Continuous therapy. Because life goes ON · Because life goes ON Jefferies 2015 Global Healthcare...

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Transcript of Continuous therapy. Because life goes ON · Because life goes ON Jefferies 2015 Global Healthcare...

Page 1: Continuous therapy. Because life goes ON · Because life goes ON Jefferies 2015 Global Healthcare Conference June, 2015 | 21 || 2 | Disclaimer These slides and the accompanying oral

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Continuous therapy.Because life goes ON

Jefferies 2015 Global Healthcare Conference June, 2015

Page 2: Continuous therapy. Because life goes ON · Because life goes ON Jefferies 2015 Global Healthcare Conference June, 2015 | 21 || 2 | Disclaimer These slides and the accompanying oral

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Disclaimer

These slides and the accompanying oral presentation contain forward-looking statements concerning ourbusiness and financial performance and condition, as well as our plans, objectives and expectations for ourbusiness, operations and financial performance and condition. These forward-looking statements involveknown and unknown risks, uncertainties and other factors that may cause our actual results, performance orachievements to be materially different from any future results, performance or achievements expressed orimplied by the forward-looking statements. In some cases, you can identify forward-looking statements byterms including ‘‘anticipates,’’ ‘‘believes,’’ ‘‘could,’’ ‘‘estimates,’’ ‘‘expects,’’ ‘‘intends,’’ ‘‘may,’’ ‘‘plans,’’‘‘potential,’’ ‘‘predicts,’’ ‘‘projects,’’ ‘‘should,’’ ‘‘will,’’ ‘‘would,’’ and similar expressions intended to identifyforward-looking statements.Forward-looking statements reflect our current views with respect to future events and are based onassumptions and subject to risks and uncertainties. You should not unduly rely on any forward-lookingstatements. Although we believe that the expectations reflected in the forward-looking statements arereasonable, we cannot guarantee that future results, levels of activity, performance and events andcircumstances reflected in the forward-looking statements will be achieved or will occur. Except as required bylaw, we undertake no obligation to update publicly any forward-looking statements for any reason after thedate of this presentation, to conform these statements to actual results or to changes in our expectations.These forward-looking statements speak only as of the date of this presentation, and we assume no obligationto update or revise these forward-looking statements for any reason.For a description of the primary risks to which we are subject, please see the “Risk Factors” section of the finalprospectus for our initial public offering, which was filed with the U.S. Securities and Exchange Commission onNovember 17, 2014. The trademarks included herein are the property of the owners thereof and are used forreference purposes only. Such use should not be construed as an endorsement of the products or services ofthe Company.

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Who we are

Innovative formulations that significantly increase clinical efficacy in CNS diseases

New formulations of existing drugs allownew administration routes that overcome current limitations

> Oral drugs with short half life; low bioavailability and/or solubility

New drug has significant advantages:

> Higher efficacy

> Fewer side effects

> Improved quality of life and ease of use

High NCE-like barriers to entry grant de facto exclusivity

High price point

Accelerated lower risk regulatory pathway (505b2), short time to market

Generics

Ethical

Development Cost / Timeline / RiskLow High

Low

High

Pri

ce/I

P p

rote

ctio

n

Innovative Formulations

Few/ limitedalternatives

Unique indication

Strong patents

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Product Candidate

Indication Preclinical Phase I Phase II Phase III TTM

ND0612HSevere Parkinson’s Disease

H1-2/2018

ND0612LModerate Parkinson’s Disease

H2/2018

ND0680Severe Parkinson’s Disease

H2/2017 EU

ND0701Severe Parkinson’s Disease

H2/2017 EU

ND0801CNS disease Cognition disorders

LD/CD, Subcutaneous

LD/CD, Intra-Duodenal

Nicotine and Opipramol, Transdermal

Apomorphine,Subcutaneous

LD/CD, Subcutaneous

BE study, 2015

BE study, 2015

Ongoing Proof-of-concept study

Pipeline of products expected to launch by 2017-2018

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ON/OFF time

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Blo

od

Lev

els

of

Levo

do

pa

Levodopa Administration

“Off” Time

“On” Time

Dyskinesia

Fluctu

ation

s

Mild

Delayed “on”Early “wearing off”

Moderate Severe

Narrowing therapeutic window with disease progression

ND0612

Levodopa, the Gold Standard, has a major drawback: short half life

(Bredberg et al. 1994)

