Apellis Company Presentation November

Transcription

1 Apellis Company Presentation November

2 Forward looking statements Statements in this presentation about future expectations, plans and prospects, as well as any other statements regarding matters that are not historical facts, may constitute forward-looking statements within the meaning of The Private Securities Litigation Reform Act of These statements include, but are not limited to, statements relating to the implications of preliminary clinical data and planned or future clinical trials and the timing thereof. The words anticipate, believe, continue, could, estimate, expect, intend, may, plan, potential, predict, project, should, target, will, would and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Actual results may differ materially from those indicated by such forward-looking statements as a result of various important factors, including: whether preliminary or interim results from a clinical trial will be predictive of the final results of the trial; whether results obtained in preclinical studies and clinical trials such as the results referenced in this presentation will be indicative of results that will be generated in future clinical trials; whether APL-2 will successfully advance through the clinical trial process on a timely basis, or at all, and receive approval from the United States Food and Drug Administration or equivalent foreign regulatory agencies; whether, if Apellis products receive approval, they will be successfully distributed and marketed; and other factors discussed in the Risk Factors section of Apellis Annual Report on Form 10-K filed with the Securities and Exchange Commission on July 31, 2018, and the risks described in other filings that Apellis may make with the Securities and Exchange Commission. Any forward-looking statements contained in this press release speak only as of the date hereof, and Apellis specifically disclaims any obligation to update any forward-looking statement, whether as a result of new information, future events or otherwise. 2

3 Key milestones for 2018 GA: Phase 2: 18 month safety & efficacy data GA: Start of Phase 3 program PNH: Phase 1b: monotherapy expansion Phase 1b: Soliris weaning in addon study Start of Phase 3 program AIHA: Phase 2: POC data in CAD Phase 2: POC data in wa-aiha AIHA: Preliminary data in CAD & wa-aiha 3

4 What we do C3 Pioneers in innate immunity & complement immunology By regulating its core component C3 Value & patient outcomes at the center of our programs Initially focused on AMD & PNH Broad potential in other immune conditions 4

5 Pipeline Product Area Disease Pre-clinical Phase 1 Phase 1b/2 Phase 3 APL-2 (intravitreal) Ophthalmology Geographic Atrophy (GA) APL-2 (subcutaneous) Hematology Paroxysmal Nocturnal Hemoglobinuria (PNH) Auto-immune Hemolytic Anemia (AIHA) Nephrology Complement-dependent Nephropathies (CDN) APL-9 (intravenous) Other Undisclosed 5

6 Apellis lead molecule: APL-2 Cyclic peptide Cyclic peptide Polyethyleneglycol (PEG) Peptides of the APL-2 family bind to a pocket of C3 and inhibit activation* Subcutaneous or intravitreal injections * Janssen, J. Biol. Chem., 282(40), ,

7 Central inhibition of complement Lectin Pathway APL-2 C3a Inflammation Classical Pathway C3b C5 C5a Inflammation Alternative Pathway Cell removal, Antigen uptake by APCs C5b MAC Cell death, secretion, lysis, or proliferation 7

8 Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare, life-threatening blood disease PNH characterized by uncontrolled hemolysis Intravascular hemolysis Red blood cell rupture in the circulation Extravascular hemolysis Red blood cell destruction by macrophages in spleen and liver ~12,000 prevalent patients in US, EU & Japan ~4,700 patients in US 35% 5-year mortality if untreated (thrombosis, severe anemia) Alexion s Soliris (eculizumab) is only approved therapy Treats only intravascular hemolysis Many Soliris treated patients remain anemic and transfusion dependent due to extravascular hemolysis 8

9 Number of patients Hemoglobin levels in patients with PNH receiving eculizumab (n=141; all hemolytic) 8 >4 g/dl 6 PNH patients on eculizumab Normal individuals Hemoglobin (gm/dl) Source: Peter Hillmen, Professor of Experimental Haematology, University of Leeds 9

10 Only 30% of patients on Soliris have bone marrow function strong enough to keep patients from experiencing anemia and/or transfusion ~30% of Patients ~40% of Patients ~20% of Patients ~10% of Patients Transfusion - v Transfusion - v Transfusion ++ Breakthrough ++ Hb >12 Hb <12 Hb <10 Hb = any 10

11 PHAROAH: APL-2 shows potential to improve eculizumab outcomes as add-on therapy in PNH 270 mg/day, N=6 Mean Hemoglobin g/dl normal treatment started Off APL-2 for 3 Weeks BMI 59 Under-dosed? Months dosing Patient transfusions treatment started Mean LDH Patient 1 Patient 4 ULN Patient 2 Patient 5 Patient 3 Patient normal Interim data as reported June

