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Copyright © 2019 Zosano Pharma Inc. | Confidential
Corporate Presentation
October 2019
Copyright © 2019 Zosano Pharma Inc. | Confidential
Forward-Looking Statements
2
This presentation contains forward-looking statements regarding Zosano’s technology and product candidates,
including ADAM, QtryptaTM and C213, and other future events and expectations. Readers are urged to consider
statements that include the words "may," "will," "would," "could," "should," "might," "believes," "estimates," "projects,"
"potential," "expects," "plans," "anticipates," "intends," "continues," "forecast," "designed," "goal," "approximately" or the
negative of those words or other comparable words to be uncertain and forward-looking. These statements are subject
to risks and uncertainties that are difficult to predict, and actual outcomes may differ materially. These include, without
limitation, risks and uncertainties associated with the process of discovering, developing and commercializing products
that are safe and effective for use as human therapeutics, risks inherent in the effort to build a business around such
products and other risks and uncertainties described under the heading "Risk Factors" in the Company's most recent
quarterly report on Form 10-Q. Although Zosano believes that the expectations reflected in these forward-looking
statements are reasonable, we cannot in any way guarantee that the future results, level of activity, performance or
events and circumstances reflected in forward-looking statements will be achieved or occur. All forward-looking
statements are based on information currently available to Zosano and Zosano assumes no obligation to update any
such forward-looking statements.
Copyright © 2019 Zosano Pharma Inc. | Confidential
Investment Highlights
▪ Proprietary intracutaneous drug delivery platform
▪ Lead program: QtryptaTM
▪ Acute migraine therapy
▪ Strong clinical data
▪ NDA filing in Q4 2019
▪ Portfolio Expansion 2019
▪ C213 for Cluster headache
▪ Unique application for delivery of Biologics
▪ Proteins
▪ Peptides
▪ Vaccines
▪ Partnering focus
▪ Qtrypta
▪ Biologics
3
Copyright © 2019 Zosano Pharma Inc. | Confidential
Transforming How Drugs Get Delivered
4
Stratum corneum
Cellular epidermis
Coated patch in skin
Coated patch in skin
Novel
Novel transdermal patch containing drug-coated microneedles
Large & Small Molecules
Microneedles can be coated with both large and small molecules
Rapid & Consistent
Allows for rapid and consistent dissolution of drugs into capillary bed
Minimizes stimulation
Shallow depth of penetration of proprietary microneedles into
superficial skin layers minimizes stimulation of nerve endings
Convenient & Discreet
Quarter size patch designed to be convenient and discreet
Easy to Use
Patient experience in trials are positive and demonstrate that the
system is easy to use
Copyright © 2019 Zosano Pharma Inc. | Confidential
Patch Application
5
Snap patch ring
assembly onto
applicator.
Twist applicator
cap from position
#1, to position #2 to
unlock for patch
application.
Press applicator
downward on skin
to apply.Patch is applied.
Remove spent patch ring to
apply consequent patches
1
2
3
4&5
Handheld, reusable applicator ensures that the same force is applied across multiple applications
and is user independent.
