Corporate Presentation
August 2020
1
Disclaimer
Some of the statements contained in this presentation constitute forward-looking statements. Statements that are not historical facts are forward-looking statements. Forward-looking statements generally can be identified by the use of forward-looking terminology such as "may", "will", "expect", "intend", "estimate", "anticipate", "believe", "continue" or similar terminology. These statements are based on the Company's current strategy, plans, objectives, assumptions, estimates and projections. Investors should therefore not place undue reliance on those statements. The Company makes no representation, warranty or prediction that the results anticipated by such forward-looking statements will be achieved, and such forward-looking statements represent, in each case, only one of many possible scenarios and should not be viewed as the most likely or standard scenario. Forward-looking statements speak only as of the date that they are made and the Company does not undertake to update any forward-looking statements in light of new information or future events. Forward-looking statements involve inherent risks and uncertainties. The Company cautions that a number of important factors could cause actual results to differ materially from those contained in any forward-looking statement.
In the context of the COVID-19 outbreak, which was declared a pandemic by the World Health Organization (WHO) on March 12, 2020, the Company is regularly reviewing the impact of the outbreak on its business.
The Company anticipates that the COVID-19 pandemic could have a material negative impact on our business operations. The worldwide impact of COVID-19 may notably affect the Company's internal organization and efficiency, particularly in countries where it operates and where confinement measures have been implemented by the authorities.
In addition, the deteriorating market conditions may impact the Company's ability to raise additional funding and/or to
enter into partnerships. Particularly, delays in the supply of drug substance or drug products, in pre-clinical and/or clinical trials, as well as delays linked to the responsiveness of regulatory authorities could occur, which could potentially have an impact on the Company's development programs. The Company will continue to proactively monitor the situation.
2
Mission and Vision
To discover, develop and commercialize innovative therapies for patients suffering from
serious chronic diseases with underlying metabolic pathophysiology
- Mid-to-latestage first-in-class pipeline: Type 2 diabetes (globally partnered) and NASH
- Pipeline expansion in chronic and rare metabolic indications
- Internal AMPK* and D-TZD# Platforms o External Opportunities
Targeting Defects in Cellular Metabolism
acetyl CoA
METABOLICINFLAMMATION DISORDERS
(cellular energy
homeostasisTISSUE
imbalances) DEGENERATION & CELL DEATH
apoptosis, necrosis
Leveraging AMPK & D -TZD Platforms
Metabolic Component + Unmet Medical Need
- Hereditary Metabolic Disorders: e.g. adrenoleukodystrophy
- Endocrinopathies
-
Renal Diseases:
e.g. diabetic nephropathy, polycystic kidney disease, others - Other: rare, orphan indications
*AMP activated protein kinase; # Deuterium-stabilized thiazolidinediones
3
Three Mid-to-Late Stage First-in-Class Drug Candidates with Novel Mechanisms and Differentiated Strategies
Global
Partnerships
Novel Mechanisms with Platform Expansion
Proprietary Programs
Cash &
Equiv. EUR 46M (USD 51.5M) as of 6/30/20
Imeglimin
(T2D)
AMPK
PXL770*Platform
PXL065** D-TZD
Platform
Other
Chronic and
Rare Leveraging
Metabolic Platforms &
Indications External
Opportunities
Anticipated first product launch in Japan in 2021 through Imeglimin
partnership with Sumitomo Dainippon Pharma
Several significant milestones in 2020 including results in NASH & other metabolic indications
Highly experienced management team; extensive metabolic R&D expertise & track record in US, EU and Japan
Global company with presence in 3 countries (France, US and Japan); listed on Euronext Paris
4
*PLX770 direct AMP-kinase activator (AMPK) from platform **PXL065 deuterium-stabilizedR-pioglitazone (mitochondrial pyruvate inhibitor) from D-TZD (deuterated thiazolidinediones) platform
Poxel Targets Key Mechanisms that have Distinct Roles in Regulating Cellular Energy Homeostasis
Multiple Entry Points Available to Intervene in Metabolic Diseases
AMPK
ActivatesInhibits
catabolicinflammation
pathwaysapoptosis
Inhibits anabolic
pathways
NASH Other
AMP-activated Protein Kinase (AMPK),
cellular energy sensor - activation:
reduces liver fat, increases insulin sensitivity, decreases inflammation
NASH Other
Mitochondrial Pyruvate Carrier
(MPC), fuel gate-keeper- inhibition:
promotes fat utilization, increases insulin
sensitivity, decreases inflammation
MPC | |
Acetyl | |
Pyruvate | Co-A |
TCA | |
cycle |
NADH
FADH2
T
T2D
Mitochondrial Respiratory Chain (MRC), cell's energy producing machine - potential to modulate
function: improves β-cell function, increases insulin sensitivity, improves endothelial and diastolic dysfunction
ATP
MRC
5
MITOCHONDRIA
Poxel Mid-to-Late Stage Metabolic Pipeline
Due to COVID-19, the Company Continues to Monitor All Developments that Might Impact the Timelines for Achievement of our Corporate Objectives
Indication | MOA | Discovery/PC | PH 1 | PH 2 | PH 3 | NDA review | Partner/ Rights Upcoming Milestones | ||||
Type 2 Diabetes | |||||||||||
Imeglimin | Type 2 Diabetes | ▪ | Target product launch 2021 | ||||||||
Japan / | MRC Modulator | ||||||||||
(T2D) | |||||||||||
Asia* | |||||||||||
Imeglimin | T2D patients | ▪ Ongoing Ph3 dialog w/ FDA; initiate | |||||||||
US / EU / | with CKD stages | MRC Modulator | |||||||||
Ph 3 post-FDA discussion | |||||||||||
Other** | 3b/4 | ||||||||||
NASH | |||||||||||
PXL770 | NASH | Direct AMPK | ▪ Ph 2a results late 3Q 20 | ||||||||
Activator | |||||||||||
▪ | Utilize 505(b)(2) pathway | ||||||||||
PXL065 | NASH | MPC Inhibitor | ▪ | 2H 20 Ph 2; initiation subject to | |||||||
COVID-19 environment | |||||||||||
PXL007 | Hepatitis B / | FXR Agonist | ▪ Complete Ph 2a program by Enyo | ||||||||
(EYP001) | NASH | Pharma 2H 2020 | |||||||||
Other Chronic and Rare Metabolic Indications | |||||||||||
Next-Gen | Adreno- | Direct AMPK | |||||||||
AMPK | ▪ | Complete preclinical studies | |||||||||
leukodystrophy | Activator | ||||||||||
2020 | |||||||||||
Chronic Kidney | |||||||||||
Next-Gen D- | ▪ | Select lead candidates | |||||||||
Diseases | MPC Inhibitor | ||||||||||
TZD | |||||||||||
Undisclosed | |||||||||||
*including: China, South Korea, Taiwan, Indonesia, Vietnam, Thailand, Malaysia, the Philippines, Singapore, Myanmar, Cambodia, and Laos. **countries not covered in the Sumitomo Dainippon Pharma agreement.