12 PHAROAH: APL-2 shows potential to improve eculizumab outcomes as add-on therapy in PNH 270 mg/day, N= normal Mean Hemoglobin treatment started g/dl Months dosing Patient transfusions treatment started Mean LDH Patient 1 Patient 4 ULN Patient 2 Patient 5 Patient 3 Patient normal Interim data as reported June

13 Hemoglobin (g/dl) LDH (xuln) PHAROAH: APL-2 add-on to Soliris - all four patients successfully transitioned to APL-2 monotherapy normal treatment started Soliris Soliris Patient transfusions Soliris Soliris Months 0 Interim data as reported Sept 4,

14 PHAROAH: APL-2 add-on to Soliris - all four patients successfully transitioned to APL-2 monotherapy Eculizumab APL-2 + Monotherapy i Eculizumab ii APL-2 Monotherapy iii Hemoglobin (g/dl) * Annual Transfusions (avg.) LDH (ULN) * 1.0x 0.8x 0.9x Reticulocytes (ULN)* 2.7x 1.2x 0.8x Patient Years (Total) NA 5.9 Years 1.9 Years Multiple of Eculizumab Label Dose (900mg x 2wk.) 1.6x 1.0x - *Average last available reading for all four patients on each dosing regimen i) last reading during eculizumab monotherapy prior to co-treatment with APL-2 (ii) last reading during co-treatment and prior to APL-2 monotherapy (iii) last reading while on APL-2 monotherapy Interim data as reported Sept 4,

15 x ULN x ULN PADDOCK (interim): APL-2 shows potential to reach normal LDH levels as monotherapy in treatment in naïve PNH patients 270 mg/day LDH (mean±se) LDH (mean±se) 12.0x 3.0x 10.0x APL-2 2.5x 8.0x 2.0x 6.0x 1.5x 4.0x 1.0x normal 2.0x 0.5x 0.0x normal Weeks 0.0x Weeks Week Week n n=13 n=13 n=13 n=10 n=8 n=5 n=5 n=4 Not Multiple 9.54x 1.76x 0.80x 0.66x 0.79x 0.95x 0.94x Taken 0.91x of ULN n n=13 n=13 n=13 n=10 n=8 n=5 n=5 n=4 Not Multiple 9.54x 1.76x 0.80x 0.66x 0.79x 0.95x 0.94x Taken 0.91x of ULN Excludes results from one of the original three patients, who had underlying metastatic ovarian cancer with a chronic low gastrointestinal bleed, unknown at the time of screening. Excludes results from one of the original three patients, who had underlying metastatic ovarian cancer with a chronic low gastrointestinal bleed, unknown at the time of screening. Interim data as reported June 26, 2018 at Apellis R&D day 15

16 PADDOCK (interim): Mean hemoglobin improvement was 3.5 g/dl (n=13) showing an impact on both intravascular and extravascular hemolysis Hemoglobin 2/13 patients had transfusions, one at day 2 and a noncompliant patient at day 14; it is believed that neither patient at day 14 had yet reached sufficient exposure to APL-2 for hematological benefit 2/13 patients had transfusions, one at day 2 and a non-compliant patient It is believed that neither patient had yet reached sufficient exposure to APL-2 for hematological benefit At last measure; excludes one patient who had underlying metastatic ovarian cancer with a chronic low gastrointestinal bleed, unknown at the time of screening, which resulted in artificially low Hb and high LDH levels that were determined to be unrelated to PNH. At last measure; excludes one patient who had underlying metastatic ovarian cancer with a chronic low gastrointestinal bleed, unknown at the time of screening, which resulted in artificially low Hb and high LDH levels that were determined to be unrelated to PNH Interim data as reported June 26, 2018 at Apellis R&D day 16

17 10^9/L umol/l PADDOCK (interim): other measures of anemia meaningfully improved with APL-2 including reticulocytes and bilirubin Reticulocytes (mean±se) Total Bilirubin (mean±se) normal 10 5 normal Weeks Weeks Week Week n n=13 n=13 n=13 n=11 n=8 n=5 n=5 n=4 Not Mean Retics Taken 92 (10^9/L) n n=13 n=13 n=13 n=11 n=8 n=5 n=5 n=4 Not Mean Bilirubin Taken 13 (umol/l) Interim data as reported June 26, 2018 at Apellis R&D day 17

