author, pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.685+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "df095586-fd17-4f97-a4cd-194c577015b8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“The drug takes a long time to work. So, sometimes people think, in the first three months, that there isn't a change, but then you will see their behavior change or their weight go up, either one.”; “I think it takes about 8 to 12 weeks to work, probably more towards 12 weeks. And that's also what you see when you look at data. At 12 weeks, you start to see a significant difference between placebo and the drug. Then the effect is more clear by 16 weeks, and it only plateaus at about 35, 40 weeks. It's a slow drug.”; “I think that the hypertrichosis, clearly, it's hypertrichosis. And over time, all the patients have developed hypertrichosis...the patients that I saw, most of them developed some degree of hypertrichosis. 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"v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/340", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-340", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "it's pretty quiet overall... what I'm not hearing people say, when can I get my hands on Vykat? Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless. I'll put it this way...this somewhat surprising and out of the blue approval that I don't think any of us were quite expecting.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-e9bff966551b", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.34 }, "kind": "paragraph", "text": "Endocrinologist sees 8-12 PW patients personally and ~20 at his institution; significant percentage of PWS population in Chicago area", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.832+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4c01da6e-b05f-41a2-a893-64c483aaa58d", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.86, "x": 0.07, "y": 0.57 }, "kind": "paragraph", "text": "Q: \"So, you're basically in the know of a substantial percentage of the patients in the Chicago area. It sounds like you're in touch with the practitioners.\"\nA: \"I would say yes, that's true.\" – Endocrinologist with academic and community hospital affiliations", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.832+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "54e8886e-3e4d-493b-8fcf-f8fca139be7f", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.39 }, "kind": "paragraph", "text": "A: \"I have appointments at Northwestern and also see patients at a local federally qualified health center. We're paired with our colleagues at [redacted], from whom we inherit quite a lot of these patients as they graduate to adult endocrinology clinics. I see somewhere between probably eight and 12 patients with Prader-Willi in a year.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.832+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "571888a8-110c-4555-aecb-66baf6b2e8c2", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "paragraph", "text": "Q: \"How many Prader-Willi patients does Northwestern have? The institutions that you're affiliated with, roughly.\"\nA: \"I would say somewhere in the range of 20 or so...obviously, some of my colleagues have some of these patients, too. I would imagine that captures probably 50% of the Prader-Willi patients in their...\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.832+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "76a830fb-a372-4958-b879-d1e8e49aae59", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.66 }, "kind": "paragraph", "text": "No enthusiasm among practitioners for Vykat\nQ: \"What are you hearing as far as enthusiasm out there? Like at Northwestern, other institutions? Is there chatter? Are people emailing about this?\"\nA: \"I think what I'm hearing is — I would say it's pretty quiet overall. But there is, as you know, there is a desperation in the air about what to do about these patients. If, in fact, there are indications that generic diazoxide can work to reduce some of the hyperphagia and is worth a try before patients become diabetic, or to evaluate if they become seriously hyperglycemic, etc., then I think there will be enthusiasm for that approach. But essentially what I'm not hearing people say, when can I get my hands on Vykat? Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless. I'm kind of waiting for some collegial conversations because we're really new into this somewhat surprising and out of the blue approval that I don't think any of us were quite expecting.\" - Endocrinologist; academic and community hospital affiliations.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.832+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d68df187-1f40-40f4-9920-46c6a29a05c2", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“it's pretty quiet overall... what I'm not hearing people say, when can I get my hands on Vykat? Because we all know diazoxide, and we all know the problems with it. It's not like we're clueless. I'll put it this way...this somewhat surprising and out of the blue approval that I don't think any of us were quite expecting.” — Endocrinologist; academic and community hospital affiliations", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-ee8383f67927", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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So, that's just interesting, but I haven't, and that's maybe telling", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-3138a572ef5f", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.72 }, "kind": "quote", "text": "“Furious” about “outrageous” cost; can get same appetite suppression for pennies\n“I think it's something like $400k a year or something outrageous…I imagine quite a lot of my patients, in fact, all of them are probably over 100 kilos. And that probably pushes me starting, starting about 150…of course, it bothers me. It makes me mad, maybe even furious, about these outrageous costs. Because ultimately, this degree of appetite suppression could be readily achieved with sedating medications like Haldol and other antipsychotics, for example, which have their own diabetogenic risk for the cost of pennies.” – Endocrinologist with academic and community hospital affiliations", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.774+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "775a69a4-3a8f-494e-b72f-3098910fb30e", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.5 }, "kind": "quote", "text": "“I haven't had emails from my patients or patients' families, which is very interesting, even though this is a pretty active community. So, that's just interesting, but I haven't, and that's maybe telling that there is maybe less either awareness or enthusiasm amongst the patient population or their families. I suspect what will happen is that there will be a variety of attempts to prescribe, start forms issued, initial experience, and then what to do with those for non-accessible patients and for patients who do respond. I think the next steps will probably be a lot will come off the branded version onto generic if it works. And for patients who are declined because of access reasons, efforts to try unbranded diazoxide and then an evaluation kind of in the next few weeks and months as to whether this approach is adequately balanced with the safety and efficacy in a way that might create an opportunity we haven't had before, or whether this is all hoopla and bluster.” -Endocrinologist; academic and community hospital affiliations.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.774+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a29d4ce7-34e9-493d-b92b-29fea3f625ef", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I think it’s something like $400k a year or something outrageous…I imagine quite a lot of my patients, in fact, all of them are probably over 100 kilos. And that probably pushes me starting, starting about 150…of course, it bothers me. It makes me mad, maybe even furious, about these outrageous costs. Because ultimately, this degree of appetite suppression could be readily achieved with sedating medications like Haldol and other antipsychotics, for example, which have their own diabetogenic risk for the cost of pennies.” — Endocrinologist with academic and community hospital affiliations.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-34f8c59af1c9", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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And I was like, \"That's rubbish.\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b2-bb627263c95e", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.07, "y": 0.57 }, "kind": "paragraph", "text": "Surprised it got approved; underwhelming data – “rubbish”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.293+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cbed0e06-019c-48d7-b2ea-1a7653c59756", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.61 }, "kind": "quote", "text": "Q: “So, you were surprised it got approved?” A: “Yeah, I wasn’t anticipating this particular piece of news in my Prader patients at this time I wasn’t expecting to see this — I don’t think there was a perspective that this was likely to happen. And I think me and my colleagues were surprised that all of a sudden we have an approval with this label right now...”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.293+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b4a6e758-b109-40b8-aa0b-a310089eb571", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.69 }, "kind": "quote", "text": "Q: “And that’s because you’re like, what? Diazoxide is a 50, 60 year old drug? Or like, what was the reason for that surprise?” A: “Because it’s been an erratic performer in trials, and I think I was comparatively unimpressed by — and somewhat inattentive as a result — to the journey of diazoxide through the trials that it has done. And I had previously kind of set in my mind that this was not particularly exciting and therefore kind of lost interest, even though I have quite a few Prader-Willi patients who have problems with hyperphagia. And so, when I saw this approval, I was like, \"What the hell?\" I wasn’t expecting that. Then, when I started looking at the data to see more positive data than I had in my head as established features of the drug. So then, I was like, oh, that looks more impressive than I thought it was, and it’s approved by the FDA. Like, okay, interesting. Let me read some more. So, I read a few more pieces, as I mentioned to you. And I thought, wow, maybe there’s something here. I do remember looking at one of the — I think it was an investor deck I pulled open or something — where they were talking about why this works. 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I would say somewhere in the range of probably 40% of my patients with Prader-Willi, even at this young age, already have diabetes. And I’ll be especially leery about introducing diazoxide into a diabetic patient for all sorts of obvious reasons. 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No surprise…and importantly, some patients get ketoacidotic because the insulin suppression is so potent at these doses that you essentially render the patient to be type-one diabetic, which increases the risk of ketoacidosis, which could be potentially lethal in wide use being in this context.” Endocrinologist; academic and community hospital affiliations.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.457+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "98370a86-793f-4cc2-8b13-93951e472e40", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "The downside, of course, is hyperglycemia and maybe some of the peripheral edema, fluid retention, maybe exacerbating some heart failure.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:38+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-608b1ad4ad85", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.07, "y": 0.54 }, "kind": "paragraph", "text": "Diabetes and edema “exacerbating” heart failure are risks", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.457+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "05905ed3-a79e-4339-9cff-0484ce5959cd", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.65, "x": 0.07, "y": 0.64 }, "kind": "paragraph", "text": "Concerned about diabetes risk from mechanism of action and “lethal” ketoacidosis in particular", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.457+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2abd6e54-4ad6-4ba5-9def-2f24d72fd57f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.07, "y": 0.79 }, "kind": "paragraph", "text": "High prevalence of and concern regarding diabetes limits TAM for Vykat", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:22.457+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a103d7ec-b471-48c6-8605-26398b0e0b2f", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "In this patient population, especially, it doesn't take much to make them diabetic or certainly hyperglycemic...and no surprise, given this mechanism of action. 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concerned about now understanding it properly vs. “marketing messages”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:23.366+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8c84a99f-70ea-4c84-a110-24cbb429af62", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.68 }, "kind": "quote", "text": "Endocrinologist highly concerned after trial investigators’ feedback regarding their intent to use the drug “It’s very compelling that a high-volume specialist who has experience with the drug in the clinical trials indicates that their observed efficacy endpoints were modest to mild, to maybe even near zero, and that they aren’t excited about this medication for their patients, and certainly not at this price point. 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I won't use it unless I do an echo. I'll do an Echo two weeks later?”\nA: “When we use it, those are kids that are on high rates of intravenous fluids already, because their blood sugar is not being stabilized on a normal amount of IV fluid that you might give someone, even a little baby size. Because they're on such high rates, when we write for diazoxide, we always write for a diuretic at the same time, because we've seen heart failure on this drug a whole bunch of times. We're definitely cautious about it.” – Pediatric oncologist, Children's Hospital of Philadelphia (CHOP), top center for pediatric endocrinology and diazoxide use in hyperinsulinism", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:29.792+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1804863a-09f3-433f-9748-0900351b4338", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.86, "x": 0.07, "y": 0.85 }, "kind": "paragraph", "text": "Stunned at the price\nQ: “The company's starting to market it at $500,000 to more than $1 million a year. That's $1,500 to $3,000 a day per pill.”