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Leadership Team
Highly Experienced Management Team; Extensive R&D and Metabolic Expertise
Thomas Kuhn (Pharm D, MBA)
CEO and Co-founder
David Moller (MD)
Executive Vice President, Chief Scientific Officer (CSO)
Sophie Bozec (PhD)
Senior Vice President,
R&D Pharmacology,
Co-founder
Anne Renevot
Chief Financial Officer
Jonae Barnes
Senior Vice President,
Investor Relations & Public Relations
Quentin Durand
Chief Legal Officer
Noah Beerman (MBA)
Executive Vice President,
Business Development &
President, US Operations
Sébastien Bolze
(Pharm D, PhD)
Executive Vice President,
Non-Clinical Development,
Co-founder
Pascale Fouqueray (MD, PhD)
Executive Vice President,
Early Development & Translational
Medicine, Co-founder
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Type-2-Diabetes
Imeglimin
Global Partnerships
First in a New Class of Potential Anti-diabetic Therapies with a Differentiated Mechanism of Action
8
Successful Completion of Phase 3 Program in Japan
JNDA Under Review; Target Launch 2021
Poxel led Phase 3 TIMES program in >1,100 T2D patients; met endpoints and objectives and observed to be safe and well-tolerated
2018 | 2019 | 2020 | |||||||
Q1 | Q2 | Q3 | Q4 | Q1 | Q2 | Q3 | Q4 | ||
TIMES 1: Monotherapy vs placebo
N= 213; 6-month treatmentJNDA Review
TIMES 2: Long term safety Mono &
Add-on to oral therapy (Open label)
N=~714; 12 months
TIMES 3: Long term safety add-on to insulin N=215; 12 months
Non-pivotal trials in renal impaired
population
Partnership Details
- Sumitomo commercialization partner for Japan, China and 11 other East and Southeast Asian countries*
- Future potential development milestone payments and sales-based payments of up to approx. $257M
- Double-digitescalating royalties
Business Opportunity Japan: Maximize Product Profile
- Sumitomo #1 diabetes franchise; Guidance FY20 $900M1
- DPP4i's are prescribed to 80% T2D patients2
- Limited treatment options for selected populations,
incl. elderly and patients with renal impairment
- elderly patients account for ~60% of T2D in Japan
- TIMES program observed to show robust efficacy with favorable safety and tolerability profile
* including: South Korea, Taiwan, Indonesia, Vietnam, Thailand, Malaysia, the Philippines, Singapore, Myanmar, Cambodia, and Laos. 1. Sumitomo Fiscal Year April-March 2. IQVIA data FY2016 and NDB data FY2016
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Imeglimin Phase 3 TIMES Program Overview (N=1,142)
Robust and Consistent Efficacy in Monotherapy and as an Add-on Therapy
TIMES 1* | TIMES 2 | TIMES 3 | ||||||||||||
Monotherapy | As an Add-on to Standard of Care | Combination with Insulin | ||||||||||||
Change in HbA1c - 24 Weeks | Change in HbA1c (vs baseline) - 52 Weeks | Change in HbA1c - 16 Weeks | ||||||||||||
Placebo | Imeglimin | Placebo | Imeglimin | |||||||||||
Patients (n) | (N=107) | (N=106) | Patients (n) | (N=107) | (N=108) | |||||||||
HbA1c (%), mean (SD) 7.93 (0.684) | 7.99 (0.764) | HbA1c (%), mean (SD) | 8.8 (0.8) | 8.7 (0.7) | ||||||||||
1000 mg | 1000 mg | |||||||||||||
Placebo | 0 | Baseline | 0 | Placebo | 0 | |||||||||
-0,12 | ||||||||||||||
from | -0,2 | from | -0,2 | from | -0,2 | |||||||||
LS mean (SE) = - | LS mean (SE) = | |||||||||||||
Change | 0.87% (0.09) | Change | -0,56 | -0,57 | Change | -0.60% (0.10) | ||||||||
-0,4 | -0,4 | -0,46 | -0,4 | -0,6 | ||||||||||
MeanLS | MeanLS | MeanLS | ||||||||||||
-0,6 | -0,6 | -0,67 | -0,6 | p < 0.0001 | ||||||||||
-0,7 | ||||||||||||||
- | -0,8 | -0,87 | - | -0,8 | -0,88 | -0,85 | - | -0,8 | ||||||
(%) | (%) | -0,92 | (%) | |||||||||||
HbA1c | -1 | p < 0.0001 | HbA1c | -1 | HbA1c | -1 | ||||||||
SU: Sulfonylurea | GLIN: Glinides | BIG: Biguanides | TZD: | |||||||||||
Thiazolidinediones AGI: Alpha-glucosidase inhibitor | ||||||||||||||
-1,2 | -1,2 | -1,2 |
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*European Association for the Study of Diabetes meeting 2019
Imeglimin Development Strategy for the US & EU
Targeting Type 2 Diabetes Patients with Chronic Kidney Disease (CKD) Stages 3b/4
- Development and commercialization partner in the US, Europe, and other countries*
- Poxel and Roivant will decide on a potential co-promotion prior to commercialization
Partnership Details
- Upfront payment: $35M1
- Equity Investment: $15M at €8.5/share
- Future potential development and regulatory milestone payments and sales-based payments of up to $600M
- Double-digitescalating royalties
Initial Development Focus: T2D patients with CKD stages 3b/42
- Demonstrated similar efficacy and was well-tolerated in renally impaired patients (TIMES 1 & Phase 2 data; Japan, US and Europe)
- PK/PD trial met primary objective in this patient population
- Favorable safety and tolerability profile observed o PK/PD data consistent with previous Poxel data
- Given FDA feedback and new draft guidance in March 2020, Metavant is adjusting its Phase 3 plan
- New FDA interactions planned for 2H 2020
- Poxel contributed $25M (~€20M) to development program over a 2-year period.
- CKD stage 3b= eGFR 30-44 ml/min/1.73 m2 inclusive; CKD stage 4 = 15-29 ml/min/1.73m2 inclusive.
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*countries not covered in the Sumitomo Dainippon Pharma agreement
Limitations of Current Therapies to Treat T2D by Kidney Disease Stage Drives Metavant Focus for Imeglimin
T2D patients with CKD stages 3b/4
- Diabetes is the most common cause of CKD
- ~ 2.4 million adults in the US2
- Increased cardiovascular risk and challenging glucose management
Underserved patient population
- Many therapies require dose reduction or not recommended in the presence of kidney disease
- Insulin and insulin secretagogues most commonly used at suboptimal doses to prevent hypoglycemia risk
- We believe there is a need for a new treatment with robust efficacy and safety profile with no hypoglycemia risk
Please note that references for this slide are in the Appendix section.
