Dr. Bill Sheridan
Analyst · JP Morgan
Thanks, Jon, and good morning. At the time of the interim analysis of Parts 1 and 2 of the Phase 2 APeX-1 trial, we discussed attack rate efficacy, drug levels, enzyme inhibition and safety. Since then we have also had the opportunity to review the quality of loss effects and I would like to share that with you today. These data provide very helpful corroborating information on the activity and potential benefits of 7353 as a once day oral drug in HAE patients. Slide 5 shows the protocol analysis and Slide 6 the intent to treat analysis. The quality of life instrument with the angioedema quality of life index developed by experts in the disease and in quality of life measurements and it's designed to assess impact of the disease in the previous four weeks. Subjects are off to score a variety of different symptoms, grouped into several domains and total in domains scores are derived normalized to a 0 to 100 scale with the 0 representing best and 100 the lowest quality of life. Peer viewed publications have established some minimum clinically important difference of six units change from baseline. This is noted as the dotted line on the charts. As indicated on the charts, a reduction in the score represents improvement. What we can immediately see from the results on the slides are. One, the change in placebo subject is very little and overall smaller than the minimum clinical important difference. Two, all the 7353 dose levels showed improvement. Three, the 125 milligram dose showed the strongest results across all domains and the total score. Four, the magnitude of effect is quite impressive with improvements of four to five times, the minimum clinical important difference. That is improvements of 20 to 30 points on average for the 125 milligram dose. For example, in the ITT analysis, the total score the main change from baseline was 26 points compared to three of placebo over the feed value of 0.003. Five, seen these effects in a four week trial is very encouraging. We look forward to completing the trial this quarter. Attack rate efficacy, quality of loss effects, tolerability, safety, drug levels and enzyme inhibition results will all factor into finalizing at dose selection the Phase 3 program. Now turning to the acute indication program, it is very exciting to have this Phase 2 trial ZENITH-1 of 7353 oral liquid formulation, the treatment of acute attacks up and running. We were strongly encouraged by experts of HAE physicians and patient advocates to consider developing this drug as an acute therapy. And we're very pleased with the level of enthusiasm we are seeing for this trial from our investigators. The design of the trial is outlined on Slide 7. This exploratory adaptive dose ranging trial consists in oral liquid formulation. We selected a liquid formulation instead of the capsule dosage form in order to accelerate absorption and also to avoid any possibility of confusion with the prophylactic indication in the marketplace. The eligible subjects had hereditary angioedema and at least one attack for the month over a three month period assessed by ordering medical records. Subjects will each have a total of three attacks treated with blinded study drug, two with active drug and one with placebo in a randomized sequence. The trial amounts for a minimum of 12 subjects of each dose levels and for studying more subjects at top those levels at stages. Drug will be self-administered after phone call discussion with the side investigator with an hour or so symptom onset. In this call, the attack will be assessed for eligibility by the investigator and for example, if the attack is laryngeal, was already progressed to vomiting or difficulty in swallowing, that event would not be eligible for study drug treatment. Subjects are asked to withhold the usual treatment for four hours, but always have the option of treating with standard medicine when they wish. The trial is structured to test three dose levels sequentially with decisions on moving through the dose cohorts based on comparing active on placebo attacks, using endpoint as proportion of responses at four hours after dosing. The assessment is made by using the change from baseline in a visual analog scale score of symptoms with worsening score as failure and the improvement or stabilization score of success. Subjects will also provide symptoms score at later time points to understand the duration of benefit. Slide 8 provides some of the analysis relative to our dose selection decisions for the ZENITH-1 study. The goals here were to ensure that we give the drug its best chance of showing efficacy and the study a range of doses so that we can inform dose selection in future studies. Using the Phase 1 data with the capsule formulation, we ran simulations of 1,000 subjects of each dose level to evaluate to early PK profile and also on how long drug levels would be sustained relative to a target concentration. The simulated PK profile for the selected dose levels, as shown in the left-hand panel with the blue shaded bar representing four to eight times EC50. The middle panel shows estimates of the time to first achieving eight times EC50 and the duration of coverage over eight times EC50. These simulations indicate that with the single dose of 7353, we have the opportunity to see rapid effects that should last for many hours, ranging for a median of four hours with the lowest dose level to 21 hours at the highest dose level. The right-hand panel simply indicates that as you would anticipate because of the long half life of the drug, the Cmax maximum concentration at the 750 milligram single-dose level will be less than that for 350 milligrams daily dosing at steady state. We've learned a huge amount from this trial and look forward to sharing results after the study has been completed. I’ll now hand over to Tom, who will review the quarterly financials.