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Kubota Pharmaceutical HoldingsFY2018 Q3 Update
November 14, 2018 Japan
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Cautionary Statement RegardingForward Looking Statements
page 2
This presentation contains forward-looking statements concerning our product development, our ability to successfully commercialize our product candidates, our technology, our competitors, our intellectual property, our financial condition and operating results and our plans for research and development programs and the timing thereof that involve risks, uncertainties and assumptions. Such forward-looking statements typically can be identified by the use of words such as “expect,” “estimate,” “anticipate,” “forecast,” “intend,” “project,” “target,” “plan,” “believe” and similar terms and expressions. These statements are based on the current estimates and assumptions of the management of Kubota Pharmaceutical Holdings Co., Ltd. as of the date of this presentation and are subject touncertainty and risks in circumstances, including, but not limited to the risk that our product candidates will not demonstrate the expected benefits and will not achieve regulatory approval or be successfully commercialized, the risk of delays in our ongoing or expected clinical trials, the risk that new developments in the intensely competitive ophthalmic pharmaceutical and device markets require changes in our clinical trial plans or limit the potential benefits of our product candidates, the accuracy of our estimates of the size and characteristics of the markets that may be addressed by our product candidates, the risk that our pre-clinical development efforts may not yield additional product candidates, and other risks and uncertainties inherent in the process of discovering and developing therapeutics and devices that demonstrate safety and efficacy. Given these uncertainties, you should not place undue reliance upon these forward-looking statements. Such forward-looking statements are subject to risks, uncertainties, assumptions and other factors that may cause our actual results to be materially different from those reflected in such forward-looking statements.Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements include, among others, those set forth in our reports on file with the Tokyo Securities Exchange and the United States Securities and Exchange Commission. The Company does not undertake any obligation to release publicly any revisions to these forward-looking statements to reflect events or circumstances after the date hereof or to reflect the occurrence of unanticipated events. All statements contained in this presentation are made only as of the date of this presentation.
“Acucela,” the Acucela logo and “Kubota” are among the registered trademarks or trademarks of Kubota Pharmaceutical Holdings in various jurisdictions.
Company Overviewand Market Environment
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Our History
page 4
Company Name Kubota Pharmaceutical Holdings, Co., Ltd.
Date of Establishment December 2015
Address Kasumigaseki Tokyu Building 4F,
3-7-1 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013 Japan
Representative Ryo Kubota, MD, PhD, Representative Executive Officer,
Chairman, President and Chief Executive Officer
Subsidiary Acucela Inc. (Seattle, Washington USA)
Apr 2002 Established Acucela Inc. in Seattle, Washington USA
Mar 2006 Relocated Acucela headquarters and R&D office to Bothell, Washington
Aug 2006 Opened the Tokyo Office in Shinagawa ward in Tokyo
Sep 2013 Relocated Tokyo Office to Shibuya ward in Tokyo
Feb 2014 Initial Public Offering on Tokyo Stock Exchange Mothers Board
Dec 2015 Incorporated a subsidiary, Acucela Japan KK (current Kubota Pharmaceutical Holdings Co., Ltd.) in Japan
Dec 2016 Completed triangle merger and redomicile transaction, and Acucela Inc. became a wholly owned subsidiary ofKubota Pharmaceutical Holdings. Kubota Pharmaceutical Holdings subsequently listed on the Tokyo StockExchange Mothers Board
We are committed to translating innovation into a diverse portfolio of drugs and devices to preserve and restore vision for millions of people worldwide.