Therapy1-16 | CKD 3a | CKD 3b | CKD 4 | Primary Concern of Using | |||||||||||||||
Agent in Advanced CKD | |||||||||||||||||||
BG | Metformin | Increased risk of lactic | |||||||||||||||||
acidosis17 | |||||||||||||||||||
4i | Sitagliptin | ||||||||||||||||||
Increased risk of precipitating | |||||||||||||||||||
DPP- | Saxagliptin | ||||||||||||||||||
symptoms of heart failure2-4 | |||||||||||||||||||
Linagliptin | |||||||||||||||||||
SGLT2i | Canagliflozin | ||||||||||||||||||
Empagliflozin | Reduced glucose | ||||||||||||||||||
Dapagliflozin | lowering effect18 | ||||||||||||||||||
RA | Exenatide ER | ||||||||||||||||||
Liraglutide | Increased gastrointestinal | ||||||||||||||||||
GLP1- | |||||||||||||||||||
adverse effects; risk of | |||||||||||||||||||
Dulaglutide | worsening kidney function19-21 | ||||||||||||||||||
Semaglutide | |||||||||||||||||||
SU | Glyburide | ||||||||||||||||||
Hypoglycemia22 | |||||||||||||||||||
Glimepiride | |||||||||||||||||||
Glipizide | |||||||||||||||||||
Contraindicated for patients | |||||||||||||||||||
TZD | Pioglitazone | ||||||||||||||||||
diagnosed with heart failure15 | |||||||||||||||||||
Insulin | Titrate to Response | Hypoglycemia22 | |||||||||||||||||
= no dose reduction | = use with caution | = dose reduction | = should not be used/contraindicated | ||||||||||||||||
12
NASH
PXL770
Proprietary Program
Direct AMPK Activator for the Treatment of NASH
13
Progression of Non-Alcoholic Fatty Liver Disease (NAFLD) and Non-Alcoholic Steatohepatitis (NASH)
Metabolic syndrome | High Morbidity | ||
Dyslipidemia | |||
Excessive caloric intake | Type 2 diabetes | Cardiovascular events | |
Obesity | |||
Sedentary lifestyle | (leading cause of death) | ||
NASH | |||
NAFLD | Hepatic impairment | ||
12% of the general | Hepatocellular carcinoma | ||
Normal
25% of the general | population |
population | 25-70% in diabetic |
>70% in diabetic & | and obese patients |
obese patients | ≥ 50 |
Cirrhosis
Estimated Market Opportunity: >$20B by 2025
J.Hepatology 2018, 68, 362-375. Market Research Engine, Jan. 2020.
14
PXL770 & PXL065 Aim to Address Hallmarks of NASH Pathology
NASH is a Complex, Multifactorial Disease
Fat gets released from the adipose tissue and accumulates in the liver cells and stays stored there
Steatosis
HALLMARKS OF NASH
MΦ
Fat accumulation and | ||
Macrophages (MΦ) | inflammation cause | Hepatic stellate cells |
become activated and lead | degenerative structural | become activated and |
to inflammation in the liver | changes; ballooning is a sign | create scar tissue |
of cell damage & suffering | ||
Inflammation | Ballooning | Fibrosis |
There are no currently approved drugs that treat symptoms & complications across all four categories
15
AMPK Activation Observed to Restore Metabolic Balance
PXL770 is a Direct AMPK Activator
AMPK
Overnutrition (metabolic syndrome, NASH, Type 2 Diabetes)
Caloric Restriction, Exercise
1) Activates catabolic pathways
- Fatty acid oxidation
- Glucose uptake
- Glycolysis
PXL770
- Inhibits anabolic pathways
- Fatty acid & triglyceride synthesis (via ACC inhibition)*
- Cholesterol synthesis
- Protein synthesis
- Mitochondrial biogenesis
3) Other benefits
- Reduces inflammation
↓macrophage and dendritic cell activation
- pro-inflammatorycytokines
- Nf-κΒ plus many others
- Reduces tissue damage (e.g. apoptosis via Caspase 6)
- Inhibits lipolysis in adipose
*Acetyl CoA carboxylase; a direct AMPK target; clinically validated; GS-0976 [Gastroenterology 155:1463-, 2018].
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Activating AMPK Observed to Show Beneficial Effects in NASH
HALLMARKS OF NASH
MΦ
Steatosis | Inflammation | Ballooning | Fibrosis | ||||||||||||||||
Improves steatosis by | Decreases inflammation by | Decreases structural | Decreases hepatic |
limiting fat flux from | moving from a pro- | degenerative changes | stellate cell activation |
adipose tissue and de | inflammatory phenotype to an | and improves cell health | and limits fibrosis |
novo lipogenesis | anti-inflammatory phenotype |
We believe PXL770 also has the potential to be used in combination with other mechanisms
for additive benefits
17
These results were observed in mouse model preclinical study.
PXL770: Preclinical Data Observed to Show Potential to Treat Underlying Root Causes of NASH
Data Observed in Multiple Rodent Models Supports Potential for PXL770's
Beneficial Clinical Effects | A. | NASH Vehicle | PXL770 |
- Improved liver steatosis
- Decreased liver (and adipose tissue) inflammation
- Decreased profibrogenic pathways in liver
- Improved plasma liver enzymes (ALT and AST)
- Improved NAFLD Activity Score (NAS)
LEAN- Chow vehicle | DIO-NASH PXL770 75mg/kg bid | |
DIO-NASH vehicle | DIO-NASH PXL770 35mg/kg bid | |
**: p< 0.01, ***: p< 0.001; **** p<0.0001 compared to DIO-NASH vehicle. n=11-12/group
Poster#4, Global NASH Congress, 26th-27th February 2018, London, UK.
