Paul Rubin
Analyst · Ladenburg Thalmann
Thanks for that kind of introduction, John, and good afternoon everyone. I’ll spend the next few minutes on the role of IL-1 beta in inflammatory diseases. Beginning here on slide six, to set the foundation for the rest of my presentation. IL-1 beta plays essential role in the medimmune system’s acute phase inflammatory response. Its presence is ubiquitous throughout the body, and it’s critically important to the body’s natural defense mechanisms to fight infection as well as other non-infectious foreign antigens. Moving on to slide 7, you could see there are three IL-1 inhibitors approved in the United States for the treatment of rheumatoid arthritis and cryopyrin-associated periodic syndrome both systemic inflammatory diseases. Response to these drugs have also shown the product’s efficacy and the number of clinical trials conducted in other inflammatory indications. The (inaudible) of these compounds has been used for over 15 years, so physicians acknowledge their efficacy and know how to use them safely. As you see in our slide 8, there is plethora of data in the literature showing IL-1 beta’s involvement in a number of diseases. The strength of this correlation ranges from clear benefit demonstrated after using drugs that block IL-1 beta, I believe down to theoretical evidence based up on animal models. The results we have generated from our Behçet's uveitis study and our Type 2 diabetes studies clearly demonstrate gevokizumab’s ability to control inflammation, suggesting the compound could be a very attractive therapy for a number of inflammatory diseases, while IL-1 beta is contributing factor. On the next slide, slide 9, you see that in the 500 patients who have received gevokizumab to-date, we’ve seen no opportunistic infections in patients treated for up to six months. Lack of opportunistic infection is an important criteria for any biologic with a potential to alter the immune system. To-date the compound’s adverse event profile has been similar to placebo. If the observed safety profile continues to be demonstrated as we expand our database, gevokizumab will compare very favorably to other market and biologics. Going to slide 10, when we look at the findings from our 400 plus patient Type 2 diabetes study, became further confident in gevokizumab’s anti-inflammatory activity and safety profile. Although the primary endpoint of this study, reduction in hemoglobin A1c did not differentiate from placebo in this patient population, we did observe a statistically significant benefit on one specific marker of inflammation, C-reactive protein as represented in this graph. Similar results were seen in additional study of diabetics performed in Mexico, combined these studies validate the fact that our drug to the modulation of IL-1 beta, clearly has an affect on this inflammatory marker. This finding validates our strategy of continuing to evaluate the use of gevokizumab and other inflammatory diseases as I will explain later. Turning now to Slide 11. We conducted an open-labeled study in seven Behçet's uveitis patients. Prior to treatment with gevokizumab, the patients had documented histories of frequent and severe disease exacerbations, typically three or four events per year. After a single injection, each had a rapid response, and their uveitis exacerbation resolved anywhere from 1 to 14 days. As you can see here on Slide 12, and several of them responded and become retreatment, their disease cleared. Subsequently, four of seven of these patients have now received once monthly treatment be a subcutaneous injections for approximately one year. To-date, we are pleased with the results in these patients as flares have been essentially quiescent throughout the time of dosing. We learned from the three patients who are no longer receiving gevokizumab that prevention of disease worsening is related to maintaining a specific therapeutic broad level of the drug. All four patients who continue to be successfully maintained on the drug have blood levels that are above this threshold. We’ve been able to use this knowledge to help with dose selection and trial design going forward. Now turning to Slide 13. I would now like to turn to the expansion of the gevokizumab global Phase III program. In United States, we’re receiving FDA approval for the treatment of non-infectious uveitis. Outside of the United States, there is the option to file as a single NIU, which is the abbreviation for non-infectious uveitis indication or as two separate indications. As indicated on slide 14, the term uveitis broadly refers to the inflammatory diseases that affect the portion of the eye known as the uvea, which is the middle of three layers that surround the eye. People with uveitis may experience decreased vision, pain, light sensitivity, and floaters. Uveitis may be caused by an infection that is commonly treated with an antimicrobial agent, or by an unknown pathogen triggering inflammation, later etiology is called non-infectious uveitis. We are focusing today solely on non-infectious uveitis. The most common form of non-infectious uveitis affects the front of the eye and is known as anterior uveitis. It usually is treated with eye drops or other topically administered drugs. Other forms include intermediate uveitis, posterior uveitis, and pan-uveitis. These types differ from anterior disease as they all include involvement of the till the back portions of the eye. Posterior uveitis refers to inflammation in the retina and the choroid. Pan-uveitis refers to inflammation of all three major parts of the eye. Behçet's uveitis is a well-known form of pan-uveitis. Due to the swelling of tissues critical condition intermediate, posterior, and pan-uveitis, which collectively make up non-infectious uveitis can lead to blindness if not treated. The only FDA-approved treatment for non-infectious, intermediate, posterior, and pan-uveitis is corticosteroid therapy. These may be given orally or systemically, injected directly into the eye or surrounding areas, or delivered via slow-release polymers that are inserted into the eye. Now the fact that physicians use other non-FDA approved drugs in addition to corticosteroid to treat non-infectious uveitis underscores the need for new treatment options. As you can see on slide 15, non-infectious uveitis has multiple etiologies. However, for the purposes of diagnosis, they’re all lumped with same indication and all are treated similarly. In