“Oral route may not be the optimal method of delivering levodopa to patients who have a fluctuating response ”

Continuous delivery has been the greatest challenge of levodopa therapy

The brain needs steady levels of dopamine

Brain dopamine replaced by oral LD

Oral LD has a short half life

Instead of supplying steady LD levels – oral LD

creates sharp fluctuations, a “saw-tooth” graph

LD fluctuations lead to motor complications

OFF time (avg. of 6 hours) and dyskinesia

20% of patients develop after 6 months; 50% of patients develop after 18 months; almost all patients in 2-5 years

Constant LD levels may slow disease progression

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Attempts to achieve continuity

Controlled release tablets

Slow release tablets

Gastric retention devices

Dispensing devices

Because it was thought impossible;

previous attempts to formulate LD into

liquid forms have failed

Why a limited benefit?

Why haven’t other drug forms been developed to enable alternative routes of administration?

NeuroDerm is the 1st to formulate LD into a liquid formulation

Because LD has only existed to date in solid

form that must be administered through the

GI tract, leading to erratic uptake and low

bioavailability

To date, efforts to improve continuous LD therapy have had limited success… NO GAME CHANGERS

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Treatment alternatives for advanced patients

Deep brain stimulation

Removal post infection ≤15%

Seizures 2.4%

Cognition impairments 41%

Device sales: ~$500M (excluding surgery)

Cost per patient: up to 100,000 1st yr, ~$25,000 yr/5yr

Intra-duodenal LD/CD pump (DuoDopa)

Peritonitis 3%

Complication of insertion 40%

Wound infection 21%

Europe sales: ~$200MCost per patient: $70,000/yr

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Lead candidates introduce a new paradigm in PD treatment

The first liquid LD/CD drug, replacing surgical treatments

Device CE approved in EU

>350,000 severe patients US and EU

Current segment treatment costs: ~$70,000 /yr/pt

H1-2/2018

2nd generation ND0612L,

delivered through a patch pump.

“One and done” operation

Device in development by a third party

The first liquid LD/CD drug, a new SOC in PD, significantly reducing OFF-time

Device CE approved (EU)

>900,000 patients US and EU

Current segment treatment costs: ~ $6,000/yr/pt

H2/2018

Severe Parkinson’s disease Moderate Parkinson’s disease Moderate Parkinson’s disease

ND0612H belt pump ND0612L belt pump ND0612L patch pump

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Clinical development

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John Nutt, MD

Nir Giladi, MD

Peter A LeWitt, MD

Olivier Rascol, MD

Clinical guidance committee & scientific advisory board

Warren Olanow, MD

Karl Kieburtz, MD, MPH

Werner Poewe, MD

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ND0612LModerate patients

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n=30

0

100

200

300

400

500

600

15 16 17 18 19 20 21 22 23 24

Me

an P

lasm

a LD

Co

nce

ntr

atio

n (

ng/

ml)

80 µl/h 120 µl/h 160 µl/h 200 µl/h 240 µl/h

Time after infusion initiation

Phase I

Phase I and phase IIaND0612L achieves steady LD levels with linear dose proportionality

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ND0612L Phase II study design

Oral SOCND0612L+oral SOC

Placebo + oral SOC

Period 1: Randomized double blind 2 weeks

ND0612L

ND0612L+Ent

Period 2: Open, 1 week

Randomization

30 moderate to

severe patients

2:1

• Safety

• Tolerability

• PK

• OFF time

• ON time w/o troublesome dyskinesia

• AIMS

• Quality of sleep (PDSS)

• Quality of life (PDQ-39)

• Disease severity (CGI-C)

Primary end points Secondary end points Exploratory efficacy end points

• LD dose adjustment

• Pump usability

Pre-Randomized

16 patients

1:1

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10

100

1000

10000

-2 3 8

Baseline(Best Current Oral Therapy)

Pla

sma

LD (

ng/

ml)

Phase II – first period pharmacokineticsND0612L stabilizes LD plasma concentration above an average of ~800ng/ml

ND0612L transforms levodopa PK in PD patients

Peak to trough 53.7 59.4 4.8

Fluctuation index 2.4 2.9 1.4

ND0612L (Adjunct to Oral Therapy)

Best Current Oral Therapy(Placebo)