\nA: “Say that slowly again, the cost.”\nQ: “It's $500,000 to $1 million or more per year per patient.”\nA: “Oh my God. I knew it was expensive. I didn't even know it was that expensive.” – Pediatric oncologist, Children's Hospital of Philadelphia (CHOP), top center for pediatric endocrinology and diazoxide use in hyperinsulinism", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:29.792+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "99999623-24d6-4714-8aa3-06e24ca9b5cc", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.59 }, "kind": "paragraph", "text": "Vykat is an afterthought with flimsy interest vs. drugs that are “more useful”; Vykat “sort of like came up”\n“I don't think people care unless it’s an absolute like enzyme replacement. The other drug we're dealing with, which I hear more about is Crenessity, which is the new drug for congenital adrenal hyperplasia. That one, to me, is more useful because it's attacking something in a very logical way. It's unique. There's no other preparation that we could exchange it with. And our kids with that condition, which I probably have about 20 of, they're on these two high doses of steroids in order to suppress their high levels of testosterone-like compounds, androgens. I look forward to starting someone on that. That Prader-Willi drug sort of like came up. We'll have a discussion about it. And, of course, we'll have to learn more before the patient comes in. I didn't know about the size of the pills and all that stuff...” – Pediatric oncologist, Children's Hospital of Philadelphia (CHOP), top center for pediatric endocrinology and diazoxide use in hyperinsulinism", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:29.792+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ad39d59c-b155-41d0-8e32-db9ef5e57e78", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“When we use it, those are kids that are on high rates of intravenous fluids already, because their blood sugar is not being stabilized on a normal amount of IV fluid that you might give someone, even a little baby size. Because they're on such high rates, when we write for diazoxide, we always write for a diuretic at the same time, because we've seen heart failure on this drug a whole bunch of times. We're definitely cautious about it.” — Pediatric oncologist, Children's Hospital of Philadelphia (CHOP)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:39+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b3-ed34edac7cae", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Now, this is completely inherent to the mechanism of action, because it's suppressing insulin production. So, the fact that this would happen in a patient population where 30% or 40% are already diabetic, it seems nuts.\"\nA: \"That is very concerning. We use this drug to make blood sugars go up in our population...well, we've talked about theoretically, the hypoglycemic effect, because we use this drug all the time, we're the biggest referral center for hyperinsulinism in little babies. And we also talked about it being a little surprising because we weren't expecting this to be the type of drug that would be used in this condition. But the study we had reviewed, it was a short article — I really don't remember the details. People seem to say, okay, we'll see. And then their presence in it, certainly at the meeting, I didn't go to any specific talks about this, but no one talked about it. I don't think it was a big enough topic to make the headlines.\" – Pediatric oncologist, Children's Hospital of Philadelphia (CHOP), top center for pediatric endocrinology and diazoxide use in hyperinsulinism", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.007+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ef67f5b2-644f-429c-95e3-cfc5f27ec5c7", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "That is very concerning. We use this drug to make blood sugars go up...we've talked about theoretically, the hypoglycemic effect, because we use this drug all the time, we're the biggest referral center for hyperinsulinism in little babies...we also talked about it being a little surprising because we weren't expecting this to be the type of drug that would be used in this condition...people seem to say, okay, we'll see...certainly at the meeting, I didn't go to any specific talks about this, but no one talked about it. I don't think it was a big enough topic to make the headlines. — Pediatric oncologist, Children's Hospital of Philadelphia (CHOP)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:39+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b4-32092099fa50", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We use this drug to make blood sugars go up...we've talked about theoretically, the hypoglycemic effect, because we use this drug all the time, we're the biggest referral center for hyperinsulinism in little babies...we also talked about it being a little surprising because we weren't expecting this to be the type of drug that would be used in this condition...people seem to say, okay, we'll see...certainly at the meeting, I didn't go to any specific talks about this, but no one talked about it. 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And I feel like the truth eventually comes out... I've seen this before... I've learned to be cautious. 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Q: The trial was functionally unblinded... A: It's very concerning... I didn't know anything about what you just told me.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:26.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "60892fcd-1774-4567-b4a6-846af58a8e00", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.9, "x": 0.05, "y": 0.65 }, "kind": "paragraph", "text": "Haven't started any patients at CHOP; skittish and concerned about the drug after our questions; skeptical in general. The liquid certainly sounds a lot easier... You obviously are 20 steps ahead of me...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:26.917+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b350f223-5dba-4974-a911-754ebe0f981d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Well, it's amazing you've done all that good investigation. It's very concerning...I feel like the truth eventually comes out... I've seen this before... I've learned to be cautious...it's so super expensive...and they didn't have weight loss data...that is concerning to me”; “you obviously are 20 steps ahead of me...I don't think we've started anyone on this in our whole practice...we may be foolishly just applying for it...it's very strange...you're quite knowledgeable on this.” — Pediatric oncologist, Children's Hospital of Philadelphia (CHOP)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:39+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b4-6192c935d28f", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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That’s the reason for my hesitancy.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.763+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7d08c97c-3bb6-42ea-b54c-964688f50d23", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "paragraph", "text": "“Cynical” and has “hesitancy” about Vykat due to known dangers of diazoxide; “problems with the study trial design”; small size of trial; “have to be cautious”\n“I would say that I know this is going to sound maybe cynical, but I’m overall, when it comes to rare diseases like this, I would say I’m skeptical in terms of if it’s going to be successful or not, because number one, these are very rare diseases. How much benefit are we going to get from this? Number two, I’m aware of what diazoxide is. So, it’s kind of like, hmm. Diazoxide can be problematic for other reasons. I would say you have to be cautious about it because there can be some not very good side effects. And since it’s such a rare disease, I don’t know what good of a power these clinical trials are going to have because they’re going to have a low amount of patients since it’s a rare disease. There’s going to be problems with the study trial design itself, the power of the study, how much statistical significance is going to be there? It’s all rather difficult to say. That’s the reason for my hesitancy.” - Endocrinologist at Massachusetts General Hospital", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.763+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "83e7b99a-271b-4eff-b780-0faaf9f8e1e8", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "paragraph", "text": "Endocrinologist at Massachusetts General with 5 PWS patients\n“I’m actually an adult endocrinologist. I have maybe up to five PWS. They’re in early adulthood. I have a very rather small amount, as you know, PWS is a rare disease. But I know some things about it. I’m an adult endocrinologist.” - Endocrinologist at Massachusetts General Hospital", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.763+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d9eccf2c-400b-4c94-bb8f-7d781d3f6ae1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I would say that I know this is going to sound maybe cynical, but I'm overall, when it comes to rare diseases like this, I would say I'm skeptical in terms of if it's going to be successful or not, because number one, these are very rare diseases. How much benefit are we going to get from this? Number two, I'm aware of what diazoxide is. So, it's kind of like, hmm. Diazoxide can be problematic for other reasons. I would say you have to be cautious about it because there can be some not very good side effects. And since it's such a rare disease, I don't know what good of a power these clinical trials are going to have because they're going to have a low amount of patients since it's a rare disease. There's going to be problems with the study trial design itself, the power of the study, how much statistical significance is going to be there? It's all rather difficult to say. That's the reason for my hesitancy.” — Endocrinologist at Massachusetts General Hospital", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:39+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b4-8feaf507e181", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Are people like, we’ll see? Is there any buzz or chatter about it?”\nA: “I think one person told me about the news of the release of the FDA approval of this medication, but that's really about it.”\nQ: “Do you plan to use it in any of your five patients? Or maybe cautiously try it? Or you’re wait and see?”\nA: “I would probably wait and see at this point. Let’s say, if the hyperphagia really worsens, or maybe if the support system says, hey, we want to try this medication. Obviously, if they already have a baseline, poorly controlled diabetes, it probably wouldn't be the best idea. I would be willing to try it, but with hesitancy.” - Endocrinologist at Massachusetts General Hospital", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.807+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "507ddc41-a664-4eee-a2dc-0bd445bc4b96", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.69 }, "kind": "list", "text": "Q: “Are you aware of what their pricing Vykat?”\nA: “I don’t, but I’m going to assume it’s probably at least $1,000. Right?”\nQ: “$500,000 to $1 million a year.”\nA: “Oh, God.”\nQ: “It’s something like $1,500 to $3,000 per pill per day for a small-molecule tablet.”\nA: “I don’t know how much success they’re going to have with insurance covering these medications.” - Endocrinologist at Massachusetts General Hospital", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.807+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bc71bccc-5c67-4a85-a1be-fceece3ce2f7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "paragraph", "text": "Has heard almost no chatter or enthusiasm about Vykat; “wait and see at this point” about using it; wouldn’t use in diabetic patients; may “be willing to try it” at some point “but with hesitancy”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.807+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4d11afd8-c0cb-4b67-968b-7c05886a6264", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.86, "x": 0.07, "y": 0.64 }, "kind": "paragraph", "text": "Had no idea of price and assumed maybe $1,000; shocked at actual price; “don’t know how much success they’re going to have with insurance”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:24.807+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "996e65c1-8b43-404c-9fc2-6b9cde9af6d6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Oh, God...I don't know how much success they're going to have with insurance covering these medications”; “I think one person told me about the news of the release of the FDA approval...but that's really about it”; “I would probably wait and see at this point...obviously, if they already have a baseline, poorly controlled diabetes, it probably wouldn't be the best idea. 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I 100,000% agree”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:39+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b4-71e347cec771", "parentComponentId": null }, { "bbox": { "h": 0.62, "w": 0.86, "x": 0.07, "y": 0.33 }, "kind": "paragraph", "text": "Has heard no enthusiasm from other endocrinologists at MGH; no PWS patient has inquired about it\nQ: “Have you heard any comments around Vykat? Are you the only person at Mass General that treats PWS patients? Have you heard other colleagues that treat PWS? Have you heard anything from them about it?”\nA: “I’m sure some of my other colleagues probably have some because some of us are also like obesity certified. But I haven’t heard anything from anybody else about it.”\nQ: “Have you had any patient inquiries out of your five patients saying, hey, this got FDA approved? I want to try it.”\nA: “I have not. No, they haven’t given me any inquiries. No.”\nQ: “Is there anything else here in your thinking about Vykat that might be useful for me to understand?”\nA: “I think we probably just need more data. I’m feeling neutral about it because diazoxide has its own issues and side effects. So, I guess it’s more of a we’ll wait and see.”\nQ: “What are the other side effects you’re concerned about from diazoxide?”