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Our Strength
page 5
People and Strategy
▪ Executive leadership with experience in health care management, life science administration & technology
▪ Broad-skilled employee base in R&D and operations with broad industry relationships
Business Development
▪ Quick Win – Fast Fail
▪ Translational Research –Initiate pre-clinical and clinical studies, and obtain proof of concept (POC) in human
Internal Research
▪ Continue to expand ophthalmic product pipeline through internal research and seek for in-licensing opportunities
▪ Establish a total solution in ophthalmology for drugs and devices
Partnership
▪ Partner with leading universities and research institutes for collaboration and in-licensing in the U.S. and Europe
▪ Enhance our technologies by partnering with large pharmaceutical companies in and outside of Japan
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Leading Causes of Blindness
page 6
21 %
8 %
26 %
20 %
9 %
45 %
Retinitis Pigmentosa
10 %
34 %
16 %
54 %
9 %
6 %
5 %
25 %
Japan
USA
Europe
Glaucoma
AMD
Others
DR
12 %Others
DR
Glaucoma
Cataract
AMD
Others
DR
Glaucoma
AMD
33 million people blind worldwide, and 191 million people suffer from moderate and severe vision impairment (MSVI)
Retinochoroidal
Atrophy
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Global Ophthalmic Drug Market Revenue Forecast
page 7
Global market forecasted to reach $38.4B in 2027, andGlobal retinal disorder drugs market at CAGR of 6.3%
US Dollars in millions
8,556 9,209 9,811 10,466 11,275 12,048 12,149 13,066 14,09315,367 16,273 17,185 18,010
7,9297,821
7,8817,973
8,0748,217 8,389
8,5998,852
9,1469,473
9,78510,102
4,2124,256
4,3484,495
4,6814,917 5,227
5,627
6,110
6,476
6,872
7,1887,196
1,6521,738
1,8401,956
2,0852,188
2,286
2,392
2,509
2,628
2,767
2,9533,134
22,349 23,02423,880
24,89026,115
27,370 28,05129,684
31,564
33,61735,385
37,11138,442
2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027
Retinal Disorder Drugs Allergic, Inflammatory & Infective, and Dry Eye Drugs Glaucoma Drugs Other Ophthalmic Drugs
source: visiongain 2017
Research & Development Focusand Development Pipeline
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Research & Development Focus
page 9
Kubota Pharma’s R&D focus is to bridge the chasm between early discovery and late confirmatory stages, namely, the translational research stage
Discovery Translational Research Confirmatory
Internal Research / Partnerships
In-House In-House / Partnered
Target DiscoveryLead
Identification
Lead optimization /
preclinical profiling
Nonclinical Development
(GxP)
Exploratory Development (POC)
Confirmatory Development
Commercialization & LCM
$30Bannual spend in the
U.S. mainly from universities and large
pharmaceutical companies
$5B
$65Bannual spend mainly from
large pharmaceutical companies
Kubota Pharma’s Focus Area
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Gene Therapy IndicationsPre-
clinicalPhase 1 Phase 2 Phase 3 Target Market
Human Rhodopsin Retinitis Pigmentosa Worldwide
Development Pipeline
page 10
Small Molecule Compounds IndicationsPre-
clinicalPhase 1 Phase 2 Phase 3 Target Market
Emixustat HCI Stargardt Disease Worldwide
Emixustat HCI Proliferative Diabetic Retinopathy Worldwide
Compound - 2 Cataract, Presbyopia Worldwide
Compound - 3Diabetic Macular Edema,
Wet AMDWorldwide
Device Description Target Market
Remote Medical Monitoring DevicePBOS: Patient Based Ophthalmology Suite
Home-based miniature OCT (optical coherence tomography)
Worldwide
Design & Prototype
Clinical Trial & Product Eng.
Regulatory Approval
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
1st Half 2018 Accomplishments
page 11
Finance
Organization
Research & Development
Jan Gene Therapy: Secured joint development agreement for AAV viral vector with Sirion (Germany)
Jan Emixustat: Completed phase 2a clinical study for emixustat for Stargardt disease; met primary endpoint
Jan Emixustat: Completed phase 2 clinical study for emixustat for PDR; biomarker improvement shown
Mar PBOS: Clinical study initiated following IRB (Internal Review Board) approval
Jun Emixustat: A meeting was held in the U.S. to discuss Stargardt disease phase 3 clinical study design
Jun Emixustat: PDR phase 2 study data suggests improvement in macular edema
Jun Gene Therapy: Global development meeting held in Germany
Jun PBOS:Global development meeting held in Switzerland
Apr Warrant offering (approximately 2.2 billion JPY)
Jun Hiroki Maekawa joins the company as Chief Financial Officer
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
2nd Half 2018 Target Milestones
page 12
▪ Emixustatdevelopment
Initiate phase 3 clinical study for Stargardt disease using emixustat
▪ PBOS development
Complete clinical study initiated in March 2018
▪ Gene Therapy development
Initiate promoter enrichment process
Initiate capsid enrichment process
Initiate transgene optimization process
Completed in November
Completed in October
Stargardt Diseaseusing Emixustat Hydrochloride
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Stargardt Disease
page 14
20/200
20/100
20/70
20/50
20/40
20/30
20/25
• Stargardt disease is a genetically inherited disorder of the retina afflicting 1 in 8,000 to 10,000 individuals.
• Stargardt is a serious unmet medical need, with fewer than 150,000 people estimated to be patients in the U.S., Japan and Europe, combined.
• The most common form of Stargardt disease is caused by a genetic mutation of the ABCA4 gene leading to the accumulation of toxic vitamin A byproducts (primarily A2E) in the retina, which results in the gradual deterioration of photoreceptors and vision.