Time (h)n=30

Day 0 Day 14 Day 14

-2 3 8-2 3 8

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10

100

1000

10000

-2 0 2 4 6 8 10

n=6

ND0612L ND0612L+Entacapone

n=10

Time (h)

Baseline(Standard of care)

Pla

sma

LD (

ng

/ml)

-2 0 2 4 6 8 10 -2 0 2 4 6 8 10

n=4

Phase II – second period pharmacokineticsND0612L stabilizes LD plasma concentration

Day 0 Day 21 Day 21

ND0612L transforms levodopa PK in PD patients

An average steady plasma levodopa concentration of 550ng/ml was maintained with ND0612L alone, and 800ng/ml when combined with oral entacapone

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ND0612L reduces OFF time w/o increasing dyskinesia (in clinic)

Improves motor fluctuations without “paying the penalty” of troublesome dyskinesia

-0.09 -0.47

-3.5

-3

-2.5

-2

-1.5

-1

-0.5

0

Ch

ange

fro

m b

ase

line

(h

r)

Placebo (n=11) ND0612L (n=18)

Troublesome dyskinesia

2 Hours reduction in OFF time 41% vs. 9% in the placebo

Reduction in troublesome dyskinesia

-0.41

-2.42

-3.5

-3

-2.5

-2

-1.5

-1

-0.5

0

Ch

ange

fro

m b

ase

line

(h

r)

Placebo (n=11) ND0612L (n=18)

OFF time

• Early onset of treatment effect observed

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ND0612L improves quality of sleep, quality of life and global clinical disease severity

90% improvement in disease severity 90% vs. 36% compared to placebo

36%

90%

0%

20%

40%

60%

80%

100%

% o

f p

atie

nts

imp

rove

d (

CG

I-C

sco

re)

Placebo (n=11) ND0612 (n=19)

Global clinical improvement

-1.78

-6.6

-10

-8

-6

-4

-2

0

Me

an c

han

ge in

PD

Q-3

9 s

core

Placebo (n=11) ND0612 (n=19)

Quality of life

17% improvement in quality of life 17% vs. 5% compared to placebo

30% improvement in quality of sleep 30% vs. 0.9% compared to placebo

-0.5

-17.13

-20

-16

-12

-8

-4

0

Me

an c

han

ge in

PD

SS s

core

Placebo (n=11) ND0612 (n=19)

Quality of sleep

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No systemic or local irritation , all patients elected to continue to the open label extension phase

Skin local safety in healthy volunteers - no local irritation

Good safety profile

In volunteers and PD patients so far:

• Draize score slightly elevated, slight pruritus, similar in both groups, normalized at week 3

• SC nodules (0.5-1cm) resolving spontaneously

• No particular systemic AE

• No patient discontinued early

• Local safety – similar to Phase I in healthy subjects

Transient and reversible local minor reaction

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ND0612HSevere patients

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Alone With entacapone

ND0612L ND0612H

Summary of preliminary results to date of phase IIa of ND0612H

Pla

sma

LD (

ng

/ml)

Steady ND0612H levels alone and with oral entacapone (1x/5h)

ND0612H should be suitable for the majority of severe (incl. Duodopa) patients

1807

1,436

596477

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Commercial development

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42%

42%

16%

~$70,000Severe

Moderate~$6,000

Mild

Breakdown by severity and cost (2011) Affects one in one hundred people over age 60 (> 6 million WW)

Moderate to severe patients - ~60 % of all PD

PD treatment market $3.8B

‒ Drugs: ~$3.3B; many are generic

‒ Devices: <1% of PD patients are treated by DBS but consume approx. $500M excluding surgery costs

‒ Duodopa sales exclude US sales and cost of surgery

‒ Most moderate and severe patients are inadequately controlled

Historical peak sales of leading treatments

Mirapex DBS Duodopa

Target population Moderate Severe Severe

Annual peak sales $0.7B WW $0.5B WW* ~ $0.2B EU

*Excluding surgical costs ($30K-$50K/pt)

Advanced PD patients –a hidden segment with the largest unmet need

Parkinson’s disease is the second largest neurodegenerative disease

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ND0612L/H serve moderate and severe PD patients –the segments with the largest unmet need

US EU Global

Total PD patients 1,000,000 1,200,000 6,300,000

Moderate PD patients 420,000 504,000 2,646,000

Severe PD patients 160,000 192,000 1,008,000

Severe PD patients treated with advanced treatments (2014)

