D-4517.2

Ophthalmology Pipeline Represents a Paradigm Shift in Treatment

THE NEED

  • Over 10M eye injections per year = Heavy treatment burden on patients and doctors
  • Approved and prospective drugs require a retinal ophthalmologist, a caregiver to drive to/from visits, and an expensive treatment

OUR SOLUTION

  • Patient administers drug at home with autoinjector subcutaneously up to once per month (potential for oral administration)
  • Market Research = > $3.5 B peak US sales
    • 51 US retinal ophthalmologists, 5 payers

    • Discount to Eylea, rebates, market access (conservative)

    • Patient market research ongoing

  • Lower cost – manufactured at up to 1/10 the cost of other approaches

HD Targets Ocular Neovascularization After Systemic Dose

D4517-effects
  • After systemic dose, uptake ONLY in activated cells in regions of inflammation
  • Crosses blood retinal barrier in monkeys, mice & rats
Selectively treating intracellular mechanisms of angiogenesis

D-4517.2: First-in-Class Home Administered Wet AMD Therapy

Mouse Laser CNV Model: Single Subcutaneous or Oral D-4517.2 Dose on Day 1

CNV Area (µm2) at Day 14

Once Every 2+ Weeks or Oral

  • D-4517.2 at 2 mg/kg (40 µg) subcutaneous (SC) dose equivalent to Eylea (aflibercept) intravitreal (IVT) dose (40 µg) at Day 14

  • Oral D-4517.2 doses equally or more effective

  • Human doses to achieve equivalent effect are safe and well tolerated

Our Approach

  • Patient administers drug at home with autoinjector up to once per month
    (potential for oral administration)

Market Expansion

  • Patients in rural areas receive convenient treatment (especially parts of China and India)
    • Diabetic patients maintain compliance (treated for decades)
    • Treatment of earlier stage of AMD
  • Lower cost – manufactured at up to 1/10 the cost of other approaches

D-4517 Alters Pharmacology through Non-Cleavable Dendrimer

Sunitinib (Sutent™) D-4517
Liver toxicity (decreased size/increased ALT/AST) No observed effect
Proteinuria, decrease in kidney size (males) No observed effect
Hypoglycemia (females) No observed effect
Decrease in heart size (males) No observed effect

Same sunitinib exposure in both groups

D-4517

proprietary Sunitinib analog

D-4517.2: Safety Established in Healthy Humans

Phase 1, Single Dose – SC Doses Up to 1 mg/kg

Study Objectives:

Complete safety, PK, metabolism, clearance and safety of single SC dose administration in adult subjects

Study Results Summary:

  • Safe and well tolerated with only mild transient injection site reactions in a few patients (technique related)
  • No changes in safety labs
  • PK translates to effective doses in preclinical models

D-4517.2: Phase 2 Proof of Concept in Wet AMD and DME Patients

Single Dose Study

Study Objectives:

Safety and pharmacodynamic activity (based on fluid level and visual acuity) of single SC dose administration in adult subjects with wAMD and DME

Study Results Summary:

  • Safe and well tolerated
  • No changes in safety labs
  • Fluid level and visual acuity measurements suggest that SC D-4517.2 localizes to and is active in the eye
  • Results support initiation of treat-to-maintain study paradigm with chronic dosing

Chronic Dose Study

Study Objectives:

The primary objectives of the study are to evaluate the safety and tolerability of multiple D-4517.2 subcutaneous doses and the ability of different D-4517.2 dose regimens to maintain fluid level and visual acuity following a single intravitreal anti-VEGF treatment. An important metric for assessing the clinical benefit of D-4517.2 in this treat-to-maintain paradigm is the time to anti-VEGF rescue following the initial dose.

Study Results Expected in First Half of 2024

TIMELINES

  • Stage 1, Phase 2 LPI in 1H 2023

  • Stage 1, Phase 2 data in 2H 2023
  • Stage 2, Phase 2 FPI in 2024

Launch wet AMD Stage 2 and Separate DME Phase 2 in Parallel

Projected Product Launch = 2028

D-4517.2 Commercial Assessment

D-45172-Commercial Assessment