EX-99.2 3 tm2213399d1_ex99-2.htm EXHIBIT99.2

Exhibit 99.2

1 PN - 943 Phase 2 Study Data Readout Dinesh V. Patel, PhD | President & CEO April 25, 2022

 

 

Today’s Agenda 2 Introduction: Dinesh V. Patel, PhD, President & CEO Data readout from the Phase 2 IDEAL Study of PN - 943 in Ulcerative Colitis (UC): Scott Plevy, MD, Executive Vice President & Therapeutic Head, Gastroenterology Reflections on the data and the unmet need in UC : Bruce Sands, MD, MS, the Dr. Burrill B. Crohn Professor of Medicine at the Icahn School of Medicine at Mount Sinai. Principal investigator of the Phase 2 study of PN - 943 in UC, consultant to Protagonist Concluding remarks : Dinesh V. Patel, PhD Analyst Q&A : Operator - moderated Q&A Participants: - Dinesh V. Patel, PhD - Scott Plevy, MD - Bruce Sands, MD, MS - Samuel Saks, MD, Clinical Development Advisor - David Liu, PhD, Chief R&D Strategy Officer - Suneel Gupta, PhD, Clinical Development Officer - Asif Ali, Chief Financial Officer - Paula O’Connor, MD, SVP of Clinical Developmen

 

 

Forward - looking Statements 2 This presentation and the accompanying oral presentation contain forward - looking statements made pursuant to the safe harbor pro visions of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical facts contained in this pre sentation, including statements regarding our future results of operations and financial position, business strategy, product candidates, capital res ources, potential markets for our product candidates, enrollment in our clinical trials, any potential impact on our business related to COVID - 19, our pot ential receipt of milestone payments and royalties under our Collaboration Agreement with Janssen Biotech, Inc., are forward - looking statements. In some ca ses, you can identify forward - looking statements by terminology such as “anticipate,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “potentially” “predict,” “should,” “will” or the negative of these terms or other similar expressions. The forward - looking statements made in this presentation involve known and unknown risks, uncertainties and other important fact ors that may cause our actual results, performance or achievements to be materially different from any future results, performance or achievemen ts expressed or implied by the forward - looking statements. These forward - looking statements are subject to risks and uncertainties, including those discuss ed in Protagonist’s filings with the Securities and Exchange Commission, including in the “Risk Factors” and “Management’s Discussion and Analysi s o f Financial Condition and Results of Operations” sections of most recently filed periodic reports on Form 10 - K and Form 10 - Q and subsequent filings an d in the documents incorporated by reference therein. Because forward - looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified and some of which are beyond our control, you should not rely on these forward - looking statements as pre dictions of future events. The events and circumstances reflected in our forward - looking statements may not be achieved or occur and actual results could differ materially from those projected in the forward - looking statements. Except as required by applicable law, we do not plan to publicly update or revise any forward - looking statements contained herein, whether as a result of any new information, future events, changed circumstances or othe rwi se. This presentation concerns products that are under clinical investigation and which have not yet been approved for marketing by the U.S. Food and Drug Administration. They are currently limited by Federal law to investigational use, and no representation is made as to their s afe ty or effectiveness for the purposes for which they are being investigated. The trademarks included herein are the property of the owners thereof and are us ed for reference purposes only. Such use should not be construed as an endorsement of such products. Nothing contained in this presentation i s, or should be construed as, a recommendation, promise or representation by the presenter or Protagonist or any director, employee, agent or ad visor of Protagonist. This presentation does not purport to be all inclusive or to contain all the information you may desire.

 

 

PN - 943 Phase 2 UC IDEAL Study Topline Results and Next Steps 4 • PN - 943 is an oral, gut - restricted a4b7 - integrin antagonist – ‘Oral Entyvio’ equivalent • Achieved clinical proof - of - concept and validation for oral, gut - restricted approach for ulcerative colitis via blockade of the a4b7 - integrin pathway • The current data supports moving PN - 943 in a phase 3 UC registrational study – 150 mg bid dose has efficacy similar to Entyvio ( vedoluzimab ) – Strong concordance between clinical remission and secondary endpoints (histology and endoscopy) • Convenience, efficacy, safety, first - in - class, foundational oral medicine for UC

