Patient Inspired Science
Establishing a leading, rare and orphan disease-focused biopharmaceutical company to deliver impactful new medicines to patients
Oppenheimer Virtual Healthcare Conference
March 17, 2021 (Live Presentation)
17 March | 2021
Forward-Looking Statements
This presentation may include forward-looking statements made pursuant to the Private Securities Litigation Reform Act of 1995. Forward-looking statements are statements that are not historical facts. Such forward-looking statements are subject to significant risks and uncertainties that are subject to change based on various factors (many of which are beyond Cerecor, Inc. ("Cerecor") control, which could cause actual results to differ from the forward-looking statements. Such statements may include, without limitation, statements with respect to Cerecor's plans, objectives, projections, expectations and intentions and other statements identified by words such as "projects," "may," "might," "will," "could," "would," "should," "continue," "seeks," "aims," "predicts," "believes," "expects," "anticipates," "estimates," "intends," "plans," "potential," or similar expressions (including their use in the negative), or by discussions of future matters such as: its 2021 outlook; the development of product candidates or products; potential attributes and benefits of product candidates; strategic alternatives for neurological assets and Millipred; and other statements that are not historical.
These statements are based upon the current beliefs and expectations of Cerecor's management but are subject to significant risks and uncertainties, including: reliance on and integration of key personnel; drug development costs, timing and other risks, including reliance on investigators and enrollment of patients in clinical trials, which might be slowed by the COVID-19 pandemic; regulatory risks; Cerecor's cash position and the need for it to raise additional capital; risks related to potential strategic alternatives for its neurology assets and Millipred; general economic and market risks and uncertainties, including those caused by the COVID-19 pandemic and those other risks detailed in Cerecor's filings with the Securities and Exchange Commission. Actual results may differ from those set forth in the forward-looking statements. Except as required by applicable law, Cerecor expressly disclaims any obligations or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein to reflect any change in Cerecor's expectations with respect thereto or any change in events, conditions or circumstances on which any statement is based.
+ Orphan Drug Designation, Rare Pediatric Disease Designation; Eligibility for Priority Review Voucher upon approval ‡ Fast Track Designation
CERC-002
Anti-LIGHT monoclonal antibody in clinical studies for COVID-19 ARDS and Severe Pediatric-onset Crohn's Disease
Executive Summary - Final Data Analysis
Phase 2 Clinical Trial Met Primary Endpoint in Patients Hospitalized with COVID-19 ARDS
• CERC-002 significantly reduced respiratory failure and mortality in Phase 2 clinical trial in patients hospitalized with COVID-19 ARDS
- This analysis updates the preliminary topline data reported on January 5, 2021, and is inclusive of 60-day safety data
- Hospitalized COVID-19 patients treated with a single dose of CERC-002 demonstrated statistically significant improvement in the primary endpoint (proportion of patients alive and free of respiratory failure over the 28-day study period) compared to placebo (n=62, p=0.044)
- Efficacy was highest in a prespecified subpopulation of patients over the age of 60 (n=34, p=0.042), the population most vulnerable to severe complications and death with COVID-19 infection
- At both the 28-day and the 60-day final timepoints, an approximately 50% trend in mortality reduction (22.5% vs 10.8%) was observed
- CERC-002 showed statistically significant efficacy on top of corticosteroids and standard of care in COVID-19 ARDS (>90% of patients in the trial received corticosteroids and >65% received remdesivir)
• CERC-002 was well tolerated with no appreciable differences in immunosuppression or other SAE between CERC-002 and placebo
• CERC-002 dramatically and rapidly reduced serum free-LIGHT levels
- ~85% reduction in free LIGHT achieved in 1 day
• Cerecor has applied for Breakthrough Therapy and Fast Track Designations, and plans to meet with FDA to discuss potential path to Emergency Use Authorization
• Additionally, the company is exploring the applicability of CERC-002 in non-COVID-19 ARDS
LIGHT is Potentially a Key Driver of the Inflammatory Response in Cytokine Storm in ARDS
LIGHT Releases Inflammatory Cytokines and Activates Both T Cells and B Cells
HVEM-mediated Signaling Pathways
Activation and Proliferation of Immune Cells
T-cell | Myeloid CellsMacro-phage |
FasL
LIGHT
FasHVEM DcR3 LTβR
TL1A
DR3
Overactivation of Immune Response May Lead to Disease
Pathology
LTβR-mediated Signaling Pathways
Upregulation of Inflammatory Molecules
IL-1 GM-CSF
IL-6 CXCL5
IL-10
• Highly expressed in neutrophils and macrophages and induces airway inflammation. It also appears to exacerbate pulmonary fibrosis in patients who recover from ARDS
• A critical factor in COVID-19 cytokine storm, pulmonary failure and longer-term pulmonary fibrosis and in broader ARDS etiologies
Cytokine Storm
Pro-inflammatory Mediators and Cytokines
Recent biomarker data from hospitalized COVID-19 patients demonstrates elevated LIGHT levels, implicating its role in ARDS1
1.
