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2015 ANNUAL REPORT

2015 ANNUAL REPORT - Remedy Pharmaceuticals · 2019-07-30 · 2015 ANNUAL REPORT. To Shareholders and Friends: ... preventing edema in severe stroke, the company held an advisory

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Page 1: 2015 ANNUAL REPORT - Remedy Pharmaceuticals · 2019-07-30 · 2015 ANNUAL REPORT. To Shareholders and Friends: ... preventing edema in severe stroke, the company held an advisory

2015 ANNUAL REPORT

Page 2: 2015 ANNUAL REPORT - Remedy Pharmaceuticals · 2019-07-30 · 2015 ANNUAL REPORT. To Shareholders and Friends: ... preventing edema in severe stroke, the company held an advisory

To Shareholders and Friends:

At REMEDY PHARMACEUTICALS, our passion and purpose is to help people afflicted with Central Nervous System (CNS) related edema to not only survive, but live life to the fullest.

CNS-related edema can occur in ischemic stroke, traumatic brain injury, subarachnoid hemorrhage, spinal cord injury, intracerebral hemorrhage, and following neurosurgery, as well as in other ischemic and traumatic CNS injuries.

Sadly, little effective treatment is currently available to care for this large and growing patient population. Thus, an abundant opportunity exists for CIRARA™ - a drug specifically designed to prevent CNS-related edema - to lower mortality, improve patient quality of life, and reduce overall healthcare costs.

Our research estimates the total served market worldwide for treating CNS-related edema to be $25 billion.

A BRIEF REVIEW OF 2015

2015 was a seminal year for REMEDY with the attainment of several critical clinical and corporate milestones. We’re excited to highlight our accomplishments from this past year and look forward to 2016 and beyond.

The crowning achievement in 2015 was the completion of GAMES-RP, our landmark phase 2 randomized, double blind, placebo-controlled study of CIRARA in severe stroke patients at risk for life threatening edema.

The purpose of GAMES-RP was to demonstrate the safety and efficacy of CIRARA in treating edema caused by severe ischemic stroke. Cerebral edema, or brain swelling, is the presence of excessive fluid in the spaces of the brain. The brain is especially susceptible to injury from edema because it is located within the confined space of the cranium. Accord-ingly, if not treated, cerebral edema may cause destruction of brain structures, and death. In the first week of an ischemic stroke, 78% of all deaths are attributable to edema. It follows then that the prevention or lessening of edema reduces mortality.

When a stroke occurs, Sur1-Trpm4 channels are expressed and open due to energy depletion, permitting sodium to flow in; intracellular water then follows, causing cell damage and cell death. This remarkable discovery, namely the existence of the Sur1-Trpm4 channel and its role in edema, was made by our Scientific Founder, Dr. J. Marc Simard (more on Dr. Simard later in this letter). Endothelial cell damage through this mechanism leads to dysfunction in the blood brain barrier (which is most pronounced in larger strokes), resulting in further swelling and in some cases, hemorrhaging.

CIRARA’s anti-edema effect as a potent blocker of Sur1-Trpm4 channels to prevent brain swelling through this mechanism, was documented in an earlier two center, 10-patient open label study of CIRARA in severe stroke patients at a high risk for life threatening swelling - GAMES-Pilot - which exhibited a survival rate of 90% versus 35% for a case-matched control group. GAMES-RP was designed to expand upon what was learned in that pilot trial, scaled to a larger sample size, with a control arm, and involving many more centers.

GAMES-RP was conducted at 18 leading medical centers in the United States. In alphabetical order they are: Abington Memorial Hospital, Abington, PA; Cleveland Clinic, Cleveland, OH; Maine Medical Center, Portland, ME; Massachusetts Gen-eral Hospital, Boston, MA; Medical University of South Caroli-na, Charleston, SC; Northwestern Memorial Hospital, Chicago, IL; Oregon Health & Science University Hospital, Portland, OR; Ohio State University/Wexner Medical Center, Columbus, OH; Rutgers (Robert Wood Johnson University Hospital), New Brunswick, NJ; Stanford University Medical Center, Stanford, CA; UMASS Memorial Medical Center, Worcester, MA; University of Arizona Medical Center - University Campus, Tucson, AZ; University of Florida, Jacksonville, FL; University of Louisville Hospital, Louisville, KY; University of Maryland Medical Center, Baltimore, MD; University of Utah Healthcare, Salt Lake City, UT; UPMC Presbyterian Hospital, Pittsburgh, PA; and Yale-New Haven Hospital, New Haven, CT.