\nA: “The big one is hyperglycemia. I know there can be some dizziness, nausea. The biggest ones, we talked about sodium and water retention, hyperglycemia. I think rarely there can be some hematologic problems, but one is the sugar issues and swelling.” - Endocrinologist at Massachusetts General Hospital\n\nVykat mechanism of action creates inherent diabetes risk – “like pouring gasoline into the fire. I 100,000% agree”\nQ: “The entire mechanism of this drug is to raise blood sugar by suppressing insulin, which is why you’ve used it for hypoglycemia. In the context of obese Prader-Willi patients, I’ve heard figures saying maybe 30%, 40% of them are diabetic to begin with. Why would you give them a drug that does this?”\nA: “Right. Well put. You’re totally right. It could be like pouring gasoline into the fire. I 100,000% agree…I’ve used diazoxide previously, not for PWS, but diazoxide helps raise blood sugar, so I’ve used it in hypoglycemia, non-diabetic, hypoglycemic. We’d have to be careful about diazoxide because it brings up blood sugar. 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It wasn’t me; it was one of my colleagues. I think she was waiting to hear back on what happened. A couple of my patients are young, and they don’t have hyperphagia. I’ve been following them since they were two months old for growth hormone. Whereas her patients are a little bit older...she just spoke up and shared because we know how this goes, sometimes, when newer things come out, everybody’s excited about it. 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I think she was waiting to hear back on what happened. A couple of my patients are young, and they don't have hyperphagia. I've been following them since they were two months old for growth hormone. Whereas her patients are a little bit older...she just spoke up and shared because we know how this goes, sometimes, when newer things come out, everybody's excited about it. But then if there's a lot of hurdles for insurance and things like that, then people become less enthusiastic.” — Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:40+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b4-d52ee64e8f63", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Did you read the clinical publications? Are you just getting up to speed? What’s your knowledge level? Your current enthusiasm level? Are you taking a wait-and-see attitude, or are you going to submit forms for everybody?” A: “I think you have a very active community; with social media you have a very active group of people that are looking for things. There’s an investigator in Florida, Jennifer Miller, who I’m sure, on the research, she’s on the papers. A lot of families that have the resources go see her once a year. So, they’re very closely connected and on the edge of things. Meaning, it’s not uncommon where sometimes patients are bringing stuff to providers because it’s rare enough where maybe somebody only sees one patient they’re not up to. We reviewed the paper in Journal Club when it came out before, and I re-reviewed the 2003 JCM paper. And then there was a ’24 follow-up paper. I reviewed those for our call today, and I was generally familiar, but I did review those. 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I did go to the Pediatric Endocrine Society meeting a few weeks ago, and I sat next to someone who's done a lot of this research - I did fellowship at CHOP, and I can say the people around the table, I sat with some people that I knew from fellowship, and most of them were not super impressed.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.255+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6c94bb5a-740f-4458-a3bd-fbb29b75ed89", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.36 }, "kind": "quote", "text": "“And it was locking up the cabinets kind of thing. A lot of the stories that the reps provided with us on Wednesday aren't things that I'm seeing right now with my patients. But most of my patients are younger. I don't have any kids that are older. 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Honestly, I feel very similar. There's a medication called Crenessity, which just came out, and they have just been pushing hard. And with Vykat, they are pushing hard. I got so much stuff in the mail, so many emails for stuff. And I feel very similar in that they're both pressing. And the Crenessity thing is for kids with CH, they can't come off hydrocortisone, but it can help a little bit. And we talked about it as a group. There's a couple of patients that, sure. But the price tag was $400,000 or $500,000 a year. And we all agreed this may be a nice adjunct for a couple of kids, but do we really think it's worth that price tag? And we all said no. And it was funny when I asked, oh, what does it cost? And I did actually ask the medical rep what Vykat cost. But the salespeople had stepped out and she's like, oh, I don't know. I can't answer that. I'm like, \"Come on, you don't know?\" – Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:26.837+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ddbd1895-f086-4e44-a0ff-52341da8de85", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“And I can tell you the point the investigator made on the Vykat cost is very poignant. Honestly, I feel very similar. There's a medication called Crenessity, which just came out, and they have just been pushing hard. And with Vykat, they are pushing hard. I got so much stuff in the mail, so many emails for stuff. And I feel very similar in that they're both pressing. And the Crenessity thing is for kids with CH, they can't come off hydrocortisone, but it can help a little bit. And we talked about it as a group. There's a couple of patients that, sure. But the price tag was $400,000 or $500,000 a year. And we all agreed this may be a nice adjunct for a couple of kids, but do we really think it's worth that price tag? And we all said no. And it was funny when I asked, oh, what does it cost? And I did actually ask the medical rep what Vykat cost. But the salespeople had stepped out and she's like, oh, I don't know. I can't answer that. I'm like, \"Come on, you don't know?\"” — Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:41+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b5-5c9aefb9ad63", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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And then the price tag.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:40+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b5-1625f61fa93e", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "paragraph", "text": "Highly concerned about diabetes risk given longstanding familiarity with diazoxide among endocrinologists\n“I think the thing that probably worries me the most is just the hyperglycemia, and what to do with that. You already have an obese population that's at risk for type 2 diabetes.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.04+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "240f90d5-bd97-4f88-84db-a8d553c5f9ee", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.38 }, "kind": "paragraph", "text": "CHOP is the “Mecca” for diazoxide treatment for hyperinsulinism; hair growth is extremely bothersome to patients – “hairy baby”; concerned with adverse effects like edema, pulmonary hypertension; “can't say there's great enthusiasm” for Vykat; “I think all of us, so particularly a lot of us who trained, there's four of us that trained to CHOP and diazoxide. We have edema, pulmonary hypertension, even the hair, to be honest. I can't tell you how many kids — for the hyperinsulinism CHOP is the Mecca. I can't tell you how many parents, just the hair is so bothersome. The alternative is your child might need to have your pancreas removed, but just the cosmetic. Maybe it'll be different in older people that already have hair and it's not a hairy baby. But I can't say there's great enthusiasm. And then the price tag. I think we're all going to say, okay, this is nice, but I think you're probably going to have some patients that respond, and maybe it's worth it or not. If you're having to lock the cabinets and things.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.04+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d26cdfd8-8971-4665-9e73-11ed2425619a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "We have edema, pulmonary hypertension, even the hair, to be honest. I can't tell you how many kids — for the hyperinsulinism CHOP is the Mecca. I can't tell you how many parents, just the hair is so bothersome. The alternative is your child might need to have your pancreas removed, but just the cosmetic. Maybe it'll be different in older people that already have hair and it's not a hairy baby. But I can't say there's great enthusiasm. And then the price tag. I think we're all going to say, okay, this is nice, but I think you're probably going to have some patients that respond, and maybe it's worth it or not. 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physician is under the impression that Soleno is sending glucose monitors \"All the things about diabetes and the blood sugar risk, they're going to basically prescribe the medication with a glucometer. They're going to actually — I think they're going to have a process where the glucometer gets sent to the family with the medication. And using one medication to treat the other —. I saw lots of babies that were put on diazoxide, and the dose was too high, and they had hyperglycemia, so, we decreased it. But there's not really a good — in the babies with hyperinsulinism, we're adjusting it because of hyperinsulinism. And these guys, they're at risk for diabetes or they might be pre-diabetic.\" - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.269+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "003c4b9d-6976-485e-a5d5-1d7791c20d52", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.86, "x": 0.07, "y": 0.72 }, "kind": "quote", "text": "Endocrinologists pushed Soleno rep on diabetes risk; titration schedule doesn't mitigate the risk \"And they suggested insulin resistance. But if you're hyperglycemic, I don't know how it's going to get better by going up more slowly on the dose or then you hold it a lower dose. Is that okay? Somebody did bring that up, and they were like, oh, we just go up more slowly. I'm not sure. With the mechanism of action of what it's doing. It's not like a GLP-1 where your body gets used to it. When they first started designing this and thinking about it, but it is in a group of people that you're very worried about, and you could probably make the argument, too, that a lot of those people, if they're more hypergaphic, if they get type 2 diabetes, they're probably the people that would benefit the most from it. But by that point, it may be too late. Because if you already have type 2 diabetes and you're making it worse, are you really helping the problem?\" - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.269+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8b7ba826-fcea-471f-b426-349c1cc863c1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“All the things about diabetes and the blood sugar risk, they’re going to basically prescribe the medication with a glucometer. They’re going to actually — I think they’re going to have a process where the glucometer gets sent to the family with the medication. And using one medication to treat the other —. I saw lots of babies that were put on diazoxide, and the dose was too high, and they had hyperglycemia, so, we decreased it. But there’s not really a good — in the babies with hyperinsulinism, we’re adjusting it because of hyperinsulinism. 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When they get older, we actually stop it. Most of the time they don't still need it, which I was a little bit surprised that they were talking about treating kids with diuretics as a standard of care with this medication — that was one of the things that the rep said. I was surprised about that because if I have somebody with congenital hyperinsulinism that has a mutation that responds to diazoxide, and we continue to treat them, and there's a couple later on in life, I would not treat that kid with a diuretic. Usually, they're old enough and they do fine. 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When they get older, we actually stop it. Most of the time they don't still need it, which I was a little bit surprised that they were talking about treating kids with diuretics as a standard of care with this medication — that was one of the things that the rep said. I was surprised about that because if I have somebody with congenital hyperinsulinism that has a mutation that responds to diazoxide, and we continue to treat them, and there's a couple later on in life, I would not treat that kid with a diuretic. Usually, they're old enough and they do fine. 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But that's not something we're typically do.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.799+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bbcd4df3-c592-4268-bc60-2ee49c95a1e5", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.22 }, "kind": "paragraph", "text": "“As far as serious cardiac events, we did talk about pulmonary edema at the visit, and she even said something about giving people a handout and how to recognize edema...and I was just like, \"huh!\" I would expect something transient, but I wouldn't expect a permanent edema, to be honest....” When we asked if Soleno was worried enough about edema to actually give families a handout, the physician replied “yes...they said something about the families are very good and teaching people how to recognize the edema at home, which, I'm an endocrinologist, and I can certainly do that, pitting versus not...but that's not something we're typically do.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.799+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9f13e20d-915e-4f3e-b9dd-7ec9a2ee2a8a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“As far as serious cardiac events, we did talk about pulmonary edema at the visit, and she even said something about giving people a handout and how to recognize edema. 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And then, they explain it's extended-release. And okay, but you can give it a couple of times a day.. And, obviously, we still don't know exactly why it works...everybody in endocrine is really familiar with diazoxide for hyperinsulinism. So, trying to understand the difference of mechanism with the long-acting and the salt formulation were some of our questions\" - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.356+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "86755aa5-1415-4399-b29d-27fe42f90064", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.78 }, "kind": "paragraph", "text": "\"Ethics of is this worth $1 million a year\"; endo's at recent annual meeting already asking why they can't use regular diazoxide Q: \"Right, but obviously the centers with the most PWS patients, centers like yours, CHOP, the sophisticated ones, those endocrinologists are all going to have tremendous experience with diazoxide suspension anyway. In those sophisticated centers, do you think they'd be more comfortable just using that off-label?