Perlin et al. (2020) mSphere. 5(4):e00699-20.
CERC-002: A Novel First-in-Class Anti-LIGHT (TNFSF14) mAb
The Only Known Clinical Stage Anti-LIGHT Antibody
• In-licensed from Kyowa Kirin Co.
• Positive toxicology profile
- 8-week monkey toxicology study was well tolerated up to 100 mg/kg per week with NOAEL at 60 mg/kg
• Phase I trial previously completed
- Up to 1200 mg SQ in healthy volunteers (n=48)
without significant toxicity
• Proprietary free LIGHT assay developed in collaboration with Myriad RBM enables a biomarker-based development approach
SQ: Subcutaneous; NOAEL: No observed adverse effect level
Discovered at La Jolla Allergy Institute and Licensed by Cerecor in 2016
LIGHT is a Central Driver of COVID-19 Related Cytokine Storm
Clinical Trial Initiated After Compelling Biomarker Study Completed June 2020
Association Between Elevated LIGHT and Mortality
Strongest in Patients Over 60
P = 0.021
10000
Key Implications
FreeLIGHTLevels(pg/mL)
80001500
• In patients over 60, LIGHT levels were significantly higher in those that eventually died than in those patients that recovered (p=0.021)
1000
500
• Observed mortality rate was higher for patients over 60 of age (82%) compared to patients <60 years (32%)
0
Healthy Controls | Recovered | Deceased |
Over 60 | Over 60 | Over 60 |
(n=14) | (n=5) | (n=23) |
Elevated LIGHT levels in hospitalized COVID-19 patients were most strongly associated with mortality in patients over 60
1. Perlin et al. (2020) mSphere. 5(4):e00699-20.
2. Arunachalam et al. (2020) Science. 369(6508):1210-1220
Cytokine Storm Drives ARDS Across Etiologies
Patients may progress rapidly and often require invasive mechanical ventilation
Pre-ARDS Disease Course
ARDS Progression
COVID-19 infection Cytokine Storm Injury due to various etiologies (e.g., pneumonia, trauma, aspiration) | Mild ARDSModerate ARDSSevere ARDS All etiologies of ARDS have high unmet need, with patients presenting at any severity and frequently progressing rapidlyCOVID-19 infection is typically associated with longer duration of ventilation in severe patients |
Potential Opportunity
Treatment / Care Setting
Typically non-hospitalized for COVID-19 infection and pre-ICU for broader ARDS | Critical Care / ICUCritical Care / ICU ICU All ARDS patients are candidates for intubation, with the vast majority of moderate and virtually all severe patients requiring invasive mechanical ventilation |
Reducing LIGHT levels may limit the proportion of patients requiring invasive mechanical ventilation, which drives high cost of treatment and low quality of life in ARDS
Source: Physician Interviews; Papazian et al. Ann. Intensive Care 2019; Bhatraju et al. NEJM 2020
CERC-002 Treatment of Cytokine Storm-Induced COVID-19 ARDS
Primary Endpoint: Respiratory Failure and Mortality Over 28 Days
Proof-of-Concept Trial Design
Randomized, Double-blind, Placebo-controlled, Multi-Center, Proof-of-Concept Clinical Trial of CERC-002 in
Adults with COVID-19 ARDS
Inclusion Criteria
Hospitalized Patients with Documented
COVID-19 Infection and
Clinical Evidence of Pneumonia with
Mild to Moderate ARDS
Enrollment (N=83)
1:1 Randomization
Primary Endpoint
• The proportion of patients treated with CERC-002 compared with placebo in addition to standard of care at site, alive and free of respiratory failure over 28 days
• 80% power to show an absolute difference of 25% between cohorts
PaO2 - Partial Pressure of Oxygen, FiO2 - Fraction of Inspired Oxygen
Key Secondary / Exploratory Endpoints
• 1-month mortality
• Change in Pa02/Fi02 ratio
• Time to and duration of invasive ventilation
