hans schikan, ceo - jefferies...(h1-2014): eur 12.7m; ye 2014 cash balance guidance: eur 52-54m...
TRANSCRIPT
Hans Schikan, CEO
Prosensa Corporate Overview
Jefferies Healthcare Conference
London, UK
November 19, 2014
This presentation may contain statements that constitute “forward-looking statements” within themeaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of1934. Forward-looking statements are statements other than historical fact and may includestatements that address future operating, financial or business performance or Prosensa’s strategies orexpectations. In some cases, you can identify these statements by forward-looking words such as“may,” “might,” “will,” “should,” “expects,” “plans,” “anticipates,” “believes,” “estimates,” “predicts,”“projects,” “potential,” “outlook” or “continue,” and other comparable terminology. Forward-lookingstatements are based on management’s current expectations and beliefs and involve significant risksand uncertainties that could cause actual results, developments and business decisions to differmaterially from those contemplated by these statements. These risks and uncertainties include, but arenot limited to, the timing and conduct of clinical trials of drisapersen and Prosensa’s other productcandidates, plans to pursue research and development of product candidates for DMD and otherindications, the clinical utility of Prosensa’s product candidates, the timing or likelihood of regulatoryfilings and approvals, Prosensa’s intellectual property position, expectations regarding payments underProsensa’s collaborations and Prosensa’s competitive position. These risks and uncertainties alsoinclude those described under the captions “Risk Factors” and “Management’s Discussion and Analysisof Financial Condition and Results of Operations” in Prosensa’s Annual Report on Form 20-F and otherfilings with the Securities and Exchange Commission. Forward-looking statements speak only as of thedate they are made, and Prosensa does not undertake any obligation to update them in light of newinformation, future developments or otherwise, except as may be required under applicable law. All
forward-looking statements are qualified in their entirety by this cautionary statement.
Forward-Looking Statements
To develop innovative, RNA-modulating
therapeutics to fill unmet medical
needs for patients with rare genetic diseases
Our Mission
2
Rare disease company based in the Netherlands, listed on Nasdaq (RNA)
Largest pipeline and clinical program in Duchenne muscular dystrophy (DMD)
NDA submission under accelerated approval for drisapersen underway,
followed by MAA in EU for conditional approval
Orphan Drug status for 6 DMD compounds
FDA Breakthrough Therapy Designation for drisapersen
Solid intellectual property position
Management with extensive experience in commercializing orphan drugs
Cash position (Sept 30, 2014): EUR 62M; Cash burn (FY-2013): EUR 22M;
(H1-2014): EUR 12.7M; YE 2014 cash balance guidance: EUR 52-54M
Corporate Highlights
3
4
Our Science - RNA Modulation
Technology platform enables us to design sequences of nucleotides that bind to specified regions of pre-mRNA which may induce exon skipping or exon inclusion, reduce mutated
toxic RNA or protein, remove specific protein domains or block protein expression
Indication Compound Discovery Pre-Clinical Phase I/II Phase III
Drisapersen
PRO044
PRO045
PRO053
PRO052
PRO055
PROSPECT
PRO289
PRO135
Duchenne
Muscular
Dystrophy
Huntington’s
Disease
Myotonic
Dystrophy
R&D - Largest Pipeline in DMD
13% of DMD patients
6% of DMD patients
8% of DMD patients
8% of DMD patients
4% of DMD patients
2% of DMD patients
5
Evolution of clinical symptoms of DMD
0 5 10 15 20 25 30
death
ventilation 24h
ventilation at night
very limited use of arms
wheelchair - skeletal deformity
walking problems
Age
X-linked, rare genetic disease
Rapid progression of muscle degeneration
75,000 patients in addressable populations
Severely debilitating and invariably fatal progressive neuromuscular disease
Duchenne Muscular Dystrophy (DMD)
6
6MWT is a validated functional endpoint for DMD and other rare diseases
Age & baseline walking ability are important variables that determine decline in the ability to walk as measured by 6MWT*
Recent publication suggests clinically meaningful change in walking ability, as measured by 6MWT, to be in the range of 20-30 meters*
Creatine Kinase (CK) is a marker of muscle damage - DMD patients have elevated levels of CK in their blood serum
Prosensa has completed enrollment with 269 patients in an observational study to characterize the natural history and progression of DMD in addition to capturing potential biomarkers
