{ "docId": "019dd923-622c-750b-8b9a-3bcd52c6e583", "docSlug": "f06b0b5d2079", "documentTitle": "Soleno Therapeutics (SLNO)", "authorId": "58_Scorpion_Capital", "authorName": "Scorpion Capital", "documentKindSlug": "activist-deck", "documentKindLabel": "Activist deck", "sourceTypeSlug": "short_seller", "sourceTypeLabel": "Short seller", "presentationDate": "2025-08-15 00:00:00", "orientation": "landscape", "aspectRatio": 1.3333334, "pageNumber": 331, "pageCount": 415, "prevPage": 330, "nextPage": 332, "slideType": "expose_contradiction", "function": "expose_contradiction", "density": "dense", "nDataPoints": 0, "notes": "The slide uses direct quotes from an endocrinologist/KOL to undermine the clinical trial results.", "elementsJson": [ "paragraph", "quote_block", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/331", "deckHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-331", "components": [ { "bbox": null, "kind": "callout", "text": "there was not a huge difference in my patients...so really, what was the improvement?", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-64ce-7561-b2b2-d0ed5b41abea", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.28, "w": 0.86, "x": 0.07, "y": 0.62 }, "kind": "paragraph", "text": "RWP study data was unreliable; didn’t see a change in patients; other confounding factors made HQ-CT scores questionable\nQ: “They really talk up this randomized withdrawal phase as evidence. 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, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "7a771020-d848-45cc-a11e-9924410c8eef", "frameworkName": null, "frameworkSlug": 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, "subkind": "paragraph", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "e5092d16-8590-4629-b819-9e2375eb3b7a", "frameworkName": null, "frameworkSlug": 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. That’s unusual.” — Trial investigator, endocrinologist, key opinion leader for PWS", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-64ce-7561-b2b2-d6c1b628fe6b", "frameworkName": null, "frameworkSlug": 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, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "f3ec2cd2-6f0d-4111-90a4-c5281a8644fd", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Trial investigator #7 was highly skeptical of the phase 3 trial and especially the “unusual” withdrawal study that was the basis of FDA approval, stating the data was unreliable; that he didn’t see a change in his patients; that confounding factors made the hyperphagia questionnaire scores dubious; that the trial had a “strong placebo effect”; and that the HQ-CT instrument was flawed due to inflated baseline scores, subjectivity, and was not a “true genuine score” – “there was not a huge difference in my patients...so really, what was the improvement?”; “all these drugs have a strong placebo effect...you could argue that it was placebo effect”; “placebo withdrawal which is unusual in terms of trials...an unusual study plan...that’s unusual.”", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "0ba4a148-77c9-4c49-92ec-39f78174aae0", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [ { "name": "antagonist-introduction", "slug": null, "matchId": "d0644fce-00cc-41d4-b3a2-cfba4a2b0674", "evidence": "Uses a trial investigator as a credible source to critique the company's trial data.", "confidence": 0.8 } ], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }