8-K
INSMED Inc (INSM)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-K
CURRENT REPORT
Pursuant to Section 13 or 15(d) of
The Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): January 10, 2022
INSMED INCORPORATED
(Exact name of registrant as specified in its charter)
| Virginia | 000-30739 | 54-1972729 |
|---|---|---|
| (State or other jurisdiction of incorporation) | (Commission File Number) | (IRS Employer Identification No.) |
| 700 US Highway 202/206<br><br> <br>Bridgewater, New Jersey | 08807<br><br> <br>(Zip Code) | |
| --- | --- | |
| (Address of principal executive offices) |
Registrant’s telephone number, including area code: (908) 977-9900
Not Applicable
(Former name or former address, if changed since last report.)
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions (see General Instruction A.2. below):
| ☐ | Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) |
|---|---|
| ☐ | Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) |
| --- | --- |
| ☐ | Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) |
| --- | --- |
| ☐ | Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) |
| --- | --- |
Securities registered pursuant to Section 12(b) of the Act:
| Title of each class | Trading Symbol(s) | Name of each exchange on which <br><br> registered |
|---|---|---|
| Common Stock, par value $0.01 per share | INSM | Nasdaq Global Select Market |
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (17 CFR 230.405) or Rule 12b-2 of the Securities Exchange Act of 1934 (17 CFR 240.12b-2).
Emerging growth company ☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
| Item 7.01. | Regulation FD Disclosure. |
|---|
As previously announced, William H. Lewis, Chair and Chief Executive Officer of Insmed Incorporated (the “Company”), will present at the virtual 40th Annual J.P. Morgan Healthcare Conference on Monday, January 10, 2022 at 3:45 p.m. ET. A live webcast of the presentation will be accessible through the investor relations section of the Company’s website. The slide presentation to be used during the presentation is attached hereto as Exhibit 99.1 and incorporated herein by reference.
The information contained in this Item 7.01, including Exhibit 99.1 attached hereto, shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or incorporated by reference in any filing under the Securities Act of 1933, as amended, or the Exchange Act, except as shall be expressly set forth by specific reference in such a filing.
| Item 9.01 | Financial Statements and Exhibits. |
|---|
(d) Exhibits.
| Exhibit<br><br> <br>No. | Description |
|---|---|
| 99.1 | Insmed Incorporated J.P. Morgan Healthcare Conference Presentation. |
| 104 | Cover Page Interactive Date File (embedded within the Inline XBRL document). |
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
| INSMED INCORPORATED | ||
|---|---|---|
| Dated: January 10, 2022 | By: | /s/ Michael Smith |
| Name: | Michael Smith | |
| Title: | General Counsel and Corporate Secretary |
Exhibit 99.1
This presentation contains forward-looking statements that involve substantial risks and uncertainties. “Forward-looking statements,” as that term is defined in the Private Securities Litigation Reform Act of 1995, are statements that are not historical facts and involve a number of risks and uncertainties. Words herein such as “may,” “will,” “should,” “could,” “would,” “expects,” “plans,” “anticipates,” “believes,” “estimates,” “projects,” “predicts,” “intends,” “potential,” “continues,” and similar expressions (as well as other words or expressions referencing future events, conditions or circumstances) may identify forward-looking statements.The forward-looking statements in this presentation are based upon the Company’s current expectations and beliefs, and involve known and unknown risks, uncertainties and other factors, which may cause the Company’s actual results, performance and achievements and the timing of certain events to differ materially from the results, performance, achievements or timing discussed, projected, anticipated or indicated in any forward-looking statements. Such risks, uncertainties and other factors include, among others, the following: failure to obtain, or delays in obtaining, regulatory approvals for ARIKAYCE outside the U.S., Europe or Japan, or for the Company’s product candidates in the U.S., Europe, Japan or other markets; failure to successfully commercialize ARIKAYCE, the Company's only approved product, in the U.S., Europe or Japan (amikacin liposome inhalation suspension, Liposomal 590 mg Nebuliser Dispersion, and amikacin sulfate inhalation drug product, respectively), or to maintain U.S., European or Japanese approval for ARIKAYCE; business or economic disruptions due to catastrophes or other events, including natural disasters or public health crises; impact of the COVID-19 pandemic and efforts to reduce its spread on the Company’s business, employees, including key personnel, patients, partners and suppliers; risk that brensocatib does not prove effective or safe for patients in ongoing and future clinical studies, including the ASPEN study; risk that treprostinil palmitil inhalation powder (TPIP) does not prove to be effective or safe for patients in ongoing and future clinical studies; uncertainties in the degree of market acceptance of ARIKAYCE by physicians, patients, third-party payors and others in the healthcare community; the Company’s inability to obtain full approval of ARIKAYCE from the U.S. Food and Drug Administration, including the risk that the Company will not successfully or in a timely manner complete the study to validate a PRO tool or the confirmatory post-marketing clinical trial required for full approval of ARIKAYCE; inability of the Company, PARI or the Company’s other third-party manufacturers to comply with regulatory requirements related to ARIKAYCE or the Lamira® Nebulizer System; the Company’s inability to obtain adequate reimbursement from government or third-party payors for ARIKAYCE or acceptable prices for ARIKAYCE; development of unexpected safety or efficacy concerns related to ARIKAYCE or the Company’s product candidates; inaccuracies in the Company’s estimates of the size of the potential markets for ARIKAYCE or its product candidates or in data the Company has used to identify physicians, expected rates of patient uptake, duration of expected treatment, or expected patient adherence or discontinuation rates; the Company’s inability to create an effective direct sales and marketing infrastructure or to partner with third parties that offer such an infrastructure for distribution of ARIKAYCE or any of the Company’s product candidates that are approved in the future; failure to obtain regulatory approval to expand ARIKAYCE’s indication to a broader patient population; failure to successfully conduct future clinical trials for ARIKAYCE, brensocatib, TPIP and the Company’s other product candidates due to the Company’s limited experience in conducting preclinical development activities and clinical trials necessary for regulatory approval and its potential inability to enroll or retain sufficient patients to conduct and complete the trials or generate data necessary for regulatory approval, among other things; risks that our clinical studies will be delayed or that serious side effects will be identified during drug development; failure of third parties on which the Company is dependent to manufacture sufficient quantities of ARIKAYCE or the Company’s product candidates for commercial or clinical needs, to conduct the Company’s clinical trials, or to comply with the Company’s agreements or laws and regulations that impact the Company’s business or agreements with the Company; the Company’s inability to attract and retain key personnel or to effectively manage the Company’s growth; the Company’s inability to successfully integrate its recent acquisitions and appropriately manage the amount of management’s time and attention devoted to integration activities; risks that the Company’s acquired technologies, products and product candidates are not commercially successful; the Company’s inability to adapt to its highly competitive and changing environment; the Company’s inability to adequately protect its intellectual property rights or prevent disclosure of its trade secrets and other proprietary information and costs associated with litigation or other proceedings related to such matters; restrictions or other obligations imposed on the Company by agreements related to ARIKAYCE or the Company’s product candidates, including its license agreements with PARI and AstraZeneca AB, and failure of the Company to comply with its obligations under such agreements; the cost and potential reputational damage resulting from litigation to which the Company is or may become a party, including product liability claims; the Company’s limited experience operating internationally; changes in laws and regulations applicable to the Company’s business, including any pricing reform, and failure to comply with such laws and regulations; inability to repay the Company’s existing indebtedness and uncertainties with respect to the Company’s ability to access future capital; and delays in the execution of plans to build out an additional third-party manufacturing facility approved by the appropriate regulatory authorities and unexpected expenses associated with those plans.The Company may not actually achieve the results, plans, intentions or expectations indicated by the Company’s forward-looking statements because, by their nature, forward-looking statements involve risks and uncertainties because they relate to events and depend on circumstances that may or may not occur in the future. For additional information about the risks and uncertainties that may affect the Company’s business, please see the factors discussed in Item 1A, “Risk Factors,” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020 and any subsequent Company filings with the Securities and Exchange Commission (SEC).The Company cautions readers not to place undue reliance on any such forward-looking statements, which speak only as of the date of this presentation. The Company disclaims any obligation, except as specifically required by law and the rules of the SEC, to publicly update or revise any such statements to reflect any change in expectations or in events, conditions or circumstances on which any such statements may be based, or that may affect the likelihood that actual results will differ from those set forth in the forward-looking statements.
To transform the lives of patients with serious and rare diseases To be a globally recognized leading biotech company that empowers great people to deliver, with a profound sense of urgency and compassion, life-altering therapies to small patient populations experiencing big health problems
Refractory MAC lung disease Front Line MAC lung disease Bronchiectasis Cystic FibrosisOther neutrophil-mediated diseases Pulmonary arterial hypertensionPulmonary hypertension associated with interstitial lung diseaseOther rare pulmonary disorders Cell therapy technology & capabilitiesProtein De-immunization | Gene Therapy | Breakthrough Manufacturing Not for promotional use
Refractory NTM: M. avium complex (MAC)Front Line Label Expansion * In the U.S., as a condition of accelerated approval, Insmed is conducting an additional clinical study to support full approval.Full approval has been granted by the European Commission and Japan’s Ministry of Health, Labour and Welfare. PRECLINICAL PHASE 1 PHASE 2 PHASE 3 APPROVED BronchiectasisCystic Fibrosis Pulmonary Arterial Hypertension (PAH)Pulmonary Hypertension associated with Interstitial Lung Disease (PH-ILD) Brensocatib and TPIP are investigational drug products that have not been approved for any indication in any jurisdiction. Not for promotional use
MAC lung disease is a rare, progressive, and chronic condition that can cause severe, permanent damage to the lungs Symptoms often worsen over time, including chronic cough, dyspnea, fatigue, fever, weight loss, and chest pain Caused by bacteria in the environment and is more likely to affect thosewith a history of lung conditions, like bronchiectasis or COPD Not for promotional use ™Prolongs release of amikacin in the lungs while limiting systemic exposure Novel, inhaled, once-daily formulation of liposomal amikacin taken with a nebulizer
ARIKAYCE was one of the U.S. Top 10 most successful non-oncology rare disease launches Consistent pricing across three major territories: U.S., EU, and Japan Approval in Japan in March 2021 Approval in Europe in late 2020 International guideline inclusion with a strong recommendation for use (1) Not for promotional use U.S. sNDA approval adding Culture Conversion Data Beyond 12 Months to Label(1) For adult patients with limited or no treatment options after six months of failed treatment. European Launch is Underway Product Now Available and Reimbursed in Germany, the Netherlands, Wales, and Scotland Japan Launch is Underway
14K Diagnosed NTMPatients (2018E)*1,400 refractory MAC patients (2018E)* 125-145K Diagnosed NTM Patients (2018E)*15K-18K refractory MAC patients (2018E)* 95-115K Diagnosed NTM Patients (2019E)*12K-17K refractory MAC patients (2019E)* *Source: Internal analysis of published NTM epidemiology, primary market research with treating HCPs, and anonymized patient level claims data in US † European 5 comprised of France, Germany, Italy, Spain and the United Kingdom Not for promotional use
*Azithromycin (AZI), Ethambutol (ETH)**Patients will be enrolled into separate open label extension study Primary Endpoint Change from Baseline to Month 13 (one month off treatment) in respiratory symptom scoreKey Secondary Endpoint Proportion of subjects achieving durable culture conversion at Month 15 (3 months off treatment) Primary Objective Demonstrate reliability, validity and responsiveness of the PRO/symptom scoresSecondary Objective Demonstrate effect of ARIKAYCE on culture conversion, time to culture conversion Key Endpoints Screening Double-Blind Registration PMR Trial Key EndpointsMonth 13 Culture Negativity Endpoint Month 15 R Months 1-6 Months 1- 12 Adults with new MAC lung infection (n=250) Psychometric Validation Study Month 7 Adults with new MAC lung infection (n=100) R 200-220 sites across ARISE and ENCORE Not for promotional use
Brensocatib is an investigational drug product that has not been approved for any indication in any jurisdiction.
An environmentalinsult or disease process leads to bronchial wall destruction and dilation Structural damage impairsprotective mucociliary clearance Increased susceptibility to chronic bacterial infection and colonization Persistent inflammatory response, causing lung damage All references to bronchiectasis related to our WILLOW and ASPEN clinical studies, potential launch of brensocatib and global prevalence refer to non-cystic fibrosis bronchiectasis.
Positive Phase 2 Data in bronchiectasis underscore potential of brensocatib DPP1 is an enzyme that catalyzes the activation of NSPs in neutrophils when they are formed in the bone marrow Neutrophils are the most common type of white blood cell and play an essential role in pathogen destruction and inflammatory mediation Strong rationale for further development in neutrophil-driven inflammatory conditions Novel once-a-day pill, reversible inhibitor of dipeptidyl peptidase 1 (DPP1) Brensocatib is an investigational drug product that has not been approved for any indication in any jurisdiction.
Exacerbation-related hospitalizationrates was higher & duration of hospitalization was longer in the placebo arm Both 10 mg & 25 mg group met primary endpoint with statistical significance Risk of exacerbation over six months reduced by 42% for 10 mg group, 38% for 25 mg group
256 Pts(~85 pts/arm) 1,620 Pts(540 pts/arm) 80% for a 40% reduction 90% for a 30% reduction 1.37 (actual)1.2 (planned) 1.2 Consistent Consistent 6 months 12 months Time to first exacerbation Rate of pulmonary exacerbation Rate of pulmonary exacerbation Time to first exacerbation
Clinic visits week 4, 16, 28, 40, 52(EOT) and 56 (EOS)Phone visits week 10, 22, 34 and 46 Stratified by:Geographic regionPseudomonas aeruginosa on sputum cultureNumber of prior PEs (2, or ≥3) in previous 12 months Off treatment 4 weeks 25 mg 10 mg Treatment period 52 weeks Baselineday 1randomization EOTday 364 EOSday 392 Up to 6 weeks 1:1:1 EOS, end of study; EOT, end of treatment; QD, once daily; PE, pulmonary exacerbation 40 Countries ~460 sites Patient Enrollment Initiated December 2020
◊ Between 450K – 675K asthma patients in the US (2%-3%3)may also havebronchiectasis Between 650K –9M COPDpatients in theUS (4%1-54%2)may also have bronchiectasis *Weycker, et al. Prevalence and incidence of NCFBE among US adults in 2013. Chronic Respiratory Disease. 2017;**Estimates suggest broadly similar per capita prevalence in European 5 as in US; ◊ Studies indicate lack of consensus on prevalence rates. Asia-Pacific rates 3X to ~10X higher than those in the US; Zhou, YM et al. Theprevalence and risk factors of bronchiectasis in residents aged 40 years old and above in seven cities in China. 2013† European 5 comprised of France, Germany, Italy, Spain and the United Kingdom Agusti, A., Calverley, P.M., Celli, B. et al. Characterisation of COPD heterogenecity in the ECLIPSE cohort. Respir Res. 2010; 11: 122Ni, Y., Shi, G., Yu, Y. et al. Clinical characteristics of patients with chronic obstructive pulmonary disease with co-morbid bronchiectasis: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2015; 10: 1465–1475 3. Kang HR, Choi GS, Park SJ, et al. The effects of bronchiectasis on asthma exacerbation. Tuberc Respir Dis (Seoul). 2014;77(5):209‐214.
