financial’disclosures - complement c3 inhibiti… · 2...
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Financial Disclosures
� Shareholder (>5%) of Apellis Pharmaceuticals
� Shareholder (>5%) of Revon Systems, LLC
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2 CONFIDENTIAL AND PROPRIETARY –DRAFT for discussion purposes only
Cedric Francois, MD, PhDPresident and CEO
Apellis Pharmaceuticals
Complement C3 Inhibition in AMD
* Ophthalmic Surgery, Lasers and Imaging Retina, March/April 2013 - Volume 44 · Issue 2: 127-132
*
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Complement Inhibitors under development in Geographic Atrophy
Activation)Pathways
Classical)pathwayActivated)by)antibody.antigen)complex
Lectin)pathwayActivated)by)lectin)and)mannose)complex
Alternative)pathwaySpontaneous)C3)
convertase)activation
C5
C5bC5a MACInflammation
Inflammation Cell)removal
Lampalizumab
Cell)destruction
C3
C3bC3a
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Complement Inhibitors under development in Geographic Atrophy
Activation)Pathways
Classical)pathwayActivated)by)antibody.antigen)complex
Lectin)pathwayActivated)by)lectin)and)mannose)complex
Alternative)pathwaySpontaneous)C3)
convertase)activation
C5
C5bC5a MACInflammation
Inflammation Cell)removal
Lampalizumab
Cell)destruction
C3
C3bC3a
EculizumabZimuraLFG-316
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Complement Inhibitors under development in Geographic Atrophy
Activation)Pathways
Classical)pathwayActivated)by)antibody.antigen)complex
Lectin)pathwayActivated)by)lectin)and)mannose)complex
Alternative)pathwaySpontaneous)C3)
convertase)activation
C5
C5bC5a MACInflammation
Inflammation Cell)removal
Lampalizumab
Cell)destruction
C3
C3bC3a
EculizumabZimuraLFG-316
POT-4APL-2
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Inhibiting complement might reduce progression of GA
LAMPALIZUMAB
� Selectively inhibits alternative pathway� Reduced GA progression by 44% in CFI+
patients� No apparent effect in CFI- patients� Monthly injections
OPPORTUNITY
� Efficacy in CFI- patients� Further reduction of progression in CFI+
patients � Reduced frequency of injections
Lampalizumab Phase 2 MAHALO Trial* (CFI+ Patients)
(n=14,13,12) (n=17,17,16)
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* Regillo CD. Lampalizumab (anti-‐factor D) in patients with geography atrophy: the MAHALO phase 2 results. Paper presented at: the 2013 Annual Meeting of the American Academy of Ophthalmology; November 16-‐19, 2013; New Orleans, LA.
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Emerging data indicates that neo-auto-antigens drive persistent, steroid-unresponsive and targeted inflammation and tissue damage via complement activation
Complement ActivationPhagocyte Activation
(e.g. M1/ M2)Oxidation of proteins /
phospholipidsAdduct formation
Cell Death
Tissue specificDendritic Cells
T Cells
B CellsLow affinity
Polyclonal Antibodies
Th17Polarization
Th17Signaling
Fluid Phase Activation
Oxidative Damage, AllergensInfections?
Break Self-Tolerance
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Role of Complement in AMD?
Classical
Alternative(MDA à CFH402)
LYSISIMMUNE
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Emerging data indicates that neo-auto-antigens drive persistent, steroid-unresponsive and targeted inflammation and tissue damage via complement activation
Complement ActivationPhagocyte Activation
(e.g. M1/ M2)Oxidation of proteins /
phospholipidsAdduct formation
Cell Death
Tissue specificDendritic Cells
T Cells
B CellsLow affinity
Polyclonal Antibodies
Th17Polarization
Th17Signaling
Fluid Phase Activation
Oxidative Damage, AllergensInfections?
Break Self-Tolerance
8
Role of Complement in AMD?
Classical
Alternative(MDA à CFH402)
LYSISIMMUNEC5
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Emerging data indicates that neo-auto-antigens drive persistent, steroid-unresponsive and targeted inflammation and tissue damage via complement activation
Complement ActivationPhagocyte Activation
(e.g. M1/ M2)Oxidation of proteins /
phospholipidsAdduct formation
Cell Death
Tissue specificDendritic Cells
T Cells
B CellsLow affinity
Polyclonal Antibodies
Th17Polarization
Th17Signaling
Fluid Phase Activation
Oxidative Damage, AllergensInfections?
Break Self-Tolerance
9
Role of Complement in AMD?
Classical
Alternative(MDA à CFH402)
LYSISIMMUNEC5,fD
fD
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Emerging data indicates that neo-auto-antigens drive persistent, steroid-unresponsive and targeted inflammation and tissue damage via complement activation
Complement ActivationPhagocyte Activation
(e.g. M1/ M2)Oxidation of proteins /
phospholipidsAdduct formation
Cell Death
Tissue specificDendritic Cells
T Cells
B CellsLow affinity
Polyclonal Antibodies
Th17Polarization
Th17Signaling
Oxidative Damage, AllergensInfections?
