CARA Stock Overview
Cara Therapeutics, Inc., an early commercial-stage biopharmaceutical company, focuses on developing and commercializing chemical entities with a primary focus on pruritus and pain by selectively targeting kappa opioid receptors in the United States.
Cara Therapeutics Competitors
Price History & Performance
|Historical stock prices|
|Current Share Price||US$8.67|
|52 Week High||US$18.93|
|52 Week Low||US$7.40|
|1 Month Change||-18.52%|
|3 Month Change||-9.69%|
|1 Year Change||-43.63%|
|3 Year Change||-51.56%|
|5 Year Change||-37.72%|
|Change since IPO||-32.84%|
Recent News & Updates
Cara Therapeutics hires new finance chief
Cara Therapeutics (NASDAQ:CARA) has appointed Ryan Maynard as its new CFO, effective Sep 12, 2022, the biopharmaceutical company announced in a regulatory filing on Monday. Maynard holds over 20 years of experience in leading finance organizations at both public and private biopharmaceutical companies. He previously served as CFO at global healthcare solutions company, LetsGetChecked. At Cara (CARA), Maynard will serve as the company's principal financial officer and principal accounting officer.
Cara Therapeutics: All Eyes On Korsuva Launch Metrics
Summary Korsuva has been approved in an indication for which, it faces little in the way of competition. A number of expansion opportunities await oral difelikefalin, with positive phase 2 data for NP opening the door to additional indications. Language surrounding launch metrics and sales for Q3 sounds cautious, and a near-term disappointment could weigh on share price. Steady history of insider sales and lack of specialist biotech funds holding positions here are possible negative indicators. CARA is a Buy, but only suitable for long-term investors. Key risks include disappointing data for ongoing studies (especially placebo effect) and competition in certain indications (atopic dermatitis). Shares of Cara Therapeutics (CARA) are down 20% over the past 5 years. So far in 2022, they are 15% in the red. I'm always on the lookout for commercial-stage ideas, especially new product launches as that potent combination of accelerating sales momentum and pipeline progress can be hard to resist. Cara caught my eye given the Korsuva launch is underway for an indication (CKD-aP in HD) in which it is the first and only product approved, in addition to bullish remarks from management in the Q2 report where they state "we anticipate demand to accelerate in the coming months, driven by large dialysis organizations that started purchasing early in the third quarter." From what I understand, the positive KOMFORT phase 2 readout in notalgia paresthetica could serve as POC and open the door to multiple other disease categories in both the neurological and dermatology space. Let's take a closer look to determine if Cara fits our criteria for the Core Biotech portfolio and whether there's sufficient commercial and clinical momentum to merit gaining exposure here. Chart FinViz Figure 1: CARA weekly chart When looking at charts, clarity often comes from taking a look at distinct time frames in order to determine important technical levels and get a feel for what's going on. In the weekly chart above, we can see a share price spike to the $30 level in Q2 2021 when the FDA and EMA accepted regulatory applications for difelikefalin injection (Korsuva) for the treatment of pruritus associated with chronic kidney disease in hemodialysis patients. From there, the market certainly "taketh away" as the stock plunged on a setback in a mid-stage study in atopic dermatitis. In summer 2022, the share price bottomed around in the $8 level and has slightly rebounded to $10. Overall, I think we are looking at a depressed chart and valuation, so long term investors who believe better days are coming would do well to accumulate a position in the current range. Overview Founded in 2004 with headquarters in Connecticut (84 employees), Cara Therapeutics currently sports an enterprise value of ~$350M and Q2 cash position of $204M providing them operational runway for roughly 2 years (I imagine they will access funds via financing by mid 2023 or so). Management's presentation at Canaccord Genuity Growth Conference provides an excellent overview: CEO Christopher Posner and CMO Joana Goncalvez are present, with Posner noting that the company is focused on pruritus (itching) and has an approved therapy Korsuva injection (approved last August). They launched in April this year with partner Vifor Pharma (recently acquired by CSL) with favorable economics in terms of launch. They also have a pipeline-in-a-drug approach with oral difelikefalin and two phase 3 programs initiated this quarter or Q1 (atopic dermatitis and chronic kidney disease in patients pre-dialysis). Third priority is around expanding utilization of oral difelikefalin via two phase 2 programs (recent positive topline data for notalgia paresthetica or NP, and a small phase 2 POC study