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Calliditas Therapeutics AB
Stockholm, June 2019
Renée Aguiar-Lucander, CEO
Disclaimer
Important information
This presentation may contain certain forward-looking statements and opinions. Forward-looking statements are statements that do not relate to historical facts and events and such statements and opinions pertaining to the future that, by example, contain wording such as “believes”, “estimates”, “anticipates”, “expects”, “assumes”, “forecasts”, “intends”, “could”, “will”, “should”, “would”, “according to estimates”, “is of the opinion”, “may”, “plans”, “potential”, “predicts”, “projects”, “to the knowledge of” or similar expressions, which are intended to identify a statement as forward-looking. This applies, in particular, to statements and opinions in this presentation concerning the future financial returns, plans and expectations with respect to the business and management of Calliditas Therapeutics, future growth and profitability and general economic and regulatory environment and other matters affecting Calliditas Therapeutics. Forward-looking statements are based on current estimates and assumptions made according to the best of Calliditas Therapeutics’ knowledge. Such forward-looking statements are subject to risks, uncertainties, and other factors that could cause the actual results, including Calliditas Therapeutics’ cash flow, financial condition and results of operations, to differ materially from the results, or fail to meet expectations expressly or implicitly assumed or described in those statements or to turn out to be less favorable than the results expressly or implicitly assumed or described in those statements. Accordingly, prospective investors and other third parties should not place undue reliance on the forward-looking statements herein. Calliditas Therapeutics can give no assurance regarding the future accuracy of the opinions set forth herein or as to the actual occurrence of any predicted developments. In light of the risks, uncertainties and assumptions associated with forward-looking statements, it is possible that the future events mentioned in this presentation may not occur. Moreover, the forward-looking estimates and forecasts derived from third-party studies referred to in the presentation may prove to be inaccurate. Actual results, performance or events may differ materially from those in such statements due to, without limitation, changes in general economic conditions, in particular economic conditions in the markets on which Calliditas Therapeutics operates, changes affecting interest rate levels, changes affecting currency exchange rates, changes in competition levels and changes in laws and regulations. The information, opinions and forward-looking statements contained in this announcement speak only as at its date, and are subject to change without notice.
2Calliditas Therapeutics March 2019
A specialty pharmaceutical company based in Stockholm, Sweden
Listed on Nasdaq in Sweden in June 2018 – Midcap segment (ticker CALTX)
Market cap June 2019: 180 MUSD
Cash position end Q1, 2019: 63 MUSD
Top 5 Shareholders: Industrifonden, Investinor, B Julander, Gladiator, AFA Insurance
Ongoing Phase 3 read out expected for IgAN in 2H 2020; Pipeline: ODD received for AIH and PBC
3March 2019Calliditas Therapeutics
Investment Summary Calliditas
Novel treatment of IgA nephropathy (IgAN) with potential disease modifying effect
Clear path to market – FDA acceptance of proteinuria as surrogate marker
Mode of action targets the origin of the disease – active in the gut
Only successful placebo controlled, randomized Ph2b study in IgA nephropathy (150 patients)
The ongoing clinical Phase 3 study NEFIGARD replicates Phase 2b
Additional potential for pipeline development, in-licensing targeting orphan disease
Significant unmet medical need with USD 1bn market opportunity, no approved drugs
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4March 2019Calliditas Therapeutics
Our lead indication: IgA nephropathy – large unmet medical need
PROFILE ESTIMATED PREVALENCE Genetic predisposition – required but not sufficient. Environmental, bacterial, dietary triggers.
Normally presents in the 20-30s – more prevalent in men than in women.
130,000-150,000
200,000
~2,100,000
~190,000
MAI
N M
ARKE
TPO
TEN
TIAL
MAR
KET
OPP
ORT
UN
ITIE
S
Up to 50% at risk of ESRD within 10-20 years.