18 PEGASUS Phase 3 Head to Head Vs. Soliris Eculizumab maintenance Screening 1 Month Run-in 4 Month Randomized controlled period Open-label APL-2 period Follow up* On Eculizumab (stable for 3 ) Meet include/exclude criteria APL-2 + Eculizumab (All Patients) Group 2 (n=35) Eculizumab Group 1 (n=35) APL-2 Group 2 Ecul. + APL-2 Group 1+2 APL-2 Group 1+2 APL-2 *Open Label extension may be offered to all participants if clinical benefit is evident Baseline 1:1 Randomized Parameter Population Primary Endpoint Design Posology Sample size PNH patients on eculizumab who continue to be anemic (Hb < 10.5 g/dl at screening) Week 16 change from baseline in hemoglobin level Randomized 1:1 APL-2:eculizumab. 1 Month Run In; 4 Month Randomization; 6 Month Open Label; 1 Month Follow Up Dose 1080 mg 2/week, SC infusion via injection pump 70 patients (35/group) randomized 1:1 provides 90% power with 2-sided=0.05 to detect a difference of 1 g/dl 18

19 STUDY 2 Phase 3 in Treatment Naïve PNH Patients Masked, controlled APL- 2 N = 32 Open label Screening N = 48 R: 1:2 26 weeks APL- 2 N = 48 No Drug N = 16 8 Parameter Population 1 Endpoint Patients with PNH (not on eculizumab) Hb stabilization, defined as avoidance of a decrease in Hb levels from baseline in the absence of transfusion through Week 26 Design Randomized 2:1 APL-2:No-treatment t 26 weeks No-treatment controlled period followed by 8 open label period Posology Sample size Dose 1080 mg, twice/week SC injection via injection pump 48 patients randomized 2:1 (32:16) to APL-2:No-treatment provides 90% power with 2-sided =0.05 to detect a 45% difference in Hb stabilization (assuming a Notreatment rate of 5% and an APL-2 rate of 50%). 19

20 APL-2 PNH program early data suggests potentially differentiated efficacy C3 APL-2 blocks C3 and inhibits intravascular & extravascular hemolysis LDH reduction appears to be equivalent to or better than C5 inhibitors Significant increase in HgB levels to normal ranges in most patients Other hematological measures meaningfully improved including reticulocytes and bilirubin Ameliorates transfusion dependence in sub-optimal responding patients on high dose C5 inhibitors (PHAROAH) Favorable product profile with convenient sub-q dosing & stability at room temperature for several While the LDH corrections seen with APL-2 monotherapy in these patients with PNH are truly remarkable, it is the significant hemoglobin correction that is most clinically meaningful. Dr. Peter Hillmen Elevated reticulocytes and bilirubin are important markers of anemia resulting from extravascular hemolysis and are not known to improve in patients treated with eculizumab or other C5 inhibitors. Dr. Anita Hill 20

21 Autoimmune hemolytic anemia (AIHA) is a group of rare autoimmune disorders characterized by the premature hemolysis of red blood cells (RBCs) by autoantibodies AIHA presents in two common forms ~25,000 AIHA patients in US AIHA patients present with anemic symptoms similar to PNH Cold Agglutinin Disease Typically associated with IgM autoantibodies 20-25% of cases Warm Antibody AIHA Typically associated with IgG autoantibodies % of cases Overall mortality of 11% IgG and IgM antibodies are the main cause of AIHA resulting in RBC phagocytosis and lysis Corticosteroids are first line therapy Many patients progress to splenectomy or Rituxan (off-label) 21

22 g/dl 10 9 /l APL-2 in Cold Agglutinin Disease (n=2) Preliminary Data Hemoglobin Reticulocytes mg/d CAD mg/d CAD mg/d CAD mg/d CAD Days Days Interim data as reported Nov 1,

23 g/dl 10 9 /l APL-2 in Warm Antibody AIHA (n=2) Preliminary Data Hemoglobin Reticulocytes mg/d wa-aiha mg/d wa-aiha mg/d wa-aiha mg/d wa-aiha Days Days Interim data as reported Nov 1,

24 Geographic Atrophy Impacts One Million People in the U.S. Alone 24

25 Geographic Atrophy - the leading cause of blindness Intermediate AMD Presence of drusen. No serious vision loss. Wet AMD Rapid, serious vision loss if untreated. First-line treatment with VEGF inhibitors. Up to 98% of chronic anti-vegf patients progress to GA. Geographic Atrophy Risk of blindness when central vision is affected. ~1M patients in US alone. No approved therapies. Source: American Academy of Ophthalmology; The Lancet; Ophthalmology; L.E.K. interviews and analysis 25

26 FILLY - Phase 2 study of APL-2 in Geographic Atrophy Sham group, n=81 (pooled) APL-2 EOM, n=79 APL-2 Monthly, n=86 APL-2 0 mg Sham injections APL-2 injections every other month APL-2 15 mg APL-2 15 mg APL-2 injections every month 26

27 FILLY timeline and endpoints Primary efficacy endpoint is the primary registration endpoint Change in geographic atrophy (GA) lesion size from baseline to month 12. images taken at treatment period 12 no injections 18 Primary safety endpoint Number and severity of local and systemic treatment emergent adverse events (TEAEs). 27