• LIGHT levels and other biomarkers of inflammation
• Viral load
Characteristic | CERC-002 (n=41) | Placebo (n=42) |
Age, years Mean (SD) | 59.2 (14.5) | 58.1 (14.2) |
Age Group <60 years (n, %) ≥60 years (n, %) |
| 21 (50.0%) 21 (50.0%) |
Gender Male Female | 25 (61%) 16 (39%) | 32 (76.2%) 10 (23.8%) |
Race White Black or African American Asian Other | 31 (75.1%) 7 (17.1%) 2 (4.9%) 1 (2.4%) | 37 (88.1%) 3 (7.1%) 0 (0%) 2 (4.8%) |
Free LIGHT Level at Baseline Mean (range) pg/mL | 348 (63 - 1050) | 273 (37 - 843) |
Concomitant Medication Use at Baseline* Systemic corticosteroids Remdesivir | 38 (95.0%) 26 (65.0%) | 37 (88.1%) 28 (66.7%) |
Patient Demographics
Data on file
* Calculated from patients dosed (n=40 for CERC-002, n=42 for placebo)
Free LIGHT is inhibited by Day 1 and remains low
FreeLIGHTLevels(pg/mL)
A Single Dose of CERC-002 Reduced Free LIGHT Levels Dramatically and Rapidly
comparable at baseline across cohorts
Data on file
• Mean free LIGHT levels were
• Mean free LIGHT levels were about 100 pg/mL higher in the patients ≥ 60 years-old
• Free LIGHT levels reduced quickly in the active cohort and increased in the placebo cohort
• The pharmacodynamic effect was on top of standard of care where approximately 90% of patients received systemic corticosteroids
CERC-002 Significantly Reduced Respiratory Failure and Mortality in Phase 2 Clinical Trial in Patients Hospitalized with COVID-19 ARDS
Primary Endpoint: Percentage of Patients Alive and Free of Respiratory Failure at Day 28
PercentageofPatientsAliveand FreeofRespiratoryFailureatDay28
CERC-002
Placebo
Overall (n=62)
Age ≥ 60 years
Age < 60 years
(n=34)
(n=28)
Efficacy was highest in patients over the age of 60* (n=34, p=0.042), the population most vulnerable to severe complications and death with COVID-19 infection
Data on file
* Prespecified analysis
A Single Dose of CERC-002 Reduced Mortality by ~50% in this Study
CERC-002 | Placebo | |
28-day Mortality | 7.7% | 14.3% |
60-day Mortality | 10.8% | 22.5% |
• A trend in ~50% reduction in mortality was observed at both the 28-day and the 60-day timepoints
• Efficacy observed is on top of corticosteroids and standard of care - (>90% of patients in the trial received corticosteroids and >65% received remdesivir)
Data on file
Safety and Tolerability
• CERC-002 was well-tolerated at a single dose of 16 mg/kg
• No serious adverse events attributable to CERC-002
• Majority of AEs judged to be mild or moderate
• No evidence of increased infections or adverse events related to immunosuppression
CERC-002 (n=40)
Placebo (n=42)
Subjects with ≥1 AE (%) Subjects with ≥1 Drug-related AE
16 (40%) 8 (20%)
21 (50%) 6 (14.3%)
AEs > 5%
Leukocytosis Anemia
Hepatic enzyme increase Acute kidney injury Respiratory failure
6 (15%)
4 (10%)
4 (10%)
3 (7.5%)
3 (7.5%)
4 (9.5%)
3 (7.1%)
2 (4.8%)
2 (4.8%)
3 (7.1%)
Data on file
COVID-19 and Broader ARDS Target Populations
COVID-19 ARDS provides a potential path to treat a larger patient population in broader ARDS
U.S. COVID-19 Related ARDS PatientsEstimated U.S. Broader ARDS Patients
Excluding COVID-19
COVID-19ARDSIncidence
Time
DiagnosedBroaderARDSIncidence(K)
2019 2020 2021 2022 2023 2024 2025 2026
There is a large market opportunity and high unmet need for effective therapy in cytokine storm induced ARDS beyond COVID-19
Source: Rubenfeld et al. N Engl J Med. 2005, 353(16):1685-93. Kissler et al. Science. 2020. UpToDate
Next Steps
• Applied for FDA Breakthrough Therapy and Fast Track Designations
• Plan to meet with FDA to discuss potential path to Emergency Use Authorization
• Manuscript in preparation with plan to present full data at a future scientific meeting
