vicore pharma...idiopathic pulmonary fibrosis (ipf), systemic sclerosis (ssc), ipf cough ... former...
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VICORE PHARMA
A Rare Disease Company with a Focus on Patients with Fibrotic Lung Disease
FORWARD LOOKING STATEMENT
This presentation may contain certain forward-looking statements and forecasts based onuncertainty, since they relate to events and depend on circumstances that will occur in the futureand which, by their nature, will have an impact on Vicore Pharma’s business, financial conditionand results of operations. The terms “anticipates”, “assumes”, “believes”, “can”, “could”,“estimates”, “expects”, “forecasts”, “intends”, “may”, “might”, “plans”, “should”, “projects”, “will”,“would” or, in each case, their negative, or other variations or comparable terminology are usedto identify forward-looking statement. There are a number of factors that could cause actualresults and developments to differ materially from those expressed or implied in a forward-looking statement or affect the extent to which a particular projection is realized. Factors thatcould cause these differences include, but are not limited to, implementation of Vicore Pharma’sstrategy and its ability to further grow, risks associated with the development and/or approval ofVicore Pharma’s products candidates, ongoing clinical trials and expected trial results, the abilityto commercialize C21, technology changes and new products in Vicore Pharma’s potential marketand industry, the ability to develop new products and enhance existing products, the impact ofcompetition, changes in general economy and industry conditions and legislative, regulatory andpolitical factors.
No assurance can be given that such expectations will prove to have been correct. Vicore Pharmadisclaims any obligation to update or revise any forward-looking statements, whether as a resultof new information, future events or otherwise.
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INVESTMENT CASE
Fibrotic lung diseases – devastating with need of better therapies
Two complementary programs for treatment of fibrotic lung disease• VP01 – C21 (new modality) in phase II
• VP02 – IMiD (reformulated) entering phase I
Differentiated programs addressing fibrosis, vasculopathy and cough –improving quality of life
Diversification through two programs with multiple indications –idiopathic pulmonary fibrosis (IPF), systemic sclerosis (SSc), IPF cough
Large market potential
Highly experienced leadership
Existing shareholders include HealthCap (28%), Robur, AP4, Handelsbanken and HBM Healthcare
Vicore is well positioned to develop novel therapies for fibrotic lung disease
THE TEAM
First class drug development team
CARL-JOHAN DALSGAARD, CEOMD, PhD, Karolinska Institute with post-doc experience from Harvard Former Head of Therapy Area Pain Control, AstraZeneca R&D10 years of experience from senior management, AstraZeneca19 years of experience as Venture Partner at HealthCap
OLA CAMBER, CMC MSc, PhD, Uppsala UniversityFormer Director Pharmaceutics & Biopharmaceuticals, PharmaciaFormer Director Astra Zeneca, Pre-formulation & BiopharmaceuticalsMore than 30 years of experience in drug development
KICKI JOHANSSON, HEAD OF DRUG DEVELOPMENTMSc Pharm, PhD Former Senior Project Leader/VP AstraZenecaAccountable for the development of over 40 new compoundsApproximately 30 years’ experience of drug development
JOHANNA GRÄNS, REGULATORY AFFAIRS MANAGERMSc, PhD, University of Gothenburg Extensive experience in preclinical R&DResearch experience in drug metabolism
HANS JEPPSSON, CFOPhD, Finance with post-doc research at UC BerkeleyCross-disciplinary background in finance and medicineFormer equity research analyst at Danske BankProfessor in Finance at Gothenburg School of Economics and Law
ROHIT BATTA, CMO MBBS, King’s College London, MFPMMedical doctor with extensive industry experience in Rare DiseasesJoins us from GSK, where he led the global medical and clinical development of the world’s first paediatric gene therapy
GÖRAN TORNLING, SENIOR MEDICAL ADVISORMD, PhD, Karolinska InstitutetMedical doctor and Pulmonologist with more than 20 years of clinical experienceFormer Director Clinical Strategy, AZ and responsible for IPF study designs
JOHAN RAUD, CSO MD, PhD, Karolinska InstitutetFormer Director Inflammation research AstraZenecaInvestment Manager KIF25 years of experience in drug development
THE VICORE TEAM
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NINA CARLÈN, CHIEF ADMINISTRATIVE OFFICEREducation from Berghs School of CommunicationMore than 15 years of marketing and communicationsResponsible for HR and company administration