Bronchiectasis to Potentially Serve as ‘Launch Pad’ for Neutrophil-mediated Portfolio Additional indications identified, to be announced in 1Q 2022 On track to release data in 2022
TPIP is an investigational drug product that has not been approved for any indication in any jurisdiction.
Prostanoidshave long beena cornerstone therapy for PAH, but clinical use has faced challenges related to rapid metabolism anddose-limiting tolerability issues TPIP could address the shortcomings of existing prostanoid therapies by potentially:Providing prolonged, localized pulmonary vasodilationOffering improved tolerability, with fewerprostanoid-related side effectsEnabling higher dosing for superior efficacy with the potential for disease- modifying effectSimplifying dosing with once daily administration
TPIP* is a dry powder formulation of treprostinil palmitil, a prodrug of the prostacyclin vasodilator treprostinilOnce delivered to the lung, treprostinil palmitil is hydrolyzed by endogenous esterases to active treprostinilThe inhalation device is a simple capsule-based dry powder inhaler (DPI) device manufactured by Plastiape and used with several approved products *Previously, treprostinil palmitil was formulated as a nebulized suspension (treprostinil palmitil inhalation suspension, or TPIS) TPIP is an investigational drug product that has not been approved for any indication in any jurisdiction.
Fulton Index = weight rationRight Ventricle / (Left Ventricle + Septum)Pulmonary Pressuremean Pulmonary Arterial PressureObliteration% of non-obliterated vesselsWall thicknessSmall vessel wall thicknessMuscularization% of muscularized vesselsCardiac Outputamount of blood pumped by the heartper minute
Supports the potential for improved tolerability,efficacy and convenience Safety profile was generally well tolerated, AEs were mild and consistent with inhaled prostanoidTolerability was improved with an up-titration approachFindings suggest TPIP may be safely dosed at nominal doses far in excess of TyvasoPK supports development of TPIP with once daily dosingTPIP showed substantially lower Cmax and longer half-lifethan that of TyvasoFuture studies would use an up-titration dosing schedule to the maximum individual tolerated dose exceeding 600 µg once daily from TPIP Phase 1 study
Phase 2aData expected in 1H 2022 Phase 2bSite initiation complete (late 2021) PAH PH-ILD Phase 2Study initiation expected early 2022
IV or Subcutaneous Inhaled (nebulized) Oral Oral Inhaled(dry powder) Continuous 4x per day 2x or 3x per day 2x per day Once daily Yes Yes Yes Yes To be evaluated in Phase 2 (encouraging preclinical & P1 data) Yes Yes Yes Yes No No Yes(but only as add-onto monotherapy) Yes To be evaluated in Phase 3 (encouraging Preclinical & P1 data) No data Yes No data No data To be evaluatedin Phase 2
Therapeutic proteinsViral capsids Transgenes Enzymes Targeting 1 new IND / YearPlans to accelerate following anticipated successful data from Pillars 1-3 ProteinDe-immunization GeneTherapyReduce viral load Improve safetyTarget rare monogenic diseases GeneEditingIn-vivo gene editingCorrective transgenes End-to-end capabilitiesReduced costs Higher yieldsLarge scale production Breakthrough ProteinManufacturing