Break Self-Tolerance
10
MAC or Complement Immunotherapy in GA?
Classical
Alternative(MDA à CFH402)
IMMUNE C5,fDC3
fD,C3
C3
Fluid Phase Activation
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Emerging data indicates that neo-auto-antigens drive persistent, steroid-unresponsive and targeted inflammation and tissue damage via complement activation
T Cells
Th17Polarization
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�Which antigens?
Role of Complement in AMD?
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CEP has been associated with AMD but its role never elucidated
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Which antigens?
1. Mice and non-human primates immunized against CEP develop GA
2. Antibodies are found in patients with AMD and correlate with disease severity
Gu, X., et al.. (2003). Carboxyethylpyrrole Protein Adducts and Autoantibodies, Biomarkers for Age-related Macular Degeneration. Journal of Biological Chemistry, 278(43), 42027–42035.
Gu, J., et al. (2009). Assessing susceptibility to age-related macular degeneration with proteomic and genomic biomarkers. MCP, 8(6), 1338–1349.
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T-cell autoreactivity against CEPCell-based assay to identify at risk patients on the point of convergence to advanced AMD and toevaluate the efficacy of drugs in patients, which will be demonstrated by immunoconversion ofT-cell auto-reactivity. Cellular technology Limited (CTL), OH.
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A randomized sham-controlled prospective Phase II clinical trial to assess the safety, tolerability and evidence of activity of APL-2 as a treatment for
Geographic Atrophy
(Enrollment complete Summer 2016 – readout Summer 2017)
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APL-2 is a potent C3 inhibitor that combines good solubility with a long intravitreal half-life. It is a PEGylated conjugate of APL-1 (aka POT-4).
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APL-2
POT-4
PEG
Intravitreal T1/2 (cyno) ~ 3.2 days
Serum T1/2 (cyno) ~ 10.4 days
• Freely soluble in water
• No MTD identified in monkeys
• Dose limited only by viscosity
• ↑Activity than POT-4
• Inhibits all 3 complement pathways
• Can be formulated in solution to be stable for months at room temperature
APL-2PK in cyno after single IVT injection
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APL-2 systemically inhibits C3 in humans
0 10 20 30 400
10
20
30
40
50
60
70
80
90
100
110
120
130
R a b b it R e d B lo o d C e ll A lte rn a tiv e P a th w a y H em o ly s is(1 :8 P la sm a D ilu t io n )
D ays
% Hemolysis (Alternative Pathway)
M A D C o h o rt 4 P a t ie n t 4
M A D C o h o rt 4 P a t ie n t 2M A D C o h o rt 4 P a t ie n t 1
M A D C o h o rt 4 P a t ie n t 3
M A D C o h o rt 4 P la c e b o P a tie n t
Treatment(Period
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(SEOM)N=40
ShamEvery Other Month
APL-2 15 mgEvery Other Month
(AEOM)N=80
Sham Monthly
(SM)N=40
APL-2 15 mgMonthly
(AM)N=80
Safety, Tolerability and Evidence of Activity N=240
Randomized 2:1:2:1
Filly – APL-2 Phase II Geographic Atrophy
Treatment Period Follow up
AM=2 D0
AEOM=2
SM=1
SEOM=1
M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12
D0 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12
D0 M2 M4 M6 M8 M10 M12
D0 M2 M4 M6 M8 M10 M12
Randomization
M15 M18
M15 M18
M15 M18
M15 M18
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Key Inclusion Criteria
� Study eye only (!)
� ETDRS BCVA of 20/320 or better
� Total GA of 1 to 7 disk areas by FAF
� If GA is multifocal, at least one focal lesion must be ≥ 0.5 DA
� Presence of hyperautofluorescence in the junctional zone of GA
Filly – APL-2 Phase II Geographic Atrophy
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Primary Efficacy Endpoint� The primary endpoint is the change in square root geographic atrophy (GA) lesion size from baseline at month 12 as measured by FAF.
Primary Safety Endpoint� Number and severity of local and systemic treatment emergent averse events (TEAE).
Filly – APL-2 Phase II Geographic Atrophy
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Recruitment acceleration
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�Large, cloud-based database of patients signed up by their physicians
�Easy to use, free system (web and app) tracks disease relevant data
�Triad of outcome-based medicine
§ Confirmed Diagnosis§ Standard Stratification§ Standard Physician- and Patient-reported Outcomes
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Recruitment acceleration
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�Free software to stratify and follow patients
�Compensate physicians for very little work
�Give access to research to patients who are otherwise not exposed
�Patients become visible to research coordinators and can be invited in trial if prescreen matches
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Conclusion: Evolution of Standard of Care in AMD
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WET GA INTERMEDIATE
STANDARD
� Anti-VEGF
NEED
� Improved Vision� Fewer Injections� No GA
STANDARD
� Supportive
NEED
� First Approved Rx (anti-complement?)
� Fewer Injections� All Patients
STANDARD
� Supportive
NEED
� First Approved Rx� ID at-risk patients� Acceptable Product
(oral?)� Regulatory Path
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Thank you Phil, Carmen and Harry!!!
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