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B. Total Liver Macrophages | C. Collagen 1A1 (Liver) | |||||
3×10 | 6 | 40 | ||||
Ly6C | (RPKM)velle | |||||
20 | ||||||
++ | 30 | |||||
2×10 | ||||||
Liver | ** | Expression | ||||
1×10 | 6 | *** | *** | |||
10 | ||||||
**** | *** | |||||
0 | 0 | |||||
D. Plasma ALT | E. NAS Score | ||||||
300 | 8 | ||||||
(U/L) | |||||||
NAS | |||||||
inotransferaseam | 200 | 6 | |||||
**** | |||||||
**** | |||||||
4 | |||||||
alanine | |||||||
100 | **** | ||||||
Plasma | **** | 2 | |||||
**** | |||||||
0 | 0 |
PXL770: Preclinical Data Observed to Show Potential to Treat Underlying Root Causes of NASH
Data Observed in Multiple Rodent Models Supports Potential for PXL770's Beneficial
Clinical Effects
- Improves metabolic syndrome associated with NASH
- Improves glycemia and lipids in metabolic rodent models:
- Increased insulin sensitivity
- Glycemic control: basal glycemia, glucose tolerance and HbA1c
Insulin Sensitivity
200
-1)
(mg.dL | 150 | |||
Bloodglucose | 50 | |||
100 | ||||
0 | 20 | 40 | 60 | |
Time (min) |
Fat Oxidation
ob/+ mice | Vehicle |
ob/ob or | HFD mice Vehicle |
HFD mice | PL770 75mg/kg bid |
HFD mice | Pioglitazone 20mg/kg qd |
ob/ob mice | PXL770 100mg/kg bid |
- Lower circulating lipids (TG's, FFA's)
- Induces a metabolic switch toward preferential fat oxidation
19
Mean fat oxydation (g/d/kg0.75)
4
****
3
****
2
1
0
Day 8 | Day 22 |
WD | WD |
****P<0.0001 vs. veh group. WD: Whole Day
PXL770: Encouraging Clinical Results Observed (n=148)
Dose-Dependent PK; Favorable Safety/Tolerability; Target Engagement; Efficacy Signals
Phase 1 Healthy Subjects (n=132)
- Linear, dose-proportional exposure with single and multiple* doses
- Terminal half-life 25h
- No drug-drug interaction with rosuvastatin (OATP and BCRP substrate)
- No SAEs or AEs leading to discontinuation
- Good tolerability; low placebo-like incidence of TAE events
- No effect on ECG parameters (no QT prolongation)
PK/PD Trial: Obese, Insulin Resistant (n=16)
- Four-weekplacebo-controlled study in likely- NASH patients
- Study objectives met:
- Consistent PK profile
- Target engagement & efficacy signals:
- suppression of de-novo lipogenesis∆ (liver synthesis of new lipids)
- improved glucose tolerance# and indices of insulin sensitivity^
- Safety and tolerability similar to placebo
Results support potential in NASH and for AMPK platform
in other chronic and rare metabolic diseases
20
* Up to 375 mg (less than dose-proportionate at 500 mg); ∆ DNL assessed via fructose loading with D2O labelled palmitate measurements; #oral glucose tolerance test; ^ HOMA-IR, Matsuda, OGIS .
PXL770 PK/PD Study Demonstrated Target Engagement and Efficacy Signals
- Inclusion criteria: controlled attenuation parameter (CAP) score >300 db/m (measured by FibroScan®) and HOMA- IR* score >2.5
- Treatment arm (n=12): four weeks PXL770 500 mg QD
- PXL770 suppressed de-novolipogenesis◊, which is responsible for ~25% of liver fat accumulation
- PXL770 improved glycemia◊ - both total and incremental glucose AUC
- PXL770 improved insulin sensitivity◊ measured by HOMA-IR (p=0.013); Matsuda# (p=0.014); OGIS∆ (p=0.012)
- AMPK activation demonstrated: beneficial impact on key pathways of liver injury and NASH
Fructose-stimulated de novo lipogenesis
Versus baseline (at week 4) (N=12)
25 | |||||||||||
(%) | 20 | ||||||||||
LIPOGENESIS | |||||||||||
15 | |||||||||||
10 | |||||||||||
NOVO | 5 | p = 0.004 | |||||||||
(Peak vs. Baseline) | |||||||||||
DE | 0 | ||||||||||
0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 1 0 |
TIME POST START FRUCTOSE (HOUR)
Oral glucose tolerance
Versus baseline (at week 4) (N=12)
210 | |||||
(MG/DL) | 190 | ||||
170 | |||||
GLUCOSE | 150 | ||||
130 | |||||
110 | p = 0.022 | ||||
90 | |||||
(AUC vs. Baseline) | |||||
70 | |||||
0 | 3 0 | 6 0 | 9 0 | 1 2 0 1 5 0 1 8 0 |
- Versus baseline; no effect in Placebo group
*Homeostatic Model Assessment of Insulin Resistance; # Diabetes Care 1999; 22: 1462-1470; ∆ Oral glucose insulin sensitivity index
21
TIME (MIN)
Baseline PXL770 500 mg OD
PXL770: Ongoing Phase 2a Program for NASH
Phase 2a 12-week, Multicenter, Randomized, Double-blind,Placebo-controlled, Parallel Group Trial
- N = 100 likely-NASH patients with and without Type 2 diabetes
- Inclusion criteria: increased hepatic fat (assessed via CAP and MRI-PDFF)
- Trial to assess efficacy and safety
- Primary endpoint: relative change in % liver fat mass (MRI-PDFF) from baseline
Results expected late 3Q 20
22
Pre-Clinical Data Demonstrate Potential Synergy of PXL770/AMPK Activation with Other Agents in Development
PXL770
Effects in
Adipose Tissue
Low grade inflammation
Lipolysis
Effects in Liver
De novo lipogenesis /
Steatosis
Chronic inflammation
Stellate cell activation /
Fibrosis
Apoptosis / cell death
Effects in Muscle
Peripheral insulin resistance
Other
Mechanisms
PXL770 / Semaglutide (GLP-1)
Mouse NASH Model
(mg) | 1500 |
#### | |
content | # |
1000 | |
lipidLiver | **** | **** | **** |
500 | |||
0 |
- p ≤ 0.05, ** p≤ 0.01, *** p≤0.001, **** p≤ 0.0001 vs vehicle
# p≤ 0.05, ## p≤ 0.01, ### p≤ 0.001, #### p ≤ 0.0001 vs
400 | combination |
N=12-13 |
(U/L)ALT | 300 | # | |||
Plasma | 200 | ||||
100 | **** | **** | **** | ||
0 | |||||
Vehicle | Semaglutide | ||||
PXL770 | PXL770 + Semaglutide | ||||
23
NASH
PXL065
Proprietary Program
MPC Inhibitor for the Treatment of NASH Utilizing the 505(b)(2) Regulatory Pathway
24
PXL065: Leveraging the Benefits of Pioglitazone
With Reduced PPARγ Activity
• Pioglitazone used in T2D for > 20 years • >30 million patient-yearsof exposure1
• Established CV outcomes benefit2
- Pioglitazone extensively studied and has demonstrated resolution of NASH
- Demonstrated "Resolution of NASH without worsening of fibrosis" in Phase 4 trial3
- Only drug recommended for biopsy-proven NASH by AASLD & EASL Practice Guidelines4
- Currently prescribed by ~14% of physicians for biopsy-proven NASH patients5
- Limited use due to PPARγ-relatedside effects: weight gain, fluid retention, bone loss