DBS new patients/yr ~13,000** ~9,000** ~22,000**

Duodopa patient base 0 ~3,500 ~4,000

Duodopa new patients/yr 0 ~700 ~800

Apomorphine patient base*** 0 ~4,000 ~6,000

Severe patients not treated with advanced treatments

~>100,000 ~>120,000 ~>700,000

*DBS, Duodopa and continuous apomorphine** 10,261 & 6,986 net yearly patient base growth plus estimated replacement of deletions from the patient base***Continuous apomorphine treatment

Only <1% of severe PD patients in the US and EU are treated by advanced treatments but spend approx. $800M* (excluding surgery)

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Future development plan

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505(2)(b) pathway for both products

ND0612L development plan agreed with the FDA

End of phase II meeting expected in 2015

Clinical development plan

Hybrid pathway is anticipated for both products

A PK similarity program for ND0612H (vs. Duodopa) was agreed with the EMA

EMA agreed to only 1 pivotal trial with no active comparator for ND0612L

H2/2014 2015 2016 2017 2018

ND0612HEU – HybridPhase IIa - 004, PK (16 patients)

Phase II – BE, 005 (12 patients)

Phase II – BE, 009 (40 patients)

Long term safety (50-100 patients)

MAA

US – 505(b)(2) / EU – HybridPhase IIb - 006, PK (30 patients)

Phase III - 010 (120 patients)

Long term safety (50-100 patients)

NDA

ND0612LPhase II – 003 (30 patients)

End of phase II meeting

Phase III – pivotal (240 patients)

Phase III – pivotal (360 patients)

Long term safety (50-100 patients)

NDA, MAA

EU approval

US approval

US /EU approval

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Expected milestones

ND0612H ND0612L

2014 • Completion of a PK study (004)

2015

• FDA clinical hold lift• Completion of a PK study vs. Duodopa (005)• Initiation of a BE study vs. Duodopa, EU (009)• Initiation of a phase II study, US (006)• Initiation of a long term safety study (011/12)

• FDA clinical hold lift• End of phase II meeting • Initiation of 2 pivotal studies (007,008)

2016

• Completion of BE study, Europe (009)• Completion of phase II study ,US (006)• End of phase II meeting • Initiation of phase III, US (010)

2017 • Completion of long term safety study (011/12)• Completion of phase III, US (010)

• Completion of pivotal studies (007,008)• Completion of long term safety studies (011/012)

2018 • EU and US approval • EU and US approval

2019/20 • Bridging study and approval of a patch pump version

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Experienced and cohesive management team

Alon Yaar, DVM MBAChief Operating Officer

Oron Yacoby-Zeevi, PhD DVMVice President R&D

Sharon Cohen Vered, PhDHead of CMC

Sheila Oren, MD MBAVice President Clinical and Regulatory Affairs

Roy Golan, CPA LLMVice President Finance

Oded S. Lieberman, PhD MBAChief Executive Officer

Robert Taub, MBAChairman

Revlon Health Care

Group (RHCG)

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NeuroDerm (NASDAQ: NDRM )

Cash: $38.9 million – March 31, 2015

Lock-up: 180 days (Expired in Mid May 2015)

Analyst Coverage & Price Target: Jefferies ($21.00), Cowen and Company ($30.00), Oppenheimer & Co. ($19.00)

& Roth Capital Partners ($17.50)

Shares Outstanding: 17 million (18.7 million on a fully diluted basis)

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Enabling a paradigm shift in the treatment of PD

Low risks, short timelines high value premium products

Positive clinical results

Numerous near term value driving milestones

• Significant reduction in LD plasma fluctuations: >800 ng/ml

• Reduction in OFF-time compared to SOC: >2 hours

• No increase in dyskinesia

• Increase in quality of life and sleep quality

• Safe and well tolerated

• First ever liquid formulation of LD/CD enables continuous administration, transforms PD therapy, replaces surgery

• $2M granted from the Michael J. Fox Foundation for Parkinson’s Research

• Formulations with low risks, cost and short time to market (2017/18)

• Innovative technology - high barriers to entry, effective exclusivity

• NCE-like value proposition and pricing

• 2014: 2 phase II study results

• 2015: 1 phase II study results; 3 pivotal studies initiation

Investment highlights

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