2018 ois aao€¦ · the anterior segment is relatively spared following suprachoroidal dosing when...

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2018 OIS AAO

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Page 1: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

2018 OIS AAO

Page 2: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

Forward-Looking Statements

This presentation contains forward-looking statements as defined in the Private Securities Litigation Reform Act of 1995, as amended. The words“may,” “will,” “could,” “would,” “should,” “expect,” “plan,” “anticipate,” “intend,” “believe,” “estimate,” “predict,” “project,” “potential,” “continue,” “target”and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words.

Clearside Biomedical, Inc.’s views as of the date of this presentation about future events and are subject to risks, uncertainties, assumptions, andchanges in circumstances that may cause Clearside’s actual results, performance, or achievements to differ significantly from those expressed orimplied in any forward looking statement. Although Clearside believes that the expectations reflected in the forward looking statements are reasonable,Clearside cannot guarantee future events, results, performance, or achievements. Some of the key factors that could cause actual results to differ fromClearside’s expectations include its plans to develop and potentially commercialize its product candidates; Clearside’s planned clinical trials andpreclinical studies for its product candidates; the timing of and Clearside’s ability to obtain and maintain regulatory approvals for its product candidates;the extent of clinical trials potentially required for Clearside’s product candidates; the clinical utility and market acceptance of Clearside’s productcandidates; Clearside’s commercialization, marketing and manufacturing capabilities and strategy; Clearside’s intellectual property position; andClearside’s ability to identify additional product candidates with significant commercial potential that are consistent with its commercial objectives. Forfurther information regarding these risks, uncertainties and other factors you should read the “Risk Factors” section of Clearside’s Annual Report onForm 10-K for the year ended December 31, 2017, filed with the SEC on March 16, 2018 and Clearside’s other Periodic Reports filed with the SEC.Clearside expressly disclaims any obligation to update or revise the information herein, including the forward-looking statements, except as required bylaw.

This presentation also contains estimates and other statistical data made by independent parties and by Clearside relating to market size and growthand other data about its industry. This data involves a number of assumptions and limitations, and you are cautioned not to give undue weight to suchestimates. In addition, projections, assumptions and estimates of Clearside’s future performance and the future performance of the markets in whichClearside operates are necessarily subject to a high degree of uncertainty and risk.

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Page 3: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

INDICATION STUDY DRUG CURRENT STATUS

Uveitis(macular edema associated with non-infectious uveitis)

Suprachoroidal XIPERE(corticosteroid triamcinolone

acetonide)

RVO(retinal vein occlusion)

Suprachoroidal XIPEREwith anti-VEGF

(Intravitreal Eylea®, Lucentis® or Avastin®)

DME(diabetic macular edema)

Suprachoroidal XIPEREalone or with anti-VEGF

(Intravitreal Eylea)

Retinal Vascular Disease

Proprietary Compound(s)

Orphan Diseases Gene Therapy

Focused Pipeline of SCS TreatmentsFor Multiple Blinding Eye Diseases

PRECLINICAL PHASE 1 PHASE 2 PHASE 3 NDA

PRECLINICAL PHASE 1 PHASE 2 PHASE 3 NDA

PRECLINICAL PHASE 1 PHASE 2 PHASE 3 NDA

PRECLINICAL PHASE 1 PHASE 2 PHASE 3 NDA

PRECLINICAL PHASE 1 PHASE 2 PHASE 3 NDA

3

Page 4: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

Proprietary Treatment Approach

Suprachoroidal

• Fluid flows instantaneously and posteriorly

• Designed consistent suprachoroidal injection procedure

• Fluid with drug is absorbed into the choroid, RPE and retina

4

Privileged Organ Requiring Local Therapy

Limitations of Current Approaches to Local Administration Include:

• Corticosteroids reach unintended tissues, causing cataracts and glaucoma

• Multi-kinase inhibitors and gene therapies require precise placement at diseased tissue

• Certain drugs like complement inhibitors may require improved exposure to the choroid

Offers Unprecedented Access to the Back of the Eye

Page 5: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

0

400,000

800,000

1,200,000

1 14 28 56 91

LensSCS

IVT

Con

cent

ratio

n (n

g/g)