 

 

PTG - 100 Ph2A Efficacy Similar to Other IBD Targeted Therapy Drugs 5 *Anti - MadCam mAb * No central read endoscopy ( Entyvio ) PTG - 100, 900 mg q.d . dose showed 44% histological remission (RHI)

 

 

The Outcome of Phase 2 IDEAL Study will Inform Phase 3 Decisions • Phase 2 data in UC with various candidates spanning different mechanism of actions – Large confidence intervals, influenced by study design, duration, size, demographics, & criteria – Phase 2 outcomes has generally predicted efficacy in Phase 3 6 Translating H Historical Ph2, Ph3, and Approval Data in UC 2 ➞ Phase 3 ➞ Approval* Candidate MoA Clinical Remission Delta Approval Phase 2 Phase 3 Vedolizumab (Entyvio ® ) 1 a4b7 integrin 19% 11.5% ✓ Ozanimod ( Zeposia ® ) 2 S1P 10% 12.4% ✓ Upadacitinib ( Rinvoq ® ) 3 JAK 19.6% 21/29.5% ✓ (black box) 1. Feagan , B. G., Greenberg, G. R., Wild, G., Fedorak , R. N., Paré , P., McDonald, J. W., ... & Vandervoort , M. K. (2005). Treatment of ulcerative colitis with a humanized antibody to the α4β7 integrin. New England Journal of Medicine , 352 (24), 2499 - 2507; Feagan , B. G., Rutgeerts , P., Sands, B. E., Hanauer , S., Colombel , J. F., Sandborn , W. J., ... & Parikh, A. (2013). Vedolizumab as induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine , 369 (8), 699 - 710. 2. Sandborn , W. J., Feagan , B. G., Wolf, D. C., D’Haens , G., Vermeire , S., Hanauer , S. B., ... & Olson, A. (2016). Ozanimod induction and maintenance treatment for ulcerative colitis. New England Journal of Medicine , 374 (18), 1754 - 1762; Sandborn , W. J., Feagan , B. G., D’Haens , G., Wolf, D. C., Jovanovic, I., Hanauer , S. B., ... & Danese , S. (2021). Ozanimod as induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine , 385 (14), 1280 - 1291. 3. Danese , S., Vermeire , S., Zhou, W., Pangan , A., Siffledeen , J., Hébuterne , X., ... & Pannaccione , R. (2021). OP24 Efficacy and safety of upadacitinib induction therapy in patients with Moderately to Severely Active Ulcerative Colitis: Results from the phase 3 U - ACHIEVE study. Journal of Crohn's and Colitis , 15 (Supplement_1), S022 - S024.; Vermeire , S., Danese , S., Zhou, W., Pangan , A., Greenbloom , S., D’Haens , G., ... & Panaccione , R. (2021). OP23 Efficacy and safety of upadacitinib as induction therapy in patients with Moderately to Severely Active Ulcerative Colitis: Results from phase 3 U - ACCOMPLISH study. Journal of Crohn's & Colitis , 15 (Suppl 1), S021. • Phase 2 data will provide specific guidance for phase 3 program on – Go/No - go decision ✓ – Dose selection ✓ – Powering of registrational primary and secondary endpoints ✓ *Cross trial comparisons complicated by different inclusion criteria, patient populations, primary endpoint definitions, timi ng of primary endpoint, phase of clinical development

 

 

IDEAL: PN - 943 Phase 2 UC Study Design 7 Part - 1: Induction Part - 2: Extended Treatment Period 5 weeks 12 weeks 40 Weeks Week 52 Randomize (n=150) Placebo BID (n=55) Active Drug 450 mg BID (n=53) Active Drug 150 mg BID (n=51) PN - 943 Adult Patients with UC N≈169 ( mITT = 159) Eligibility: • Moderate – Severe UC • 3 - Component Mayo Score 5 - 9 points Inclusion: • B io - naïve and bio - experienced patients Primary endpoint: • C linical Remission* at Week 12 (450 mg bid vs. placebo) Secondary endpoints: • C linical Remission* at Week 12 (150 mg bid vs. placebo) • Endoscopic, histopath , mucosal Exploratory endpoints: • Blood %RO, FCP Induction Phase of study completed and preliminary data readout presentation aligned to guidance of first half of Q2 2022 * Definition of clinical remission based on Adapted Mayo Score: • Stool Frequency subscore (SFS) ≤1 • Rectal Bleeding subscore (RBS) of 0 • Endoscopy subscore ≤1