GAMES-RP enrolled 77 patients randomized and treated Per Protocol, 41 in the CIRARA arm and 36 in the placebo arm. The average NIH Stroke Score (a clinical measure of stroke severity) was 20 in the CIRARA group and 20.5 in the placebo group. The average MRI-derived Diffusion Weighted Imaging (DWI) lesion volume was 157 cc in the CIRARA group and 162 cc in the placebo group. In other words, these were critically ill patients with large strokes and poor expectations of survival.

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As reported last October during an exclusive 75-minute ses-sion at the Neurocritical Care Society Annual Meeting, 90-day mortality in the CIRARA group was greatly reduced; midline shift was halved; CIRARA-treated subjects had across-the-board improvements in modified Rankin Scale (mRS); and there were no safety issues.

VALUE OF THE SERVED MARKETS FOR BRAIN EDEMA

PERCENTAGE OF ISCHEMIC STROKE PATIENTS THAT DIE OF EDEMA

Here are selected study results, as previously reported:

Of the 77 patients in the primary analysis, there were 19 deaths within the first 30-day period, 6 of 41 in the CIRARA group (15%), versus 13 of 36 (36%) in the placebo group (p=0.03), corresponding to a reduction in mortality of 60%. Within the 90-day follow up period, there were a total of 20 deaths, 7 of 41 subjects in the CIRARA group (17%), versus 13 of 36 (36%) in the placebo group (p=0.06), a reduction in mortality of 53%.

One of the most striking outcomes of the study was midline shift (MLS) measured at 72 hours after stroke. As the affected hemisphere of the brain swells following a large ischemic stroke, its space-occupying effect can lead to midline shift, where, as the name implies, the injured hemisphere of the brain shifts past the midline, pushing into and compressing the other hemisphere of the brain. This shift directly results in

altered consciousness and when severe enough, can result in coma and death.

Consistent with CIRARA’s mechanism of action, there was a 50% reduction in edema measured by MLS at 72-96 hours. CIRARA-treated patients had a mean MLS of 4.4mm versus 8.8mm in the placebo group (p=0.0006). This is considered portentous, as past studies have shown that MLS above 5mm predicts poor neurological and functional outcomes due to compression of the brain stem and eventual herniation of the brain.

What’s very exciting is that the halving of MLS in the CIRARA group, validates the mechanism of action by which CIRARA works, i.e., edema reduction, providing strong evidence of exactly why mortality was reduced and functional outcomes improved.

In regards to functional outcomes, the mRS is a common outcome measure to determine the degree of disability or de-pendence in the daily activities of people who have suffered a stroke. The scale runs from 0 to 6, 0 being perfect health, and 6 indicating death. In this population of severe strokes, a mRS of 0-4 at 90 days is considered positive. 61% of the CIRARA group had a 90-day mRS of 0-4, versus 47% for the placebo group, or 29% more subjects in the CIRARA group. The median mRS in the CIRARA group was 4 versus 5 in the placebo arm.

Phase 2 studies are designed to evaluate the therapeutic ef-fect of a new drug, and confirm the initial safety established in phase 1 trials. Information gained from such studies helps de-termine the best protocol and outcome measures for a phase 3 study. GAMES-RP was no different. One of the unexpected observations from the study was the apparent randomness of decompressive craniotomy (DC), a neurosurgical procedure in which a large part of the skull is removed (and then later re-at-tached) to allow the swollen brain room to expand outward, thus preventing compression of normal brain tissue. Some 93% of the DCs were performed at only seven of the 18 study sites. Nevertheless, CIRARA improved outcomes regardless of whether patients had a DC or not.