in primary biliary cholangitis with data readout 2H 22). They have a very strong balance sheet, $204M and guidance to 1H 24 (does not include revenue received from launch). Corporate Slides Figure 2: Combined patient opportunity across lead indications Q2 was the first quarter of launch, total net sales were $17M of which Cara's profit share was $8M. That was comprised mainly of channel stocking (launch inventory in anticipation of future demand). Initial demand is driven by smaller dialysis organizations and recently they got formulary coverage of two largest dialysis organizations (comprise 80% of the market). Recently they announced that the Fresenius Medical Care salesforce is joining the promotional mix as well. They expect demand to steadily increase over the next couple quarters and Q3 will draw down some of that inventory they put in the channel (sounds conservative). Total addressable patient population is 200,000 and most of those preside with Fresenius and DaVita for whom they have formulary coverage. They are fully reimbursed by Medicare for minimum of 2 years (granted in April) via TDAPA designation (only other analogue is Amgen's parsabiv launched in 2018 and they had TDAPA designation for 3 years). Once they get out of the TDAPA payment, the product goes into the bundle and they would expect it to increase to cover an innovative drug like Korsuva. One distinction though is that parsabiv went into the bundle with two other drugs including generic oral version that shifted incentive to generic, whereas Korsuva would go into the bundle with additional funding without any additional competition as there are no competitors in that functional category). CMS recently came out with proposed rule for 2023 for end stage renal disease patients in the bundle/payment system, and they specifically call out concerns for drugs designated with TDAPA (proposed four options that all are positive in terms of adding additional money outside the bundle for an innovative drug like Korsuva). We probably won't hear back from them on this issue until 2024. Early days of launched, shipped 1800 vials to dialysis clinics and anecdotally feedback is quite positive (very high levels of awareness among nephrologists and very high intent to treat). Week over week they are seeing increases in number of clinics ordering and majority of them reordering (gives hope that they are having positive first experiences with the product). Moving on to oral Korsuva, NP indication is an interesting opportunity and affects 650,000 patients. It's treated by medical dermatologists and there are no FDA-approved therapies for this neuropathic itch. The strategy is to look at their drug in systemic, dermatologic and neuropathic conditions to demonstrate broad utility. Data showed that the drug works broadly across disease areas regardless of the underlying pathogenesis (what's causing that itch). It also confirmed the mechanism of action, works with strong neuro-modulatory manner to inhibit the itch. Corporate Slides Figure 3: Positive POC data in NP shows path forward to broader utility NP is a more homogenous type of itch and patient (itch is just neuropathic and strong data is a result of strong neuro-modulatory effect). Atopic dermatitis itch is a combination of inflammatory component as well as neuro-modulatory, so oral difelikefalin should work there. The company's phase 3 program is using it as an adjunct to topical corticosteroids (address inflammatory itch) while difelikefalin addresses the neuro-modulatory. In systemic itch, pathogenesis is multi-factorial and drug should work there given prior data. Placebo response does vary by condition. NP is the first study (nothing else is in trials) and going forward data has been submitted to dermatological conference (placebo response could go higher in the future). 4 point response was the primary endpoint and was around 20%. In Atopic dermatitis they saw 20% placebo effect in mild-to-moderate patient population as well. Stage 3 patients (higher placebo response) have not been included in the ongoing phase 3 study. On the con side, pain and itch are very subjective endpoints. Corporate Slides Figure 4: Phase 2 data in AD focusing on mild-to-moderate subgroup For atopic dermatitis, management acknowledges the evolving competitive landscape and flurry of development in the moderate to severe space and it's all focused on inflammatory component coupled with disease modification. Topicals are still utilized in mild to moderate cases and they are not always effective. Placebo effect to my eyes is the big risk for phase 3 study especially considering the prior phase 2 trial failed to meet the primary endpoint in the moderate to severe population and the company chose to instead focus on the key secondary endpoint (percentage of patients who achieved an improvement from a baseline of ≥4 points in the weekly mean of the daily 24-hour Itch NRS score at week 12, which is now the