• There are no approved treatments for Stargardt Disease.
• There are many symptoms a person with Stargardt may experience including spots in the vision, color vision deficits, distortion, blurriness, and loss of central vision in both eyes.
• Kubota Pharma received Orphan Drug Designation from the FDA for the treatment of Stargardt disease in January 2017.
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
What Happens in the Eye with Stargardt Disease
page 15
retinal pigment
epithelium (RPE)rodscones
macula
retina
lipofuscin
toxic lipofuscin
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
The Visual Cycle (simplified)
page 16
enzyme RPE65
“vitamin A”
toxic lipofuscin
retinal pigment
epithelium
(RPE)
rod
photoreceptor
all-trans-retinalopsin
RPE rod photoreceptor
11-cis retinalprotein opsin11-cis retinal
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Solution – Emixustat
page 17
less toxic lipofuscin
Emixustat
Emixustat modulates the visual cycle by inhibiting a critical enzyme of this
pathway, retinal pigment epithelium protein 65 (RPE65). Slowing the visual
cycle reduces the availability of vitamin A derivatives (11-cis- and all-trans-
retinal) to form precursors of A2E and related compounds.
RPE
11-cis retinal
enzyme RPE65
“vitamin A”
rod photoreceptor
protein opsin 11-cis retinal
opsin all-trans-retinal
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Emixustat Reduces 11-cis Retinal and Prevents Light Damage
page 18
Emixustat
treated
ONL
ONL
ONL
light damage model
30 min
untreated
wild type
100
0 10 20minutes in dark following photobleach
30
200
300
400
rod
photo
recepto
rre
sponse
(uV
)
vehicle
0.8 mg/kg
Emixustat
Recovery of rod photoreceptor sensitivity measured by ERG
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Emixustat Reduces Lipofuscin Accumulation
page 19
wild-type
ABCA4-/-(vehicle)
ABCA4-/-
(Emixustat 3mg/kg)Modified from: Bavik C, Henry SH, Zhang Y, Mitts K, McGinn T, Budzynski E, et al.
(2015) Visual Cycle Modulation as an Approach toward Preservation of Retinal
Integrity. PLoS ONE 10(5): e0124940. doi:10.1371/journal.pone. 0124940.
A2E/reduction of lipofuscin
vehicleT0
0.03 0.1 0.30
A2E
(pm
ole
/eye
)
1.0 3.0
Reduction of A2E Accumulationday 90
25
20
15
10
5
Emixustat (mg/kg) (*p ˂ 0.05)
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Emixustat HCl Phase 2a Study for Stargardt Complete
page 20
→ Multicenter (6 clinical sites in the US), randomized, double-blind trial
22 subjects diagnosed with macular atrophy secondary to Stargardt randomly assigned to one of three treatment arms in a 1:1:1 ratio; emixustat 2.5 mg, 5 mg, and 10 mg. Subjects are orally dosed once daily in the evening for one month. Study is designed to evaluate safety, pharmacodynamics and tolerability of emixustat in subjects.
Evaluations:• Change in electrical response of the retina to a flash of
light, as measured by electroretinogram
• Percent suppression compared to baseline of rod b-wave amplitude recovery after a photobleaching light
Results:• ERG recovery after photobleaching was dose-
dependent and maximum reduction in recovery rate was more than 90% compared to baseline (see disclosure dated January 15, 2018)
• Showed safety and tolerability of emixustat with the administered doses in subjects
• Targeting initiation of Phase 3 clinical trial in 2018Q4P
erc
ent
suppre
ssio
n(%
)
Emixustat HCl
2.5 mg 5 mg 10 mg
mean
median
100
90
80
70
60
50
40
30
20
10
0
-10
-20
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Emixustat HCl Phase 3 Study for Stargardt Initiated
page 21
→ Multi-center (approximately 30 sites in 10 countries worldwide), randomized, double-masked, and placebo-controlled trial
Approximately 160 subjects diagnosed with macular atrophy secondary to Stargardt disease randomly assigned to emixustat 10 mg or placebo (2:1 ratio) once daily for 24 months.
The first patient enrolled (FPFV; first patient first visit) in this clinical study on November 7, 2018.
Primary Objective:• To determine if emixustat reduces the rate of macular
atrophy progression, in comparison to placebo, in subjects with Stargardt disease
Secondary Objectives:
• To assess changes in visual function parameters such as BCVA (best-corrected visual acuity) letter score and reading speed
emixustat
PBOS: Home-Based Remote OCT Device(Optical Coherence Tomography)
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Retinal Diseases Treatment Using OCT
page 23
• AMD and other neovascular retinal diseases are the leading cause of blindness and the number of patients is
increasing from aging.