It is generally accepted that the earlier the treatment of acute injuries, the better. A post hoc analysis showed there were 16 patients in the study who were dosed within 8 hours of onset of their stroke, equally divided between the CIRARA and placebo groups. There were no deaths in this CIRARA dosed subgroup. Half the placebo subgroup died.

As thought provoking, is that within this early-treated patient subset 75% of the CIRARA group had 90-day mRS of 0-4 vs. 25% for the placebo group. This is obviously very encourag-ing data, and we believe we have determined some modest changes to the protocol as well as numerous operational procedures that will reduce time to treatment by an hour or more in the phase 3 study.

25$BILLION

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OTHER 2015 MILESTONES

Following GAMES-RP and in pursuit of a phase 3 study in preventing edema in severe stroke, the company held an advisory board meeting in December with clinicians, trialists, statisticians and other experts in the field to review the phase 2 trial data and help refine the protocol and endpoints for a phase 3 study.

With that input in hand, the company met with consultants from CLINTREX to further evaluate and refine the protocol and endpoints. CLINTREX team members have recently served as Director of the Division of Neurologic Products (formerly the Neuropharmacologic Drug Products division) of the FDA, and Chairman of the Peripheral and Central Nervous System Advisory Committee of the FDA.

Following these two key meetings, the company requested an end-of-phase 2 meeting with the FDA in order to review the phase 2 results and discuss key aspects of the design of the phase 3 study. We expect that meeting to take place in late February or early March, which will allow us to begin steps to initiate a phase 3 study, hopefully before year end.

REDUCTION IN 90-DAY MORTALITY, CIRARA VS. PLACEBO GROUP

REDUCTION IN AVERAGE MIDLINE SHIFT, CIRARA VS. PLACEBO GROUP

To assist in these efforts, the company has made some key hires. Ann Tunstall has 25 years of experience in the healthcare industry, identifying and implementing effective regulatory and clinical development strategies for novel and repositioned pharmaceuticals and combination products. We’re very pleased, after some 10 years of working with us as a consultant, that Ann has agreed to join us as Vice President of Regulatory and Clinical Operations. Her experience covers a wide range of therapeutic areas, with a particular focus on neurological indications. Dr. Tunstall has a Ph.D. in Biomedical Engineering from the University of Texas Southwestern Med-ical Center, an M.S. in Material Science from Duke University, and a B.S. in Biomedical Engineering from Duke University.

We also welcome Tom MacAllister, JD, PhD., as a Special Advisor to REMEDY. Tom has hands-on experience in running a phase 3 acute CNS trial and has been very helpful with study design and the many other elements involved in running a clinical trial. He is a pharmaceutical executive with a PhD in molecular biology and over 25 years of experience including business development, drug discovery, preclinical and clinical development, regulatory strategy, intellectual property acqui-sition and enforcement, as well as commercialization. Tom is an attorney licensed to practice law in the Commonwealth of Virginia, the District of Columbia and before the United States Patent & Trademark Office.

With the addition of Alan Cutler to the team, we gain his over two decades of successful product research and development and commercialization experience. As Vice President of Chemistry Manufacturing and Controls, Alan will be focused on scale-up of drug manufacture and other elements of commercialization. Previously, Alan held the position of Vice President of Research and Development and Chief Scientific Officer at Three Rivers Pharmaceuticals, LLC (now Kadmon Pharmaceuticals, LLC), Senior Director of Research and Devel-opment at Ascend Therapeutics, and Senior Project Leader at DSM Pharmaceuticals Inc. Dr. Cutler also spent 18 years in various R&D and global project-leadership positions at 3M. He received his Bachelor’s Degree in Chemistry from SUNY at Buffalo and his Doctoral Degree from the University of East Anglia’s School of Chemical Sciences.