registration endpoint). They are confident about design being optimal, but reading between the lines I think the CEO sounded less confident on actually achieving the primary endpoint. Majority of these patients they are enrolling are mild to moderate. Safety profile repeatedly shows consistency and predictability. Across different disease areas they see predominantly GI effects, headache and dizziness. With long term use they do not expect it to look any different (events did not increase over time, some decrease over time as they typically occur in first few weeks on treatment). As for phase 2 in PBC, this is a small proof of concept study (just want to see numerical separation and positive signal). They want to see consistent pattern of effect, early onset of action and sustained effect. For the IV product, they are fully-partnered with Vifor in the US and EU (who owns nearly 14% of the company, not a stretch to think they decide to simply buy Cara out at some point). For wholly-owned oral difelikefalin, they will look for ex US partnerships and in the US retain the option to 'go it solo' in commercializing (especially for concentrated markets). Other Information For the second quarter of 2022, the company reported cash and equivalents of $204M as compared to $30M cash used in operating activities. Net loss was $4.2M, while total revenues amounted to $23M ($15M milestone payment for Kapruvia approval and $8M in collaboration revenue related to profit-sharing). Research and development expenses fell to $19.9M, while G&A rose to $7.6M. Again, management is guiding for operational runway into 1H 2024 (this is conservative, as they are not including any product revenue received or milestone payments that could come). Accumulated deficit is $480M and again I would expect another financing at some point in 2023, perhaps the back half of the year. On the conference call, regarding launch metrics and what to expect in the future, management reminds us that for them to record revenue Vifor must ship to wholesalers and then demand is generated (sounds again like Q3 could be soft or below expectations before the ensuing uptick). The CEO expects demand to accelerate into the back half of the year as Fresenius and Davita are online, formulary protocols are in place and they are starting to see ordering done by clinics. Again, keep in mind that the $8M in revenue received on net sales of just under $17M amounts to 47% of net sales (assumes 60% profit split at non-Fresenius accounts). As for prior financings, the July 2019 secondary offering took place at price point of $23/share (representing a double from current levels). Moving on to nuggets from other presentations, the KOMFORT readout call was certainly worth listening to: The big idea here with oral difelikefalin (DFK) is to provide clinical benefit regardless of underlying cause of pruritus, to treat it across a broad variety of disease categories. NP data affirms core strategy is on target and on track. As for market opportunity in NP, they estimate 2.7M adults have neuropathic itch including NP (disease significantly underdiagnosed with only a quarter of NP patients under care of a provider). There are no FDA approved therapies and off label treatments currently used have little or no efficacy or safety & tolerability concerns. In addition to data mentioned in Figure 3, significantly greater proportion of patients on DFK achieved 4 point improvement in WI-NRS compared to placebo (endpoint regulators will be looking at in pivotal studies). 41% of patients on DFK versus 18% on placebo with statistical separation versus placebo seen as early as week 2 and sustained through week 8. Corporate presentation Figure 5: Promising efficacy in NP on registrational endpoint As for safety data, there were similar proportion of patients reporting 1 treatment related adverse event on DFK and placebo. Most events were mild to moderate in severity, with one severe event occurring on placebo. 12 patients on DFK (19.4%) and 4 on placebo (6.3%) discontinued due to adverse event (concerningly high number on DFK arm). Dizziness and nausea were most common events. In Q&A, as for rates of discontinuation, management states that discontinuation rate in NP was consistent with what they saw in atopic dermatitis. They will need to do some "dose finding" going forward, but are not considering titration. As for institutional investors of note, I mentioned prior that Vifor owns nearly 14% of the company. Otherwise, a possible red flag or at least neutral point is that I see mainly generalist funds in this one (BlackRock with 13.5% stake and Vanguard with 5.6% stake). As for insiders, CEO Chris Posner owns over 200,00 shares. Steady history of sales by multiple members of leadership over the past year(s) is not encouraging.
|CARA||US Pharmaceuticals||US Market|
Return vs Industry: CARA underperformed the US Pharmaceuticals industry which returned 3% over the past year.