Based on current expectations, this capital supports major data readouts as of 9/30/21 as of 9/30/21 *Excludes stock options, unvested RSUs, shares underlying outstanding convertible notes, and any shares to be issued pursuant to future milestones achieved related to recent business acquisitions
Completed enrollment in WILLOW launch NEJM publication of WILLOW data Positive preclinical data & initiated clinical studies Development in additional indications Advance into P2b for PAH Japan launch(underway) IND readycandidate PAH P2a data and PH-ILD P2 trial initiation PK/PD data in P2 for CF Advance development in additional indications Top 10 Launch
investor.relations@insmed.com 646-351-0954 We are committed to bringing forth technologies and medicines in therapeutic areas with thegreatest potential to make adifference in patients’ lives. 30
Approval has been granted in the U.S., EU, and Japan for ARIKAYCE US 4 patents issued to 2034Japan, EU, Australia, China counterpart patents issued to 2034 US, Europe, Japan, Chinain-licensed compound patent exclusivity until 2035 U.S. multiple issued patents to2035 12-year regulatory exclusivityEU patent to 203510-year regulatory exclusivityJapan patent exclusivity to 2035
300kg capacity 2mm capacity 50g capacity 10,000 capsules capacity 200L capacity To come online450L capacity
Stratified by Pseudomonas aeruginosa on sputum culture and use of macrolides EOS, end of study; EOT, end of treatment; NE, neutrophil elastase; ppFEV1, percent predicted forced expiratory volume in 1 second; QD, once daily. Phase 2 WILLOW Study: NCT03218917 Clinic visits day 1, week 2, week 4,8, 12, 16, 20 and 24/EOT 25 mg 10 mg Baseline day 1randomization EOT EOSday 169 day 197 ± 3 1:1:1 Time to first exacerbation over 24 weeks in patients with non-cystic fibrosis bronchiectasis (NCFBE) Pulmonary exacerbation rate over 24 weeks Change in QOL-Bronchiectasis questionnaire respiratory symptoms domain over 24 weeks Change in post-bronchodilatorppFEV1 over 24 weeks Change in sputum NE activity from pretreatment to on- treatment Off treatment 4 weeks Treatment period 52 weeks Up to 6 weeks
10 mg 25 mg p-value ^ 0.027 0.044 Hazard Ratiop-value ^ 0.580.029 0.620.046 Brensocatib was generally well- tolerated in the WILLOW studyMost common adverse events (AEs) in patients treated with Brensocatib were cough, headache, sputum increase, dyspnea, fatigue, and upper respiratory tract infection 10 mg 25 mg Rates of (AEs) leading todiscontinuation 10.6% 7.4% 6.7% Rates of adverse events of special interest (AESIs) Periodontal disease 2.4% 7.4% 10.1% Hyperkeratosis 0% 3.7% 1.1% Infections that were considered AESIs 18.8% 16.0% 16.9% With documented history of ≥2 pulmonaryexacerbations in prior 12 months Randomized 1:1:1 Double Blind 256 Patients Screening up to 6 weeks for sputum evaluation and periodontal evaluation 10 mg once daily 25 mg once daily Primary Efficacy: Time to first pulmonary exacerbationSecondary Efficacy:Rate of pulmonary exacerbations*Change in the Respiratory Symptoms DomainScore of the Quality of LifeBronchiectasis questionnaire Change in post-bronchodilator FEV1Change in concentration of active neutrophil elastase in sputumSafety: Tolerability (e.g., AEs and AEs of specialinterest – infection, skin, and periodontal conditions)