Copyright © 2019 Zosano Pharma Inc. | Confidential
▪Lead Program: Qtrypta™ (M207)
▪ Acute migraine therapy
▪ Novel
▪ Clinical studies completed
▪ Addresses unmet patient needs
▪ NDA filing in 4th Quarter
6
Copyright © 2019 Zosano Pharma Inc. | Confidential
Qtrypta – Completed Development
Preclinical studies
▪ Published in Journal of Pharmaceutics – May 2018
▪ Published in Journal of Pharmaceutical Sciences – June 2018
Phase 1 – PK study
▪ Published in Pain Management – August 2017
Pivotal efficacy study
▪ Published in Cephalalgia – November 2017
Phase 3 – 12 month safety study
▪ Data presented at IHC – September 2019
NDA filing – On track for year end
▪ PK bridging study – completed
▪ Human factors study – completed
▪ Registration batch stability testing - completed
▪ Pre-NDA clinical meeting – completed
▪ Pre-NDA CMC meeting in November 7
Copyright © 2019 Zosano Pharma Inc. | Confidential
39 Million People in the US Suffer From Migraines
8
▪ 3rd Most Prevalent Disorder in the World▪ Impacts ~25% of U.S. Households ▪ Occurs in 12% of U.S. Population▪ 85% of Chronic Migraine patients are women
▪ $36B in Lost Productivity▪ $5.4B in Treatment Costs
Source: Migraine Research Foundation
PREVALENT
DEBILITATING
COSTLY
▪ 90% Unable to Function Normally▪ 1.2 MM ER Visits per Year▪ 25% experience 4+ Migraines/month▪ Attacks Last 4-72 Hours
Copyright © 2019 Zosano Pharma Inc. | Confidential
MANY PATIENTS ARE DISSATISFIED AND WILLING TO TRY SOMETHING NEW
9
42%37%
50% 48%
39%
79%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Inadequatepain relief
Slow onsetof action
Recurrence/worsening of pain
Inability to function/work quickly aftertaking medication
Undesireableadverse events
Would be willing totry another acute
medication to treatthe headache!
Areas of Dissatisfaction With Current Acute Therapies
Source: Bigal ME et al. Headache. 2007;47:475-479.
Copyright © 2019 Zosano Pharma Inc. | Confidential
41.5%
68.3%
14.3%
42.9%
0%
20%
40%
60%
80%
Pain Freedom MBS
% S
ub
ject
s A
chie
vin
g P
ain
Fre
edo
m o
r Fr
eed
om
fro
mM
BS
at 2
Ho
urs
Qtrypta 3.8mg Placebo
Need: Freedom from pain Statistically Significant Impact on Pain Freedom and MBS
10
p=<0.0001TG = 27.2
p=<0.0009TG = 25.4
ACHIEVEMENT OF CO-PRIMARY ENDPOINTS
Spierings ELH et al. Randomized, double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine. Cephalalgia 2018 Feb;38(2):215-224.TG = Therapeutic Gain (difference between Qtrypta and Placebo)
Copyright © 2019 Zosano Pharma Inc. | Confidential
Need: Freedom from pain Need: Fast onset of action Pain Freedom: Over 48 Hours
11
7.3%
17.1%
26.8%
41.5%
51.2%54.9%
62.2%
69.5% 64.6%
0%
20%
40%
60%
30 minutes 45 minutes 1 hour 2 hour 3 hour 4 hour 12 hours 24 hours 48 hours% S
ub
ject
s A
chie
vin
g Pa
in F
reed
om
Pain Freedom 30 Minutes to 48 Hours
Qtrypta Placebo
*
**
**
****
**
****
Spierings ELH et al. Randomized, double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine. Cephalalgia 2018 Feb;38(2):215-224.
*p=<0.05 **p=0.01
Copyright © 2019 Zosano Pharma Inc. | Confidential
12
23.2%
46.3%
56.1%
68.3%
80.5% 81.7% 82.9% 80.5%78.0% 78.0%
0%
20%
40%
60%
80%
15 minutes 30 minutes 45 minutes 1 hour 2 hour 3 hour 4 hour 12 hours 24 hours 48 hours
% S
ub
ject
s A
chie
vin
g P
ain
Re
lief
Pain Relief 15 Minutes to 48 Hours
Qtrypta Placebo
*
** ** ** ******
Spierings ELH et al. Randomized, double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine.
Cephalalgia 2018 Feb;38(2):215-224. *p=<0.05 **p=0.01
Need: Substantial pain relief Need: Fast onset of action~ 80% Of Patients Had Pain Relief Through 48 Hours
Copyright © 2019 Zosano Pharma Inc. | Confidential
Need: No recurrence/absence of pain Qtrypta: Sustained Pain Freedom
13
31.7%26.8%
10.4% 9.1%
0%
10%
20%
30%
40%
2-24 Hours 2-48 Hours
% o
f Su
bje
cts
wit
h S
ust
ain
ed
Pai
n F
ree
do
mat
24
an
d 4
8 h
ou
rs
Qtrypta 3.8mg Placebo
p=0.0001 p=0.0035
Spierings ELH et al. Randomized, double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine. Cephalalgia 2018 Feb;38(2):215-224.