\" A: \"I think so. If they couldn't get approval for Vykat — but we do talk about the ethics of is this worth $1 million a year? And you have this conversation with the same thing with Crenessity. The conversation I had at the Pediatric Endocrine Society conference, what we all said was, can we just prescribe regular diazoxide?\" - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:27.356+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a2151fcd-a9b3-4219-aca3-a4ac490d006d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "For our group because half of us trained at CHOP, we use a lot of diazoxide, and I even asked that question like, can you just use your garden variety diazoxide. And then, they explain it's extended-release. And okay, but you can give it a couple of times a day.. And, obviously, we still don't know exactly why it works...everybody in endocrine is really familiar with diazoxide for hyperinsulinism. So, trying to understand the difference of mechanism with the long-acting and the salt formulation were some of our questions — Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:41+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b5-45928fde94ba", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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pediatric endocrinologists “super comfortable” with off-label and generic diazoxide suspension; “most should be pretty comfortable with it”; cost will lead people to think about using it instead “We actually asked that as far as the pill, because the trial's four and up....I think some people are less comfortable writing off-label, although to be honest, a lot of things in pediatrics are off-label, specifically pediatric endocrine. Even diazoxide, to be honest, I'm super comfortable with it just because in fellowship we saw so much hyperinsulinism. Most people should be pretty comfortable with it. Hyperinsulinism, meaning congenital hyperinsulinism in babies that are born with their pancreases that are just making too much insulin. Then they have hypoglycemia. That's typically what we treat it for. We use it a lot. We all are pretty familiar with it. It's part of our daily conversations and the cost. I think that will make people say, huh.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:32.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "50662b10-04fc-47af-a202-4b7de7ef43f7", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.86, "x": 0.07, "y": 0.72 }, "kind": "paragraph", "text": "Soleno rep appears to be suggesting that Vykat’s extended release formulation is “able to penetrate the brain better” Q: “What was the drug rep's answer when you asked this question about substitutability with generic?” A: “Her line was extended-release. And because it's salt, it's different in talking about penetration to the brain. That's what she said.” Q: “She said the salt has clinical benefit and penetration to the brain?” A: “She said something about the salt form being able to penetrate the brain better and be more effective. Again, the exact verbiage, I don't remember.” - Pediatric endocrinologist at a Delaware academic center with eight endocrinologists and ~50 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:32.244+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dfeb0ad7-8b90-4900-b9dc-daec14c09290", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“to be honest, a lot of things in pediatrics are off-label, specifically pediatric endocrine... diazoxide, to be honest, I'm super comfortable with it...most people should be pretty comfortable with it...we use it a lot...we all are pretty familiar with it...and the cost...I think that will make people say, huh”; “her line was extended-release...and because it's salt, it's different in talking about penetration to the brain...that's what she said...she said something about the salt form being able to penetrate the brain better and be more effective.” — Pediatric endocrinologist at a Delaware academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:43+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-8c362a63b25c", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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There are a lot of people that don’t know about the drug. I really haven’t spoken to those others in the study, but that would be interesting to talk to them to get a couple of different opinions from the people in the study. I think that’s important now. It’s not something we typically do, but it’s something I need to do now. Most of the enthusiasm has come from the families about the drug. 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I appreciate your input about it...you brought up factors that I think maybe you are unique in bringing them up because of your interaction with all these different people...no, I appreciate it.\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.142+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ba2751b4-03d6-423e-b4fd-03284b2f7561", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"You're right. You're definitely right about that. A lot of it's coming from — Soleno definitely has quite an involvement in this. And definitely a lot of it, I'm sure who's supporting the study people being supported by Soleno, they are communicating on the same message. But, I mean, that happens. You're absolutely right. The more opinions you get, the better. But most of us in the medical field are not going to get this information; we're just not going to. It sounds weird because we're prescribing the drug, but we do rely on ethical research. 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I'm more worried about the edema.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-6f01e213cac1", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The endocrinologist indicated significant concern about edema-induced cardiac risk, as well as diabetes, to the point that he has asked Soleno for an answer; and plans baseline cardiac evaluations, which we presume would involved an echocardiogram", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.621+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f157367c-ef0a-4d1e-8da9-11e9966cc09f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.56 }, "kind": "quote", "text": "I'm more concerned about the edema than the hyperglycemia - it's easier to monitor for the hyperglycemia than for the edema. And so that's been a question I've asked them: how do they clinically evaluate for edema if you're not going to be seeing the patient all the time? Are you relying on reports by the parents, etc.? If you actually look at the data, I think 30% of drug patients, treated patients actually developed edema, while 10% of the placebo developed edema, which is 1 in 10 in the placebo group developed edema. I'm more worried about the edema.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.621+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "39a134f1-25af-473b-9c96-5d7796c90dce", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.75 }, "kind": "quote", "text": "My concern is how do we clinically monitor it? I personally am doing baseline cardiac evaluations on these patients to ensure that optimal cardiac health, etc., in case they do develop edema, which can put strain on the cardiac function. But that's something that we have to monitor for by doing maybe weekly weights, relying on the parents, etc. There are ways of dealing with it. You can reduce the dose, you can stop drugs, you can put them on a diuretic. But the proof is going to be when we start treating these patients and seeing what happens. But that's really the number one for me, the edema. And then the hyperglycemia...we just have to wait and see what happens.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:28.621+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "86905b90-f466-48b2-a025-fcf8229ef60a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I'm more concerned about the edema than the hyperglycemia...it's easier to monitor for the hyperglycemia than for the edema...that's been a question I've asked them: how do they clinically evaluate for edema if you're not going to be seeing the patient all the time?...I think 30% of drug patients, treated patients actually developed edema... 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Correct. I have that correct. You are hearing information that a lot of people haven't heard.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-86c883def707", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "\"You bring up a very good points...you are hearing information that a lot of people haven't heard.\" He then referred to \"study people\" who we suspect to be Jennifer Miller: \"I know the study people as well, and maybe it's biased...maybe that's a biased impression that I'm getting....it's sort of not absolutely appropriate...if they have an issue with the study, they really should be publishing a letter about it in the journal that published the study\"; \"what you're saying is concerning and worrisome...this is not information that's out there...this definitely gives a pause to it...I'm careful about the drug, but maybe more hesitant...you're absolutely right....\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.131+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6c2b6b83-7ec6-41c8-91e7-665f815e0b89", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.85, "x": 0.07, "y": 0.65 }, "kind": "quote", "text": "Physician expressed caution about Vykat after our questions. 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[Highlighted quotes follow]", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.131+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a53d39dd-5bf3-4b00-9595-928b2ec3f3e8", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“You bring up a very good points, but if you review the studies and look at the studies, this information is not suggested in the study. Correct. I have that correct. You are hearing information that a lot of people haven't heard. Having noted that, I always am a benefit-risk person in terms of prescribing a drug. I've spoken to — I know the study people as well, and maybe it's biased.. Maybe that's a biased impression that I'm getting. Maybe that's a biased impression that I'm getting. 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It’s a very small space.”\nA: “This is not good. This is not good at all.”\nQ: “If one pharmacology expert gets up and says, here's the PK curve, here's the data manipulation in the Soleno paper, here's a formula for the oral equivalent dose —.”\nA: “But clinically, we've been dosing these patients, the hypoglycemic patients, we've been dosing them two, three times a day. Historically, that's what we're doing. Basically, is the suggestion now that we don't need to dose them 2 or 3 times a day?”\nQ: “Diazoxide has a long half-life. It's not like you need to be dosing them all day long.”\nA: “But historically, we've done it 2 to 3 times. I think I'm going to rely on that data. 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I’m not a PK person, but if you’re telling me that there’s a similarity, it would make no sense to do it in a tablet — if you’re saying that the PK data is similar. You’re absolutely right. Has that been an issue, a question that I brought up? Yes, it has been a question because you are giving, sometimes, developmentally delayed individuals, trying to get them to take this medication. 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No, you're absolutely right. In retrospect, could they be doing a better job with it? Absolutely correct. I can't argue with you. I can't argue with you.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:41+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b5-cff81edebb65", "parentComponentId": null }, { "bbox": { "h": 0.48, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "list", "text": "A: \"The other thing actually, to bring up sort of a negative point is you have to be really — a lot of these patients are on psychiatric drugs and other drugs, and it is quite complicated to — and I've asked them, Soleno. They've suggested some website to see interactions of Vykat with these other drugs, and it is quite complicated to - and I've asked them, Soleno. They've suggested some website to see interactions of Vykat...that's also a concern...the five patients that I picked are not on any other drugs as well. That is definitely somewhat of an obstacle as well. Do you understand what I'm saying? Q: \"The potential drug-drug interactions. These patients have a lot of comorbidities and a lot of other medications, naturally.\" A: \"Yeah, the specific CYP drugs and things like that.\" Q: \"And there are a lot of contraindications in the Vykat label, different CYPD, whatever, all these different pathways.\" A: \"That's what I'm talking about.\" Q: \"And the company just referred you to some website? They didn't even have a clear answer for it?\" A: \"Well, they referred to [chuckles] an FDA website and some other sites in terms of drug interactions. 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I can't argue with you.\" – Division Chief for pediatric endocrinology at a major NE academic center", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:36.34+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6a8bd62c-2ca7-475c-9654-aab524008ef3", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.33 }, "kind": "paragraph", "text": "Highly concerned about drug-drug interactions with Vykat; Soleno just referred him to an FDA site; limits the TAM dramatically; chose first 5 patients as ones not on other drugs; \"extra work...a pain for us\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:36.34+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f0da1773-fbef-4657-a810-398605314b31", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "The other thing actually, to bring up sort of a negative point is you have to be really — a lot of these patients are on psychiatric drugs and other drugs, and it is quite complicated to — and I've asked them, Soleno. 