a Exacerbations cited by investigator as primary reason for hospitalization. 8.0% 6.1% 4.6% 0% 2% 4% 6% 8% 10% Patients (%) 10.1 7.0 6.5 0 2 4 6 8 10 12 Days (N) Exacerbation- related hospitalization rates was higher & duration of hospitalization was longer in the placebo arm
Chalmers et al, ERS International Congress 2020, 7-9 September. RCT4135 BSI, bronchiectasis severity index; FEV1, forced expiratory volume in 1 secondaBulgaria/Poland
Chalmers et al, ERS International Congress 2020, 7-9 September. RCT4135
3 (3.5) 3 (3.7) 4 (5.5) 9 (10.6) 6 (7.4) 6 (6.7) 19 (22.4) 11 (13.6) 10 (11.2) 9 (10.6) 5 (6.2) 4 (4.5) 3 (3.5) 0 4 (4.5) 67 (78.8) 75 (92.6) 74 (83.1) 10 (11.8) 15 (18.5) 12 (13.5) 3 (3.5) 8 (9.9) 12 (13.5) 6 (7.1) 9 (11.1) 9 (10.1) 2 (2.4) 3 (3.7) 9 (10.1) 9 (10.6) 5 (6.2) 4 (4.5) 9 (10.6) 5 (6.2) 3 (3.4) *Treatment emergent adverse event
1.1. Idiopathic PAH (IPAH) 1.2. Heritable 1.2.1. BMPR2 1.2.2. ALK1, ENG, SMAD9, CAV1, KCNK3 1.2.3. Unknown 1.3. Drug- and toxin-induced 1.4. Associated with 1.4.1. Connective tissue diseases HIV infectionPortal hypertensionCongenital heart diseasesSchistosomiasis1’ Pulmonary veno-occlusive disease and / or pulmonary capillary hemangiomatosis1’ Persistent pulmonary hypertension ofthe newborn Chronic obstructive pulmonary diseaseInterstitial lung diseaseOther pulmonary diseases with mixedrestrictive and obstructive patternSleep-disordered breathingAlveolar hypoventilation disordersChronic exposure to high altitudeDevelopmental abnormalities 2.1. Left ventricular systolic dysfunction 2.2. Left ventricular diastolic dysfunction 2.3. Valvular disease 2.4. Congenital/acquired left heart inflow/ outflow tract obstruction and congenital cardiomyopathies Hematologic disorders: chronic hemolytic anemia, myeloproliferative disorders, splenectomySystemic disorders: sarcoidosis, pulmonary histiocytosis: lymphangioleiomyomatosisMetabolic disorders: glycogen storage disease, Gaucher disease, thyroid disordersOthers: tumoral obstruction, fibrosing mediastinitis, chronic renal failure, segmental PH
M. R. Corboz, et al. (2017) J. Pharmacol. Exp. Ther. 363:348–357. 10XCmax 0.01 0.1 101 100 1000 10000 0 5 10 15 20 25 Lung TRE eq (ng/g) Time (h) Treprostinil Palmitil 42 μg/kg Treprostinil Palmitil 108 μg/kg Treprostinil 215 μg/kg Treprostinil Palmitil Treprostinil Inhaled TP Inhaled TP Inhaled TPInhaled TP Plasma TRE (ng/mL) Treprostinil Palmitil Treprostinil Palmitil Treprostinil Treprostinil F.G. Leifer et al. (2018) Drug Res 68: 1-10
Cmax (ng/mL) 0.089 0.958 AUC0-24(ng*h/mL) 0.614 0.872 Tmax (h) 1.02 0.258 T1/2 (h) 5.69 0.485 Han et al. (2016) Single-Dose Pharmacokinetics of C16TR for Inhalation (INS1009) vs Treprostinil Inhalation Solution. ERS International Congress, September 3-7, London, United Kingdom, abs 3505 (poster PA2303). Substantially lowerCmax than Tyvaso®Persistent plasma levels of drug beyond 12 hours consistent with sustained release Plasma Treprostinil Concentration (ng/mL) Time Since Dose (h)