76% of patients who were pain free at 2 hours realized sustained pain freedom through 24 hours65% realized sustained pain freedom though 48 hours
Copyright © 2019 Zosano Pharma Inc. | Confidential
Need: Ability to function/work quickly and consistentlyNeed: Eliminate hangover effectMigraine-ACT (Assessment of Current Therapy)
Proportion of participants who answered “Yes” at 48 weeks:
14
Question n (%)
Does your migraine medication work consistently, in the majority of your
attacks?104 (96%)
Does the headache pain disappear within 2 hours?92 (85%)
Are you able to function normally within 2 hours?91 (84%)
Are you comfortable enough with your medication to be able to plan your
daily activities?101 (94%)
A total of 342 subjects received study drug, 335 treated at least 1 migraine, 257 completed 6 months of the study and 128 completed 1 year.
84% of subjects
were able to
function normally
at 2 hours
Migraine-ACT questionnaire: a standardized evaluation completed by patients to assess the effectiveness of a patient’s acute treatment of migraine therapy (Highest score 4.0)
Migraine-ACT Scores Suggest Excellent Response to Qtrypta
Copyright © 2019 Zosano Pharma Inc. | Confidential
Long Term Safety Results – Presented at IHC
Efficacy consistent with pivotal study:• Pain Freedom at 2 hours: 44%• Pain Relief at 2 hours: 81%• Freedom from MBS at 2 hours: 68%
Well Tolerated Safety Profile• Most common AE was redness/swelling.
• 95% were mild and 80% resolved within 48 hours.• Less triptan-like side effects than typically found with the class.
• Less than 2% of patients reported effects like dizziness and paresthesia
15
Copyright © 2019 Zosano Pharma Inc. | Confidential
Target Market: Difficult to treat migrainesPublished in Headache – January 2019
16
Pain-Free 2 Hr MBS-Free 2 Hr
n(%)Placebo ADAM
Zolmitriptan 3.8 mg
P -Value* Placebo ADAM
Zolmitriptan 3.8 mg
P- Value*
Nausea/Vomiting (51) 14% (59) 44% 0.0005 (51) 45% (59) 68% 0.009
On Awakening (44) 16% (36) 44% 0.0056 (44) 39% (36) 72% 0.0031
Severe Pain (33) 15% (39) 26% 0.2489 (33) 42% (39) 64% 0.0376
Time To Treat ≥ 2hrs (40) 10% (36) 33% 0.0169 (40) 41% (36) 69% 0.0137
MBS: Most Bothersome Symptom *Nominal
▪ The rapid absorption profile of ADAM zolmitriptan may contribute to its ability provide pain- and MBS-freedom in
many patients even when treatment is delayed.
▪ Intracutaneous administration may provide an additional advantage in patients with nausea by bypassing the
need for swallowing or inhaling medication.
▪ The efficacy results seen in this trial suggest that ADAM zolmitriptan may be more effective than other routes
of administration of triptans, particularly oral.
EFFICACY OF ADAM ZOLMITRIPTAN (INTRACUTANEOUS ZOLMITRIPTAN) FOR THE ACUTE TREATMENT
OF DIFFICULT-TO-TREAT MIGRAINES
Results
Conclusions
Copyright © 2019 Zosano Pharma Inc. | Confidential
Qtrypta Highly Differentiated And Addresses Unmet Needs
17
81% Pain Relief in 2 Hours
EFFECTIVEFAST
Peak Plasma Concentration in 15 Mins
COMPLETE SUSTAINED
41.5% Pain
Freedom in 2 Hours63% Sustained Pain
Relief From 2-48 Hours
Kellerman DJ, Ameri M, Tepper SJ. Rapid systemic delivery of zolmitriptan using an adhesive dermally applied microarray. Pain Management doi: 10.2217/pmt-2017-0036 (2017). Spierings ELH et al. Randomized,
double-blind, placebo-controlled, parallel-group, multi-center study of the safety and efficacy of ADAM zolmitriptan for the acute treatment of migraine. Cephalalgia 2018 Feb;38(2):215-224.