• Anti-VEGF drugs delivering to eye through a very slender needle are current available treatment for retinal disease,
but:
➢ High cost (about 150,000 yen per injection)
➢ Repeated injection is necessary
➢ Timing of injection is different for each patient
➢ Real-time monitoring for each patient is a key for an optimal treatment
• OCT (optical coherence tomography) device is used to detect nascent disease progression, but:
➢ High cost (over 10 millions yen)
➢ Technical knowledge is required for reading
Low cost, home-based, ophthalmic self-monitoring OCT device, designed to monitor disease progression to support effective treatment regimen.
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Miniature OCT Device Solution: PBOS
page 24
Low cost, home-based, ophthalmic self-monitoring OCT device (optical coherence tomography)
Optical Coherence Tomography(OCT)Images
In its first iteration, the PBOS aims to improve treatment outcome in patients diagnosed and treated for DME, wet AMD, and other neovascular retinal diseases.
The PBOS is being designed to detect nascent disease progression and support patient re-treatment prior to irreversible vision loss due to disease progression.
• Small handheld OCT device for self monitoring by patients
• Real-time monitoring of eye disease therapy progression
• Addresses increase in demand for mobile Health applications (mHealth) in home care and remote medical care field
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Standard of Care and Unmet Needs in Neovascular Retinal Diseases
page 25
8.0
ETDRS
Letter Score
for treating
patients
4.0
ETDRS
Letter score
for treating
patients
12 Months
Fixed Monthly Injections
7.7
Number of injections per year
5.2
Number of injections per year
12 Months
Standard of Care
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Miniature OCT Device Solution: PBOS
page 26
No disease progressionDetect nascent disease
progression
PBOS
PatientSelf-Check
PatientSelf-Check
Physician
PBOSApp
PBOSApp Healthcare
Institution Access
PBOS
Using the internet, PBOS is a low-cost home-based patient self-monitoring device, designed to monitor disease progression to support effective treatment regimen.
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Example of Test Data
page 27
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
PBOS Clinical Study Completed
page 28
→ Single-center study in the U.S.
12 subjects with normal macular thickness and 20 subjects with center-involving macular edema were evaluated to measure the quality and resolution of retinal thickness assessments using PBOS.
Clinical trial initiated on March 23, 2018 (FPFV, First Patient First Visit) and completed on October 8, 2018 (LPLV, Last Patient Last Visit).
Evaluations and Results:
Between normal subjects and subjects with macular edema:
• Demonstrate reproducibility and repeatability of retinal thickness measurements
• Demonstrate ability to measure retinal thickness changes
• Demonstrate correlation of retinal thickness measurements of PBOS vs a hospital-grade OCT unit
Acucela has completed a successful clinical study that demonstrated all of the above evaluation points.
2018
Q1 Q2 Q3 Q4
Clinical Trial
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Miniature OCT Device Solution: PBOS Development Plan
page 29
▪Anticipated clinical trial completion, product engineering, and specification finalization
▪Anticipated production model build and final evaluation, and, regulatory approval (510(k))
▪Targeting commercial manufacturing readiness
Retinitis Pigmentosa using Gene Therapy (Optogenetics)
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Retinitis Pigmentosa is a Blinding Disease
page 31
• Earliest and most frequent symptom is night blindness, decreased vision or tunnel vision
• Affects roughly 1 in 5,000 people in Japan
• To date, no pharmacological treatment is available
• Progressive loss of vision in childhood leads generally to blindness by age 40
• The cause of RP is complex, with over 100 different gene mutations identified
NORMAL VISION
DECREASED VISION
TUNNEL VISION
BLINDNESS
Affects roughly 1 in 4,000 people, both in the United States and worldwide and approximately 1.5 million people worldwide are affected by the disease
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Gene Therapy Technology - Optogenetics
page 32
• This genetic mutation-independent therapy will utilize a
viral vector to transduce the ON-bipolar cells of the retina
with human rhodopsin
• Rhodopsin’s biological mechanism imparts a relatively high
level of light sensitivity for this type of therapy and as a
human protein, may minimize any immunological impact
• Recombinant adeno associated virus vectors are
considered the best and most promising gene delivery
system for therapeutic applications
• This technology has been shown to be effective at