 

 

Enrollment by Country 8 Percentages are based on the total number of subjects in each column Country Subjects Screened (N=338) n (%) Subjects Randomized (N=169) n(%) Poland 163 (48.2) 97 (57.4) Russia 45 (13.3) 24 (14.2) United States 60 (17.8) 13 ( 7.7) Georgia 20 ( 5.9) 10 ( 5.9) Ukraine 15 ( 4.4) 9 ( 5.3) Italy 11 ( 3.3) 5 ( 3.0) Korea, Republic of 5 ( 1.5) 5 ( 3.0) Hungary 3 ( 0.9) 2 ( 1.2) Canada 10 ( 3.0) 1 ( 0.6) Austria 2 ( 0.6) 1 ( 0.6) Serbia 2 ( 0.6) 1 ( 0.6) Germany 1 ( 0.3) 1 ( 0.6) Bulgaria 1 ( 0.3) 0 Total 338 169

 

 

9 Placebo (N=55) PN - 943 150mg bid (N=51) PN - 943 450mg bid (N=53) Age yrs , mean (SD) 38 (10.6) 42 (12.6) 38 (13.3) Male sex, n (%) 35 (63.6) 26 (51.0) 33 (62.3) Weight (kg), mean (SD) 71.7(17.39) 74.3 (15.61) 74.4 (15.18) BMI, mean (SD) 24.2 (4.80) 25.7 (5.11) 24.6 (4.18) Duration of UC, months Mean (SD) 77.0 (66.0) 66.4 (61.91) 72.8 (64.87) Median (min - max) 58.7(3.9, 247.2) 51.55 (6.0, 275.5) 48.66 (4.6, 244.6) Disease extent, n (%) Proctitis 1 ( 1.8) 2 ( 3.9) 1 ( 1.9) Left sided colitis 38 (69.1) 34 (66.7) 33 (62.3) Pan colitis 16 (29.1) 15 (29.4) 19 (35.8) Baseline modified MCS Mean (SD) 6.95 (1.061) 6.76 (0.992) 6.81 (1.144) Median (min - max) 7 (5, 9) 7 (5, 9) 7 (4, 8) Current oral corticosteroids n (%) 9 (16.4) 5 (9.8) 15 (28.3) Immunosuppressants n (%) 11 (20.0) 6 (11.8) 10 (18.9) Exposure to biologics, n (%) 10 (18.2%) 5 ( 9.8%) 6 (11.3%) Demographic and Disease Characteristics at Baseline – mITT Population

 

 

30.2% 13/43 17 .0% 8/47 14 % 6/43 0 5 10 15 20 25 30 35 150 mg BID 450 mg BID Placebo Clinical Remission (%) mITT Bio - Naïve ( Δ 16%) 27.5 % 14/51 15.1 % 8/53 14.5 % 8/55 0 5 10 15 20 25 30 150 mg BID 450 mg BID Placebo Clinical Remission (%) mITT ALL ( Δ 13%) CONFIDENTIAL 10 P=0.035 Clinical Remission 13% D vs placebo for PN - 943 in mITT and 16% D in BIO - Naive P=0.081

 

 

37.2 % 16/43 23.4 % 11/47 14.3 % 7/49 0 5 10 15 20 25 30 35 40 150 mg BID 450 mg BID Placebo Histologic Remission (%) (RHI≤6) 36.4 % 16/44 20.8 % 10/48 16 .0% 8/50 0 5 10 15 20 25 30 35 40 150 mg BID 450 mg BID Placebo Histologic Improvement ( Geboes <3.1) CONFIDENTIAL 11 P=0.0107 P=0.0213 Histologic Remission and Improvement Statistically Significant Differences D 23% in remission D 20% in improvement ( Δ 23%) ( Δ 20%)

 

 