CHRISTIAN HALL, INVESTOR RELATIONSMSc, Stockholm School of Economics Experience as sell side analyst at SwedbankIR consultant at Oxenstierna & Partners
MINMI FLENSBURG; CLINICAL OPERATIONSDMV, PhD Experience from Novo, Lundbeck and several biotech companiesSuccessfully leading drug candidates through phase I-IV
FIBROTIC LUNG DISEASE
Rare diseases with large medical needs
IDIOPATHIC PULMONARY FIBROSIS (IPF)A rare interstitial pulmonary disease with unknown etiologyHigh morbidity with shortness of breath and cough with a life expectancy of 3-5 years after diagnosis
Two drugs on the marketEsbriet and Ofev only slows disease progression and show significant side effects, despite that reached sales of $ 2.3 billon in 2018
PrevalenceUS: 150,000EU: 100,000Male>female
IPF COUGHA dry persistent cough In IPF a severe debilitating cough correlates to disease progression, morbidity and mortality
The pictures below shows a herniated diaphragm due to IPF cough
Prevalence for IPF with severe dry coughUS: 60,000EU: 40,000Male>female
Severe dry cough is thesymptom that impacts quality of life the mostCurrently no therapyis available
The IPF patient wants to feel better, stop coughing and live longer – in that order
SYSTEMIC SCLEROSIS (SSc)
A rare autoimmune disease with heterogeneous clinical manifestationsThe disease is chronic and has frequently a progressive course, can affect every organ with significant disability, disfigurement and mortality
Prevalence for severe disseminated diseasewith ILDUS: 36,000EU: 21,000Female>male
Treatment optionsOfev (nintedanib) is recently approved for SSc/lung fibrosis (ILD)
PIPELINE
Two phase II programs and one program with proven clinical efficacy
Fibrosis
Exploratory Preclinical Phase I Phase II
cvSystemic Sclerosis
Idiopathic PulmonaryFibrosis
VICORE PIPELINE
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VP01 (C21)
VP02 (IMiD)
FOLLOW-ON MOLECULES (AT2R)
Idiopathic PulmonaryFibrosis
VP01 (C21)
First in class small molecule AT2R agonist
C21 MODE OF ACTION
C21 is the first small molecule angiotensin II type 2 receptor (AT2R)agonist and also a low affinity thromboxane receptor (TP) antagonist
C21 AT2R
TP
AntagonistLow affinity
AgonistHigh affinity
Antifibrotic
Vasodilation
Reduced platelet activation
Anti-inflammatory
C21 has dual mode of actions, both of which are relevant for IPF and SSc
CounterbalanceAT1R
AT2R EXPRESSION IN MAN
According to the Human Protein Atlas, AT2R is primarily expressed in lung in healthy individuals
8%
0%
4%
6%
2%
10%
IPF SScControl
Total AT2r quantificationIn idiopathic systemic sclerosis (IPF) and systemic sclerosis (SSc), AT2R is dramatically upregulated suggesting a crucial role in counteracting fibrosis
Parra 2014
AT2R is expressed in human lung with a significant up-regulation in fibrotic disease
Wollin 2014Heckmann 2016Rathinasabapathy 2018
Esbriet PamrevlumabOfev C21
C21 IN THE BLEOMYCIN IPF MOUSE MODEL
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Reduction of fibrosis score (∆ compared with placebo) when drugs are given as prevention
-23%-38% -41%
-65%
PIRFENIDONEROCHE
50MG/KG
NINTEDANIBB-I
60MG/KG
ANTI-CTGFFIBROGEN30MG/KG 0.03MG/KG
C21 effect is at least comparable to standard of care
C21
Esbriet PamrevlumabOfev
C-21 IN THE MONOCROTALINE PH MOUSE MODEL
20
10
5
0
15
100
60
40
20
80
4
2
1
0
3
4
2
1
0
3
% InterstitialLung Fibrosis
Right Ventricularsystolic pressure
Relative AT2Receptor Expression
Relative TGF-βGene Expression
Representative images of lung fibrosis
C21 reverses cardiopulmonary fibrosis and reduce PH
C21 IS ALSO A TP-RECEPTOR ANTAGONIST
In addition to the NO-mediated vasodilation via AT2R C21 also exhibit an AT2R independent vasodilation in human resistance vessels via the thromboxane receptor
C21 can address vasculopathy through both AT2R and TP receptor
Vicore, data on file
VP01 – STATUS
PreclinicalEfficacy
Strong effects in models of IPF and pulmonary hypertensionReduce expression of profibrotic growth factorsDilates small resistance vessels
Safety 3 months toxicology data in mouse, dog and non human primate
CMC Established production method for C21Initially formulated as a solutionCapsule formulation under development
Phase I Completed 2019200 mg daily is safe and well toleratedConfirmed dose sufficient for AT2R engagement
Phase II IPF(PoC)
Clinical trial application (CTA) to be filed 2019Double blind, randomized and placebo controlled120 patient safety and lung function studyPowered to pick up a functional difference
Phase II SSc(PoM)
CTA filed 2019Mechanistic study to capture vascular effects
IPR Orphan drug status in IPF, 7 years in the US and 10 years in EU
VP02 (IMiD)
Effective therapy targeted directly to the lung