- Pioglitazone, TZDs: both genomic (PPAR) and non-genomic (MPC) mechanisms
- PXL065 is an NCE which selectively mediates non-PPAReffects of Pioglitazone
- Takeda 2014. https://www.takeda.com/newsroom/newsreleases/2014
- Diab & Vascular Disease Res 2018; 16:133-143
- Ann Intern Med. 2016, 165(5), 305-315
- J Hepatol. 2016, 64(6),1388-402; Hepatology 2018, 67, 328-357
- Therap Adv Gastroenterol. 2016, 9(1), 4-12
Non-Genomic Mechanisms (MPC)
gene | |||
PPAR | RXR | transcription | |
• | Enhanced lipid metabolism | ||
• | Anti-inflammatory |
• Contributes to glucose lowering
25
Pioglitazone has Demonstrated Resolution of NASH
Largest Effect of Oral Agents - Use Limited by Weight Gain
80% | Resolution of NASH | |||||||||||||
P < 0.001 | ||||||||||||||
% | 70% | without worsening of fibrosis | ||||||||||||
NA | ||||||||||||||
Improvement, | ||||||||||||||
60% | ||||||||||||||
Phase 3 or 4 Trials | Phase 2 Trials | P < 0.001 | ||||||||||||
50% | ||||||||||||||
P = 0.019 | ||||||||||||||
40% | ||||||||||||||
with | 70% | P = 0.02 | ||||||||||||
30% | NA | 59% | ||||||||||||
Patients | P = 0.066 | 45% | ||||||||||||
20% | 39% | P = 0.0514 | ||||||||||||
P = 0.13 | ||||||||||||||
pbo | P = 0.494 | 27% | 24% | |||||||||||
10% | 25% | pbo | 19% | pbo | pbo | |||||||||
17% | ||||||||||||||
pbo | 12% | 15% | pbo | pbo | 17% | 19% | ||||||||
pbo | 8% | 9% | pbo | pbo | ||||||||||
8% | 9% | |||||||||||||
0% | 6% | 6% | 5% | |||||||||||
Pio | Ocaliva | Elafibranor | CVC | Liraglutide | Resmetirom | Aramchol | Alderfermn | Semaglutide | Lanifibranor | |||||
ORAL | Intercept | Genfit | Allergan | Novo Nordisk | Madrigal | Galmed | NGM | Novo Nordisk | Inventiva | |||||
ORAL | ORAL | ORAL | INJECTION | ORAL | ORAL | INJECTION | INJECTION | ORAL |
26
Pio Cusi Phase 4 trial (3045 mg, 18 mos) - Ann Intern Med. 2016, 165(5), 305-315 (only completers with definite NASH at baseline). Patients on placebo benefited from 4% weight loss due to hypocaloric diet Ocaliva REGENERATE Phase 3 trial (25 mg, 18 mos) - Lancet. 2019, 394(10215), 2184-2196
Elafibranor RESOLV-IT Phase 3 trial (120 mg, 52 wks/) - Press release May 11, 2020
CVC (Cenicriviroc) CENTAUR Phase 2 trial (150 mg, 2 yrs) - Hepatology 2020, Jan 13 epub
Liraglutide Phase 2 trial (0.6 increased to 1.8 mg sc weekly 48 wks) - The Lancet, 2016, 387(10019), 679-690
Resmetirom (MGL-3196) Phase 2 trial (80 mg +/- 20 mg, 36 wks) - Lancet 2019 394:2012-24. Results from per protocol, not intent to treat (ITT) population.
Aramchol Phase 2 trial (600 mg, 52 wks) - press release June 12, 2018. No effect on "Fibrosis without worsening of NASH".
Aldaferin (NGM282) Phase 2 trial (1 mg, 24 wks, cohort 4) - Press release Feb 25, 2020. P value not disclosed.
Semaglutide Phase 2 trial (0.4 mg, 72 wks) - Press release May 6, 2020. P value not disclosed.
Lanafibranor Phase 2 trial (1200 mg, 24 wks, ITT population) - Press release Jun 15, 2020(also at 800 mg 33% pts met endpoint, p=0,043)
No head-to-head trials have been conducted. Data derived from different clinical trials with potentially different designs, patient populations, and definition of NASH resolution.
PXL065: A Single Stabilized Stereoisomer of Pioglitazone
Benefits of Pioglitazone for NASH with Reduced PPARγ Side Effects
- Pioglitazone is a mixture of 2 stereoisomers with dramatically different properties
- PXL065 is the deuterium-stabilizedR-stereoisomer
S-Pioglitazone (stabilized)PXL065 (stabilized R-pio)
• MPC inhibitor | 500 Tablets | • MPC inhibitor |
NIDC 64764-451-26 | ||
• Strong PPARγ agonist | actos® | • Very weak PPARγ |
(pioglitazone) | ||
agonism | ||
Tablets | ||
45 mg |
- Undesired side effects:
- | Weight gain | • | Anti-inflammatory |
- | Fluid retention | • | Activity in NASH |
S-Pio | R-Pio |
27
PXL065 Targets Inhibition of MPC
Without PPARγ Agonist Activity from S-Stereoisomer
MPC Inhibition in HepG2 Cells
PPARγ Agonist Activity |
re s p ir a t io n o l) | |
r iv e n | c o n tr |
te - d | (% |
P y r u v a |
1 2 5
1 0 0
- 5
- 0
-
5
0
IC50 (µM)
P X L 0 6 5 ( d - R - p io )6.5 | ||||||
d - S - p io | 8.5 | |||||
P io g lita z o n e | 6.8 | |||||
0 . 0 1 | 0 . 1 | 1 . 0 | 1 0 . 0 | 1 0 0 . 0 | ||
lo g C o n c | ( μ M ) |
1 0 0 | ||||||
EC50 (µM) | ||||||
P X L 0 6 5 ( d - R - p io ) | >>100 | |||||
n | d - S - P io | 3.5 | ||||
c tiv a tio | P io g lita z o n e | 4.6 | ||||
5 0 | ||||||
a | ||||||
P P A R γ | ||||||
% | ||||||
0 | ||||||
0 . 0 1 | 0 . 1 0 | 1 . 0 0 | 1 0 . 0 0 | 1 0 0 . 0 0 | ||
lo g C o n c | ( μ M ) |
PPARγ activation in fluorescence-based TRAP220 coactivator recruitment assay Results are expressed as % of response of positive control (10µM rosiglitazone)
28
PXL065 Targets Inhibition of MPC & Modulates Cellular Fuel Utilization
MPC Regulates Transport of Pyruvate Across Mitochondrial Inner Membrane
Pyruvate | MPC Acetyl | TCA |
Co-A | ||
cycle NADH | ||
FADH2 |
ATP
MRC
29
MITOCHONDRIA
Regulates cellular fuel selection - Modulates cell signaling
Additional Validation
- MPC inhibition implicated as beneficial for neuroinflammation/ neurodegeneration1
- Liver-selectiveMPC2 -/- mice:
- Decreased gluconeogenesis; protection from hyperglycemia2
- Protection from diet-induced NASH - transaminase elevations, fibrosis score, stellate cell activation3
Inhibiting MPC leads to improvements in NASH and metabolic disease endpoints
1. Ghosh et al, Sci Trans Med 2016; 8:368ra174; Shah et al, Curr Alzheimer Res 2014; 11:564-573
2. McCommis et al, Cell Metab 2015; 22:682-694
3. McCommis et al, Hepatology 2017; 65:1543-1556
Decreasing Entry of Pyruvate by Inhibiting MPC has Desirable Effects in NASH
30
HALLMARKS OF NASH
MΦ
Steatosis | Inflammation | Ballooning | Fibrosis | ||||||||||||||||
Increasing fat oxidation | Resetting mitochondrial | Resetting mitochondrial | Inhibiting MPC decreases |
decreases liver fat | metabolism improves | metabolism protects cells | HSC1 activation and |
content | inflammation | from degeneration | markers of fibrogenesis |
PXL065 also has the potential to be used in combination with other mechanisms for additive benefits