Time, days

XIPERE™

The anterior segment is relatively sparedfollowing suprachoroidal dosing when compared

to intravitreal dosing

Improving Ocular Distribution of Triamcinolone Acetonide (TA) through suprachoroidal delivery

Over 10X the amount of TA remaining in the choroid and RPE following suprachoroidal

administration compared to intravitreal injection

Potentially providing improved visual outcomes, increased durability, reduced treatment burden that

can lead to improved benefit to risk *Based on pre-clinical studies

0

10,000

20,000

30,000

40,000

50,000

60,000

1 14 28 56 91

Aqueous HumorSCS

IVT

Con

cent

ratio

n (n

g/m

L)

Time, days

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

1 14 28 56 91

Sclera-Choroid-Outer Retina

SCS

IVT

Con

cent

ratio

n (n

g/m

L)

Time, days

5

Page 6: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

UVEITISOne of the World’s Leading Causes of Blindness

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Page 7: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

7

Status of Current Therapy in Macular Edema Associated with UveitisThe POINT Study1,3

7

1. Thorne, 20182. 2nd injections were based on macular edema criteria, either because of not improving or worsening edema3. Clearside does not make any comparative claims regarding any products included in the POINT study4. Protocol allowed week 8 for intravitreal and subtenon TA but suggested week 12 in the case of intravitreal Ozurdex

Periocular (Sub-tenon or orbital floor) 40 mg

TA (Kenalog®)

Sustained release dexamethasone

implant (Ozurdex®)

Intravitreal 4 mg TA

(TRIESENCE®)

MacularEdema 23% 46% 39%

MeanVisualAcuity 4.27 9.5 9.7Rescue(2nd steroiddosegivenbyweek8or12)2,4

49% 56% 49%

IOPloweringmedsinitiated 24% 33% 31%

POINTStudyConclusion:IntravitrealTAandintravitrealdexamethasoneimplantweresuperiortoPeriocularTAinvisualacuityimprovementsinuveitic macular

edema patients

Page 8: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

8

PEACHTREEPivotal Phase 3 Clinical Trial testing SCS TA in CME involved Uveitis

3:2 randomization of suprachoroidal XIPERE vs. sham injection; 160 patients total

Primary endpoint at 6 months; superiority of best corrected visual acuity outcome from treatment

SHAM

Week-2 Day 0

Day0

Week4

Week8

Week12

Week16

Week20

Week24

Day0

Week4

Week8

Week12

Week16

Week20

Week24

Screening (2 weeks)

Active Arm: Suprachoroidal injection of 4 mg XIPERE

Control Arm: Sham injection procedure

Randomization Phase (6 months)

Enrollment

Suprachoroidal XIPERE

Suprachoroidal XIPERE

SHAM

Two-arm, randomized, controlled, double-masked, multi-center trial at ~60 clinical sites

8

Page 9: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

9

46.9

15.6

0

10

20

30

40

50

Active Control

46.9% (n=45)

15.6% (n=10)

% p

atie

nts

gain

ing

≥15

ETD

RS

lette

rs in

BC

VA fr

om b

asel

ine

PEACHTREE Met Its Primary EndpointETDRS BCVA

Proportion of patients in each arm gaining ≥ 15 ETDRS letters in BCVA from baseline at Week 24

p<0.001

N=96 N=64

9

Page 10: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

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Vision Gained Rapidly and Sustained Through Week 24Mean Change in BCVA in ETDRS Letters by Visit

10

9.6

11.7 11.712.9 12.4

13.8

1.3 1.7 1.63.0 2.8 3.0

0

5

10

15

Wk 0 Wk 4 Wk 8 Wk 12 Wk 16 Wk 20 Wk 24

Active Arm Control Arm

Baseline ETDRS letters read

54.7: active arm; 53.6: control arm

Mea

n ch

ange

at e

ach

visi

t fro

m b

asel

ine

in

BC

VA in

ETD

RS

lette

rs re

ad

Page 11: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

11

• Resolution of signs of uveitis is a clinically significant outcome • Suprachoroidal XIPERE provides clinically relevant outcomes in all anatomical locations

Clear Evidence Suprachoroidal XIPERE Provides Resolution of Inflammation in Uveitis