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willing to prescribe to desperate families pushing for it, but no interest in appealing insurer denials given lack of efficacy", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.976+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d110eff7-7910-4319-a088-3639b2c1e618", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.81 }, "kind": "quote", "text": "“You've identified a lot of the issues that I've been thinking about. And yet, I'm still trying to get people on it. I guess that I'm feeling maybe a little more hypocritical after talking to you, but I feel like the expectation is there that since this is FDA approved and available, that trying to get on the drug is important to families. What I'm not doing is I'm not feeling like when I get a denial that the patient is being robbed of something that's life-saving, and that I want to devote all my energy to getting this approved because it's a travesty if they're getting denied, which would be the case if I was prescribing the drug that I actually felt like was going to be life-saving to a patient that was getting denied.” - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.976+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "22a1f23c-57eb-4f38-943a-8f23e724a76a", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.63 }, "kind": "quote", "text": "“I'm hoping that there's some benefit from the drug. And that some of the issues that you're describing with the studies — I wasn't aware of all of them, but of course, the failure of the clinical trial and then the extension that had the signal, of course, I'm familiar with that. I agree that it's marginal. Of course, I'm hoping that they're going to be offered the medication now that it's available...” - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.976+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9d80d844-bf5d-4ab3-be93-75b771e29f76", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“the failure of the clinical trial and then the extension that had the signal, of course, I'm familiar with that...I agree that it's marginal...there is definitely some pressure and expectation from families” — Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-9f026691973b", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Maybe some pediatric endocrinologists that aren't part of an academic center have like 1 or 2 patients, and so they're interested in learning more. But people positioned like me are probably prescribing it, but with some question about how successful it's going to be.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:42+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-40fe7f30013f", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.57 }, "kind": "paragraph", "text": "No buzz or chatter about Vykat at recent key annual endocrinologist meeting; some people probably prescribing it \"but with some question about how successful it's going to be\"; didn't bother to attend any Vykat sessions", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.851+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9c635416-a7fd-4926-b803-36cf3105fd17", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "paragraph", "text": "Patient enthusiasm driven mainly by Facebook PWS groups; \"been wanting to start it as soon as it was released\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.851+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a8292b46-db48-43ac-8a91-0a266bcc14d8", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.44 }, "kind": "quote", "text": "\"I would say that many of my patients are on Facebook groups and so on. That type of family is aware that Vykat is available. They were aware that it was going to be available before it was available. They've been excited for it. They've been wanting to start it as soon as it was released.\" - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.851+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "10dea69d-c45f-46a8-b100-9de77c429bed", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "quote", "text": "Q: \"Were you at the endocrinology meeting the other week? The big annual one?\" A: \"Yes.\" Q: \"And how much buzz or excitement there was on Vykat, or has it been pretty muted?\" A: \"First of all, I'd say the average pediatric endocrinologist doesn't care because they don't have any patients with Prader-Willi Syndrome. The buzz is only amongst people in the quote-unquote, Prader-Willi community. Maybe some pediatric endocrinologists that aren't part of an academic center have like 1 or 2 patients, and so they're interested in learning more. But people positioned like me are probably prescribing it, but with some question about how successful it's going to be.\" Q: \"But this wasn't like chatter in the hallways among PWS people at the meeting?\" A: \"I wouldn't say that.\" Q: \"And if you had to rank the level of enthusiasm or discussion among PWS people at the annual meeting, the big PWS people for Vykat, on a scale of 1 to 10, what do you think that enthusiasm or excitement level was that you observed?\" A: \"I didn't attend any of the Vykat sessions.. I didn't personally talk to anybody about Vykat at the conference.\" - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.851+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cebcca46-2cd1-47df-a705-98e938a409d1", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I would say that many of my patients are on Facebook groups and so on...they've been excited for it...they've been wanting to start it as soon as it was released” — Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center. “I didn't attend any of the Vykat sessions.. I didn't personally talk to anybody about Vykat at the conference...” — Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:42+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-464882ea4c8c", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Or get a little more guidance about how to be successful from the manufacturer.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:42+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-24ce6fdb12a8", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.86, "x": 0.07, "y": 0.39 }, "kind": "list", "text": "...but only 3 insurance approvals out of 15 forms submitted; 6 patients denied outright; 4 patients in black hole where insurer won't act, so essentially denied for now; not appealing the denials at present", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.944+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eeae9ac2-407e-469f-9d48-7ecf0cc53741", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "denial to approval ratio: 3:1", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:42+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-2d5db48571f0", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.45 }, "kind": "paragraph", "text": "Q: “How many forms have you submitted for insurance authorization? How many have you submitted already in the last month?”\nA: “I would say about 15.”\nQ: “And how many of those have gotten approved or denied?”\nA: “Several have denied it. If I was to say 15, three approved it, I would probably say six denied it. And four have said premature to approve or deny.”\nQ: “It sounds like a 2:1 denial-approval ratio right now.”\nA: “Mm-hmm.”\nQ: “And for the six denials, are you going to appeal it, write letters and peer reviews? Or are you just going to let it go for now?”\nA: “We're waiting until we have a little more information about how to be successful with the appeals. 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If I was to say 15, three approved it, I would probably say six denied it. 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"kind": "callout", "text": "It's a very unique situation in the PWS community because Miller is a destination for these families... there's other interventions that are not evidence-based that she promotes, CoQ10, levocarnitine, MCT oil...she promotes these things as really important...and so, patients will go see her, and come back and want to start these non-evidence-based supplements...she's a proponent of these loosely evidence-based interventions for Prader-Willi Syndrome...and I feel like patients come back with a lot of requests, oftentimes, that are a little bit maybe out there that they're asking me to co-sign....", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 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levocarnitine, MCT oil...she promotes these things as really important...and so, patients will go see her, and come back and want to start these non-evidence-based supplements...she's a proponent of these loosely evidence-based interventions for Prader-Willi Syndrome...and I feel like patients come back with a lot of requests, oftentimes, that are a little bit maybe out there that they're asking me to co-sign....”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:26.812+00", "model": 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As I've been taking care of these patients over the last ten years, there's other interventions that are not evidence-based that she promotes, CoQ10, levocarnitine, MCT oil. She promotes these things as really important. And so, patients will go see her, and come back and want to start these non-evidence-based supplements. And some of it has some data, and it's all pretty benign and cheap, to be honest. So, a lot of us are pretty agnostic about these interventions that it's just like whatever. But she's a proponent of these loosely evidence-based interventions for Prader-Willi Syndrome. And I feel like patients come back with a lot of requests, oftentimes, that are a little bit maybe out there that they're asking me to co-sign as their doctor that they see throughout the year. And most of the time, I do because they're generally benign things that they're convinced are going to be helpful. 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highly skeptical of arguments for Vykat vs. generic", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.668+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dd1ca864-21c3-444d-b5dd-c8088e8dae0b", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "I feel cynically or realistically, that they're marketing an extended-release to get a different drug so they can get the patent.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-af8a39897f92", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The endocrinologist thinks generic diazoxide suspension is no different than Vykat and that the field will soon figure this out; that Soleno has provided no convincing answer for why its tablet formulation is necessary; that it is just a cynical patent ploy...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.668+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f53cef5-9aaf-47ea-8567-848aa94b1511", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "quote", "text": "Q: \"If somebody is convinced by the diazoxide data and they like it, why wouldn't they just prescribe generic diazoxide suspension over the extended-release tablet? What's the rationale?\" A: \"So, this is the thing that is really a big question in my mind...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:30.668+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0890698b-6dc0-4277-af0a-fe1f7aac9a22", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "So, this is the thing that is really a big question in my mind, because I don't really understand why — I haven't gotten a good answer, I don't feel like — why extended-release is necessary for this mechanism of action. And I feel cynically or realistically, that they're marketing an extended-release to get a different drug so they can get the patent. Why wouldn't I just be prescribing diazoxide? When I've asked other folks, they said diazoxide doesn't work. But in my mind, I'm just wondering if that's just they're bought and sold by the company to say that, to convince me not to prescribe diazoxide and prescribe Vykat. I feel like if I was to continue to have failure of getting this approved or other doctors would have failure getting this approved, I imagine that there would be more discussion around prescribing diazoxide liquid. And I'm just interested to see how that all plays out because I don't think that question has been answered to my satisfaction of exactly what you just asked me. 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I said, \"Why wouldn't I just prescribe diazoxide?\" And she said, Oh, it doesn't work.' But I don't know if that was because she was also motivated to get the Vykat approved.\" - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.736+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a47db8f3-99ca-40f7-9e5f-0678cf55200a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.39 }, "kind": "paragraph", "text": "Q: \"This whole thing just seems like in one of these meetings, an annual society meeting, it's going to take one journal paper where somebody gets up there and says, here are the equivalent dosages of oral suspension versus tablet. And my read is that the company is going to be in trouble because it's a very small world, and you can't be the only one asking this question.\"\nA: \"No, I don't think I am. As a prescriber, it's always nice to have an FDA indication for a medication that has side effects, because if I'm just going off-label with a drug that could give them diabetes or edema or death, then I feel like I have more cover prescribing a medication with an FDA indication. But I don't think anything you're saying is surprising to me, or that all the things that I've been thinking to myself, and so, I don't disagree.\"\nQ: \"Have you asked the company about this issue?\"\nA: \"I feel like I've asked representatives, and I don't think the answer can really convince me that I had my question resolved.\"\nQ: \"And you asked a rep, or you asked some trial investigators, or spokespeople?\"\nA: \"I think a rep.\"\nQ: \"And do you remember what the rep said? I'm just curious how they're trying to position it.\"\nA: \"The rep said that he didn't have the answer but that he knows that doctors participating in making it believe that the diazoxide doesn't work. Maybe the answer had to do with something, obviously, to the extended-release nature of the drug. But it wasn't a complete enough answer that it really made me convinced that it wasn't just a little bit of lip service.