• Currently exploring the applicability of CERC-002 in non-COVID-19 ARDS
CERC-007
Phase 1b anti-IL-18 monoclonal antibody for Multiple Myeloma and Still's Disease (AOSD and sJIA)
Multiple Myeloma Is The Second Most Common Blood Cancer Globally
MM is characterized by the neoplastic proliferation of plasma cells with the overproduction of monoclonal proteins or M-proteins
A progressive disease with both cell-autonomous genetic abnormalities, and microenvironmental changes contributing to the growth of the malignant neoplasm2
Multiple Myeloma (MM) Pathophysiology
1NCI SEER Website; 2Palumbo. NEJM. 2011; 3ClearView Analysis 2017.
Patient PopulationSigns and SymptomsTreatment ApproachPrognosis
Disease Overview
• Prevalence in U.S. ~140,0001
• Occurs in older people (median age at diagnosis is 69) 1
• 35% of patients are younger than 651
• Majority may present with anemia, bone pain or elevated creatinine while fatigue, hypercalcemia, and weight loss observed in a minority of patients2
• MM is treated with at least one of three main classes of agents, utilized in combination across all lines of therapy3:
• Immunomodulators - Revlimid®, Pomalyst®
• Protease inhibitors - Velcade®, Kyprolis®
• Anti-CD38 - Darzalex®, Sarclisa®
• Estimated 5-year survival is ~50% in the U.S., though specific genetic deletions such as 17p may be associated with shorter survival1
First-in-Class Anti-IL-18 High Affinity Monoclonal Antibody
Data from phase 1 study demonstrated favorable PK and safety profile
• In-licensed from Medimmune / AZ
• Potent and durable IL-18 inhibition
- Evaluated in phase 1 SAD for COPD (n = 31)
- IV doses of 10, 30, 100, 300 or 1000 mg
- Well-tolerated
• Phase 1b asset
- 13-week monkey tox completed
- Frozen, unformulated bulk material available to support clinical proof-of-concept in patients and nonclinical 6-month chronic tox studies
Data on file: AstraZenaca
Strong Potential in Multiple Myeloma
IL-18 Levels Are Elevated in Many MM Patients and Correlate with Poor Survival
(n=69)
(n=76)
• Patients with high IL-18 have significantly worse median survival (42 months vs. >84 months, p value= 0.0026, HR = 1.84)
• Reducing IL-18 levels prolongs survival in rodent models of multiple myeloma
Source: Nakamura Cancer Cell. 2018. 33(4):634-648.e5
CERC-007 Treatment of Patients with Resistant and Refractory Multiple Myeloma
Initiating Trial in Multiple Myeloma as a Single Agent with Plans for Combination
Proposed Dose Escalation and Expansion Trial Design
A Multicenter, Open-Label, Dose-Escalation Phase 1b Study of CERC-007 in Subjects with Relapsed or
Refractory Multiple Myeloma
Inclusion Criteria
Patients with treatment resistant and refractory multiple myeloma had exposures to IMIDs, Proteasome inhibitors and anti-CD38 mAb
No more than 4-6 lines of therapy
Estimated Enrollment: Dose Escalation ~ 14 Expansion Phase = 14
Primary Endpoint
• Establishment of RP2D in Dose Escalation Phase
• Response rate by International Myeloma Working Group criteria at 8 weeks in Expansion Phase
Key Secondary / Exploratory Endpoints
• Change in SPEP from baseline
• Safety and tolerability
• Change in IL-18 levels in blood and bone marrow
• Change in Myeloid derived suppressor cells in bone marrow from baseline to 8 weeks
MM initial cohort successfully completed 1Q 2021
Proof of concept top line data anticipated 2H 2021
RP2D - Recommended Phase 2 Dose, SPEP - Serum Protein Electrophoresis
• Rare disease with estimated U.S diagnosed prevalence of 3,500 to 7,0001
• Symptoms include fever, rash, pharyngitis, arthritis, liver disease, increased ferritin