72.0 74.368.4

17.4 20.0 22.7

0

20

40

60

80

Anterior Chamber Cells Anterior Chamber Flare Vitreous Haze

% s

ubje

cts

with

sco

res

of z

ero

CLS-TA arm Control ArmActive

11

Page 12: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

12

Patient Rescue: Kaplan-Meier

Prop

ortio

n of

Pat

ient

s N

ot R

escu

ed

Time to Rescue (days)Active Control + Censored

Over 85% of subjects in the Active arm did not require rescue therapy, compared to 28% of subjects in the Control arm

12

Page 13: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

13

Safety: Elevated IOP > 21 mm Hg, Meds, or 10 mm Hg Change

“Elevated IOP” includes (a) increased IOP, (b) ocular hypertension, and (c) glaucomaAE = adverse event; IOP, intraocular pressure.** intravitreal OZURDEX® (dexamethasone intravitreal implant) and subtenon and intravitreal triamcinolone acetonide

13

11.5

15.6

0

5

10

15

20

25

30

Active Control

N=11/96 N=10/64

Perc

ent S

ubje

cts

IOP AE Rates Among All 160 Subjects IOP AE Rates Among 64 Control Subjects

0 0

26.3

0

5

10

15

20

25

30

NoRescue

OtherRescue

Local Corticosteroid

Rescue**

N=10/38

Perc

ent S

ubje

cts

(N=18) (N=8)(N=38)

NoFiltrationSurgeries

Page 14: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

14

Safety: Cataracts in XIPERE and Sham Arms

7.3%6.3%

0

2

4

6

8

Active Control

Percen

tageofcataractA

Es

Mar-2018 | NIU program | P3, PEACHTREE, trial | Topline data

% Cataract AEs in Each Arm

No cataract surgeries in this trial

14

Page 15: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

15

Planned Transition from Clinical-Stage to Commercial-Stage Company

Based on feedback from multiple meetings with and pre NDA questions to the FDA, we believe PEACHTREE will be the only Phase 3 clinical

trial required to support the filing of a New Drug Application (NDA)

• Anticipating NDA submission by end of 2018

• Ramping up commercial capabilities:o Building team with launch experience spanning all areas of

commercial expertise, including marketing, access and reimbursement, sales and market analytics

o Strategizing as to how to efficiently reach the approximately 1,900 uveitis and retinal specialists in the U.S.

• Also intend to pursue marketing authorizations outside of the U.S.

15

Page 16: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

RVONew Approach with XIPERE + anti-VEGF

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Page 17: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

SAPPHIRE

Control arm; Intravitreal Eylea; Q4Wk

Combination arm: Suprachoroidal XIPERE + Intravitreal Eylea; Q12Wk

Day0

Week4

Week8

Week12

Week16

Week20

Week24

Weekww

Weekxx

Weekyy

Weekzz

2 Month primary efficacy endpoint

Submit with

6 months data

Continue to follow subjects

out to 1 year

PRNEnrollment

Day0

Week4

Week8

Week12

Week16

Week20

Week24

Weekww

Weekxx

Weekyy

Weekzz

Suprachoroidal XIPERE + Intravitreal Eylea

Intravitreal Eylea

• Two-arm, randomized, controlled, double-masked, multi-center trial at ~150 clinical sites• 1:1 randomization of suprachoroidal XIPERE + intravitreal Eylea vs. intravitreal Eylea alone• Randomization across similar populations of BRVO and CRVO• One year study with primary outcome at 2 months; superiority of best corrected visual acuity

Anticipated First Phase 3 RVO Clinical Trial readout in 4Q 2018

17

Page 18: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

TANZANITE Phase 2 Trial Met Its Primary Endpoint

Proportion of patients in each arm gaining ≥ 15 ETDRS letters in BCVA from baseline

18

Combination Arm; N=23

Control Arm; N=23

Month 1≥15 letters gained

39% 52%

Month 2≥15 letters gained39% 61%

Month 3≥15 letters gained43% 52%

Page 19: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

DMESuprachoroidal XIPERE Alone or in Combination

with an Anti-VEGF Agent

19

Page 20: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

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TYBEE Met Its Primary EndpointMean Change in BCVA from baseline at Week 24; the data1 are tested for

equivalence by comparing the 90% confidence intervals

(1) p=0.664; p>0.05 implies equivalence | Table 14.2.1.1.1; Listing 16.2.6.1 | 1. Data without major deviations; data with major deviations shows similar result

