Dr. Jonathan Zalevsky
Analyst · Oppenheimer. Your line is open
Thank you, Howard. Starting off with our lead immunology program, REZPEG is a unique molecule that aims to address the underlying Treg deficiencies and consequently, over activity of affected T-cells in autoimmune diseases by selectively activating and expanding Tregs. REZPEG provides a completely different mechanism of action compared to the other drugs that are currently approved or under development in the atopic dermatitis space. This program is uniquely positioned as the most advanced IL-2-based Treg mechanism in the clinic. REZPEG has potential in multiple autoimmune diseases, and while right now, our focus is on atopic dermatitis, there are plans to explore REZPEG in other autoimmune indications in the future. As Howard mentioned, we discovered the data previously reported for REZPEG by Eli Lilly was miscalculated. The primary errors were related to miscalculations for the EASI score and the PASI score, as well as the EASI-related and PASI-related clinical efficacy endpoints reported at EADV in September of 2022 in the atopic dermatitis and psoriasis posters that were presented. This discovery was only made after all rights to REZPEG were returned to Nektar and the raw data files from the REZPEG clinical studies were transferred to Nektar. A leading independent statistical firm was then employed to analyze the raw data de novo and the firm confirmed that the original statistical analysis calculated by Lilly were incorrect. For atopic dermatitis, EASI is the validated and widely used standard measurement for atopic dermatitis study that has been used by clinicians and reported in the literature for over 20 years. The EASI measures the severity of atopic dermatitis for patients and scoring ranges from zero with no disease to 72 maximal disease. The corrected and audited interim data analysis for the atopic dermatitis study utilizes the validated 72-point EASI scoring system and includes all the patient data that was available at the time of the EADV 2022 data cut. The data demonstrate that 12 weeks of REZPEG therapy at the highest dose resulted in a mean EASI score improvement of 83% with a p-value of 0.002 as compared to placebo and an EASI 75% response rate of 41%. In addition to the strong efficacy, we observed the 12 weeks of treatment with REZPEG, which is at least in line with or better than efficacy observed after 16 weeks of treatment with dupilumab, which in Phase IIa and Phase IIb studies showed a 74% and 68% improvement, respectively. An important observation in the new and corrected data was that REZPEG also provided a rapid and steep drop in EASI scores immediately after initiation of therapy. Specifically, after only two doses of REZPEG, the mean drop was minus 71% for the highest dose at the week four-time point. The corrected data also reinforces the remitted effect and durability of REZPEG responses in atopic dermatitis patients. As Howard stated, the possibility that REZPEG could provide, for the first time, a therapy that could be dosed less frequently than anything patients have available now and could provide real long-term durability. With the differentiated T-regulatory cell mechanism that we specifically designed, the underlying scientific basis for why this is happening has been hypothesized for some time. The concept is that stimulating the T-regulatory cells could result in the reeducation of the immune system by treating the underlying pathology to not just the symptoms of the disease. These clinical data provide for the first time a novel clinical finding, demonstrating that the Treg mechanism can translate into effectively what looks like memory of the immune system, resulting both in long-term durability and strong efficacy in atopic dermatitis. This is the first clinical observation of a Treg stimulating therapy being efficacious in atopic dermatitis and has the key opinion leaders extremely enthusiastic. The durability of response that we’ve observed is not seen with DUPIXENT or the other agents in the IL-4 and IL-13 class or with JAK inhibitors. And again, this has us and KOL is very enthusiastic about the potential for long-lasting responses and infrequent maintenance dosing with REZPEG in the setting of atopic dermatitis. There were no underlying formulaic or mathematical miscalculations of the other efficacy endpoints presented at EADV last year. However, I’ll point out that with all the patient data included in the new and corrected data, there was also some improvement in the vIGA responder and NRS Itch responder endpoints from what was previously reported at EADV. For the highest dose of REZPEG, the vIGA increased from 24% reported at EADV up to 29%. And for the NRS Itch measurement, the improvement was from 35% reported EADV up to 41%. For psoriasis, endpoints related to the PASI were similarly miscalculated for the validated 72-point PASI scoring system. PASI is also a validated and widely used standard for over 20 years, which is used by clinicians and reported in the literature to measure the severity of psoriasis plaques in patients. The scoring also ranges from zero with no disease to 72 for maximal disease. The corrected and audited final data analysis for the psoriasis study utilizes the validated 72-point PASI scoring system. The corrected data showed a 44% change from baseline PASI and PASI-50 and PASI-75 response rate of 32% and 21%, respectively. The statistical and clinical teams in charge of the two studies at Lilly were made aware that Nektar discovered the data errors. The Lilly team confirmed the errors and written communications with Nektar. We plan to hold an investor meeting with key opinion leaders in the coming weeks to present additional new data from the atopic dermatitis study for the 12-week induction and for the 36-week follow-up period for REZPEG, all of which strengthens the concept of REZPEG providing a remitted effect. We will also share more details about the new study design for the Phase IIb study in biologic-naïve patients with moderate-to-severe atopic dermatitis who have progressed on topical corticosteroids. We expect to initiate the trial in October of this year and we expect data in the first half of 2025. While our near-term focus for REZPEG is on atopic dermatitis, we continue to believe that REZPEG has broad potential in multiple indications. As development of this program progresses, we will continue to evaluate further opportunities and indications for REZPEG. Now turning to our immunology preclinical research programs. We are advancing our research pipeline for two autoimmune disease programs. The first program we are working on is our TNF receptor 2 or TNFR2 agonist antibody being developed in collaboration with biologic design. TNFR2 is highly expressed on Tregs, neuronal cells and endothelial cells, and TNFR2 agonism has been shown to potentiate the suppressive effect and overall functional properties of Tregs. If absent it is associated with autoimmunity and other genetic conditions resembling FOXP3 loss-of-function. In contrast, its presence has been associated with immunoregulatory function and protective effects for multiple cell populations and tissues in the body. Working with our collaborator, we have identified two lead antibodies that have been validated for selective TNFR2 binding, cell type specificity and TNFR2 agonism in primary human cell-based assays. The lead antibodies are currently undergoing manufacturing cell line development. We, along with the immunology community are very excited about the TNFR2 target and our lead TNFR2 agonist antibodies show a desirable biochemical and cellular profile. We are aggressively progressing this program toward IND-enabling studies and believe that a selective TNFR2 agonist holds great promise for the treatment of multiple autoimmune diseases. Our second preclinical program is a conjugate version of the CSF1 protein. This molecule was engineered to optimize the receptor ligand interaction and the exposure to selectively modulate the resolution process of inflammation. So traditionally, CSF1 is a myeloid targeting cytokine that’s involved in monocyte development and monocyte mobilization. In the right cytokine MOU [ph], CSF1 creates the kind of resolution macrophages that are ideal whenever you need to turn off an inflammatory response. With CSF1, we have tuned the ligand receptor binding property to generate a novel signal to the CSF1 receptor. We are characterizing this biology in multiple biologic contexts, including acute and chronic inflammation, as well as fibrosis. We are very excited about these programs and plan to file an IND for at least one of the programs in 2024 and look forward to keeping you updated on our progress as these programs mature. And now I’d like to turn the call over to Mary to provide an update on our oncology program, NKTR-255. Mary?