\" - Pediatric endocrinologist, leads one of the largest PWS clinics in US with 30-40 patients; 11 endocrinologists, major academic center", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.736+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cb2a958c-d478-42b5-9103-ab5011a38d98", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "No, I don't think I am. As a prescriber, it's always nice to have an FDA indication for a medication that has side effects, because if I'm just going off-label with a drug that could give them diabetes or edema or death, then I feel like I have more cover prescribing a medication with an FDA indication. But I don't think anything you're saying is surprising to me, or that all the things that I've been thinking to myself, and so, I don't disagree. — Pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:43+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-a49f7876a72e", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.736+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9be9b9d3-9d9d-47f1-96c8-c12330a05eec", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "The endocrinologist stated that other physicians are asking the same question about generic substitution; that’s he’s asked Soleno why Vykat is necessary versus the generic and that the answer lacked credibility; and that he also asked Jennifer Miller who allegedly stated that regular diazoxide doesn’t work – an answer he viewed as similarly questionable, and which we view as brazenly disingenuous marketing on behalf of Soleno given the lack of any clinical evidence to support it.", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.736+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9167b46e-1332-4507-9f8a-09ad15ec134d", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 388, "type": "setup", "title": "The slide uses a combination of summary text and direct interview transcripts to build a case against the drug's adoption.", "function": "introduce_nominees", "rawType": "nominee_bio", "block": null, "metadata": { "slideType": "nominee_bio", "slideTypeCanon": { "name": "Nominee bio", "slug": "nominee_bio", "status": "active", "canonId": "019de52d-1136-70ae-861a-f546f0c9d1ef", "version": 1, "description": null }, "function": "introduce_nominees", "functionCanon": { "name": "Introduce nominees", "slug": "introduce_nominees", "status": "active", "canonId": "019de52d-1833-77fe-ac47-5f26d823a84a", "version": 1, "description": null }, "density": "dense", "densityScore": 69, "componentCount": 7, "textChars": 3265, "nDataPoints": 0, "notes": "The slide uses a combination of summary text and direct interview transcripts to build a case against the drug's adoption.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:14:31.491+00", "seconds": 3.851, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/388", "deck": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckAnchor": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-388", "deckJson": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "stated that they were all highly skeptical of Vykat with no plans to prescribe; called Soleno a \"one-trick pony\" and was bewildered anyone would think to use diazoxide in PWS patients, dismissing Vykat as \"bananas\" and \"Mickey Mouse\"", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-ff3f2d9ecb96", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.16 }, "kind": "paragraph", "text": "Recently reviewed Vykat papers at a “journal review” with 8 endocrinology colleagues – stated that they were all highly skeptical of Vykat with no plans to prescribe; called Soleno a “one-trick pony” and was bewildered anyone would think to use diazoxide in PWS patients, dismissing Vykat as “bananas” and “Mickey Mouse”; extreme concern about diabetes, cardiac events, and fatal DKA; compared it to the Aduhelm debacle; and stated that generic diazoxide suspension is superior to Vykat’s tablet format – “more questions than answers.” He added that he spoke with Jennifer Miller at a recent conference – “obviously, they were trying to educate/sell the drug” - and that no families have asked about Vykat – “we’re not hearing a bunch” - and that they’ve refused to meet the drug rep – “they’d like to, but we’ve got limited time…”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.491+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0cd4a057-03cf-4383-9295-7f2a14877c3a", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.64 }, "kind": "paragraph", "text": "No PWS families have inquired about Vykat; no start forms submitted; will eventually “see where things are at”\nQ: “And of these 3-6 patients, have you already submitted any start forms, or are you taking a wait-and-see attitude right now?”\nA: “We’ll take it as they come through and see where things are at and talk about stuff.”\nQ: “This wasn’t like all the patients are emailing all the doctors or WhatsApp-ing each other?”\nA: “Yeah, we’re not hearing a bunch. Well, I think most of the communication is coming from the company, obviously.”\nQ: “Did any of the families ping you saying, we’ve got to try this drug?”\nA: “Not yet.”\nQ: “Has a drug rep showed up yet?”\nA: “No, they haven’t shown up yet. They’d like to, but we’ve got limited time. And if I have somebody who shows up for anything new, we have them team with an MSL because I don’t want somebody who can’t answer my questions. I know the reason that the walls are up. And again, I’ve lived through quite the changes through pharma. But I want an MSL as well as a rep because I want somebody who can answer the questions.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.491+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8b9dd191-41ff-4d2c-8184-d1a1f242b679", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.55 }, "kind": "quote", "text": "I am aware of the data and have seen some of the data presented and looked at the paper. I have about 3 to 5 PWS patients at the moment. We do trials, so I expect we were contacted about the trial. We actually did it in our journal club with our group. And then I was just both at the European and the US peds-endo meetings. And I actually spoke to Dr. Miller. And, obviously, they were trying to educate/sell the drug.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.491+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "34a2f101-1865-4937-a892-e449a7623747", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I am aware of the medication and have seen some of the data presented and looked at the paper. I have about 3 to 5 PWS patients at the moment. We do trials, so I expect we were contacted about the trial. We actually did it in our journal club with our group. And then I was just both at the European and the US peds-endo meetings. And I actually spoke to Dr. Miller. And, obviously, they were trying to educate/sell the drug.\" — Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b7-03817f878ff3", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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And other interventions do make a big difference, especially when they're started early.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c4-c54612dee8a2", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.77 }, "kind": "paragraph", "text": "Vykat price is “bananas” as PWS is not an expensive condition and “other interventions do make a big difference”\nQ: “They're marketing at 500,000 to $1 million a year. Were you aware of that?”\nA: “That price is bananas because the disease isn't that expensive. And other interventions do make a big difference, especially when they're started early. And engaging the families to be the at-home therapist, just like kids with autism and ADA, makes a huge difference.” - Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.38+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "559fb2b0-437c-43ac-a3e7-7ba79c08b42e", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.52 }, "kind": "paragraph", "text": "A: “We sat around the table reading the article. Didn't necessarily go into all the details that you discussed, and, obviously, didn't have some of the insights that you had. But the specific things that we talked about were diabetes and cardiac risk. At this point, nobody is really saying this is something we absolutely should be doing. And even with a couple of new other therapies out for CAH, etc., well, again, the company thinks it's the best thing since sliced bread. You know what? We are going to do our standard of care...we're not going to start it day one. For other disease states where there were no medications, some of the bone stuff, and having the utmost respect for some of the investigators, we started the new meds right away. The safety profile was great. The existing treatment sucked. 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Then you give them diazoxide to suppress the insulin.” A: “Right. I've been doing that since I was a fellow. And the hypertrichosis is certainly real. The dose is lower. And they argue that it's a salt, and the dose is lower. I was unaware that there are different channelopathies that develop based on your Prader-Willi mutation. 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I've been here almost 30 years. We've had a couple of deaths from DKA...", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:31.094+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4e082ebf-e7d3-4443-8024-ab82cf1c99fa", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"if you got somebody on diazoxide and you've got somebody on growth hormone... that also is increasing your risk of diabetes...in DKA in overweight people, you also can get type 2 diabetes and wind up in a different type of ketoacidosis with hyperosmolar problems and coma...we've had a couple of deaths from DKA, but we've actually had two from hyperosmolar, type 2's...you're on a second medication that is increasing your sugar while you're on a medication that may be decreasing your insulin...and if you get DKA in type 2, there's a subset that gets something called hyperosmolar...it's bad and very, very difficult to treat...it has a relatively high mortality rate....\" — Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b6-ef1a397782cf", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We had a family diagnosed as an infant. And they went down to see her once, and I ran into her here and talked to her. I said, by the way, are you still seeing this kid? Because I haven’t seen them back. And again, I don’t have an ego, I could care less if patients go elsewhere...I think the thing that she told me most interestingly — because I was nonplussed by the change in BMI — but she said, anecdotally, that the behavior completely changes. And what she did tell me, and again, this is an n of one, is that she had a patient who was developing diabetes, and I don’t remember the specifics, but she was going to stop the medication — and again, I don’t remember the specifics, that’s the weird thing — because she thought that with other interventions that she had an armamentarium, maybe GLPs — that they can get rid of the diabetes.”\nQ: “This patient developed diabetes because of Vykat?”\nA: “Yeah. 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And again, like I said, this n of one was very interesting, that Jennifer Miller said, hey, treat the diabetes...”\nQ: “Do you know how old was that patient that developed diabetes?”\nA: “She was a teenager.” - Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:37.283+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d959bba8-2f46-4b30-8729-a5819a7d3eb6", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "quote", "text": "“Having that part of the discussion with her, she wasn’t sanguine, but I think she was realistic, and said, this may help; it’s not for everybody... 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appeared skeptical given generic diazoxide suspension is a substitute – \"more questions than answers\"", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:32.468+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b6a5767e-3c9a-439e-a9d0-bfb6e3f54f67", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.28 }, "kind": "quote", "text": "Q: \"If somebody stands up at a conference, some KOL gives a talk and says, here's oral suspension, here's the equivalent — even the people that love this drug, why would they not use oral suspension? What am I missing here?\"\nA: \"I don't think you're wrong in that. I think there are probably more questions than answers. I do pharma work. I've been a PI and I've been a medical monitor for growth hormone stuff and puberty stuff, and I've been on DSMBs and actually even went to a pre-NDA meeting once, and I was in the bullpen for the outside board review once. I think a perfect example is the Alzheimer's drug. Alzheimer's is a horrible, fatal, expensive disease with no treatment. And so, if you're willing to take the risk of CNS bleeding on the chance that we may stabilize a decline and give mom, dad, grandma, and grandpa a year or three years of an interactive life, yeah. And there are other drugs that are being looked at. If we're looking for a magic bullet, this isn't magic, and it's not a targeted bullet.\" - Pediatric endocrinologist, division chief at an academic center", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:32.468+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "19cf8754-7be8-48d2-b13e-4d02c3152c6a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "quote", "text": "Q: \"If somebody gave you a table, all things being equal, which one would you prefer - an oral suspension or this DCCR extended-release tablet?\"\nA: \"Of course, we would want to use an oral suspension. Some medications we don't have. We don't have thyroid hormone suspension; we don't have hydrocortisone oral suspension. So, we had it made locally, or we crush tablets and give it in formula. 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How many Prader-Willi patients do you currently manage?”\nA: “Five. I was not been an investigator, and I was not involved in any manuscripts and papers. I am just aware of it as a physician, as a pediatric endocrinologist, managing Prader-Willi Syndrome patients.”\nQ: “And are you a community physician, or are you at an academic center?”\nA: “I am a pediatric board-certified pediatric endocrinologist, and I work in the tertiary children's hospital that's affiliated with the medical academic center and medical school.” – Pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:44.792+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "55017ef3-0542-4167-bf3e-2265ffbf318b", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.81 }, "kind": "paragraph", "text": "Endocrinologists are extremely familiar with diazoxide already; concerned about diabetes risk\n“As pediatric endocrinologists, we are familiar with the short-acting form of diazoxide. We have used that for quite some time for our patients with congenital hyperinsulinism. We are familiar with the drug itself. But some side effects that have been a concern...it mostly may present as a lymphedema versus congestive heart failure that we are worried more in our newborns. Hyperglycemia, again, we know that diazoxide causes it.” – Pediatric endocrinologist", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:44.792+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "af2555ec-2793-4b18-a0a9-1a3a2f49d445", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.67 }, "kind": "paragraph", "text": "No start forms submitted; “we are going to wait”; no outreach from Soleno MSL to address their questions/concerns\nQ: “Have you submitted any forms for any of your 5 or 6 patients yet to get Vykat, or are you going to wait?”