1. HSC: Hepatic Stellate Cell.
PXL065: Similar Activity to Pioglitazone in NASH Mouse Models
Results Consistent with Potential Beneficial Clinical Effects
Steatosis | Inflammation | Ballooning | ||
C D | d ie t | M C D | d ie t | C D | d ie t | M C D | d ie t | C D | d ie t | M C D | d ie t | ||||||
4 | 4 | 3 | |||||||||||||||
3 | * * * | * * * | * * * | 3 | * * | * | 2 | * | * * | ||||||||
2 | 2 | * * * | * * * | ||||||||||||||
1 | 1 | 1 | |||||||||||||||
0 | 0 | 0 | |||||||||||||||
v e h ic le p io | 0 6 5 | v e h ic le | p io | 0 6 5 | v e h ic le p io | 0 6 5 | v e h ic le | p io | 0 6 5 | v e h ic le p io | 0 6 5 | v e h ic le | p io | 0 6 5 |
Fibrosis
C D | d ie t | M C D | d ie t |
3 |
2 | * * | * | * * | * * | |
1 | |||||
0 | |||||
v e h ic le p io | 0 6 5 | v e h ic le | p io | 0 6 5 |
- Liver histopathology on day 43 in mice fed a Choline Deficient (CD) or a Methionine/Choline Deficient (MCD) diet
- Pioglitazone (30 mg/kg/day) or PXL065 (15 mg/kg/day), Wilcoxon rank sum test vs vehicle; *p < 0.05, **p < 0.005, ***p < 0.001
31
Summary of PXL065 Benefits in NASH
PXL065 (R-Pio) Retains Benefits of Pio; S-Pio Drives Weight Gain in Mouse Model
NASH Rodent Models1 | Pio | PXL-065 | |
Functional Parameters | |||
| Hepatic Triglycerides | ✓ | ✓ |
| Hepatic Free Fatty Acids | ✓ | ✓ |
| Hepatic Cholesterol | ✓ | ✓ |
| Hepatic Steatosis | ✓ | ✓ |
| Hepatic Inflammation | ✓ | ✓ |
| Hepatic Ballooning | ✓ | ✓ |
| Hepatic Fibrosis | ✓ | ✓ |
Weight Gain | ✓ | - | |
Edema | ✓ | - |
Body Weight Gain in Mouse Model2 | ||||||||||
6 | (0-11 days) | |||||||||
* * * * | * * * * | |||||||||
p io | ||||||||||
* * * * | * * * * | * * * * | ||||||||
e | ||||||||||
d -S - p io | ||||||||||
* * * | * * * * | * * * * | ||||||||
g | ||||||||||
* * * * | ||||||||||
n | PXL065 | * * * | * * * * | * * * * | ||||||
4 | * * * * | |||||||||
a | * * * * | |||||||||
* * * | ||||||||||
h | ||||||||||
v e h ic le | * * * | |||||||||
c | ||||||||||
h t | * | |||||||||
ig | 2 | fir s t d o s e | ||||||||
* | ||||||||||
e | ||||||||||
w | ||||||||||
o d y | 0 | |||||||||
b | -5 | 0 | 5 | 1 0 | ||||||
% | ||||||||||
-2 | d a y | |||||||||
- NASH rodent models selected based on literature: C57BL/6J mouse model of weight gain & edema (Nat Med 2005, 11, 861-866) and methionine-choline deficient (MCD) model of NASH (Lab Investig. 2007, 87, 56-65). Additional choline deficient (CD) model of NASH was validated with RenaSci. In MCD model both pio and PXL065 reduced ballooning. d-S-pio was only run in the CD model where no effect on ballooning with any compound was observed.
- Weight gain measured in C57BL/6J mouse model. Pioglitazone dosed at 30 mg/kg, d-S-pio and PXL065 dosed at 15 mg/kg. Statistical significance determined by 1-way (total day 11) or 2-way (% by day) ANOVA with Dunnett's post-test average ± SEM; * p < 0.05, ** p < 0.01, *** p < 0.001, **** P < 0.0001
32
PXL065 Utilizing 505(b)(2) Regulatory Pathway
1992 FDA guidance document "Development of New Stereoisomeric Drugs"
- Streamlined development expected for single enantiomers of approved racemic drugs
- Existing nonclinical data from the racemate can be relied upon to support the safety of the single enantiomer, and an abbreviated pharmacology and/or toxicology evaluation and initial clinical characterization may be pursued (Section IV of FDA, 1992)
Ability to rely on data generated by others in
- Product label for parent drug
- Published literature
Potential opportunities to bridge to data from parent drug
- Fewer animal toxicity studies
- Example: 28 day and 90-day studies in 1 species instead of 2
- Example: no need for 2-year rat carcinogenicity study
- Potential for fewer clinical trials for submission of NDA
- Safety database with <1500 subjects
3333
PXL065: Phase 1 Study Results
15 mg PXL065 vs. 45 mg Actos®1: Similar R-Pio Exposure; S-Pio Exposure Decreased ~5-fold
Exposure to R-pio | Exposure to S-pio | |
- Single (SAD) and repeated (Ph1b) oral dose studies completed
- Stabilization and sustained higher exposure to R-pio (limited conversion to S-pio)
- PK dose proportionality; no food effect
- tablet formulation qualified in Ph1b study
- Well tolerated at all doses tested
34
1. Actos is the branded version of pioglitazone and a registered trademark of Takeda Chemical Industries, Ltd.
PXL065: One Phase 2 Trial in Biopsy-Proven NASH Patients
Leveraging 505(b)(2) Pathway
36-week multicenter, double-blind,placebo-controlled, parallel group, randomized trial to evaluate the safety and efficacy of3 doses in ~120 noncirrhotic biopsy-proven NASH patients
Screening | Double-blind Treatment Period | Follow-Up |
Repeated Dose | ||
8 weeks | 36 weeks | 2 weeks |
Placebo
PXL065 7.5 mg
PXL065 15 mg
PXL065 22.5 mg
- Phase 2 objective: identify one or two doses for Phase 3 registration trial
- Primary objective: Assess efficacy of escalating doses by relative change in liver fat (MRI-PDFF)
- Secondary objectives:
- Assess other efficacy parameters (e.g. ALT, liver histology)
- Assess safety and tolerability (e.g. body weight gain)
• Assess pharmacokinetics at pre-specified timepoints and PK/PD correlation
35
PXL770 & PXL065 Aim to Have the Following Effects for NASH
Potential for Use in Combination with Other Agents in Development
Effects in
Adipose Tissue
PXL770
PXL065
Low grade inflammation
Lipolysis
Peripheral insulin resistance
Effects in Muscle
De novo lipogenesis
Effects in Hepatocytes
36
NASH
Effects in Liver | PXL770 |
PXL065 | |
Steatosis | |
Chronic inflammation | |
Fibrosis | |
Gluconeogenesis |
Effects in
Hepatic
Stellate Cells
Fibrogenesis
Hepatic stellate cell activation
Effects on Mitochondria Structure and Function
Additional Opportunities
Pipeline Expansion
Chronic and Rare Metabolic
Indications
Next Generation AMPK Activators
Next Generation D-TZD's*
*Deuterium-modified thiazolidinediones
37
AMPK and MPC Dysregulation are Implicated in the Biology of Various Metabolic Diseases
AMPK | MPC |
Pyruvate |
Acetyl | |
Co-A | |
TCA | ATP |
cycle | |
NADH |
FADH2
MRC
Activates | Inhibits | |
catabolic | ||
Inhibits | inflammation | |
pathways | ||
anabolic | apoptosis | |
pathways |
T
MITOCHONDRIA
Exploring applications of current and next generation AMPK activators and MPC inhibitors in
biologically relevant metabolic diseases
Rare Metabolic | Renal | Endocrine |
Adrenoleukodystrophy | Diabetic kidney disease | Type 2 diabetes |
(ALD; AMN) | Polycystic kidney disease | Polycystic ovary syndrome |
Mitochondrial disorders | ||
38
Potential of AMPK Activation to Treat Adrenoleukodystrophy
ALD AMN
Why AMPK ?