Richard Steinhart, MBA, CPA, joined us in October as Chief Financial Officer. Richard is a veteran of the biotechnology and medical device industries, with nearly 30 years of experience. Earlier in his career he was employed by MELA Sciences, Inc., as the Company’s Senior Vice President, Finance and Chief Fi-nancial Officer, Treasurer and Secretary. Prior to MELA, Richard was a Managing Director of Forest Street Capital/SAE Ventures, a boutique investment banking, venture capital, and manage-ment consulting firm focused on healthcare and technology companies. Prior to that, he was VP and Chief Financial Officer of Emisphere Technologies, Inc. His other experience includes 7 years at CW Group, Inc., one of the country’s first venture capital firms focused exclusively on medical technology and biopharmaceutical companies, where he was a General

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Partner and Chief Financial Officer. Richard began his career at Price Waterhouse (now PricewaterhouseCoopers). He holds B.B.A. and M.B.A degrees from Pace University and is a Certi-fied Public Accountant (inactive).

IMPROVEMENT IN PROPORTION OF PATIENTSWITH MODIFIED RANKIN SCALES OF 0-4

We’ve deepened our corporate board with the appointment of J. Marc Simard, M.D., Ph.D., the company’s Scientific Founder, and Professor of Neurosurgery, Pathology and Physiology at the University of Maryland School of Medicine. Dr. Simard is a board-certified clinical neurosurgeon with an active practice, specializing in vascular neurosurgery, which includes the surgery and management of patients with stroke, subarach-noid hemorrhage and other vascular lesions of the brain. He also serves as chief of Neurological Surgery at the Baltimore Veteran’s Affairs Medical Center. Dr. Simard is an experienced investigative scientist who is responsible for the original discovery of the Sur1-Trpm4 channel and for initiating the work showing involvement of the channel in acute CNS injury. Dr. Simard’s work on the Sur1-Trpm4 channel has led to the award of numerous U.S. and international patents, as well as filings for several others.

Kurt Landgraf joined our board in July. Kurt has over 45 years of commercial experience including 30 years in the pharmaceutical industry in the United States, Europe, Middle East, and Africa. He worked at DuPont from 1980 to 2000 as Director Marketing Services, DuPont Pharmaceuticals, Director Medical Products Division Europe Middle East Africa, Director DuPont Pharmaceuticals and Radiopharmaceuticals Divisions, Executive Vice President DuPont /Merck Pharmaceuticals, President and CEO of DuPont /Merck Pharmaceuticals. He was then asked to return to the DuPont Company, first as Chief Financial Officer then Executive Vice President, Chief Oper-ating Officer and Chairman of DuPont Europe. After leaving DuPont Kurt was President and CEO of the Educational Testing Service in Princeton New Jersey until 2014. Kurt is a member of the Board of Directors at the Corning and Louisiana Pacific Corporations.

Also in July, Charles Mele was appointed as a special advisor to the board. Mr. Mele currently serves as Special Counsel to WebMD Health Corp (NASDAQ: WBMD). Mr. Mele has held

senior executive positions with high growth health care com-panies in his 30-year career including Medco Containment Service, Medical Manager and Emdeon Corporation and most recently as Executive Vice President and General Counsel of HLTH Corporation, the corporate parent of WebMD.

Furthermore, we are happy to advise you that Edgar S. Woolard, Jr. has most recently agreed to act as a special advisor to the board. Ed is the former Chairman and Chief Executive Officer of DuPont. Ed spent four decades with DuPont, before retiring in 1997. As highlighted in Fortune magazine’s 2012 article, “50 Greatest Business Decisions of All Time,” it was Ed, as newly appointed Chairman of the Board of Apple who, in 1997, spearheaded the decision by the board to fire then-CEO Gil Amelio and bring Steve Jobs back to the company, thus saving Apple from likely bankruptcy. Mr. Woolard is a former director of the New York Stock Exchange Inc., Telex Communications Inc., Citigroup Inc., IBM, Bell Atlantic Delaware, and Apple. He is also a former Chairman of the Business Council.

As we expanded the Remedy team throughout the year, we also remain focused on broadening our intellectual property portfolio, an integral aspect of our commercialization strategy. Our patent portfolio currently includes 15 issued patents from five patent families covering methods of use, formulations, manufacturing, and a proprietary dosing regimen. With the issuance of our proprietary dosing regimen patent in February of this year, the company gained further exclusivity, which runs through the year 2031.