5March 2019Calliditas Therapeutics
Disease origin and progression – predominant theory
March 2019 6Source: Suzuki et al, J Am Soc Nephrol 2011;22(10):1795-803; Novak et al, Curr Opin Nephrol Hypertens 2013; 22(3):287-94; Novak et al, Kidney Dis (Basel). 2015; 1(1):8-18.
Calliditas Therapeutics
IgA nephropathyCluster complexesImmune responseSugar deficient IgAPeyer´s patches1 2 3 4
In patients there is an increase in a subclass of immunoglobulin molecules (“IgA”) which lack a specific sugar modification
The sugar-deficient IgA molecules trigger an immune response resulting in formation of antibody clusters
As the clusters enter the circulation, they form even larger complexes that eventually lodge in the kidneys
Deposits of immune complexes result in inflammation, necrosis and destruction of the kidneys’ filtration apparatus
Lymphoid tissue; Peyer’s patches in the distal part of the small intestines produces IgA antibodies
Nefecon offers local treatment at origin of disease
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Active substance is budesonide
90% first pass liver metabolism minimize systemic side effects
Designed to provide a locally restricted and highly concentrated release of budesonide to the Peyer’s patches for maximum effect
Targeted local delivery of potent immunosuppressive agent to Peyer’s patches in the ileum
Unique two-step release profile
─ PH-governed delayed disintegration of the capsule
─ Pulse like exposure throughout the Ileum
Drug product based on known active ingredient Unique targeted release profile
Bude
soni
de co
ncen
trat
ion
March 2019Company Presentation
Successful Phase 2b trial
March 2019
Primary endpoint: Reduction in proteinuria
2.7%
-27.3%-21.5%
Placebo Nefecon(16 mg)
Nefecon(8 mg)
% ∆
UPC
R
Large study population –150 patients
Randomized, double-blinded, placebo controlled
-9.8%
0.6%
-0.9%
Placebo Nefecon(16 mg)
Nefecon(8 mg)
% ∆
eG
FR
Secondary endpoint:Stabilization of eGFR
Oral dose taken daily over a nine-month period
European study in 62 sites in 10 countries
P (16mg)=0.0026P (8mg) = 0.0064
P (16mg)<0.01P (8mg)<0.03
Only Phase 2b Study in IgAN to reach Primary Endpoint Conclusion – Efficacious and safe drug profile
Efficacy Phase 2b trial of 150 patients demonstrated
clinically relevant reduction in proteinuria and GFR stabilization in the treatment arms
UPCR reduction compared to placebo - 9 months treatment (p=0.0066)
eGFR stabilization compared to placebo – 9 months treatment (p=0.0026)
Safety and tolerability Medication-related adverse effects were
transient and mainly mild (77%) to moderate (22%)
No metabolic adverse events (hypertension, diabetes, weight gain)
No severe infections Benign safety profile of 16 mg Nefecon
8Calliditas Therapeutics
Clinical Phase 3 study NEFIGARD to confirm Phase 2b results
Nefecon Phase 2b design
Run-in
9 months on treatment
Nefecon Phase 2b design
Nefecon Phase 3 design – NEFIGARD
→ Phase 3 study design replicates successful Ph2b
→ 200 versus previous 150 patients (Ph2b)
→ 16mg Nefecon once daily oral dose
→ Surrogate marker; Proteinuria for market approval
Key highlights
9March 2019Calliditas Therapeutics
Endpoint: Proteinuria reduction in IgAN patients
→Around 150 clinical sites in 19 countries
→Up to 450 patients in total
→Read out on first 200 patients basis for approval and US market launch
→Top line read-out estimated H2 2020
→Endpoint: Proteinuria reduction for approval of Phase 3 study…
→…with eGFR in post approval follow up
• Endpoint for Phase 3 study identical to endpoint for Phase 2b: Proteinuria reduction.