11.8 % 6/51 1.9 % 1/53 3.6 % 2/55 0 2 4 6 8 10 12 14 150 mg BID 450 mg BID Placebo Endoscopic Remission* (%) (ESS=0) 43.1 % 22/51 20.8 % 11/53 16.4 % 9/55 0 5 10 15 20 25 30 35 40 45 50 150 mg BID 450 mg BID Placebo Endoscopic Improvement** ( ESS= 0 or 1) 12 P=0.0023 Endoscopic Remission and Improvement Strong improvement in quantitative endoscopic parameters ** ESS = 0 or 1 *ESS = 0 ( Δ 8.2 %) ( Δ 26.7%)

 

 

23% 7% 0% 5% 10% 15% 20% 25% Vedo Placebo Clinical Remission (%) Vedolizumab* 30.2 % 14 % 0 5 10 15 20 25 30 35 150 mg BID Placebo Clinical Remission (%) PN943 13 Clinical Remission Comparison in Bio - Naive PN - 943 Vs Vedolizumab efficacy in Phase 2 Studies Δ 16.3% Δ 15.5% * Feagan 2017; Clin. Gastroenterology & Hepatology 15: 229 - 239

 

 

Safety Summary 14 • Generally well tolerated • No drug discontinuation from AEs • No drug related SAEs • Safety analysis similar for the 150 mg BID dose versus the placebo group * pre - existing, not drug related System Organ Class Preferred Term Placebo (N=57) n(%) PN-943 150mg (N=55) n(%) PN-943 450mg (N=57) n(%) Total (N=169) n(%) Total Number of TEAEs 47 46 54 147 Number Of Subjects With At Least One TEAE 22 (38.6) 21 (38.2) 30 (52.6) 73 (43.2) Infections And Infestations 2 ( 3.5) 7 (12.7) 12 (21.1) 21 (12.4) Covid-19 1 ( 1.8) 2 ( 3.6) 3 ( 5.3) 6 ( 3.6) Nasopharyngitis 0 1 ( 1.8) 3 ( 5.3) 4 ( 2.4) Upper Respiratory Tract Infection 1 ( 1.8) 1 ( 1.8) 1 ( 1.8) 3 ( 1.8) Urinary Tract Infection 0 0 2 ( 3.5) 2 ( 1.2) Cervicitis 0 0 1 ( 1.8) 1 ( 0.6) Conjunctivitis 0 1 ( 1.8) 0 1 ( 0.6) Cytomegalovirus Infection 0 0 1 ( 1.8)* 1 ( 0.6) Fungal Skin Infection 0 1 ( 1.8) 0 1 ( 0.6) Hordeolum 0 0 1 ( 1.8) 1 ( 0.6) Respiratory Tract Infection 0 0 1 ( 1.8) 1 ( 0.6) Respiratory Tract Infection Viral 0 0 1 ( 1.8) 1 ( 0.6) Rhinitis 0 1 ( 1.8) 0 1 ( 0.6) Gastrointestinal Disorders 7 (12.3) 5 ( 9.1) 6 (10.5) 18 (10.7) Colitis Ulcerative 2 ( 3.5) 1 ( 1.8) 2 ( 3.5) 5 ( 3.0) Nausea 1 ( 1.8) 3 ( 5.5) 0 4 ( 2.4)

 

 

15 PN - 943 Trough Concentrations and Receptor Occupancy 0 4 8 12 0 3 6 9 12 Weeks P N - 9 4 3 ( n g / m L ) 0 4 8 12 0 20 40 60 80 100 120 Weeks R e c e p t o r O c c u p a n c y ( % )

 

 

Inverse D ose R esponse 16 • A bell - shaped dose response in Phase 2 UC studies is a frequent occurrence across multiple therapies that block the a4b7 integrin/ MAdCAM pathway – Observed since 1997 but still not fully understood – Decisions made to move into Phase 3 trials based on identification of an effective Phase 2 dose • A potential scientific explanation is based on the role of regulatory T cells (Treg) that dampen immune function – “Decreased activity (of Ontamalimab ) at increased doses is related to over - depletion of regulatory T cells …and other leukocyte subsets known to express a4b7 integrin, including intraepithelial lymphocytes, mucosa - associated invariant T cells, and eosinophils…” ( Vermeire , Lancet, 2017) • In chronic inflammatory diseases like IBD disease like UC, the objective is to block effector T cell (Teff) but not Treg function

