{ "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": 68, "pageCount": 415, "prevPage": 67, "nextPage": 69, "slideType": "villain_critique", "function": "name_villain", "density": "overcrowded", "nDataPoints": 4, "notes": "The slide uses a 'villain' or 'expert critic' framing to undermine the credibility of a clinical trial and its associated drug.", "elementsJson": [ "headline_text", "bullet_list", "footnote" ], "metadataConfidence": 1, "imagePath": null, "slideHref": "/slides/019dd923-622c-750b-8b9a-3bcd52c6e583/68", "deckHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583", "deckJsonHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583.json", "deckAnchorHref": "/decks/019dd923-622c-750b-8b9a-3bcd52c6e583#slide-68", "components": [ { "bbox": null, "kind": "callout", "text": "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.", "attrs": null, "subkind": null, "toolName": "Visual emphasis", "toolSlug": "visual-emphasis", "confidence": null, "componentId": "019dd953-64ce-7561-b29a-a786c2463751", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.18, "w": 0.86, "x": 0.07, "y": 0.7 }, "kind": "list", "text": "Highly critical of the HQ-CT endpoint, blasting it as soft and subjective unlike histologic markers; indicated the baseline HQ-CT scores made no sense, and questioned if the statistical artifacts in the trial were just elevated baseline scores falling to the average level in PWS patients due to placebo – “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?”", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "1e45a9af-7a72-4b3d-ab8a-d46ade91cca7", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.12, "w": 0.86, "x": 0.07, "y": 0.57 }, "kind": "list", "text": "Stated that the vast majority of PWS are simply not candidates for Vykat: patients under 10 are easily managed by parents who can keep hyperphagia under control; and of the older patients, 30-40% are diabetic and inappropriate for the drug. He added that the PWS patients who need a drug the most are the ones with the least compliance and food security measures, making any drug ineffective.", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "8dfcab86-9d1a-4ead-a66a-d015848731ff", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.25, "w": 0.86, "x": 0.07, "y": 0.23 }, "kind": "list", "text": "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": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "950b9753-8154-4b36-99e5-c046a8fa332a", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.08, "w": 0.86, "x": 0.07, "y": 0.48 }, "kind": "list", "text": "Indicated tepid interest in the field toward Vykat and that the TAM is “at most” 10% of PWS patients, with possibly 10-15% of patients who may “trial it” over the next two to five years.", "attrs": null, "subkind": "bullet", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "fb44e48d-e18f-4135-9e97-455c0168db15", "frameworkName": null, "frameworkSlug": null }, { "bbox": null, "kind": "quote", "text": "“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.”; “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 #7", "attrs": null, "subkind": null, "toolName": "Authority citation", "toolSlug": "authority-citation", "confidence": null, "componentId": "019dd953-64ce-7561-b29a-aa11258c9086", "frameworkName": null, "frameworkSlug": 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, "subkind": null, "toolName": null, "toolSlug": null, "confidence": null, "componentId": "9a91fcec-f5c8-4f9a-aad9-410182f455a8", "frameworkName": null, "frameworkSlug": null }, { "bbox": { "h": 0.15, "w": 0.86, "x": 0.07, "y": 0.07 }, "kind": "title", "text": "Trial investigator #7: Co-author on Soleno trial paper and a key opinion leader with ~40 PWS patients at one of the largest clinics; developed the PWS treatment guidelines. Participated in the phase 3, open-label, and withdrawal studies.", "attrs": null, "subkind": "headline", "toolName": null, "toolSlug": null, "confidence": null, "componentId": "ea4c6921-de75-4ba6-89f2-4ebbed81ef47", "frameworkName": null, "frameworkSlug": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "imagePathAlt": null, "thumbSrc": null, "thumbSrcAlt": null, "locked": true }