Return vs Market: CARA underperformed the US Market which returned -23.7% over the past year.
|CARA Average Weekly Movement||8.9%|
|Pharmaceuticals Industry Average Movement||11.5%|
|Market Average Movement||6.9%|
|10% most volatile stocks in US Market||15.7%|
|10% least volatile stocks in US Market||2.8%|
Stable Share Price: CARA is not significantly more volatile than the rest of US stocks over the past 3 months, typically moving +/- 9% a week.
Volatility Over Time: CARA's weekly volatility (9%) has been stable over the past year.
About the Company
Cara Therapeutics, Inc., an early commercial-stage biopharmaceutical company, focuses on developing and commercializing chemical entities with a primary focus on pruritus and pain by selectively targeting kappa opioid receptors in the United States. The company is developing product candidates that target the body's peripheral nervous system and immune cells. The company’s lead product is KORSUVA (difelikefalin) injection for the treatment of moderate-to-severe pruritus associated with chronic kidney disease (CKD) in adults undergoing hemodialysis.
Cara Therapeutics Fundamentals Summary
|CARA fundamental statistics|
Is CARA overvalued?See Fair Value and valuation analysis
Earnings & Revenue
|CARA income statement (TTM)|
|Cost of Revenue||US$81.60m|
Last Reported Earnings
Jun 30, 2022
Next Earnings Date
|Earnings per share (EPS)||-1.23|
|Net Profit Margin||-135.72%|
How did CARA perform over the long term?See historical performance and comparison
Is CARA undervalued compared to its fair value, analyst forecasts and its price relative to the market?
Valuation Score 3/6
Price-To-Sales vs Peers
Price-To-Sales vs Industry
Price-To-Sales vs Fair Ratio
Below Fair Value
Significantly Below Fair Value
Key Valuation Metric
Which metric is best to use when looking at relative valuation for CARA?
Other financial metrics that can be useful for relative valuation.
|What is CARA's n/a Ratio?|
Price to Sales Ratio vs Peers
How does CARA's PS Ratio compare to its peers?
|CARA PS Ratio vs Peers|
|Company||PS||Estimated Growth||Market Cap|
WVE Wave Life Sciences
EYPT EyePoint Pharmaceuticals
CARA Cara Therapeutics
Price-To-Sales vs Peers: CARA is good value based on its Price-To-Sales Ratio (9.5x) compared to the peer average (10.4x).
Price to Earnings Ratio vs Industry
How does CARA's PE Ratio compare vs other companies in the US Pharmaceuticals Industry?
Price-To-Sales vs Industry: CARA is expensive based on its Price-To-Sales Ratio (9.5x) compared to the US Pharmaceuticals industry average (2.8x)
Price to Sales Ratio vs Fair Ratio
What is CARA's PS Ratio compared to its Fair PS Ratio? This is the expected PS Ratio taking into account the company's forecast earnings growth, profit margins and other risk factors.
|Current PS Ratio||9.5x|
|Fair PS Ratio||2.1x|
Price-To-Sales vs Fair Ratio: CARA is expensive based on its Price-To-Sales Ratio (9.5x) compared to the estimated Fair Price-To-Sales Ratio (2.1x).
Share Price vs Fair Value
What is the Fair Price of CARA when looking at its future cash flows? For this estimate we use a Discounted Cash Flow model.
Below Fair Value: CARA ($8.67) is trading below our estimate of fair value ($48.97)
Significantly Below Fair Value: CARA is trading below fair value by more than 20%.
Analyst Price Targets
What is the analyst 12-month forecast and do we have any statistical confidence in the consensus price target?