• At Week 24 each arm shows a statistically improvement in BCVA from baseline (*p<0.001)• Data at each visit starting Week 4 show similar outcomes with no statistically or clinically meaningful difference when

comparing data from each arm20

Mea

n ch

ange

from

bas

elin

e in

B

CVA

(ETD

RS

lette

rs) r

ead

Baseline BCVA in ETDRS letters: 58: control arm; 57: active arm

13.5* 12.3*0

5

10

15

20

25

Control Combination

(1)

Page 21: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

21

Combination Arm Achieved Equivalent Vision with Fewer Treatments

23

10

0

5

10

15

20

25

Control Combination

Num

ber o

f add

ition

al E

ylea

Inje

ctio

ns in

the

PRN

sta

ge

(1)

• ~50% fewer treatments through week 12• ~57% fewer treatments in the PRN period (p=0.03)

21 (1) p=0.03

Page 22: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

SUMMARY

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Page 23: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

Patent No. Significance Expiration

U.S. 7,918,814 Provides exclusivity for the administration of any drug to the eye by inserting a microinjector into the sclera or corneal stroma of a patient’s eye, and infusing the drug into the sclera or cornea 2029

U.S. 8,197,435 Provides exclusivity for administration of any drug to the suprachoroidal space, when the drug is administered through a microinjectorthat is inserted into the patient’s sclera 2027

U.S. 8,636,713 Provides exclusivity for all hollow microinjector ocular delivery methods of anti-inflammatory drugs, so long as the anti-inflammatory drug is infused into the suprachoroidal space 2027

U.S. 8,808,225 Provides exclusivity for all hollow microinjector ocular delivery methods of drug, so long as the drug is infused into the suprachoroidal space 2027

U.S. 9,788,995 Provides exclusivity for all microinjector ocular delivery methods of drug at any ocular insertion site for controlled release 2027

U.S. 9,180,047 Provides exclusivity for methods for delivering a substance to a region of the eye (e.g., SCS, sclera, choroid) via loss of resistance injection technology 2034

U.S. 9,539,139 Provides exclusivity for apparatus with actuation rod configured to operate via loss of resistance injection technology 2034

U.S. 9,636,253 Provides exclusivity for methods for delivery a substance to a region of the eye (e.g., SCS, sclera, choroid) via an adjustable needle and loss of resistance injection technology 2034

U.S. 9,770,361 Provides exclusivity for apparatus with adjustable needle configured to operate via loss of resistance injection technology 2034

U.S. 9,572,800 Provides exclusivity for methods of treating a posterior ocular disorder in a human via non-surgical administration of axitinib to the SCS 2033

U.S. 9,636,332 Provides exclusivity for methods of treating a posterior ocular disorder in a human via non-surgical administration of triamcinolone to the SCS 2033

U.S. Appl. No. 15/673,073(allowed)

Provides exclusivity for methods of treating macular edema (e.g., secondary to RVO) in a human via non-surgical administration of an anti-inflammatory drug to the SCS and non-surgical administration of a VEGF antagonist to the eye 2033

U.S. Appl. No. 15/714,441(allowed)

Provides exclusivity for apparatus with an adjustable needle configured to operate via loss of resistance injection technology and a medicament container containing triamcinolone 2034

U.S. Appl. No. 15/383,582(allowed) Provides exclusivity for methods of delivering a substance to a target tissue using loss of resistance injection technology 2035

Proprietary Access to the Suprachoroidal Space

23

Page 24: 2018 OIS AAO€¦ · The anterior segment is relatively spared following suprachoroidal dosing when compared to intravitreal dosing Improving Ocular Distribution of Triamcinolone

Major Near-Term Anticipated MilestonesProvide Multiple Potential Value-Inflection Points

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2018 2019

Uveitis

RVO

DME

P3 Data (PEACHTREE) NDA Submission

Topline P3 Data

P2 Data (TYBEE)

Publications

Analysis & Presentation

Phase 3(SAPPHIRE)

Phase 3 (TOPAZ)

NDA Review

6 month P3 Data