- AMPK is suppressed in brain from ALD patients1
- ABCD2/3 could replace function of missing ABCD1; AMPK activation with metformin elevates ABCD2 levels in patient cell lines and ABCD1-KO mice1
- Deletion of AMPK1 in glial cells of ABCD1-null mice (AMN model) → mitochondrial dysfunction/low ATP 2
PXL770 reduces VLCFA & | P-ACC | ||
induces ABCD2/ABCD3 in | |||
cells from human AMN-ALD | |||
patients | P-AMPK | ||
ABCD2 | |||
1. | J Neurochem 138:86-, 2016 | ABCD3 | |
2. | Singh J, Med Inflamm, 2015 | ||
39 | T |
Potential for AMPK Activation to Treat
Renal Diseases | 80 | |
DKD | Albumin/Creatinine mg/mgRation | 20 |
• AMPK activity is reduced in human/rodent DKD tissue samples2 | ||
Diabetic Kidney Disease | 60 | |
• Multiple pathways engaged; anti-inflammatory,anti-apoptotic, | 40 | |
anti-fibrotic effects of AMPK1 | ||
• Preclinical efficacy reported with indirect and direct AMPK | Urine | |
activation3 | 0 |
PKD
Polycystic Kidney Disease
- Autosomal dominant; fourth leading cause of CKD
- Significant unmet medical need
- AMPK activation validation:
- AMPK pathways linked to pathophysiology (eg mTOR4; CFTR5)
- In vivo efficacy with both indirect and direct AMPK activators6
1. Curr Op Nephrol 2017, 26:375-83; Curr Drug Targets 2018; 19:709-20; 2. J Clin Invest 2013; 123:4888-99
3. J Med Chem 2016; 59:8068-81; JPET July 2019; JPET 2017; 361:303-311; 4. mammalian target of Rapamycin
5. cystic fibrosis transmembrane conductance regulator 6. J Clin Invest 2001; 108:1167-74; PNAS 2011;108: 2462-67; Sci Rep 7:7161,2017; EBioMed 47:436-45, 2019
PXL770 Improves Kidney Function in
ZSF1 Rat Model of DKD
✱✱✱ | ✱✱✱ |
Lean | ***: p< 0.01 |
ZSF-1 | |
ZSF-1+PXL770 150 mg/kg bid | |
ZSF1+Enalapril 10 mg/kg/d | |
PXL770 Reduces Cyst Volume in vitro
(Madin-Darby Kidney cells)
Significant:
*vs control, & vs. metformin 10 µm (&), vs. metformin 100 µM (§) and 1 mM (#)
Metformin PXL770
40
Upcoming Milestones
41
Cash Through Significant Upcoming Milestones into 2022
T2D NASH | ||
T2D NASH | • Imeglimin Japanese NDA approval | |
• EASD presentations: | • | Imeglimin product launch |
Imeglimin & PXL770 | • | PXL065 Ph 2 recruitment completed |
- PXL770 Phase 2a Results
Q3
2020 | 2021 | 2022 |
H2
T2D NASH Other
- Metavant interactions w/FDA for Imeglimin Ph 3 plan
- PXL065 Ph 2 initiation in ~120 biopsy proven NASH patients*
- Imeglimin Japan Diabetes Society presentation
- PXL770 and PXL065: presentations at AASLD and NASH Summit and data published
- Additional preclinical results in rare diseases for AMPK and TZD platforms
NASH CASH
- PXL065 Ph 2 results
- As of 6/30/20 cash & cash equivalents: EUR 46.0 million (USD 51.5 million)
- Cash runway into 2022
42
1. Contingent on a safe and stable environment for patient recruitment and the availability of clinical trial sites during the COVID-19 outbreak.
Appendix
43
Key Financial & Shareholder Information
44
Market data
Ticker: POXEL
ISIN: FR0012432516
Number of shares: 28,471,523*
Key financials
- As of 6/30/20 cash & cash equivalents: EUR 46.0 million (USD 51.5 million)
- Cash runway into 2022
*at June 2020.
Shareholder ownership*
14.6%
Andera Partners
16.7%
54.2% Bpi France Floating
9.5% | ||
Founders | ||
5.0% | ||
Roivant Sciences | ||
Analyst coverage | Ltd | |
Degroof Petercam | Benoit Louage | |
Gilbert Dupont | Guillaume Cuvillier | |
Jefferies | Peter Welford | |
JMP Securities | Jason Butler | |
Kepler Cheuvreux | Arsene Guekam | |
Oddo | Martial Descoutures |
References for Slide 12
- Glucophage [package insert]. Princeton, NJ: Bristol-Myers Squibb Company; 2018
- Januvia [package insert]. Whitehouse Station, NJ. Merck & Co, Inc.; 2019
- Onglyza [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals; 2019
- Tradjenta [package insert]. Ridgefield, CT. Boehringer Ingelheim Pharmaceuticals; 2019
- Invokana [package insert]. Titusville, NJ. Janssen Pharmaceuticals; 2020
- Jardiance [package insert]. Ridgefield, CT. Boehringer Ingelheim Pharmaceuticals; 2020
- Farxiga [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals; 2020
- Bydureon [package insert]. Wilmington, DE. AstraZeneca Pharmaceuticals; 2019
- Victoza [package insert]. Plainsboro, NJ. Novo Nordisk; 2019
- Trulicity [package insert]. Indianapolis, IN. Eli Lilly and Company; 2019
- Ozempic [package insert]. Plainsboro, NJ. Novo Nordisk; 2019
- Sanofi-Aventis.Diabeta (glyburide) [package insert]. U.S. Food and Drug Administration. Revised July 2016.