28 Filly baseline characteristics Sham injections N=81 APL-2 every other month N=79 APL-2 monthly N=86 Bilateral GA, n (%) 72 (90.0%) 64 (82.1%) 71 (85.5%) History of CNV in Fellow Eye, n (%) 29 (35.8%) 28 (35.4%) 36 (41.9%) GA lesion size, mean, mm 2 (SD) 8.2 (4.1) 8.9 (4.5) 8.0 (3.8) BCVA score, mean letters (SD) 59.8 (17.2) 58.4 (16.0) 59.8 (15.7) BCVA score (Snellen equivalent) 20/63 20/80 20/63 LL-BCVA score, mean letters (SD) 33.6 (17.8) 31.4 (17.1) 36.3 (16.6) Groups were well balanced as to age, gender and race 28

29 Lesion growth (mm) APL-2 slowed GA growth at 12 (square root) primary endpoint sham injections APL-2 every other month APL-2 monthly % lesion growth difference p=0.067 vs Sham % lesion growth difference p=0.008 vs Sham Modified Intent to Treat population (mitt), Observed, Mixed-Effect Model 29

30 Lesion growth (mm) Lesion growth by six-month periods (square root) - post hoc analysis Sham group Sham injections APL-2 EOM APL-2 injections every other month APL-2 Monthly APL-2 injections every month % lesion growth difference vs sham p= % lesion growth difference vs sham p < Data from subjects with a measurable GA lesion size at both Months 6 & 12 30

31 Lesion growth (mm) Lesion growth by six-month periods (square root) - post hoc analysis Sham group Sham injections APL-2 EOM APL-2 injections every other month APL-2 Monthly APL-2 injections every month % lesion growth difference vs sham p >0.5 12% lesion growth difference vs sham p = 0.47 Data from subjects with a measurable GA lesion size at both Months 6 & 12 & 18 31

32 Lesion growth (mm) After cessation of treatment at 12, GA growth resumes but treatment effect is maintained through 18 (square root) sham injections APL-2 every other month APL-2 monthly % lesion growth difference p=0.097 vs Sham 20% lesion growth difference p=0.044 vs Sham Modified Intent to Treat population (mitt), Observed, Mixed-Effect Model 32

33 Lesion growth (mm) GA growth comparison: fellow eye vs study eye - post hoc analysis Sham group Sham injections APL-2 EOM APL-2 injections every other month APL-2 Monthly APL-2 injections every month 0.4 N=72 N=63 Difference N= p > % 23% Difference p = Fellow Study Fellow Study Fellow Study Includes patients from the Bilateral GA Population 33

34 New onset wet AMD Sham group Sham injections APL-2 EOM APL-2 injections every other month APL-2 Monthly APL-2 injections every month 1% 8% 18% 9% 21% 12-month outcomes 18-month outcomes 34

35 New onset wet AMD FILLY: 38% of enrolled patients had wet AMD in the non-study eye (fellow eye), balanced between the three groups 6 patients developed wet AMD in the month non-treatment period (5/6 had fellow eye wet AMD) Sham group Sham injections DRY APL-2 EOM every other month DRY Fellow eye WET APL-2 Monthly every month Fellow eye DRY Fellow eye WET Expected based on natural history ~2%/yr for Dry fellow eye patients (Sunness et al 1999) and ~10%/yr for Wet fellow eye patients (Marques et al. 2013) 35

36 FILLY phase 2 trial C3 Preventing complement activation by blocking C3 No specific genotype driving results Statistically significant data in largest Phase 2 in GA (n=246) Further confidence in results from intra-patient control Results correlated to treatment frequency with increasing effect size over time Phase 3 program initiated Risk benefit profile observed at 18 supporting decision to move to Phase 3 Upon discontinuation of APL-2, treatment effect is maintained through 18 36

37 DERBY & OAKS - Phase 3 Program Overview Population 1 o Endpoint 2 Global Studies Patients with Geographic Atrophy secondary to AMD Change in total area of GA lesion(s) based on FAF at Month 12 Each study will have the following design: Screening - R:2:1:2:1 2 years APL-2 Monthly N = 200 Design Double Masked, Randomized 2:1:2:1 APL-2 EOM N = 200 Treatment 15 mg/0.1 ml Intravitreal Injection vs. Sham Injection Sham Monthly N = 100 Sham EOM N = 100 Sample size 600 Subjects from approx. 100 multinational sites per study 37

38 Key milestones for 2018 GA: Phase 2: 18 month safety & efficacy data GA: Start of Phase 3 program PNH: Phase 1b: monotherapy expansion Phase 1b: Soliris weaning in addon study Start of Phase 3 program AIHA: Phase 2: POC data in CAD Phase 2: POC data in wa-aiha AIHA: Preliminary data in CAD & wa-aiha 38

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40 Thank you design by 40