David Weiner
Analyst · Oppenheimer. Please proceed with your question
Good morning. Today we will be providing updates on three key elements of our CM-101 Clinical Development Program. One, we will provide additional details on the status of our Phase 2 Safety Pharmacokinetics Biomarker study in Liver Fibrosis Patients. Two, we will provide additional details on the revisions to our randomized placebo-controlled dose findings study in primary sclerosing cholangitis patients. And three, we will update our progress towards finalizing the design of our Planned Phase 2 Biological Proof of Concept trial of CM-101 in Systemic Sclerosis. Let me begin with the liver fibrosis trial, which we are in the process of wrapping up. For context on this trial, it is useful first to review some background on the Phase 1 clinical studies of CM-101. We initiated the clinical development of CM-101 with a single ascending dose study in healthy subjects, which demonstrated the safety and tolerability of the intravenous administration of doses of CM-101 up to 10 milligrams per kilogram. We then progressed to a Phase 1b assessment of the safety, tolerability and initial biological activity of multiple ascending doses of CM-101 in subjects with NAFLD or non-alcoholic fatty liver disease. The trial was randomized and placebo controlled, were two cohorts of eight subjects each received either placebo or CM-101 one group at 2.5 milligrams per kilogram intravenously, and the second group at 5 milligrams per kilogram subcutaneously. Both groups received five doses once every three weeks for a total treatment period of 12 weeks. It's instructive to review the key results of these studies, as they provide the backdrop for the Phase 2 trial now underway. Administration of CM-101 was found to be safe and well tolerated. Favorable multiple dose kinetics of CM-101 were obtained, along with evidence for peripheral target engagement at both dose levels. Importantly, initial signs of activity as CM-101 were observed on serum based biological markers, as well as liver stiffness assessed by the non-invasive elastic graphic method known as FibroScan. The serum biomarkers were Pro-C4 and TIMP1. Pro-C4, a marker of collagen type 4 formation was decreased by 10% from baseline in subjects who received 2.5 milligrams and 5 milligrams of CM-101 with no change observed in placebo patients. Similarly, a comparable reduction in TIMP1, which is a component of the widely used composite ELF biomarker score was observed in CM-101 treated subjects while it's increased in subjects who received placebo. And in addition to the effects observed on these important markers of extracellular matrix biology, favorable and concordant changes were also observed in six additional fibrosis biomarkers in subjects receiving CM-101. These biological markers are also outcome markers we're assessing in the ongoing liver fibrosis trial. Regarding liver physiology, we observed a decrease in liver stiffness reflected by approximately 15% reduction from baseline in subjects receiving CM-101 as compared to no change in subjects receiving placebo. Based on these promising early results, and with the intent to confirm and extend these findings, and to broaden our understanding of the mechanism of action, and potential beneficial clinical effects of CM-101 in fibro inflammatory liver disease, we initiated the current study a randomized placebo-controlled trial in patients with Non-Alcoholic Steatohepatitis or NASH. Patients with stage F1C, F2, and F3 disease were enrolled in the trial and were randomized to either CM-101 at a dose level of 5 milligrams per kilogram administered subcutaneously over placebo. Patients received eight doses of study drug once every two weeks for a treatment period of 15 weeks. The primary outcome measure of the trial is safety and tolerability. Key secondary outcomes include evaluation of multiple serum based fibrotic markers, including ELF score, Pro-C3, Pro-C4, and CK-18. Evaluation of multiple serum based inflammatory markers, including C-reactive protein, fibrinogen, haptoglobin, and alpha 2 macroglobulin. Changes from baseline in clinical laboratory measures utilized to evaluate a static function, including ALC, AFT, total bilirubin and lipid profiles. Evaluation of liver fat content by MRI and liver stiffness by FibroScan and evaluation of the local tolerability in pharmacokinetics following subcutaneous delivery on CM-101. Regarding trial status as of August 1 of the 23 patients that were enrolled and randomized, all 23 have completed treatment, and four of those remained in the protocol defined safety follow up period. We are on target for a final readout in the fourth quarter, and look forward to sharing the clinical trial data at that time. We believe that the data from this trial will provide useful insights and support of the CM-101 Development Program. Although the sample size is small, based on the encouraging signs of activity we saw in the Phase 1b study in NAFLD patients. We believe that evaluating the same relevant outcomes that a patient population with more severe liver inflammation and fibrosis is likely to be informative. Importantly, these data represent the first readout of CM-101’s activity in patients with established liver disease. For the important secondary objective of exploring the safety and drug exposure achieved with our subcutaneous formulation, we