• Measured in the first 200 patients after nine months of oral treatment – basis for the accelerated approval in the US / conditional approval in Europe
• Potential for full approval if proteinuria reduction is substantial, or on basis of planned interim analysis in post approval observational study. Data on kidney function expected around 18 months from top line read out
• Convenient, oral medication for broad population with disease modifying potential – avoidance of dialysis
• FPI in November 2018
• Company sponsored statistical framework, Inker et al 2016, basis for FDA surrogate marker acceptance
10Calliditas Therapeutics March 2019
ESRD causes considerable costs to society
March 2019
Cost of dialysis
USD 89,000 USD 70,000-200,000
Average annual cost per person in the US
Hemodialysis treatment in 20131 Based on payer's interviews 20162
Total estimated annual hemodialysis cost in the US of USD 42 billion1
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Cost of transplantation
USD 414,800
Average cost per kidney transplant
Total invoiced fees per transplantation3
Total estimated annual kidney transplantation cost of in the USA of USD 7 billion
Source: 1) U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014. 2) Calliditas estimate based on interviews commissioned by the Company. 3) Milliman, Milliman research report:2017 U.S organ and tissue and transplant cost estimation and discussion.
Calliditas Therapeutics
Commercialization strategy for Nefecon
March 2019
Calliditas believes that IgA nephropathy represents a market opportunity of USD 1bn or more in the US
Rights Maintain all rights to Nefecon in the US in all indications
Commercial strategy
Company managed US commercialization Assess partnerships in EU and RoW Target IgA nephropathy patients at risk of
progressing to ESRD (up to 50%) Earlier stage treatment to prevent
progression and preserve kidney function
Focus on clinics providing treatment of IgAN patients - Hub and spoke structure
Targeting of identified group of nephrologists with a relatively small sales and marketing organization
Collaborate with patient organizations
General commercial strategy US commercialization strategy
Rationale for US commercialization
Significant unmet medical need Desire for early stage and safer treatments Sizeable socioeconomic benefits
Orphan drug Specialist target market Disease modifying potential
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Strong product protection and product exclusivity
March 2019
Orphan designation
Existing patents
Patent strategy
Soft barriers
Granted orphan drug designation in the US and Europe. Data protection and market exclusivity for 7 years and 10 years, respectively
Granted patents covering Nefecon, its formulation and method of manufacturing - runs until 2029
Strategic focus on the US and Europe with extension into other geographical markets
New patent estate initiated in 2018
Significant formulation and manufacturing know-how
Bioequivalence studies would require adaptation
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Pipeline Indications - Autoimmune Hepatitis (AIH)
March 2019Corporate Presentation 14Source: 1) Feld et al, Hepatology 2005;42:53-62, Sahebjam and Vierling, Front Med. 2015 Jun;9(2):187-219. 2) Sahebjam and Vierling, Front Med 2015; 9(2):187-219. 3) Czaja, Expert Opin Drug Saf. 2008;7(3):319-33; Czaja, Liver Int 2009;29(6):816-23; Manns et al, Hepatology 2010;51(6):2193-213 (AASLD 2010 AIH Guideline).
The disease A rare, orphan, chronic inflammation of the liver
The cause is unknown
Leads at variable rates to cirrhosis with complications like portal hypertension, liver failure and liver cancer
Typical symptoms are fatigue, abdominal discomfort, jaundice, enlarged liver, skin rashes, joint pains and in women, loss of menstruation
Standard of care Currently no products approved in the US / care treatment includes immunosuppression with systemic steroids
(prednisone) alone or in combination with azathioprine
Up to 80% of treated patients report steroid related side effects after 2 years and 15% discontinue due to drug related adverse events
Calliditas estimates the intolerance and relapse segments together comprise 35-40% of the total population, or approximately 25,000 patients
Estimated prevalence
50,000 – 80,000
Annual US incidence 0.1 – 1.9
per 100,000
Primary Biliary Cholangitis (PBC)
November 2017Analyst presentation 15Source: 1) Lindor et al, Hepatology. 2009 Jul;50(1):291-308,EASL PBC Clinical Practice Gudielines, Journal of Hepatology 2017; 67:145–172. 2) Nguyen et al, Best Pract Res Clin Gastroenterol 2010; 24(5): 647–654. 3) Kim et al, Gastroenterology 2000;119:1631–1636). 4) EASL PBC Clinical Practice Gudielines, Journal of Hepatology 2017; 67:145–172. 5) Company estimate based on prevalence reported by Kim et al Gastroenterology 2000; 119(6):1631-6. 6) Company estimate based on prevalence reported by Kim et al Gastroenterology 2000; 119(6):1631-6 and Nguyen et al, Best Pract Res Clin Gastroenterol 2010; 24(5):647-54.