* McDonald, Muscle & Nerve 2013
DMD Natural History and Endpoints
7
6-M
inu
te W
alk
Dis
tan
ce,
m 700
100
200
600
500
400
300
5 10
Functional Outcome - 6MWT Conceptual Representation
Late intervention
Early intervention
Approx. age years
8
7
Based on natural history, DMD boys lose approximately 40-60 meters in 6MWT per year
Lead Compound - Drisapersen
20-mer Antisense Oligonucleotide (AON) with specific binding to exon 51 of dystrophin gene pre-mRNA
Administered by once weekly subcutaneous injection (6mg/kg)
May address up to 13% of all DMD patients
Granted orphan drug status in US, EU, Japan, Australia
Breakthrough Therapy designation granted by the FDA
NDA submission initiated under rolling review and Fast Track status
Issued patents include US patent expiring 2023; EU patent expiring 2021
9
Study Phase Study design N Status
CLIN-02DMD114673
Phase I/II +Extension
Open label, repeat dose escalation (extension phase 6 mg/kg/wk intermittent);
12Complete; extension ongoing
DEMAND IDMD114118
Phase IPlacebo-controlled, pharmacokinetics/safety; single dose
20 Complete
DEMAND IIDMD114117
Phase IIExploratory placebo-controlled, dose regimen comparison; ex-US, 24/48 wks
53 Complete
DEMAND IIIDMD114044
Phase IIIRandomized, placebo-controlled, confirmatory study; global, 48 wks
186 Complete
DEMAND IVDMD114349
Phase II/III Extension
Open label, extension study for DEMAND II) & DEMAND III ; 96 wks
234 Closed
DEMAND VDMD114876
Phase IIExploratory placebo-controlled, dose-comparison; US only, 24 wks
51 Complete
DMD115501Phase II/IIIExtension
Open-label, extension study for US & Canadian subjects from DEMAND III, IV, V
72 Recruiting
Drisapersen Clinical Program
10
More than 300 patients and over 450 patient treatment years in global clinical program
Overview of Supportive Studies + Analyses
*pb = placebo (DEMAND IV: pb/delayed treatment); dr = drisapersen 6 mg/kg; Tx difference on 6MWD; not all analyses shown11
Clinically meaningful treatment difference across program; DEMAND III outlier
Efficacy results up to 3.4 years (177 weeks) appear to show delay of disease progression
0
100
200
300
400
500
600
700
800
0 12 24 36 48 60 72 80 93 105 117 129 141 153 165 177
Dis
tan
ce w
alke
d (
m)
Weeks
Age at
week 177
13.7
14.3
11.4
10.9
12.6
9.3
13.3
15.4
13.0
14.8
Long Term Study DMD114673
8 weeks on – 4 weeks off
12
N=10
Mean age is 12.9 years at 177 wks
13
Dis
tan
ce w
alke
d (
m)
Weeks
Mean change from baseline: +33 m
[Median change from baseline: +64 m]
Mean change from baseline: -25 m
[Median change from baseline: +8 m]
Long-term data suggest stabilization on 6MWT
Ambulant boys: N=8
All boys: N=10
Long Term Study DMD114673
Study DesignΔ 6MWT
(m)SD (m)
Study(years)
N
McDonald 2010¹ Natural History -57 104 1 18
Ataluren 2010¹ Placebo arm -42 90 1 57
Mazzone 2011² Natural History -42 74 1 71
Goemans 2012¹ Natural History -38 96 1 19
McDonald 2013² Natural History -59 82 1 33
Mazzone 2013² Natural History -122 78-97 2 113⁴
Goemans 2013² Natural History -125 139 2 14
Pane, 2014³ Natural History -146 146 3 68
DMD patients lose approximately 40-60 m in 6MWD in 1 year, 150 m in 3 years
¹All ages; ²Age >7, ³Age ≥7, ⁴ All patients in study
Functional Outcome - 6 Minute Walk Test
14
(11)
20
DEMAND II (DMD114117)
(25 week endpoint)
+32m (n=18)
DEMAND V(DMD114876)
(24 week endpoint)
+16m (n=18)
-11m (n=16)
Δ6MWD = +31mp=0.003
Δ6MWD = +27mp=0.069
Δ6MWD = +35mp=0.014
DEMAND II + DEMAND V(DMD114117 + DMD114876)
(post-hoc analysis 24/25 weeks)
-4m (n=18)
Drisapersen 6 mg/kg/weekPlacebo
Two placebo-controlled studies show treatment benefit on 6MWD
+20m (n=36)
-11m (n=34)
15
Placebo Controlled Studies - 6MWD
Visit Treatment N nUnadjusted
mean baseline value (sd)
Adjustedmean (se)
Treatment difference
(m)95% CI P-value
All Subjects
Week 48
Placebo 61 59 348 (92) -53 (10)
Drisapersen 125 117 337 (96) -42 (7) +10 (-15,35) 0.415
≤ 7 years at baseline
Week 48
Placebo 29 29 383 (67) -25 (11)
Drisapersen 51 50 368 (65) -4 (9) +21 (-7,50) 0.131
> 7 years at baseline†
Week 48
Placebo 32 30 316 (101) -83 (16)
Drisapersen 74 67 316 (107) -76 (11) +7 (-29,43) 0.703
> 7 years at baseline, and baseline 6MWD ≥300m and ≤450m
Week 48
Placebo 15 14 351 (34) -67 (20)
Drisapersen 34 33 375 (42) -42 (13) +25 (22,72) 0.292
Model includes terms for Treatment, Visit, Treatment by Visit, Study, Baseline 6MWD and Baseline 6MWD by Visit
DEMAND III by Age and Baseline 6MWD
†Includes subjects >11 years of age: drisapersen, n=11; placebo, n=1
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What Happened in DEMAND III?