Analyst Forecast: Target price is more than 20% higher than the current share price, but analysts are not within a statistically confident range of agreement.
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How is Cara Therapeutics forecast to perform in the next 1 to 3 years based on estimates from 8 analysts?
Future Growth Score5/6
Future Growth Score 5/6
Earnings vs Savings Rate
Earnings vs Market
High Growth Earnings
Revenue vs Market
High Growth Revenue
Forecasted annual earnings growth
Earnings and Revenue Growth Forecasts
Analyst Future Growth Forecasts
Earnings vs Savings Rate: CARA is forecast to become profitable over the next 3 years, which is considered faster growth than the savings rate (1.9%).
Earnings vs Market: CARA is forecast to become profitable over the next 3 years, which is considered above average market growth.
High Growth Earnings: CARA is expected to become profitable in the next 3 years.
Revenue vs Market: CARA's revenue (36.5% per year) is forecast to grow faster than the US market (7.6% per year).
High Growth Revenue: CARA's revenue (36.5% per year) is forecast to grow faster than 20% per year.
Earnings per Share Growth Forecasts
Future Return on Equity
Future ROE: CARA's Return on Equity is forecast to be low in 3 years time (17.1%).
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How has Cara Therapeutics performed over the past 5 years?
Past Performance Score0/6
Past Performance Score 0/6
Growing Profit Margin
Earnings vs Industry
Historical annual earnings growth
Earnings and Revenue History
Quality Earnings: CARA is currently unprofitable.
Growing Profit Margin: CARA is currently unprofitable.
Past Earnings Growth Analysis
Earnings Trend: CARA is unprofitable, but has reduced losses over the past 5 years at a rate of 8% per year.
Accelerating Growth: Unable to compare CARA's earnings growth over the past year to its 5-year average as it is currently unprofitable
Earnings vs Industry: CARA is unprofitable, making it difficult to compare its past year earnings growth to the Pharmaceuticals industry (5%).
Return on Equity
High ROE: CARA has a negative Return on Equity (-32.46%), as it is currently unprofitable.
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How is Cara Therapeutics's financial position?
Financial Health Score5/6
Financial Health Score 5/6
Short Term Liabilities
Long Term Liabilities
Stable Cash Runway
Forecast Cash Runway
Financial Position Analysis
Short Term Liabilities: CARA's short term assets ($176.2M) exceed its short term liabilities ($21.2M).
Long Term Liabilities: CARA's short term assets ($176.2M) exceed its long term liabilities ($983.0K).
Debt to Equity History and Analysis
Debt Level: CARA is debt free.
Reducing Debt: CARA has not had any debt for past 5 years.
Cash Runway Analysis
For companies that have on average been loss making in the past we assess whether they have at least 1 year of cash runway.
Stable Cash Runway: CARA has sufficient cash runway for more than 3 years based on its current free cash flow.
Forecast Cash Runway: Insufficient data to determine if CARA has enough cash runway if its free cash flow continues to grow or shrink based on historical rates.
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What is Cara Therapeutics's current dividend yield, its reliability and sustainability?
Dividend Score 0/6
Cash Flow Coverage
Dividend Yield vs Market
|Cara Therapeutics Dividend Yield vs Market|
|Company (Cara Therapeutics)||n/a|
|Market Bottom 25% (US)||1.7%|
|Market Top 25% (US)||4.7%|
|Industry Average (Pharmaceuticals)||2.6%|
|Analyst forecast in 3 Years (Cara Therapeutics)||0%|
Notable Dividend: Unable to evaluate CARA's dividend yield against the bottom 25% of dividend payers, as the company has not reported any recent payouts.
High Dividend: Unable to evaluate CARA's dividend yield against the top 25% of dividend payers, as the company has not reported any recent payouts.
Stability and Growth of Payments
Stable Dividend: Insufficient data to determine if CARA's dividends per share have been stable in the past.
Growing Dividend: Insufficient data to determine if CARA's dividend payments have been increasing.