The disease A progressive chronic autoimmune disease of the liver
The bile ducts are destroyed by inflammatory processes, bile accumulates in the liver causing an increase in the liver volume (cholestasis)
If untreated, the active liver tissue is destroyed and replaced by fibrous tissue, cirrhosis and liver transplant
Early symptoms include fatigue, itchy skin and dry eyes/mouth. Later stages - liver stiffness, musculoskeletal pain, edema, jaundice and underactive thyroid
Standard of care
Ursodeoxycholic acid (UDCA) and obeticholic acid (Ocaliva) are the only FDA-approved medical treatments for PBC3
No targeted anti-inflammatory therapy is registered in the US or Europe
Previous trials indicates that corticosteroids may alleviate symptoms and improve biochemical and histologic findings4
Estimated prevalence
140,0005
Annual US incidence 0.3 – 5.8
per 100,0002
Out-licensing of Nefecon to Greater China
November 2017Analyst presentation 16
The Market IgA Nephropathy is more common in China than in Europe
or the US, and is cited in publications as being the most common reason for ESRD.
According to a large Chinese epidemiology study1 on over 13,000 renal biopsies, IgAN represented over 30%.
A convenient, oral medication to control the disease with the potential of avoiding ESRD is particularly attractive in a China, taking into account travelling distance to hospitals etc.
The Deal Partnering with Everest Medicines, a well funded, private biopharma company with highly experienced staff
predominantly with big pharma backgrounds. Have a broad pipeline of late stage clinical programs for China
Total deal value of $121m, with $15m in upfront payment
Everest Medicines responsible for the development and commercialization in the territory
Potential to be the first approved medication for IgAN in China, targeting a significant unmet medical need Source: 1) Am J Nephrol 2009;30:268-273
Going forward: focus on Nefecon program & Pipeline
H1 2018
• Filing of new patent application related to Nefecon
Ongoing updates regarding commercial strategy and plans
H2 2018 H1 2019 H2 2019 H1 2020 H2 2020 H1 2021 H1 2022
• NEFIGARD first patient in
• Application for ODD for second indication submitted
• Application for ODD for third indication submitted
• Filing of Pediatric Investigational Plan submitted to EMA
• Approval of ODD designation for second indication
• Approval of ODD designation for third indication
• EMA meeting to discuss surrogate marker
• FDA meeting regarding regulatory pathway for second indication
• 200 patients recruited
• Clinical trial for pipe line indication initiated subject to FDA guidance
• EMA decision regarding pediatric pathway
• Top line read out for 200 patients
• Study fully recruited
• Filing with regulatory agencies for market approval
• Enrolment first patient in treatment modality trials / label expansion
• Interim analysis based on 450 patients for validation of surrogate marker
• Commercial launch of Nefecon
17March 2019Corporate Presentation
Investment Summary Calliditas
Novel treatment of IgA nephropathy (IgAN) with potential disease modifying effect
Clear path to market – FDA acceptance of proteinuria as surrogate marker
Mode of action targets the origin of the disease – active in the gut
Only successful placebo controlled, randomized Ph2b study in IgA nephropathy (150 patients)
The ongoing clinical Phase 3 study NEFIGARD replicates Phase 2b
Additional potential for pipeline development, in-licensing targeting orphan disease
Significant unmet medical need with USD 1bn market opportunity, no approved drugs
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18March 2019Calliditas Therapeutics