IMiDs
• IMiDs belong to a well established drug class which includesthalidomide, lenalidomide and pomalidomide
• Controlled studies and case reports confirm that systemic thalidomideresolves IPF cough
• However, peripheral neuropathy and other systemic side effects have limited the use
• IMiDs are also powerful immunomodulators and anti-inflammatory suggesting an effect also on the underlying disease
• To capture the lung effect and reduce systemic exposure Vicore is developing a formulation that delivers the IMiD directly to the lung
Heckmann 2016Rathinasabapathy 2018
Esbriet PamrevlumabOfev C21
IMiDs IN BLEOMYCINE IPF MOUSE MODEL
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Reduction of fibrosis score (∆ compared with placebo) when drugs are given as treatment
Heckmann 2016Rathinasabapathy 2018Choe 2010
-1% -10%-41% -45% -50%
PIRFENIDONEROCHE
50MG/KG
NINTEDANIBB-I
60MG/KG
ANTI-CTGFFIBROGEN30MG/KG 0.03MG/KG 4MG/KG
Esbriet PamrevlumabOfev C21 Thalidomide
IMiDS are at least comparable to standard of care
IMiDs IN IPF – CLINICAL EVIDENCE
Toby MaherLondon
Treated individual cases
Lin ZhangXi’an
Open label placebo controlled studySignificant improvement in lung function
Significant reduction of cytokines
Maureen HortonBaltimore
Double blind placebo controlledcross over study
Significant reduction of coughImprove quality if life
Letitia Kawano-DouradoSao Paulo
Treated individual cases
Rebecca HarafToledo
Published case report
Consistent feedback from multiple centres – IMiDs work, however safety challenges remain
IMiDS IMPROVE QUALITY OF LIFE IN IPF
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Quality of life, as measured by the specificSt George’s Respiratory Questionnaire (SGRQ), is improved by IMiD treatment
An absolute change of 7 is considered clinically relevant
No other approved or investigational drug even shows stabilization of SGRQ
Change in SGRQ scores
Thalidomide12 w; n=20
∆=11.2; p=0.001
Nintedanib52 w; n=700 and 500∆=2.05; p=0.0095
0
10
10
Δ Improvement
Δ Deterioration
2012
IMiDS are the only drug class that improves Quality of life
DRUG FORMULATION FOR DIRECT LUNG DELIVERY
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IMiDs in amorphous form are loaded in nanopores of biodegradable microspheres
After lung deposition there is an immediate release of 30% and a sustained release of the remaining 70% as the microspheres degrade
Direct pulmonary delivery is expected to reduce systemic exposure by 50-85%
VP02 – STATUS
PreclinicalEfficacy
Strong effects in models of IPFReduction of TNF and other cytokine release
Safety Systemic safety well knownLocal lung tolerability to be established
CMC Established production method for APIInhalation presentation in nanoporous microspheres ongoing, evaluating PK
Phase I Planned for 2020PK will determine probability of success
Clinical Tablet form with systemic exposure have shown dramatic effects on cough and quality of life, as well as on lung function
IPR Patent application for product filed in May 2018
MARKET
Price for one year’s treatment is close to $100,000
Combined global sales exceeded $2.3 billion in 2018
75% of the sales are in the US
Allied Market Research estimates annual sales of $3.6 billion in 2023
THE PULMONARY FIBROSIS MARKET
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Global IPF sales by brand
$0
$250
$500
$750
$1 000
$1 250
2014 2015 2016 2017 2018
Mill
ion
Esbriet Ofev
Company reports, Bloomberg
Ofev will be launched 2019/20Global dSSc/ILD sales by brand
There are no drugs for IPF cough on the marketGlobal ILD/cough sales by brand
FINANCIAL
FINANCIAL INFORMATION
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Listed on Nasdaq Stockholm main market on Sep 27, 2019 STOCK
HealthCap VII L.P. 27.8%Göran Wessman 8.3%Swedbank Robur 6.3%Fourth Swedish National Pension Fund 4.9%HBM Healthcare Investments (Cayman) Ltd 4.6%Kjell Stenberg 3.6%Unionen 3.4%Pomona-gruppen AB 2.5%Shaps Capital 2.3%Alfred Berg 2.2%Handelsbanken Funds 2.1%Other 31.8%Total number of shares (42,374,714) 100%
LARGEST SHAREHOLDERS
June 30, 2019
SEK730 million (approx. €68 million)MARKET CAPSept 30, 2019
SEK193 million (approx. €18 million) CASH
June 30, 2019
NEAR TERM TENTATIVE MILESTONES
Filing of CTA* for mechanistic SSc phase II study with C21 – October 1
Capsule formulation of C21 – October 1
Filing of CTA for PoC** in IPF with C21
Filing of CTA for open label extension
Selection of candidate formulation for VP02
Filing of CTA for phase I inhalation with IMiD
Progress in backup chemistry program
*Clinical Trial Application**Proof of Concept
SUMMARY
Vicore is well positioned to develop novel therapies for
fibrotic lung disease