HOW CIRARA COULD HELP IN OTHER INDICATIONS

Subarachnoid hemorrhage (SAH) is a serious, often life-threatening type of hemorrhagic stroke. Estimates are that there are some 30,000 to 35,000 cases of SAH in the U.S. each year. The subarachnoid space is the area between the brain and the skull. It is normally filled with cerebrospinal fluid, which acts as a floating cushion to protect the brain. When a brain aneurysm ruptures in this space, it can lead to fluid buildup and increased pressure on the brain, causing secondary injury. Preclinical studies have shown that CIRARA reduces neuroinflammation and cognitive impairment in SAH.

Glioblastoma is an aggressive form of cancer that begins within the brain. There are 12,000 to 14,000 cases diag-nosed in the U.S. each year. Typically treatment involves surgical resection to remove the tumor. Although removal of all affected tissue is important to prevent the tumor from spreading further or from recurring, which can save or extend a patient’s life, like any invasive procedure, brain surgery can lead to complications. A small trial is in consideration to study in the pre-treatment and-postsurgi-cal use of CIRARA to prevent brain edema.

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Following the announcement of the GAMES-RP results, the company completed a $9.7 million financing. Money from this bridge round will be used to prepare for the phase 3 study in preventing edema in severe stroke and to plan and initiate phase 2 studies in other indications. In this regard we are currently evaluating a study in subarachnoid hemorrhage, as well as one in treating glioblastoma resection patients who may experience post-surgical edema.

We still look forward to data from a small Department of Defense-sponsored traumatic brain Injury (TBI) pilot study run by a third-party consortium, and while the study was severely underpowered, we hope to gain insight into the safety profile of CIRARA in TBI patients. With that information in hand, we can plan accordingly for a larger phase 2 trial in moderate to severe TBI.

As many of you are aware, the preclinical data for CIRARA in spinal cord injury (SCI) is superb, and was replicated in 2012 by an external laboratory as part of a National Institute of Neu-rological Disorders and Stroke-sponsored study. While there are only between 11,000 and 17,000 cases of acute SCI’s annually in the U.S., the impact of SCI on the individual, fam-ily and healthcare system is immense. We were approached by researchers from the Ohio State University who offered to fund a 10-patient open-label pilot study of CIRARA in SCI patients, similar to GAMES-Pilot. This study is in the process of initiating sites and recruiting patients.

REMEDY was granted Orphan Drug status for SCI and has additional Orphan Drug applications under review by the FDA. An orphan indication is a disease that affects fewer than 200,000 people in the U.S. Products that are designated as or-phan drugs receive certain advantages, such as 7-year market exclusivity, access to certain grants, and waiver of registration and other fees by FDA. Accordingly, they have become an area of significant growth and investment in the past few years.

The preclinical aspect of our approach was further developed during 2015, with a superb publication1 , which found that our target, the Sur1-Trpm4 channel, which is not constitutive-ly present in CNS tissues, is upregulated in infarcted brain cortexes, but not in non-infarcted cortexes in human brains. In other words, in examining the brains of deceased stroke victims, in the hemisphere where the stroke occurred, Sur1-Trpm4 channels were present while in the other hemisphere there were no signs of the channel. Prior molecular evidence of our target’s expression in ischemic stroke was based on animal models, and this is the first time these channels have been proven to be upregulated in human ischemic stroke.

ACKNOWLEDGING OUR SCIENTIFIC FOUNDER

Medicine often gets a bad rap. While we might sometimes complain about wait times in the doctor’s office or the increas-ing cost of healthcare, the truth is that medical science has never advanced at such a rapid pace. There are new break-throughs in medicine being made every day. Diseases

ESTIMATED ANNUAL NUMBER OF STROKEPATIENTS AT RISK FOR LIFE-THREATENING

EDEMA IN THE U.S.

NUMBER OF PEOPLE EACH YEAR GLOBALLYTHAT ARE AT RISK FOR BRAIN EDEMA

have been eradicated, lives saved, and millions of people are healthier and happier.