41.5%
14.3%
Qtrypta 3.8 mg Placebo
Copyright © 2019 Zosano Pharma Inc. | Confidential
0
20
40
60
80
100
0 0.5 1 1.5 2
Time, hZomig 5mg Oral Zomig 5mg Nasal Imitrex 6mg Inj Imitrex 100mg Tab M207
Qtrypta™ (M207)
Qtrypta Is Well Positioned Against Current Triptans
18
PAIN RELIEF OVER TIME1 (REFERENCE COMPOUNDS)
1. Comparisons are not based on data resulting from head-to-head trials and are not direct comparisons of safety or efficacy. Different protocol designs, trial designs, patient selection and population number of patients, trial endpoints, trial
objectives and other parameters that are not the same between the relevant trials may cause any comparisons of results from different trials to be unreliable.
Copyright © 2019 Zosano Pharma Inc. | Confidential
Positioning Against New Entrants
19
41.5%
32.2%
38.8%
19.2% 19.6% 20.7% 21.8% 21.2%
34.3%
51.0%
68.3%
40.7%
48.7%
36.6% 37.6%
34.1%
38.9% 37.7%
64.1%
0%
20%
40%
60%
Qtrypta Lasmiditan 200mgSamurai study
Lasmiditan 200mgSpartan study
Rimegepant 75 mg301 study
Rimegepant 75 mg302 study
Ubrogepant 25mg Ubrogepant 50mg Ubrogepant 100mg Onzetra Xsail - nasal Zembrace 3 mg -injectable
% o
f Su
bje
cts
ach
ievi
ng
Pai
n F
ree
do
m a
nd
MB
S Fr
ee
do
m a
t 2
Ho
urs
Comparison of Pain Freedom and MBS Freedom at 2 Hours1
Pain Freedom MBS
2
1. Comparisons are not based on data resulting from head-to-head trials and are not direct comparisons of safety or efficacy. Different protocol designs, trial designs, patient selection and population number of patients, trial
endpoints, trial objectives and other parameters that are not the same between the relevant trials may cause any comparisons of results from different trials to be unreliable.
2. Onzetra Xsail was not tested for MBS Freedom
Copyright © 2019 Zosano Pharma Inc. | Confidential
Qtrypta Well Positioned Against New Entrants
20
81.0%
59.0% 56.0% 58.1%61.0% 67.6% 60.0%
0%
20%
40%
60%
80%
Qtrypta Lasmiditan 200mg Rimegepant 75 Samurai study mg 301 study
Rimegepant 75mg 302 study
Ubrogepant 100mg
Onzetra Xsail -nasal
Zembrace 3 mg -injectable
% S
ub
ject
s A
chie
vin
g P
ain
Rel
ief
at 2
Ho
urs
Comparison of Pain Relief at 2 Hours1
1. Comparisons are not based on data resulting from head-to-head trials and are not direct comparisons of safety or efficacy. Different protocol designs, trial
designs, patient selection and population number of patients, trial endpoints, trial objectives and other parameters that are not the same between the relevant trials may cause any comparisons of results from different trials to be unreliable.