Earnings Payout to Shareholders
Earnings Coverage: Insufficient data to calculate payout ratio to determine if its dividend payments are covered by earnings.
Cash Payout to Shareholders
Cash Flow Coverage: Unable to calculate sustainability of dividends as CARA has not reported any payouts.
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How experienced are the management team and are they aligned to shareholders interests?
Average management tenure
Chris Posner (52 yo)
Mr. Christopher A. Posner also known as Chris, serves as President and Chief Executive Officer at Cara Therapeutics, Inc. since November 9, 2021 and serves as Director of Cara Therapeutics, Inc. since Augu...
CEO Compensation Analysis
|Chris Posner's Compensation vs Cara Therapeutics Earnings|
|Date||Total Comp.||Salary||Company Earnings|
|Jun 30 2022||n/a||n/a|
|Mar 31 2022||n/a||n/a|
|Dec 31 2021||US$10m||US$116k|
|Sep 30 2021||n/a||n/a|
|Jun 30 2021||n/a||n/a|
|Mar 31 2021||n/a||n/a|
|Dec 31 2020||US$280k||n/a|
|Sep 30 2020||n/a||n/a|
|Jun 30 2020||n/a||n/a|
|Mar 31 2020||n/a||n/a|
|Dec 31 2019||US$302k||n/a|
|Sep 30 2019||n/a||n/a|
|Jun 30 2019||n/a||n/a|
|Mar 31 2019||n/a||n/a|
|Dec 31 2018||US$494k||n/a|
Compensation vs Market: Chris's total compensation ($USD9.90M) is above average for companies of similar size in the US market ($USD2.92M).
Compensation vs Earnings: Chris's compensation has increased whilst the company is unprofitable.
Experienced Management: CARA's management team is not considered experienced ( 1.8 years average tenure), which suggests a new team.
Experienced Board: CARA's board of directors are considered experienced (8.2 years average tenure).
Who are the major shareholders and have insiders been buying or selling?
Insider Trading Volume
Insider Buying: CARA insiders have only sold shares in the past 3 months.
Recent Insider Transactions
|14 Sep 22||SellUS$111,024||Martin Vogelbaum||Individual||10,800||US$10.28|
|28 Feb 22||SellUS$20,292||Scott Terrillion||Individual||1,972||US$10.29|
|12 Nov 21||SellUS$131,207||Jeffrey L. Ives||Individual||8,180||US$16.04|
|Owner Type||Number of Shares||Ownership Percentage|
Dilution of Shares: Shareholders have been diluted in the past year, with total shares outstanding growing by 7.3%.
|Ownership||Name||Shares||Current Value||Change %||Portfolio %|
Cara Therapeutics, Inc.'s employee growth, exchange listings and data sources
- Name: Cara Therapeutics, Inc.
- Ticker: CARA
- Exchange: NasdaqGM
- Founded: 2004
- Industry: Pharmaceuticals
- Sector: Pharmaceuticals & Biotech
- Implied Market Cap: US$465.804m
- Shares outstanding: 53.73m
- Website: https://www.caratherapeutics.com
Number of Employees
- Cara Therapeutics, Inc.
- 4 Stamford Plaza
- 9th Floor
- United States
|Ticker||Exchange||Primary Security||Security Type||Country||Currency||Listed on|
|CARA||NasdaqGM (Nasdaq Global Market)||Yes||Common Stock||US||USD||Jan 2014|
|69C||DB (Deutsche Boerse AG)||Yes||Common Stock||DE||EUR||Jan 2014|
|0HTC||LSE (London Stock Exchange)||Yes||Common Stock||GB||USD||Jan 2014|
Company Analysis and Financial Data Status
|Data||Last Updated (UTC time)|
|Company Analysis||2022/09/27 00:00|
|End of Day Share Price||2022/09/27 00:00|
Unless specified all financial data is based on a yearly period but updated quarterly. This is known as Trailing Twelve Month (TTM) or Last Twelve Month (LTM) Data. Learn more here.