It wasn’t too long ago that as the weather warmed up every year, parents worried about their children contracting polio. We don’t give it a thought today. Only 20 years ago a case of the chicken pox was a rite of passage for kids. Not any more. Thanks to science, HIV/AIDS is no longer a death sentence. We’ve even made great strides in treating many forms of can-cer that, for decades, seemed to defy the best and brightest in medicine.

Sometimes innovation happens by accident, or the dint of hard work. And other times in a moment of great inspiration. Sometimes a tiny improvement comes along and other times, it’s a jaw-dropping and awe inspiring miracle. But however it happens and whatever it may be, it advances medicine and represents a step forward for mankind, and helps us under-stand ourselves and the world around us better.

In the case of CIRARA, it all started in the brilliant mind of Dr. J. Marc Simard, who, as we noted, discovered the Sur1-Trpm4 channel and its impact on brain edema. He then took his discovery further with a drug that closes the channel from

1 Mehta RI et al. Sur1-Trpm4 Cation Channel Expression in Human Cerebral Infarcts. J Neuropathol Exp Neurol. 2015 Aug;74(8):835-49.

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opening. We have Dr. Simard to thank for finding the solution to the medical mystery behind brain edema, which has stymied the medical community for far too long, taken the lives of millions of people, and burdened survivors and their families and not to mention the healthcare system. We hope to take CIRARA to market in the next few years and have the world benefit from Dr. Simard’s astonishing achievement.

LOOKING AHEAD TO 2016

We believe that 2016 is set to be a transformative year for REMEDY PHARMACEUTICALS as we advance on many import-ant fronts.

As mentioned before, we plan to meet with the FDA to review the findings from our Phase 2 study and discuss proposed protocol and endpoints for our phase 3 study. We hope to initiate steps to begin such a trial shortly thereafter.

Concurrently, we will continue to meet with investment bankers, sell-side analysts, institutional investors as well as pharmaceutical companies. We remain focused on exploring all avenues for strategic opportunities in order to finance our phase 3 study, as well as other value-creation activities.

We also look forward to expanding our participation in indus-try conferences and events. We are working to broaden our reach into other additional CNS indications, as highlighted above, and pursuing additional orphan drug status claims here and in Europe. To ensure we execute at full capacity, we will continue building out the Remedy team.

To accommodate our growing staff, and pending the signing of a lease, by midyear we look to move our offices to the National Historic Landmark Woolworth Building in New York City, once the tallest building in the world when it opened in 1913. Standing in the limestone and granite structure’s mag-nificent lobby, with its vaulted ceiling surfaced with Byzantine mosaics, cornices of gilded tracery, and the lunette murals, “Labor” and “Commerce,” all designed by famed architect Cass Gilbert (who designed the United States Supreme Court), reminds us of the importance of building a company that has lasting value.

In short, 2016 will be a busy year, but one we enter filled with excitement and energy!

IN CLOSING…

We would like to thank the patients and their families, along with the physicians, healthcare professionals and organiza-tions who placed their trust in us and participated in our clin-ical trials to date, for whom, without their support, medicine could not advance.

We also thank our investors for the faith they have placed in us, which we strive to repay through the creation of enhanced shareholder value by building a world-class CNS pharmaceuti-cal company we can all be proud of.

Finally, we are extremely grateful to our staff, board of direc-tors and consultants for their hard work and devotion to our vision, and as well as share our pledge to bring life-saving treatment to those in need. We look forward to another year of progress in making that a reality.

Thank you to all our stakeholders for being a part of this exciting journey.

Sincerely,

Sven Jacobson David GeliebterCEO Executive Chairman

PLEASE NOTE

This document contains forward-looking statements that reflect management’s current views with respect to future events. Such statements are subject to risks and uncertainties that are beyond Remedy Pharmaceuticals’ ability to control or estimate precisely. Remedy Pharmaceuticals makes no representation on the accuracy or completeness of the information presented herein, nor does it intend or assume any obligation to update any forward-looking statements to reflect events or circumstances after the date of these materials. © Copyright 2016. Remedy Pharmaceuticals. All rights reserved.

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Our lead product, CIRARA™, is a high affinity inhibitor of Sur1-Trpm4 channels designed to prevent edema in a variety of CNS-related indications.