Victor Perlroth
Analyst · SunTrust
Hi, Robyn. So I think your first question is a little bit around, well, is there a new safety environment for new anti-VEGF, because of what’s happened to Beovu. I think an important consideration there is, whether what happened with Beovu is like a surprise, right. And that only when it went into like a large commercial population, right, did people begin to see some tail event, okay, which I don’t think is really accurate? I think, if you look back, right, the report of this kind of retinal artery occlusion, right, or inflammatory blindness really goes back to the beginning of the molecule, right. You can look back at some of those FDA databases, back to 2015 under Alcon, right, and under the shortlist of a couple different severe adverse events, you’ll find reports of retinal artery occlusion. So I think it was always present – at a useful yet, low percentage, right, maybe you could argue or quibble, right, with Novartis, is it 0.1%, but more seemingly in the label is closer to 1% et cetera. So I think – given that and then you begin to say, well, is it manufacturing, right? Or is it the actual molecule? And I think even recently, right, some of the new Novartis announcement suggests that they’ve looked at manufacturing and they don’t think that’s the cause. They haven’t found any correlation with manufacturing. I think, you begin to look more at the molecule itself, right. And then you begin to look at more – some complexities around the biology of that molecule, right, very high pre-existing ADA, very high treatment-emergent ADA, lower visual acuity benefits for patients that have ADA, all of these things are unusual for anti-VEGF biologics. It turns out as the European regulators put it, right, as we’ve discussed, Robyn, in their assessment that this type of biology, right, high pre-existing ADA, high treatment-emergent has also been seen for other sort of quote unquote, non-natural antibody fragment platforms, right, like diabodies and [camelids] [ph]. So maybe there’s some whether it’s innate immune or I don’t really know, right. I don’t think anybody understands to date, but a complex biology that accidentally happens to be here with this Beovu format. So we don’t have that, obviously, with KSI-301 were fully antibody, we haven’t had any pre-existing ADA, in terms of what we’ve measured to date and appear to have very low or what we may call spurious at treatment-emergent ADA with our molecule. And with the current clinical experience that we have, which is, north of 100 patient years now, across the 1 billion DAZZLE, haven’t seen any signs of like a similar problem that people see with Beovu. Now, of course, people will worry, and the question is, well, when do you feel that enough data has been generated? So we have some confidence that there’s not a tail safety event. And I think, there’s not really an easy answer to that, right. I mean, we do monthly or more assessments across all of our pivotals. Don’t forget we’re running the pivotal program with all of the indications in parallel, right, rather than running one indication in series, right, and then the next and then the next. So we’re trying to generate as much of this data both from a safety, efficacy and durability standpoint, as quickly as possible, and we’re trying to be as transparent, as we can with running this 1b study and presenting the data as we can. So I don’t think, there’s any special secret, but I think fundamentally, we’re not suffering a lot of the same baggage in terms of design and complexity of underlying biology. And we have a good amount of clinical data available, and we’re not seeing this complex pattern that they had. So that’s kind of a comment around Beovu. In terms of the IL-6 VEGF, we call that our OG2072 protein, right, it’s the protein component of our bioconjugate, so it could be evaluated systemically. And as a systemic agent, which would be given in acute manner, right, say and COVID-19 patients, you can give whatever dose level you want. I think, if you look at the Regeneron, or you look at the Actemra, the Roche molecule, they have different dose levels in terms of mgs per kg. But from a systemic standpoint, you can get quite large doses. So we think, we can get very strong anti IL-6, in this case as a ligand. And also very strong anti-VEGF, whatever dose level is required. And also, as I think we mentioned, intriguingly we’ve seen some very interesting synergy across both of those biologies. And so, perhaps the molecule could be important, and so, we want to make the molecule available. And at the same time, we get those ancillary benefits of some real manufacturing acceleration of the program, because the core critical path for the IND and First in Human really was GMP manufacturing of the antibody. So that’s a core feature of the KSI-501 acceleration. And then in terms of putting all 3 of the big indications into a single BLA, Jason, maybe you could talk a little bit about that regulatory strategy.