each etiology there is a strong link to interleukin-1 beta, so it makes scientific sense to try gevokizumab in these conditions. In all cases, the condition of the eye upon inspection as well as upon observation of tissue under the microscopes is similar, therefore leading us to conclude that even with different causes, the end result to the eye is the same. Slide 16 demonstrates that non-infectious uveitis is copy attention of other pharmaceutical companies. Most of the other drugs in development are reformulations of old drugs, however there is one other biologic that is targeting the disease. HUMIRA, which is a TNF inhibitor is important control of inflammation and is being developed for non-infectious uveitis. Gevokizumab’s mechanism of action is dissimilar from HUMIRA’s and successful development of our compound will provide an important option to the treating physician. In addition, continued demonstration of a favorable safety profile for gevokizumab can offer an important alternative. Presently, the only FDA-approved treatments for NIU corticosteroid-based. Non-infectious uveitis patients either receive very high oral doses of steroids or have been extended release polymer containing steroids injected into the eye. While these are generally successful in treating the disease, they do carry significant risks or in the case of polymers can result in ocular discomfort. These facts repositions in patients in search of new treatment options. As previously shown, we’ve exposed close to 500 patients to gevokizumab and its safety profile seems to be encouraging. To-date, the injections have been very well tolerated in its potency of 300 femtomolar binding affinity allows for a low dose single injection. Turning to the next slide, 17, we’re confident to the rationale supporting the expansion of the program to seeking FDA label for gevokizumab in States. For treatment in patients with non-infectious uveitis affecting intermediate and/or posterior segments of the eye. Our open-label trial of gevokizumab in Behçet's uveitis will be a rapid and significant improvement of the disease. Behçet's is viewed as a subset of non-infectious uveitis, and is located on the severe end of the spectrum. Ultimately, Behçet's uveitis is treated with exactly the same medications as those NIU subsets that are viewed as lot severe. There is significant additional support for the role of IL-1 beta and the development NIU. Inflammation in general including that of the uvea clearly is related to inflammatory cytokine, and IL-1 beta is an important cytokine above in initiating the inflammatory cascade. It is driven by the presence of inflammatory cells like macrophages, which are present in the inflammation of the uvea. Macrophages both produce and release IL-1 beta as part of the inflammatory process. Blocking IL-1 has been shown to prevent the development of non-infectious uveitis in multiple animal models of the disease. Furthermore, in a syndrome called CINCA, which is congenital and inflammatory in nature, and Anakinra one of the FDA approved IL-1 blockers has been reported to control the uveitis associated with the disease, providing further evidence of the role of IL-1 beta in human uveitis, and the utility of IL-1 blockade. Finally, many of the cause of etiologies of non-infectious uveitis stem from rheumatic disease that are also intimately related to the presence of IL-1 beta. To summarize our plan going forward, as you can see in Slide 18, we recently participated in an end of Phase II with FDA to discuss our revised development strategy for gevokizumab in non-infectious uveitis. Based on these discussions, we intend to use the results of two planned studies, one in non-infectious uveitis and the other in Behçet's subset of NIU, to form the basis of the BLA. The final clinical development program will fulfill the FDA requirements for safety and efficacy, as well as the requirement for treating 300 patients for six months with the dose to be marketed. As this program is intended to be global in scope, the final protocol will await feedback from the European Medicines Agency. After this final end product is received, we believe the trial could initiate by the second quarter of 2012 and take 18 to 24 months to produce top line results. Moving to Slide 19. Now, that I’ve given you as full of an assessment as I can on IL-1 beta mediation, non-infectious uveitis, and why we’re confident to expand the gevokizumab Phase III program, I’ll briefly unveil plans to expand the value of XOMA’s most advanced asset. We know gevokizumab has potential beyond the uveitis indications, and we are committed to expanding the value of our primary assets in an efficient manner. As is shown on Slide 20, we will launch a proof-of-concept program, which we can rapidly identify other diseases that could be treated successfully with our compound. We will be doing a series of these proof-of-concept trials, but we expect it will give us a definitive signal of clinical activity in a short period of time. The indications we are choosing are clinically independent, so the success or failure of any one is not linked to the success or failure of any or the others. We see this as a good way to mitigate risk, all proof-of-concept trials would be conducted in diseases with large medical needs and where treatment with a biologic could be wanted. Well, there are many diseases that have IL-1 beta components, we established a strict set of criteria as you could see on the next slide that were created to meet not only the medical needs, but also XOMA’s business needs. In addition to having an obvious scientific rationale, we must be able to obtain a data read-out in a relatively short period of time. We will look at diseases where the end point has been validated and where we can design a study powered for a definitive response without being overly expensive. All indications will use existing formulations and will not require prototype studies prior to initiation. We have identified several indications that fit all of these criteria, which we are presently narrowing down. We intend to run this thing concurrently until the data from the first study on May, 2012, the second near year-end and the third in the first half of 2013. We believe this program give us multiple opportunities to show the benefit of gevokizumab for a very low investments. We expect to announce the first indication next month. With that, I will turn the call back to John.