believe the study results will also provide us the pharmacokinetic and tolerability data needed to inform next steps in the development of the current subcutaneous formulation of CM-101. Turning to our Primary Sclerosing Cholangitis trial. We view PSC as a promising clinical indication for CM-101 based on the extensive preclinical and translational data generated by our researchers that highlights the potential role of CCL-24 in PSC related disease pathophysiology, and the observed activity of CM-101 in attenuating, the fibro inflammatory processes that characterize the disease. As such, we previously indicated our interest in increasing our clinical efforts in this rare disease, including expanding the size and scope of our ongoing trial, and importantly, in adding a dose finding component to better inform the optimal CM-101 dose to advance into late development. Today, we can report that we have finalized the trial revisions and has begun regulatory submissions with a major clinical trial protocol amendments support trial expansion. However, it is useful to note that much in the trial design has not changed. The core design of the trial as a randomized placebo controlled multiple dose study remains unchanged. The patient population under study, namely PSC patients with large duct disease of more than 24 weeks duration also remains unchanged. The trials double blind treatment period where all enrolled patients receive five administrations of study drugs, which is either CM-101 or placebo. intravenously every three weeks remains the same. Finally, all outcome measures in the trial, including evaluations of serum ALP level, serum biological markers, and Fibroscans remain unchanged. Revisions to the trial include the following: an increase in the total number of patients to be enrolled to 93; inclusion of two dose cohorts in addition to the current 10 milligram per kilogram cohort; a lower dose cohort to evaluate 5 milligrams per kilogram and a higher dose cohort to evaluate 20 milligrams per kilogram. Each cohort will enroll 25 patients with PSC. An increase in the number of placebo patients to 18 to ensure enrollment of placebo patients contemporaneously to all CM-101 dosing cohorts. The addition of an open label extension to the trial, with the additional administration of up to 11 doses of CM-101 given every three weeks by intravenous infusion. The addition of the open label portion of the trial brings the maximum total duration of treatment to 48 weeks, a change in the trials primary outcome to an evaluation of CM-101, safety and tolerability. Lastly, consistent with the fact that the primary outcome of the trial is safety. The study is not formally powered to assess efficacy. However, we have maintained cohort sizes sufficient to detect with expected variability, a clinically relevant improvement in serum ALP levels, which is defined as change from baseline. Serum ALP is a key secondary outcome measure for studies in PSC. As we noted previously, we will be performing an interim blinded safety analysis of the currently enrolling dose cohort in the PSC study, expected to be completed before the end of this year. The primary purpose is to facilitate a safety review by the data monitoring committee to support the planned higher dose cohort of 20 milligrams per kilogram in the trial. Since the study will remain blinded, we will not be reporting details of the safety analysis at that time. Based on a number of key factors, including our ongoing efforts to expand the number and geographic footprint of clinical trials sites. The current development landscape of trials in PSC and the increased size of the study, we anticipate that the top line data from this Phase 2 trial and PSC will be available in the second half of 2024. Lastly, turning to our Phase 2 Systemic Sclerosis trial. We have by working closely with a number of leading systemic sclerosis disease experts made good progress towards the finalization of the clinical trial design. As we have discussed, we are focusing the goal of this trial towards establishing biological proof of concept on clinically relevant aspects of this complex disease. Focusing on CM-101’s potential activity in modifying the skin, lung, and that filler pathophysiology observed in SSc patients. We remain on track to launch the trial by the end of this year. We plan to provide details on the final SSc trial design in the next couple of months, either on a special webcast prior to or at our next quarterly call. In summary, I'm pleased to report that we are making steady progress towards obtaining critical clinical data in our CM-101 Development Program in rare inflammatory and fibrotic diseases, including evaluating safety, tolerability, pharmacokinetic, and biological and physiological data from our liver fibrosis trail to provide further insight into CM-101 mechanism of action to support the evaluation of higher doses of CM-101 in the clinical development program, and to inform the next steps in the development of a subcutaneous formulation of CM-101. Extending our efforts in primary sclerosing cholangitis to obtain safety, tolerability, biomarker and clinical efficacy data on multiple dose levels of CM-101 and generating proof of concept biological data on clinically relevant aspects of systemic sclerosis to help guide the design of late stage registrational trials. I will now turn the call over to Don. Don?