Portfolio Expansion
Copyright © 2019 Zosano Pharma Inc. | Confidential
Copyright © 2019 Zosano Pharma Inc. | Confidential
Significant Unmet Need in Cluster Headache
▪ Highly disabling chronic neurological condition1
▪ Recognized as most severe pain known to humans
▪ 15%-22% have suicidal ideations2
▪ Short-lasting headache attacks characterized by3:
▪ Severe unilateral temporal/orbital pain
▪ Ipsilateral autonomic symptoms
▪ Lasting 15–180 minutes (when untreated)
▪ Sense of restlessness or agitation
▪ Prevalence of cluster headache
▪ Approximately 1 in 1000 (0.12%) suffer from the condition
▪ Prevalence similar to Parkinson's and Multiple Sclerosis4,5
▪ Over 300,000 people suffer from cluster headache in the US
22
1. Jürgens T, Gaul C, et al. Impairment in episodic and chronic cluster headache. Cephalalgia 2010; 31:671–682.2. Rozen TD, Fishman RS. Cluster headache in the United States of America: demographics, clinical characteristics, triggers, suicidality, and personal burden. Headache 2012;52:99-113. 3. Headache Classification Committee of the International Headache Society (IHS). The International
Classification of Headache Disorders, 3rd edition. Cephalalgia 2018: 38, 1–211. 4. Fischera M, Marziniak M, Gralow I, Evers S. The incidence and prevalence of cluster headache: a meta-analysis of population-based studies. Cephalalgia 2008;28:614-8. 5.
Ford HL, Gerry Em Johnson M et al. A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds. J Neurol 2002; 249:260-5. 6. Klapper, et all, (2011) Cluster Headache. Headache, Face, Neck Pain Science, Evaluation and Management. Retrieved from https” books.Google.com.
Copyright © 2019 Zosano Pharma Inc. | Confidential
Cluster Headache (C213): Clinical Trial Program
23
Cluster Patients: 120
Population: Chronic or episodic cluster headache sufferers
Design:Each cluster headache sufferer will take a single dose to treat a qualifying
headache
Dosing: 1.9 mg, and 3.8 mg vs placebo (1:1:1)
Co-primary Endpoints:• Proportion of subjects with pain relief at 15 minutes
• Proportion whose pain relief is sustained from 15 minutes to 60 minutes
IND filed in August 2019
Phase 2/3 Clinical Trial Design
Copyright © 2019 Zosano Pharma Inc. | Confidential
Future: Intracutaneous Delivery Biologics
▪ Original focus of Intracutaneous drug delivery
▪ Demonstrated delivery
▪ Proteins
▪ Peptides
▪ Vaccines
24
Copyright © 2019 Zosano Pharma Inc. | Confidential
Opportunity: Vaccines Consistent delivery at target site ensures optimal immune response
▪ Antigen-coated microneedles delivery
directly to epidermal/dermal skin layers
rich in AP cells
▪ Improved immune response
▪ Less adjuvant
▪ Microneedle coating accommodates
vaccine proteins, glycoconjugates,
microparticles and DNA
▪ Dry-coated formulation provides
antigen stability and rapid dissolution in
skin interstitial fluid
25
Copyright © 2019 Zosano Pharma Inc. | Confidential
Vaccines: Demonstrated clinical performance in Phase 1 study
▪ Zosano trivalent flu patch vs. commercial IM vaccine
▪ Excellent fold titer increase and seroprotection ▪ Comparable Immune response with only a 5 minute patch wear time 26
Copyright © 2019 Zosano Pharma Inc. | Confidential
2019 Milestones
27
Goal Timing
Publication of difficult to treat migraine data in Headache Q1 ✓
Completion of long term safety study – Qtrypta™ (M207) Q1 ✓
Initiate Phase II in Cluster Headache – Qtrypta™ (C213) Q3 ✓
Initiate Pre-clinical development with Biologics Q4
Non dilutive capital – Partnership Q4
File NDA - Qtrypta™ Q4
Copyright © 2019 Zosano Pharma Inc. | Confidential
Experienced Management Team
28
Name Title Experience
John Walker Chief Executive Officer
Greg Kitchener Chief Financial Officer
Hayley Lewis SVP, Operations
Dushyant Pathak, PhD SVP, Business Development
Donald Kellerman, PharmDVP, Clinical Development &
Medical Affairs