restoring vision in blind rd-/- mice with human rhodopsin
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Gene Therapy Technology - Optogenetics
page 33
Technology allows expression of human rhodopsin in ON bipolar cells using a viral vector in retinitis pigementosa patients
• Retinitis pigmentosa patients most commonly first experience a loss of rod photoreceptor, but the other retinal cell layers remain intact
• By activating the ON-bipoloar cells with human rhodopsin, it produces a light induced visual signal in the absence of photoreceptors
• This gene therapy utilizes a viral vector to transduce the ON-bipolar cells of the retina with human rhodopsin and restore visual response
• Expression of human rhodopsin in the ON bipolar cells is expected to restore some level of light sensitivity to the patient
• Rhodopsin’s biological mechanism imparts a relatively high level of light sensitivity for this type of therapy and as a human protein, may minimize
any immunological impact
• Genetic mutation-independent therapy
Light Sensitive ON Bipolar Cells
DEAD PHOTORECEPTORS
HUMAN RHODOPSIN VIRAL VECTOR
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Gene Therapy Technology - Optogenetics
page 34
Wild type Treated Blind
• Restoration of vision in blind rd-/- mice with human rhodopsin
• Treated mice respond to video of a swooping owl like wild type control animals
Blind
distance (cm) 0 50 100 150
Wild type
Treated
source: Cehajic-Kapetanovic et al. 2015, Current Biology 25, 2111-2122
Gray screen
Owel video
p<0.01
**
**
**
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Retinitis Pigmentosa:Optogenetics Development Plan
page 35
▪Anticipated initiation of promoter and capsid enrichment, and transgene optimization programs
▪Anticipated initiation of CMC process development and pre-IND nonclinical studies
▪Targeting IND filing to initiate clinical study for patients with Retinitis Pigmentosa
FY2018 Q3 Financial Results
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Overview of FY2018 Q3: P/L (IFRS)
page 37
¥ Millions9 months ended September 30
Inc/Dec Reasons for change2017 2018
Operating revenue
ー ー ー
Expenses 2,922 2,341 △ 581
R&D 1,895 1,761 △ 135
• Increased efficiencies realized from prior yearcost savings measures
• Decreased share-based compensation expense• The completion of Phase 2 PDR study and
Phase 2a Stargardt study.
G&A 1,027 581 △ 446
• Lower personnel expenses due to cost savingsmeasures -¥237M
• Completion of the IFRS project and theRedomicile Transaction:¥ -137M
Loss from operations(△) △ 2,922 △ 2,341 + 581
Net loss(△) △ 2,794 △ 2,183 + 611
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Overview of FY2018 Q3: B/S (IFRS)
page 38
¥ Millions Dec 31, 2017 Sep 30, 2018 Inc/Dec Reasons for change
Current assets 11,673 10,229 △ 1,444
Cash and cash equivalents, and Other financial assets
11,197 9,911 △ 1,285 (※)
Non-current assets 1,724 1,610 △ 113
Other financial assets 1,566 1,462 △ 104 (※)
Total assets 13,396 11,840 △ 1,557
Current liabilities 327 400 + 74Increase in Accrued liabilities and Trade payables
Non-current liabilities 103 95 △ 8
Equity 12,967 11,344 △ 1,623• Decrease due to Net loss• Increase due to the Warrant exercise
Liabilities and Equity 13,396 11,840 △ 1,557
(※)Total Cash and cash equivalents, and Other financial assets
12,763 11,373 △ 1,390• Operating CF: ¥ -2,028M• Warrant exercise of 1.2M shares:
\ +449M
Kubota Pharmaceutical Holdings Co., Ltd. (4596)
Financial Outlook for FY2018
page 39
¥ MillionsOperating revenue
Loss from operation
Loss before income tax
Net loss
FY2018 (Forecast) - △3,500 △3,370 △3,370
FY2017 (Actual) - △3,620 △3,445 △3,445
※1 Exchange rate for the forecast: 1 US Dollar = 110 Japanese Yen※2 There are no changes to the earnings projections for FY2018 released on February 13, 2018.
Outlook for Operating revenue
➢ We are pursuing various partnering efforts and expects to generate revenue in the future through collaboration withstrategic partners.
Outlook for Loss from operations
➢ R&D cost will increase due to Phase 3 for Stargardt and continued development of PBOS and our other programs.
➢ G&A costs, including personnel and overhead expenses, will be lower than 2017 due to cost savings measures.
Warrant Financing
➢ The 21st SARs with Moving-strike was issued in April 2018.
➢ Estimated total proceeds is ¥2.2 billion (Estimated amount is calculated based on the initial exercise price).
Forward-looking financial information and estimates contained in this presentation were previously disclosed by the Company in the Company’s Kessan Tanshin dated November 14, 2018. Such forward-looking financial information and estimates speak only as of the dates of initial disclosure and this presentation is neither updating nor confirming the previously provided forward-looking financial information, guidance and estimates.
Thank you