• No definitive genetic or infectious cause
• ~40% have severe chronic disease2
• Treatment: NSAID, steroids, immunosuppressants and anti-IL-1
Adult-Onset Still's Disease (AOSD) Overview
1. ClearView Healthcare Partners Analysis, May 2017
2. Gerfaud-Valentin et al. (2014) Autoimmun Rev. 13(7):708-22.
3. Figure from Kudela et al. (2019) BMC Rheumatol. 3:4.
Systemic Juvenile Idiopathic Arthritis (sJIA) Overview
• Rare childhood onset disease with estimated U.S. diagnosed prevalence of 4,500 to 6,5001
Serum IL-18 Levels Significantly Elevated in sJIA Patients
• Intermittent fever, rash and arthritis; often splenomegaly, lymph nodes
• Autoinflammatory disease - not autoimmune
- IL-1, 6, 18 other cytokines important in the pathogenesis
• Treatment: NSAID, DMARDS and Targeted Therapies (anti-IL-1 and anti-IL-6)
- Significant number of refractory patients
1. ClearView Healthcare Partners Analysis, May 2017
2. Figure from Kudela et al. (2019) BMC Rheumatol. 3:4.
Proof-of-Concept Clinical Data: IL-18 Binding Protein Demonstrates Efficacy Response in Patients with AOSD
IL-18 Binding Protein Response Rates
• AB2 Bio clinical proof-of-concept in
PercentageofResponders
Patients Received Subcutaneous Administration of 80 or 160 Mg
AOSD (n = 23) using IL-18 binding protein (T1/2 = 40 h)
- >50% of AOSD patients treated with
IL-18bp achieved response
• Serum IL-18 correlates with disease severity - 4/4 patients with undetectable serum
IL-18 had a clinical response
Three Times per Week
Gabay et al. Ann Rheum Dis. 2018. 77(6):840-847
Response defined as an improvement of joint count (both Swollen Joint Count (SJC) and Tender Joint Count (TJC) according to a 44-joint assessment) by ≥20% from baseline values, and a 70% decrease of CRP levels compared with baseline values (or reduction to normal levels) or normalization of ferritin
CERC-007 Treatment of Patients with Adult Onset Still Disease
Potential best-in-class and first-in-class anti-IL-18 mAb
Proposed Proof-of-Concept Trial Design
A Multicenter, Phase 1b Study of CERC-007 in Subjects with Active Adult Onset Stills Disease
Inclusion Criteria
• Patients with active AOSD as measured by high fever, elevated CRP and ferritin
• Failed on NSAIDS and Corticosteroids
Estimated Enrollment: N = 12
CERC-007 14 mg/kg (max 500 mg) q 4 weeks
(n=6)
Primary Endpoint
• Reduction of CRP by at least 50% and elimination of fever for > 48 hours
12 weeks
12 weeks
Key Secondary / Exploratory Endpoints
• Change from Baseline DAS score, modified Pouchet score, and DAS-CRP
• Change in CRP, Ferritin, and ESR
• Change in IL-18 levels
• Safety and tolerability
AOSD initial data anticipated 2Q 2021
CRP - C Reactive Protein, DAS - Disease Activity Score,
CERC-006
Phase 2-ready, Dual mTORC 1/2 small molecule inhibitor for Complex Lymphatic Malformations
Complex Lymphatic Malformations Are a Family of Potentially Life-threatening Congenital Diseases
• Fluid accumulation in limbs, abdomen, and chest which can lead to major disability and death
• Complex lymphatic malformations are not readily treatable by sclerosing agents or surgery many times due to their complexity and location
Source: Figure adapted from Brouillard et al. (2014) J Clin Invest. 124(3):898-904
• Neoplastic lesions caused by mutations in PI3K/AKT/mTOR pathway
• Leads to local proliferation of lymphatic endothelial cells and perturbation of lymph flow
High Potency, Second Generation, Dual Inhibitor of mTORC1/2
Potential for improved efficacy and tolerability
• In-licensed from Astellas
• Phase 2-ready asset
- 4-week nonclinical tox studies completed
- Previously studied in Phase 1 MAD (n = 128)
- Development discontinued upon determination that target efficacious doses were above MTD (30mg QD)1