Variability
44 clinical trial sites, across 19 countries
Many centers new to DMD clinical trials
Difference in standards of care
Heterogeneity
Patient population was generally older, more heterogeneous & more advanced in their disease than inthe previous placebo controlled studies, as evidenced by baseline characteristics
1 in 4 pts was >7 yrs & <300m baseline 6MWT
+29%
Time sincediagnosis[months]
58
4745
DEMAND IIIDEMAND VDEMAND II
-21%
6MWD[meter]
337
396
428
+167%
Rise fromfloor time[sec]
12.3
5.04.6
+48%
4 stairs climb-ascent time[sec]
4.74.6
3.1
-18%
Musclestrength [lbs]
102
125124
Baseline characteristics in DEMAND III; boys were generally more advanced in disease
DEMAND III - More Advanced Disease
Drisapersen arm = 6 mg/kg/week; figure shows differences for drisapersen arm; similar baseline characteristics for placebo arm18
StudyMean change in
6MWD for continuous treatment (n)*
Mean change in 6MWD for placebo/delayed
treatment (n)*
Difference in change in 6MWD between
treatment arms (n)*
DEMAND IVall patients
–67 m (69) –113 m (44) +46 m (113)
DEMAND IVfeeder study DEMAND II
–5 m (17) –57 m (13) +52 m (30)
DEMAND IVfeeder study DEMAND III
–87 m (52) –136 m (31) +49 m (83)
DEMAND IV≤ 7 years of age
+8 m (31) –29 m (21) +37 m (52)
DEMAND IV>7 years of age† –128 m (38) –190 m (23) +62 m (61)
*Includes all subjects (21 subjects lost ambulation during DEMAND III; 13 subjects lost ambulation during DEMAND IV. Zero values were imputed
once the subject had lost ambulation; zero minus baseline value).
Long Term (96 weeks) - DEMAND IV
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Time (weeks)
PlaceboDrisapersen
Dri
sap
erse
n t
issu
e le
vel
(mg/
g)
Leaky muscle fibers in DMD promote
AON uptake
AONs enter nuclei, bind to exon 51 of DMD pre-mRNA,
and induce skipping
Exon 51 skipping results in novel dystrophin production
Improved muscle physiology and
structure
qRT-PCRTissue PK IFA CK
20
Confirmed Mechanism of Action
21
0 10 20 30 40 50
10,000
12,000
8,000
6,000
0
14,000
∆ in CK level between Drisapersen(6mg/kg/wk) and placebo
-4,045(p<0.001)
DEMAND III(at week 48)
DEMAND V(at week 24)
DEMAND II(at week 25)
-3,327(p=0.064)
-1,305(p=0.439)
CK levels [IU/L]¹
DEMAND III
DEMAND V²
DEMAND II
PlaceboDrisapersen 6mg
Week¹Preliminary analysis; ²Treatment duration 24 weeks
Muscle Pathology: Decrease in CK
Consistent decrease in Creatine Kinase (CK) across 3 placebo controlled studies
0
5
10
15
Semi-tendinosus
Bicep femoris
Vastus medialis
Vastus intermedius
Vastus lateralis
Rectus femoris
22
Preliminary MRI data suggest reduced fat infiltration. Data are supportive for drisapersen-induced improved muscle pathology
Drisapersen 6mg/kg/week (n=5)Placebo (n=5)
DEMAND V: Change in apparent fat fraction from baseline [%] at 48 weeks in 6 muscle groups
Muscle Pathology: Reduced Fat Infiltration
Key Safety Data
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Drisapersen is generally well tolerated, with an adverse event (AE) profile consistent with that described previously for this class of molecule
59 SAEs reported on drisapersen, most considered unrelated: 15/59 SAEs were considered related or possibly related to drisapersen
In total 12 of >300 subjects have withdrawn permanently from treatment owing to AEs
Most commonly reported AEs include injection-site reactions and renal abnormalities (including subclinical proteinuria); cases of (moderate to severe) thrombocytopenia have been reported
FDA Guidance Letter received on June 2, following meeting on May 14. Regulatory pathway possible under accelerated approval on existing data
Rolling NDA submission underway with first module (>15,000 pages) submitted on October 10; next module in preparation, anticipated submission December