225 µg QD×7 days 6 subjects QD×7 days 2 subjects 112.5 µg 6 subjects 225 µg 6 subjects 450 µg 6 subjects 675 µg 6 subjects 2 subjects 112.5 µg QD ×4 days } 6 subjects 225 µg QD ×3 days QD×7 days 2 subjects Informed by prior TPIS Phase 1 study All doses were administered using 112.5 µg capsulesTPIS: Treprostinil Palmitil Inhalation Solution TPIP: Treprostinil Palmitil Inhalation Powder QD: Quaque Die or Once-a-day Assessing safety, tolerability and pharmacokinetics of TPIP in healthy volunteersExploring dose range & identifying potential dose limiting toxicities
* Moderate TEAEs: 225 µg – 1 subject with nausea and vomiting; 675 µg – 2 subjects with hypotension, 1 subject with chest discomfort, low oxygen saturation and dyspneaIncludes all AEs that occurred in more than two subjects, as well as others of interest TEAEs were Consistent with Inhaled Prostanoid and Mostly Mild 6 (100) 6 (100) 6 (100) 6 (100) 2 (100) 26 (100) 4 (66.7) 3 (50.0) 4 (66.7) 6 (100) 0 (0.0) 17 (65.4) 0 (0.0) 1 (16.7) 0 (0.0) 3 (50.0) 0 (0.0) 4 (15.4) 1 (16.7) 1 (16.7) 2 (33.3) 3 (50.0) 0 (0.0) 7 (26.9) 0 (0.0) 1 (16.7)* 2 (33.3) 1 (16.7) 0 (0.0) 4 (15.4) 0 (0.0) 1 (16.7) 1 (16.7) 2 (33.3)* 0 (0.0) 4 (15.4) 0 (0.0) 0 (0.0) 1 (16.7) 1 (16.7) 0 (0.0) 2 (7.7) 0 (0.0) 1 (16.7)* 0 (0.0) 0 (0.0) 0 (0.0) 1 (3.8) 2 (33.3) 2 (33.3) 3 (50.0) 4 (66.7) 0 (0.0) 11 (42.3) 2 (33.3) 2 (33.3) 1 (16.7) 0 (0.0) 0 (0.0) 5 (19.2) 1 (16.7) 0 (0.0) 1 (16.7) 1 (16.7)* 0 (0.0) 3 (11.5) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7)* 0 (0.0) 1 (3.8) 0 (0.0) 0 (0.0) 0 (0.0) 1 (16.7) 0 (0.0) 1 (3.8)
* Moderate TEAEs: 225 µg – 1 subject with chest discomfort (subject discontinued day 2), 1 subject with throat irritation (day 2-7), 1 subject with syncope (day 1)Includes all AEs that occurred in more than two subjects, as well as others of interest 5 (83.3) 6 (100) 4 (100) 15 (93.8) 6 (100.0) 4 (66.7) 2 (50.0) 12 (75.0) 3 (50.0) 0 (0.0) 0 (0.0) 3 (18.8) 4 (66.7) 2 (33.3) 0 (0.0) 6 (37.5) 3 (50.0) 1 (16.7) 0 (0.0) 4 (25.0) 2 (33.3) 1 (16.7) 0 (0.0) 3 (18.8) 1 (16.7)* 0 (0.0) 0 (0.0) 1 (6.3) 1 (16.7) 0 (0.0) 0 (0.0) 1 (6.3) 1 (16.7) 0 (0.0) 0 (0.0) 1 (6.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 6 (100.0) 1 (16.7) 2 (50.0) 9 (56.3) 1 (16.7)* 0 (0.0) 0 (0.0) 1 (6.3) 1 (16.7) 1 (16.7)* 2 (33.3) 0 (0.0) 4 (25.0) Lower TEAEFrequency with Titration and Mostly Mild
Current PAH LandscapePrevalence of PH[1] WHO Group 1[2][in U.S. as of 2019] New PH OpportunitiesPrevalence of PH ILD[4]& PH COPD[5] in WHO Group 3[2][in U.S. as of 2019] Opportunities Beyond PHPrevalence of Chronic Fibrosing ILD[2] [in U.S. as of 2019] Chronic Fibrosing ILD Patients >100,000 Patients in U.S. PAHPatients >45,000 Patients in U.S. >130,000 Patients in U.S.Slide information sourced from United Therapeutics November 2020 Corporate Presentation 35%FC III[3] 6%FC IV[3] 17%FC I[3] 42%FC II[3] PAHPatients ~30,000PH ILD ~100,000PH COPD >100,000CHRONIC FIBROSING ILD [1] PH – Pulmonary Hypertension [2] Estimated patient populations based on United Therapeutics internal market research [3] The World Health Organization [WHO] created a system of four functional classes [FC] for patients with PAH. Class I means fewer symptoms and less restriction of activity. Class I symptoms are considered the least severe, and Class IV symptoms the most severe. [4] ILD=Interstitial Lung Diseases. [5] COPD ] Chronic Obstructive Pulmonary Disease