- Significantly lower doses than MTD likely required to treat complex lymphatic malformations
• Dual mTOR inhibitor maximizes impact of mTOR blockade, as mTORC2 is insensitive to rapalogs
- Orally available, ATP-competitive kinase inhibitor;
IC50 = 22 nM and 65 nM for mTORC1 and mTORC2, respectively2
1 Mateo et al. Br J Cancer. 2016, 114(8):889-96.; 2 Bhagwat et al. Mol Cancer Ther.2011, 10(8):1394-406
Off-label Use of mTOR Inhibitor Sirolimus in LM
Open-label clinical studies support efficacy, however use is limited by tolerability issues and lack of FDA approval
• Phase II trial enrolled patients with complicated vascular anomalies1
- Study enrolled patients with different subtypes of LM not controlled by previous medication, sclerotherapy and/or surgery
- Sirolimus was administered orally for 12 courses of 28 days each
- 57 patients were evaluable for efficacy at the end of course 6, and 53 were evaluable at the end of course 12
• Safety and tolerability profile leads to low compliance, requires frequent monitoring - Physicians reported that sirolimus causes high rates of stomatitis (~60%)
- Sirolimus bears black box warning for immunosuppression and malignancies
Overall Response Complete Response Partial Response Progressive Disease
6-month (n=57)
12-month (n=53)
Grade 2 or > AEs
0 47 (83%)
0
• Blood/bone marrow (50%)
45 (85%)
• Gastrointestinal (55%)
1 Adams et al. Pediatrics. 2016, 137(2):e20153257.
CERC-800s
Monosaccharide therapy for Congenital Disorders of Glycosylation (CDGs)
Congenital Disorders of Glycosylation (CDG):
Life-Threatening, Ultra-Rare, Inborn Errors of Metabolism (IEMs)
Impaired glycoprotein production and function can simply be restored with substrate supplementation therapy
• Glycosylation is essential for protein structure & function, particularly for circulating proteins and enzymes such as hormones and coagulation factors
• Currently approximately 150 CDGs identified
• Due to a genetic mutation, CDG patients lack the ability to synthesize functioning glycoproteins
• Life-threatening multi-system diseases: failure to thrive, developmental delay, hypotonia, neurologic abnormalities, hepatic disease, and coagulopathy
• Administration of therapeutic doses of specific monosaccharides targeted to specific CDGs can partially restore impaired glycoprotein production resulting in a meaningful clinical benefit
- PGM1-CDG: D-galactose supplementation1
- MPI-CDG: D-mannose supplementation2
- LAD-II (SLC35C1-CDG): L-fucose supplementation3
1Wong et al. (2017) Genet Med. 19(11):1226-1235. 2Harms et al. (2002) Acta Paediatr. 91(10):1065-72. 3Marquardt et al. (1999) Blood. 94(12):3976-85. 33|
Pharmaceutical Grade Treatments for CDGs
Opportunity to be the first FDA approved drugs for CDGs
• Established therapeutic POC
• GMP manufacturing and FDA approval will ensure quality and consistency
• Potential for reimbursement
D-GalactoseD-MannoseL-Fucose
*All three CERC-800 compounds granted RPDD prior to September 30, 2020; eligible for Priority Review Voucher upon approval
Highlights Through 2022
Multiple catalysts and 4 potential PRV awards from first-in-class medicines for diseases with no approved treatment options
CERC-002: COVID-19 ARDS TOP LINE DATA1
Potential EUA1
CERC-002: Severe Pediatric Onset Crohn's Disease Proof-of-Concept Initial Data
CERC-800sCERC-002
CERC-007
CERC-006
PRV Award
* PRV Eligible 1 COVID-19 Related ARDS; additional pivotal study will be run if necessary 2Broader ARDS. EUA: Emergency Use Authorization
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Cerecor Inc. published this content on 17 March 2021 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 17 March 2021 13:31:03 UTC.