\nA: “We are going to wait...we are going to wait. We have not met with their medical science liaison. They have not expressed interest so far to come and talk to us, and we have not met the rep. 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Let me put it that way. We know that...", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b7-5c3e3fec6870", "parentComponentId": null }, { "bbox": { "h": 0.07, "w": 0.86, "x": 0.07, "y": 0.38 }, "kind": "paragraph", "text": "Can't give tablets to pediatric patients unless crushed; likely to try generic diazoxide suspension instead; pre-existing concerns about diazoxide - \"not an ideal drug, put it that way\"; same issues carry over to Vykat", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:32.233+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a617ddc7-6583-418b-8a50-6ba9f263ea39", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.86, "x": 0.07, "y": 0.46 }, "kind": "quote", "text": "Q: \"So, if somebody wants to use Vykat, my question is, why would they just not use the oral suspension? How do you even prescribe a tablet to a five-year-old?\"\nA: \"You don't. That's the thing. Unless you're able to crush it and you're not supposed to, so to speak, crush the extended-release medications. That might become — if people see these trials and they get refusals with all the knowledge now that you shared, and I'm sure it's going to come up at some point. Perhaps as clinicians start experiencing some of this, or patients start experiencing some of these issues, people may just say, let's try this other medication, just the regular diazoxide, which is not an ideal drug. Let me put it that way. We know that...\"\nQ: \"That also means Vykat is not ideal. There are just different methods of administration of the same drug.\"\nA: \"Correct, yes, they are. 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Unless you're able to crush it and you're not supposed to, so to speak, crush the extended-release medications. That might become — if people see these trials and they get refusals with all the knowledge now that you shared, and I'm sure it's going to come up at some point. Perhaps as clinicians start experiencing some of this, or patients start experiencing some of these issues, people may just say, let's try this other medication, just the regular diazoxide, which is not an ideal drug. Let me put it that way. 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clinical data is “underwhelming” with a history of failed trials and no hard endpoint; “old news” as endocrinologists are very familiar with diazoxide and don’t view it as novel, and would just use generic suspension instead anyway; thinks “severity of edema and cardiac risk is probably being underplayed” and is “real and significant”; worries about diabetes risk; is unwilling to invest administrative time to push for insurance approval as “I don’t believe it is that powerful or effective to begin with” and “not worth it to fight super hard” – “I don’t have anybody who’s actually started it...one of my patients...we’ve had a discussion...but the family wanted to...think about it first...some of them are going to be intrigued with any new options, and others are going to be a little more hesitant.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.977+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e2d50054-f5d9-463b-9e68-90b55bedd96a", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.54 }, "kind": "quote", "text": "Private practice with 5 PWS patients; no start forms submitted; one family wants to “learn about” and “think about it” A: “I am in private practice at a medium-sized private practice. We have about four docs now. I do a bit of everything within endocrinology.” Q: “And how many PWS patients do you currently manage?” A: “Maybe five. I have my little cohort of those patients, but this is not a common enough condition that I have a large group.” Q: “Have you submitted any start forms for Vykat or do you have any patients on it?” A: “So far, I don’t have anybody who’s actually started it. I have one of my Prader-Willi patients, who I saw just recently, and we’ve had a discussion about getting on the medication. But the family wanted to read about it, learn about it, think about it a little bit first. And so, some of them are going to be intrigued with any new option, and others are going to be a little more hesitant for something that was just recently approved, don’t necessarily feel ready to start a brand new medication or anything along those lines.” - Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.977+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "509aef1b-361a-4827-988a-06847b72c92a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.81 }, "kind": "quote", "text": "Most private practice endocrinologists may have zero to two PWS patients at most “I do think I’m probably better read than average. I would guess that a lot of my private practice colleagues have between zero and two Prader-Willi patients. Basically, don’t see it or have like one or two people. I have a little bit more than average. And it just happens to be in my little area, the pedi-endo that’s the busiest pedi-endo is actually really quite good about making sure that they actually come to see us. And, as a result, we’ve gotten a bit more of these patients.” - Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.977+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "820c0c6a-0bba-4a38-9c11-f04529987a13", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "So far, I don't have anybody who's actually started it. I have one of my Prader-Willi patients, who I saw just recently, and we've had a discussion about getting on the medication. But the family wanted to read about it, learn about it, think about it a little bit first. And so, some of them are going to be intrigued with any new option, and others are going to be a little more hesitant for something that was just recently approved, don't necessarily feel ready to start a brand new medication or anything along those lines. — Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:44+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b7-7514093b5ae7", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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drug barely got FDA approval; failed trials, “not some world-changingly powerful medication”", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.295+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "79c0457b-f058-4b57-9875-3cdb07cfa3b2", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.85, "x": 0.07, "y": 0.44 }, "kind": "list", "text": "Clinical data is “underwhelming” esp the withdrawal study upon which FDA approval was based; skeptical of lack of hard endpoints one would expect vs. just a questionnaire", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.295+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8f581e45-8fd2-4d2b-8212-4e956ed5f22c", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.85, "x": 0.07, "y": 0.19 }, "kind": "paragraph", "text": "stating the studies were “a little underwhelming” and failed to show weight reduction or a proper endpoint – and that he wouldn’t push it patients: “if the goal here is largely appetite, weight, that sort of zone, at least show a benefit in BMI or something...those are the typical endpoints that we use...in this space”; “the data is not so strong with this medication that we're going to push hard”; “while the medicine is approved and there are not a lot of options in PWS, it's not like the data was like so strong...the drug had to fight hard to get approved...it failed at initial trial and had to get a second bite at the apple...it's not some world-changingly powerful medication.”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.295+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9934ab89-c0ba-4d5b-af54-eb69e6c67873", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.85, "x": 0.07, "y": 0.72 }, "kind": "quote", "text": "Q: “Do you think PWS families in that second group, that's how they're relating to Vykat right now? Just kind of more wait-and-see. Is that your assessment?” A: “...so far, to be fair, the data is not so strong with this medication that we're going to push hard as far as that's concerned... And while the medicine is approved and there are not a lot of options in PWS, it's not like the data was like so strong. The drug had to fight hard to get approved. It tried a trial before, and it failed at initial trial and had to get a second bite at the apple and everything like that. It's not some world-changingly powerful medication.” - Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.295+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "586c901b-fd5a-4d91-84d4-17b9d43624e3", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.85, "x": 0.07, "y": 0.51 }, "kind": "quote", "text": "Q: “The entire basis of FDA approval is a randomized withdrawal study, where the patients on placebo had a worsening on the dysphagia survey. And that's it, basically.” A: “That's exactly right. It's a little underwhelming... if the goal here is largely appetite, weight, that sort of zone, at least show a benefit in BMI or something. Those are the typical endpoints that we use when we talk about medicines in this space.” - Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.295+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e14cad82-bbf5-4e15-99bc-91019e680772", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"That's exactly right. It's a little underwhelming. Your questionnaire result was better in one group versus another. But hard endpoint - heart attacks, strokes, deaths. Granted, that's a very high bar to meet. Very few drugs are going to be so powerful that you knock it out of the park that way. But, if the goal here is largely appetite, weight, that sort of zone, at least show a benefit in BMI or something. Those are the typical endpoints that we use when we talk about medicines in this space.\" — Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-70f3-714d-84c5-0ead1e9800e2", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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not “a brand new medication”; if any families are actually interested in Vykat, then will have to educate them on the safety issues with diazoxide. “And I do think that the data is — I'd rather have something than nothing, but it's not particularly powerful. And if I am going to do the medicine, I do want to have some familiarity. I guess I kind of already do. Diazoxide is not, in and of itself, a brand-new medication. It's a drug that we've used in other disease states for years. At least I have some familiarity on the safety, and that family didn't specifically about ask about this. They were just like, let me think about it. We'll talk about it at our next appointment. Fine. Very fair. If they had been asking a little bit more questions, then I might have been like, okay, well, here's the information about how the drug works. It's a new medicine in that it was approved for this condition very recently. But the actual drug has been approved for many years to be used in other diseases. Many people have been put on it previously...we actually know this stuff pretty well because it's a drug that's been out for a while...” - Endocrinologist in TX, private practice with 5 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:33.951+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cbf2018e-365e-4d63-8e5c-f419af429c2a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“And I do think that the data is — I'd rather have something than nothing, but it's not particularly powerful. And if I am going to do the medicine, I do want to have some familiarity. I guess I kind of already do. Diazoxide is not, in and of itself, a brand-new medication. It's a drug that we've used in other disease states for years. At least I have some familiarity on the safety, and that family didn't specifically about ask about this. They were just like, let me think about it. We'll talk about it at our next appointment. Fine. Very fair. If they had been asking a little bit more questions, then I might have been like, okay, well, here's the information about how the drug works. It's a new medicine in that it was approved for this condition very recently. But the actual drug has been approved for many years to be used in other diseases. 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The risks are real and significant, and probably underplayed to some degree, and the benefit is mild at best...I am a little bit surprised about the approval, that it was able to be approved. I get that there are no medicines currently approved in the space. And so, having anything is better than having nothing is the thought process there. But this is not a drug that is going to be a game-changer in this space. I think that there are so many different medicines on the appetite side of the ledger, on the weight management side of things in development, that I just don't think that I'm going to be turning to this very often. I was planning on trying it on at least somebody to get some clinical experience with it. I was not involved in any of these research studies. I don't have a lot of experience with the medicine, obviously in Prader-Willi, and I have my small cohort of folks who have used it for hypoglycemia. 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The risks are real and significant, and probably underplayed to some degree, and the benefit is mild at best...I am a little bit surprised about the approval, that it was able to be approved. I get that there are no medicines currently approved in the space. And so, having anything is better than having nothing is the thought process there. But this is not a drug that is going to be a game-changer in this space. I think that there are so many different medicines on the appetite side of the ledger, on the weight management side of things in development, that I just don't think that I'm going to be turning to this very often. I was planning on trying it on at least somebody to get some clinical experience with it. I was not involved in any of these research studies. I don't have a lot of experience with the medicine, obviously in Prader-Willi, and I have my small cohort of folks who have used it for hypoglycemia. 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I have one patient who I saw last week. She's a 28-year-old who's living at home, who weighs about 340 pounds with Prader-Willi. She actually is on a GLP-1 and she's on insulin. I have run a GLP-1 and I've had some success. But she has diabetes. And you're concerning me even more in terms of the information you're giving me from the primary investigators. Obviously, I don't think it's a miracle drug, but I have some patients where I exhausted everything else. 