 

 

Clinical Evidence of Bell Shaped Dose Response in UC Studies 17 Anti - a4b7 Integrin Antibody Vedolizumab (VDZ) Ph3 Exposure - Response for Clinical Remission with VDZ Treatment* *Becker, Gut, 2021

 

 

Clinical Evidence of Bell Shaped Dose Response in UC Studies 18 Anti - MAdCAM - 1 Antibody Ontamalimab (SHP647/PF - 00547659) Ph2 Clinical Remission at Week 12 By Anti - MAdCAM Treatment * * Vermeire , Lancet, 2017

 

 

Clinical Evidence of Bell Shaped Dose Response in UC Study 19 Anti - IL - 23 Antibody - Mirikizumab 4.8 15.9 22.6 11.5 0 5 10 15 20 25 30 Mirikizumab Clinical Remission (%) Placebo 50 mg (N=63) 200 mg (N=62) 600 mg (N=61) * Sandborn, Gastroenterology, 2020 Ph2 Clinical Remission by Mirikizumab IL - 23 Antagonist Treatment*

 

 

• PN - 943 150 mg BID appears to be a safe & effective dose – 27.5% Clinical remission vs 14.5% in placebo (delta 13%, p = 0.08) for mITT analysis ▪ 16% delta in BIO - naïve population (p = 0.04) – Strong concordance with efficacy across multiple key secondary endpoints with statistically significant differences in histologic remission/improvement and endoscopic improvement at the 150 mg BID dose – Confirmation of clinical effect with equivalent dose of PTG - 100 (900 mg QD) in PROPEL [150x2 (bid) x 3 (potency)] • Taken together, these results show that PN - 943 exerts a gut restricted MOA in the local tissue environment – Confirmatory of our original TPP of ‘Entyvio in a pill’ like efficacy • Safety analysis similar for the 150 mg BID dose versus the placebo group • No correlation between clinical efficacy for gut - restricted PN - 943 and blood PK and %RO • Inverse dose response demonstrated, consistent with several other modalities in the integrin pathway • The IDEAL study supports further development of PN - 943 in UC registrational trials Preliminary Conclusions and Next Steps 20

 

 

PN - 943 Phase 2 UC IDEAL Study Topline Results and Next Steps 21 • PN - 943 is an oral, gut - restricted a4b7 - integrin antagonist – ‘Oral Entyvio’ equivalent • Achieved clinical proof - of - concept and validation for oral, gut - restricted approach for ulcerative colitis via blockade of the a4b7 - integrin pathway • The current data supports moving PN - 943 in a phase 3 UC registrational study – 150 mg bid dose has efficacy similar to Entyvio ( vedoluzimab ) – Strong concordance between clinical remission and secondary endpoints ( histo - remission) • Convenience, efficacy, safety, first - in - class, foundational oral medicine for UC

 

 

Programs Candidates Study Phase 1 Phase 2 Phase 3 Key Milestones HEMATOLOGY & BLOOD DISORDERS Hepcidin Mimetic Rusfertide (PTG - 300) s.c. POLYCYTHEMIA VERA (PV) VERIFY 300 - 11 • Patient screening underway REVIVE 300 - 04 • Enrollment completed • Updates at 2022 conferences PACIFIC 300 - 08 • All patients resumed dosing in OLE HEREDITARY HEMOCHROMATOSIS (HH) 300 - 06 • Clinical PoC established INFLAMMATORY & IMMUNOMODULATORY DISEASES Oral GI Restricted ⍺ 4β7 - Integrin Antagonist PN - 943 IDEAL • 159 patient study • Topline data supportive of moving into Ph3 study • Ph3 planning underway Oral IL - 23R Antagonist PN - 235 • Psoriasis 240 patient study initiated • IBD Ph2 Initiation in 2H 2022 Product portfolio 22 Addressing unmet needs in multiple indications with multi - billion - dollar market potential PV Ph2 PoC trial Ulcerative Colitis (UC) Ph2 PoC PV Ph2 in patients with elevated Hct (>48%) Psoriasis Ph2b PoC trial HH Ph2 PoC PV Ph3 trial

 

 

Thank you 23