Regular interactions with FDA (meetings September and October); next meeting planned for January 2015, with submission of final module expected shortly thereafter
Two confirmatory post-approval studies were discussed with FDA in meeting on October 22; studies planned to start prior to anticipated approval
EMA - interactions ongoing, plan to file for conditional approval shortly after submission of file with FDA
Drisapersen Regulatory Update
24
1. Open-label study of drisapersen with historical control
Prosensa’s fully enrolled Natural History Study (269 patients) may serve as a control
2. Randomized, placebo-controlled trial of another exon-skipping drug with a similar mechanism of action, directed at a different exon
PRO044 may serve this purpose
Both study designs discussed with FDA
Final protocols currently in preparation for submission to IRB’s
Anticipated start in Q1 and Q2 2015, resp.
Confirmatory Studies - FDA Guidance
25
0%
20%
40%
60%
80%
100%
0 200 400 600 800 1000
% f
ibre
s
Fibre dystrophin intensity (a.u.)
Distribution dystrophin per fibre
cu
mu
lati
ve
%
Dystrophin Assessment Methodology
32
40
38
36
42
2
1
10
16
64
911
7
53
12
15
13
8
14
23
1817
21
20
22
30
19
24
2928272625
35
33
31
34
4443
41
39
37
47464549
48
Sensitive, reproducible and objective methodology for dystrophin analysis developed by Prosensa and published in peer-reviewed online journal (PLOS ONE)
Objective: measures dystrophin over the entire membrane of a fibre and is operator
independent
Reproducible: method verified across multiple samples and experiments
Sensitive: assesses dystrophin levels by immunofluorescence in muscle biopsies from
BMD & DMD patients
Dystrophin Expression is Variable
Demonstration of a pharmacodynamic effect requires comparison of 2 biopsies pre- and post-treatment, taken from the same muscle, & sampled from areas of similar disease state
Follow-on Exons Moving Forward
PRO044
Positive dystrophin response detected in 12 of 21 evaluable biopsies
Dose exposure modelling predicts effective dose range at 6-9 mg/kg i.v.
Safety findings consistent with known class safety profile; no drug-related SAEs
Dosing of first patients in extension study Q1 2015
Placebo-controlled study anticipated to start 1H 2015
PRO045Dose finding study ongoing; preliminary results expected in Q4 2014
PRO053
Dose finding study ongoing; preliminary results expected in Q1 2015
PRO052/PRO055/PROSPECT
Preclinical studies ongoing
28
PROSPECT - Multiple Exon Skipping
Addresses rare mutations, initially in exon 10 to 40 region
Proof-of-concept obtained in multiple patient muscle cell cultures
Initial applicability between 5% and 20% of DMD patient population
29
30
Q3-2014 Re-dose initial group of boys (US & EU)
Q4-2014 NDA rolling submission commenced with FDA
Q1-2015 Anticipated completion of NDA submission with FDA
Q1-2015 Expected MAA application for drisapersen with EMA
1H-2015 Initiation of two confirmatory studies to support potential accelerated approval for drisapersen
Key Milestones Drisapersen
Rare disease company based in the Netherlands, listed on Nasdaq (RNA)
Largest pipeline and clinical program in Duchenne muscular dystrophy (DMD)
NDA submission under accelerated approval for drisapersen underway,
followed by MAA in EU for conditional approval
Orphan Drug status for 6 DMD compounds
FDA Breakthrough Therapy Designation for drisapersen
Solid intellectual property position
Management with extensive experience in commercializing orphan drugs
Cash position (Sept 30, 2014): EUR 62M; Cash burn (FY-2013): EUR 22M;
(H1-2014): EUR 12.7M; YE 2014 cash balance guidance: EUR 52-54M
Corporate Highlights
31