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I have one patient who I saw last week. She's a 28-year-old who's living at home, who weighs about 340 pounds with Prader-Willi. She actually is on a GLP-1 and she's on insulin. I have run a GLP-1 and I've had some success. But she has diabetes. And you're concerning me even more in terms of the information you're giving me from the primary investigators. Obviously, I don't think it's a miracle drug, but I have some patients where I exhausted everything else. And I felt that it's something that I need to at least give it a shot and see what happens. — Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:46+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64ce-7561-b2b7-f801dc6ebfd7", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I had my concerns, but you're giving me a lot more concern that the people who are most in the know and most involved seem to be very, very uncomfortable with it. And that is giving me pause as well.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:46+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cf-7128-a313-479a23e823f6", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.73 }, "kind": "list", "text": "Concerned about small trial size; wants to review the data again after our questions; “beginning to wonder”\n“A lot of it is going to be, it's going to be real world because the trial itself is small. You're basically making me go back and look at all the data again, because now I'm much more concerned about some of the things that you bring up. I was hoping that it would have utility in maybe 3 or 4 of my patients if I could get it approved. Now I'm beginning to wonder whether maybe I need to have a different type of focus in terms of what I want to do right now so that .” – Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "33ec335c-4bd4-49b9-a34d-b978227e58ea", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.57 }, "kind": "list", "text": "Had pre-existing concerns about Vykat; also concerned at skepticism by trial investigators\n“I keep on getting back to the thing that concerns me the most is that I was not as aware. I had my concerns, but you're giving me a lot more concern that the people who are most in the know and most involved seem to be very, very uncomfortable with it. And that is giving me pause as well.” – Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4c0f6b9a-04b4-46ab-9fc8-507ed7b5e523", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.41 }, "kind": "list", "text": "“Suspicious”\nQ: “I spoke with a key trial investigator and he said he didn't see $500,000 worth of benefit from the drug, not even $5,000 worth of benefit of the drug. And I asked him how many of his 50 patients he has on Vykat. He said none.”\nA: “I tend to be a little bit suspicious as well.” - Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c42fb663-085a-4116-99de-c69de6114731", "parentComponentId": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "paragraph", "text": "The endocrinologist stated he was particularly concerned after we shared color from study investigators with a negative opinion of Vykat, and that it reinforced his pre-existing skepticism: “I tend to be a little bit suspicious as well”; “the thing that concerns me the most is that I was not as aware...I had my concerns, but you're giving me a lot more concern that the people who are most in the know and most involved seem to be very, very uncomfortable with it”; “the trial itself is small...you're basically making me go back and look at all the data again, because now I'm much more concerned about some of the things that you bring up....”", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "306d5746-d0d2-491b-9136-085014cfaf15", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I tend to be a little bit suspicious as well.\" — Endocrinologist based in NYC, 15 PWS patients; \"I keep on getting back to the thing that concerns me the most is that I was not as aware. I had my concerns, but you're giving me a lot more concern that the people who are most in the know and most involved seem to be very, very uncomfortable with it. And that is giving me pause as well.\" — Endocrinologist based in NYC, 15 PWS patients; \"A lot of it is going to be, it's going to be real world because the trial itself is small. You're basically making me go back and look at all the data again, because now I'm much more concerned about some of the things that you bring up. I was hoping that it would have utility in maybe 3 or 4 of my patients if I could get it approved. 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GLP’s already being imported cheaply from countries with price caps", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.959+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e88ae721-6c1e-47c1-b1f4-ad30036b2c51", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.68 }, "kind": "paragraph", "text": "A: “It’s a shorter half-life also?”\nQ: “They’re both just diazoxide so presumably similar half-life once in plasma.”\nA: “Oh, it is the same half-life.”\nQ: “Why would anybody use a half-million to $1,000,000 tablet versus an inexpensive oral suspension that also seems safer?”\nA: “I agree...the idea, and I was going to bring that up even at the onset, the fact that we have a generic. I don't know if you're aware that's going on with the GLP-1s all the time right now, that they're getting it from out of the country. There are companies now that are importing it from England. They have price caps on it, so it's much, much cheaper.” – Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.959+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "880c25ce-9832-4e5f-bf0b-32c115c1c38b", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.86, "x": 0.07, "y": 0.38 }, "kind": "paragraph", "text": "Q: “I had a PhD in pharmacokinetics look at the few shreds of PK data that Soleno has been willing to publish, because I think they're scared about the fact that they are basically equivalent pharmacokinetically. And the only reason they did an extended-release formulation is because there's a generic. There's no clinical rationale for it.”\nA: “Correct. Unfortunately, that's not uncommon. Take a look at the weight loss drugs Contrave and Qsymia which have generics. And we do that all the time for patients for weight loss and we just put them on the generic, and it cost them almost nothing as opposed to — it's nowhere near what Vykat cost, but it's the same idea. I'm very, very familiar with that.” – Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:35.959+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e1c1a176-d0e4-4478-80ed-1275c6ff3975", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Correct. Unfortunately, that's not uncommon. Take a look at the weight loss drugs Contrave and Qsymia which have generics. And we do that all the time for patients for weight loss and we just put them on the generic, and it cost them almost nothing as opposed to — it's nowhere near what Vykat cost, but it's the same idea. I'm very, very familiar with that. — Endocrinologist based in NYC, 15 PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:47+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cf-7128-a313-f6643c757166", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.07, "y": 0.95 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I practiced both adult and pediatric nephrology. We do have a good number of Prader-Willi patients. This are a rare, rare cases, so we don’t have too many in the community. But when they do come, we do follow them for long-term treatment.. And they come to our service because they may have some electrolyte imbalance. And they are followed by developmental delay, neurologist, pediatric neurologist as well. And they may have lower extremity edema. And sometimes, they have proteinuria; sometimes they don’t. They may have a skin rash. They may have excessive hair growth. They may have hyperglycemia.”\nQ: “I wasn’t aware that nephrologists also treat PWS patients? Are you called in to consult for the presentation? Or do you actually manage PWS patients?”\nA: “Well, we’re co-managing this because they may be managing the hyperglycemia. But sometimes these patients have edema, and they need diuretics. They have electrolyte imbalance in the hypokalemia-hyperkalemia, acidosis-alkalosis. So, we’re kind of managing that together…we’re in the suburbs of Chicago. Our group is very large. We get a lot of tertiary referrals…we have five tertiary care centers in our area. And there’s not a lot of community nephrologists that can handle academic-level work.” – Nephrologist who manages PWS patients,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.696+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "551357e3-d71a-452e-9988-19b7b3ef677b", "parentComponentId": null }, { "bbox": { "h": 0.3, "w": 0.86, "x": 0.07, "y": 0.65 }, "kind": "paragraph", "text": "Only 1 PWS patients out of 5-7 has applied for Vykat; still unapproved by insurer; possibly a second patient in a few months\nQ: “But does it make you think twice before you put a PWS patient — have you put any patients on Vykat yet? Have any of them filled out the form or gotten approval or anything?”\nA: “We’re in process. I haven’t gotten approved yet. We have filled out the form, and we’re working with our partners in endocrinology, because they’re kind of leading the discussion, and we’re co-managing them. So, we’re taking care of the proteinuria and the management of the edema. I know that there were a few patients that were already on Vykat that were referred for edema and proteinuria, and we were able to put them on an SGLT-2 and a GLP-1. That’s where I do my management of it.”\nQ: “You’ve had one patient out of these 5 or 7 apply. When did they apply? Do you know how long insurance approvals are taking?”\nA: “Oh yeah, it’s taking time, so we applied for it, and I have not heard that it got approved because I know it’s several thousand dollars a year.”\nQ: “How many more patients do you plan to put on it? Are you going to put this one on it and try it for six months or year? 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I want to get some experience.” – Nephrologist who manages PWS patients,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 21:26:24.696+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ccffd338-6574-4ba8-8c58-053921aa23f5", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I haven’t gotten approved…we have filled out the form…oh yeah, it’s taking time.” — Nephrologist who manages PWS patients", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:48+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cf-7128-a314-925e10e6b196", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.25, "x": 0.07, "y": 0.96 }, "kind": "source-note", "text": "Source: Scorpion Capital consultation calls with experts", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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This is what I do for a living. If I have edema, it’s a saltwater imbalance or it’s a low albumin oncotic pressure problem. If the albumin is low, then the third spacing — they may need a diuretic. If they’re having salt retention due to the hyperphagia, then we still need to put them on a diuretic.”\nQ: “I actually find that quite interesting that two patients on the trial had edema that warranted referral to a specialist who knows how to address it. How old were these patients? 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only prescribing if a patient pushes for it; unlikely to spend time chasing insurance approval Q: “How much enthusiasm have you heard around this drug? Is it pretty quiet? Is it a game changer? What’s the reaction out there?” A: “From the folks that I’ve seen with the disease, obviously, they’re on top of it. I have not been visited by a drug rep or anyone like that. I do think that it’s feast or famine. If we do have a patient, they want to get on it, I’m happy to help them, as long as it doesn’t become labor-intensive. But sometimes, the pre-authorization process is labor-intensive, and you have to write a few letters and stuff. It takes a lot of time.” Q: “And then how much do you think the $500,000, $1 million a year price will impact how many patients physicians put on it?” A: “I think it’s going to be tough to justify it if you have a lot of volume. But I think the physicians will try it once or twice. And if they find out that they’re not getting approved or there’s too much work, they may try the generic.”– Nephrologist who manages PWS patients,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:36.409+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "88b5e6e7-829a-493f-baee-c98f0a8de02f", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.58 }, "kind": "paragraph", "text": "No chatter about Vykat from PWS physicians; “pretty quiet” Q: “What have you heard from colleagues in the Chicago area? Are you hearing a lot of chatter about Vykat or not so much?” A: “No.” Q: “People that you know in your professional circle that treat PWS patients, is anybody emailing, texting each other? Or pretty quiet?” A: “Pretty quiet.” –Nephrologist who manages PWS patients,", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:14:36.409+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c2836655-51bd-4947-8af6-e92132a0862d", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“Pretty quiet.” — Nephrologist who manages PWS patients; “I have not been visited by a drug rep or anyone like that. I do think that it's feast or famine. If we do have a patient, they want to get on it, I'm happy to help them, as long as it doesn't become labor-intensive. But sometimes, the pre-authorization process is labor-intensive, and you have to write a few letters and stuff. It takes a lot of time.” — Nephrologist who manages PWS patients; “I think it's going to be tough to justify it if you have a lot of volume. But I think the physicians will try it once or twice. 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I can say that they lost at least 10% of body weight over the course of six months.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 23:48:49+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64cf-7128-a315-057114a21bf7", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.86, "x": 0.07, "y": 0.24 }, "kind": "paragraph", "text": "Success with GLP’s in PWS patients; “works in terms of losing weight”\nQ: “Have you seen GLP drugs used in PWS patients?”\nA: “Yes. 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