- Amaryl (glimepiride) [package insert]. Bridgewater, NJ. Sanofi-Aventis; 2018
- Pfizer. Glucotrol (glipizide) [package insert]. U.S. Food and Drug Administration. Revised September 2008.
- Takeda Pharmaceuticals. Actos (pioglitazone) [package insert]. U.S. Food and Drug Administration. Revised July 2011.
- Lantus [package insert]. Bridgewater, NJ. Sanofi-Aventis; 2019
- Lalau JD. Lactic acidosis induced by metformin: incidence, management and prevention. Drug Saf. 2010;33(9):727-740.
- Perkovic V, Jardine MJ, Neal B et al. Canagliflozin and Renal Outcomes in Type 2
Diabetes and Nephropathy. N Engl J Med. 2019; 380:2295-2306.
- Davies MJ, Bain SC, Atkin SL, et al. Efficacy and safety of liraglutide versus placebo as add-on to glucose-lowering therapy in patients with type 2 diabetes and moderate renal impairment (LIRA-RENAL): a randomized clinical trial. Diabetes Care. 2016;39:222-230.
- Idorn T, Knop FK, Jorgensen MB, et al. Safety and efficacy of liraglutide in patients with type 2 diabetes and end-stage renal disease: an investigator-initiated, placebo- controlled, double-blind,parallel-group, randomized trial. Diabetes Care. 2016;39:206- 213.
- Linnebjerg H, Kothare PA, Park S, et al. Effect of renal impairment on the pharmacokinetics of exenatide. Br J Clin Pharmacol. 2007;64(3):317-327.
- Avogaro A, Schernthaner G. Achieving glycemic control in patients with type 2 diabetes and renal impairment. Acta Diabetol. 2013;50(3):283-91.
*Centers for Disease Control and Prevention (CDC). NCHS. NHANES. Laboratory Data, 2015-2016. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2017.
45
Imeglimin Observed to Restore Normal Mitochondrial Function in Type 2 Diabetes (T2D)
Diabetic state is caused by an impaired mitochondrial state
Mitochondrial Respiratory Chain (MRC) becomes activated
MRC
Activating the MRC has these desirable downstream effects in T2D:
Increases glucose- | Improves β-cell | Improves insulin | Improves endothelial |
dependent insulin secretion | dysfunction | sensitivity in muscle | and diastolic |
from pancreas | and survival | cells and liver cells | dysfunction |
46
Imeglimin: A Differentiated Mechanism of Action in the Mitochondria Enabling 'Glucose-plus' Benefits
Normal Cell | Diabetic Cell | Treatment with Imeglimin |
ROS: reactive oxygen species mPTP: mitochondrial permeability transition pore
Diabetic state: Impaired mitochondrial function leading to
- Insufficient insulin secretion from pancreas
- Insulin resistance in liver and muscles
- β-cellsdysfunction and death
- Endothelial cell dysfunction and death
Imeglimin treatment: Restored normal mitochondrial function
- Glucose-loweringrelated benefits:
- Improve β-cells function and survival
- Increase glucose dependent insulin secretion from pancreas
- Improve insulin sensitivity in liver and muscles
- Beyond glucose-lowering related benefits:
- Improve endothelial dysfunction
- Improve diastolic dysfunction
47
Imeglimin Phase 2b Trial In Japan Met Primary and Secondary Endpoints (N=299)
- Full Phase 2b data presented at the European Association of the Study of Diabetes, Lisbon (Sept. 2017)
3 weeks | 6-10weeks | 24 weeks | 1 week |
Screening | Placebo Run-In | Double-Blind Treatment Period | Follow-Up |
(Wash-out) | |||
Placebo
Imeglimin 250 mg BID
Imeglimin 1000 mg BID
Imeglimin 1500 mg BID
- Phase 2b trial in Japan met primary HbA1c endpoint and secondary endpoints
- Demonstrated efficacy in chronic kidney disease patients was similar to patients with normal renal function
- Observed to be well tolerated:
- Rate of observed adverse events similar to placebo at 500 mg and 1000 mg. Slightly higher rate of GI events at 1500 mg (no adverse event greater than 10%)
- No serious adverse events related to Imeglimin
- No weight gain
• Optimal dose for Phase 3 program in Japan is 1000 mg
48
Imeglimin Phase 2b Trial in Japan Met Primary Endpoint in Reduction of HbA1c vs. Placebo (N=299)
HbA1c (%) - LS Mean Change from Placebo
Change in HbA1c from Baseline
7.94% | 7.85% | 7.91% | ||||||||||||||||||||
0 | ||||||||||||||||||||||
500 mg | 1000 mg | 1500 mg | ||||||||||||||||||||
N=75 | N=73 | N=73 | ||||||||||||||||||||
-0.2 | ||||||||||||||||||||||
-0.4 | ||||||||||||||||||||||
-0.52% | ||||||||||||||||||||||
-0.6 | ||||||||||||||||||||||
** | ||||||||||||||||||||||
-0.8 | ||||||||||||||||||||||
-0.94% | ||||||||||||||||||||||
-1.0 | -1.00% | |||||||||||||||||||||
** p < 0.0001 | ** | |||||||||||||||||||||
-1.2 | ** | |||||||||||||||||||||
European Association of the Study of Diabetes, in Lisbon (Sept. 2017)
49
Phase 2b Trial in Japan: Similar Efficacy Demonstrated in T2D Patients with Renal Impairment vs with Normal Kidney Function
Change in HbA1c - 24 Weeks
HbA1c (%) - LS Mean Change from Placebo
500 mg | 1000 mg | 1500 mg | ||||||||||||||||||||||||||||||||||||||||||||
eGFR ≥ 80 | eGFR < 80 | eGFR ≥ 80 | eGFR < 80 | eGFR ≥ 80 | eGFR < 80 | |||||||||||||||||||||||||||||||||||||||||
0 | ||||||||||||||||||||||||||||||||||||||||||||||
N=24 | N=51 | N=24 | N=49 | N=23 | N=50 | |||||||||||||||||||||||||||||||||||||||||
-0.2 | ||||||||||||||||||||||||||||||||||||||||||||||
-0.4 | -0.44% | |||||||||||||||||||||||||||||||||||||||||||||
-0.53% | ||||||||||||||||||||||||||||||||||||||||||||||
-0.6 | ||||||||||||||||||||||||||||||||||||||||||||||
-0.8 | -0.83% | |||||||||||||||||||||||||||||||||||||||||||||
-0.89% | ||||||||||||||||||||||||||||||||||||||||||||||
-1.0 | -0.92% | -0.92% | ||||||||||||||||||||||||||||||||||||||||||||
-1.2
50
Contacts
Jonae R. Barnes
Senior Vice President, Investor Relations, Corporate Communications and Public Relations
jonae.barnes@poxelpharma.com +1 617 818 2985
Aurélie Bozza
Investor Relations and Communication Director aurelie.bozza@poxelpharma.com
+33 6 99 81 08 36
51
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Disclaimer
Poxel SA published this content on 06 August 2020 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 06 August 2020 08:53:10 UTC