KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision

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KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
KOL EVENT MEETING
An update on promising results with PRIMA in
            advanced dry-AMD

            MARCH 5, 2018
                         KOL Meeting - Paris - March 5, 2019   1
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Forward Looking Statements

T his doc um ent c o nta in s inf or m at ion on P ix iu m Vis ion ’s m ark ets and c om peti t i ve pos i t ion , and m ore s pec if ic a l l y, on th e s i ze of its m ark ets . T his i nf orm atio n h a s
been d ra wn f rom var io us s our c es o r f rom th e c om pani es o wn es t i m ates . In ves to rs s h ou ld not bas e the i r i n ve s tm ent dec is ion on th i s inf orm atio n . T h is d o c um ent
als o c ont a ins c e rta i n f or ward - look ing s ta tem ents . T hes e s tatem ent s are not gua rantees of the Com pan y's f utu re pe rf orm ance . T hes e f or wa rd- l ook ing stat em ents
r e late to th e Com pan y' s f utur e pr os pec ts , de ve lo pm ents and m ark etin g s trat eg y and are b as ed on an a l ys es of e arn ings f orec as ts and es tim ates of am ounts not ye t
determ i nab le . For wa r d - look ing s t atem ents ar e s ubj ec t to a va r iet y of ris k s and unc erta i nt ies as t he y re la te to f uture e ve nts and a re dependen t on c irc um s tanc es
that m a y o r m a y not m ater ia l i ze in the f uture . P ix i um V is ion dra ws yo u r a ttent i on to t he f ac t tha t as f or ward - loo k ing s ta tem ents c ann o t unde r a n y c i rc um s tanc e be
c ons true d as a guar a n tee of the Com pan y's f uture perf orm anc e an d that the Com pan y’ s ac tua l f inanc i a l pos it i on, res u l ts and c as h f l o w, as we l l as the tre nds in
the s ec t or in wh ic h th e C om pan y ope rate m a y d if f er m ater ia l l y f r om thos e p ropos ed o r ref l ec ted in the f or ward- lo ok ing s tatem ent s c onta in ed i n th i s do c um ent .
Furth erm ore, e ve n if Pix ium V is ion ’s f inanc ia l pos i t ion, res u lts , c as h- f lo ws and de v e lopm ents in the s ec t or in w hic h the C om pan y op e rates were to c onf orm to the
f or ward - look i ng s t ate m ents c onta ine d in th i s doc um ent, s uc h res u lts o r de v e lopm ents c a nnot b e c o ns tru ed as a re l i ab le ind ic a t ion of the C om pan y's f uture res u lt s
or d e ve lopm ents . T he C om pan y does no t u ndertak e a n y o b l igat i on to up date or t o c o nf irm pr oj ec t ions o r e s tim ates m ade b y ana l ys ts o r t o m ak e pub l ic an y
c orrec t i on to an y p r os pec t i ve inf or m at ion in orde r to ref lec t an e v ent or c irc um s tanc e t hat m a y oc c ur af ter th e date of th is pres e nt ati on . A des c r ipt io n of thos e
even ts tha t m a y ha ve a m ater i a l ad ve rs e ef fec t on the b us ines s , f i nanc ia l pos it i on o r res ults of P ix ium V is ion, or on its a b i l it y t o m eet its ta rgets , appea rs in th e
s ec ti ons " R is k Fac to r s " of its “ Doc um ent d e Bas e” f i led wi th th e F renc h Au tor i té de s Marc hés F inanc ie rs . B y at tend in g t h is p r es entat io n o r ac c ept i ng th is
doc um ent, you agr ee to be bound by the f oregoing res tric tions s et out above .

                                                                                  KOL Meeting - Paris - March 5, 2019                                                                                               2
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
• A Bioelectronics company developing bionic vision systems to
  compensate for severe vision loss or blindness

• PRIMA, miniaturized wireless implant, novel breakthrough
  technology to treating blindness

• In clinical stage initially treating dry age-related macular
  degeneration (dry-AMD), a significant unmet medical need

                    Corporate Presentation – February 2019       3
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Agenda

▪ 8:30    Welcome & introduction
          K. Ishaque, CEO Pixium Vision
▪ 8:35    PRIMA inventor’s motivation
          Pr. D. Palanker
▪ 8:50    First in human study PRIMA in AMD
          Pr. J-A. Sahel
▪ 9:05    Real world unmet medical need: Atrophic dry-AMD
          Pr. F. Holz
▪ 9:20    Q&A
▪ 10:00   Close

                        KOL Meeting - Paris - March 5, 2019   4
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
PRIMA inventor’s motivation

  Daniel Palanker, PhD

  Professor Department of Ophthalmology, School of Medicine,
  and Director Hansen Experimental Physics Laboratory,
  Stanford University, California, USA

                          KOL Meeting - Paris - March 5, 2019   5
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Photovoltaic Restoration of Sight
in Age-Related Macular Degeneration

           Daniel Palanker

    Department of Ophthalmology and
  Hansen Experimental Physics Laboratory
         Stanford University, CA

              KOL Meeting - Paris - March 5, 2019   6
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Subretinal Electrical Stimulation of the Bipolar Cells

                                                                Electric
                                                                current
                                                                Neural
                                                                signals

                          KOL Meeting - Paris - March 5, 2019              7
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Photovoltaic Retinal Prosthesis: System Design

                                camera

                    dichroic mirror

                                                Subretinal implant   880nm beam

                           KOL Meeting - Paris - March 5, 2019                    8
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
1
                                                                        0.9                 20 mm pixels,
Restoration of central vision in AMD                                    0.8                8 levels of grey
                                                                        0.7
                                                                        0.6

                                                               acuity
                                                                        0.5
                                                                        0.4
                                                                        0.3
                                                                        0.2
                                                                        0.1
                                                                          0
                                                                              0   10       20        30           40
                                                                                  eccentricity, degrees

                         KOL Meeting - Paris - March 5, 2019                                                  9
KOL EVENT MEETING MARCH 5, 2018 - An update on promising results with PRIMA in advanced dry-AMD - Pixium Vision
Operation of Subretinal Photovoltaic Prosthesis

Advantages of the photovoltaic approach:                                                  880 nm light
• Simplicity of the PV implant allows its
   miniaturization and wireless operation.                                                Neural signals
• Small size and lack of wires enables minimally
   invasive surgery.
• Modular design enables enlarging visual field                                                                     GCL
   via small retinotomy.
• Image projection is naturally linked to eye
   movements.
• System enables image processing (autofocus,
   zoom, contrast enhancement, background
   removal, etc.).
• System can be integrated with advanced                                                                            INL
   computer vision for naming the people,
   reading the text and other advanced functions.
• Image can be transferred directly from a
   computer to the video glasses for reading,
   watching TV, etc.

                                                    KOL Meeting - Paris - March 5, 2019
                                                                                                           100 mm    10
Photovoltaic Retinal Prosthesis: System Design

                        KOL Meeting - Paris - March 5, 2019   11
Benefits of the network-mediated retinal stimulation
                                                                                                   RCS pON          RCS pOFF

•    Flicker fusion at high (>20Hz) frequencies (now confirmed in patients).
•    Adaptation to static images.
•    Antagonistic center-surround organization of receptive fields.
•    ON and OFF responses.
•    Linear and non-linear summation of subunits in RGC receptive fields,
     which is essential for high acuity.

                                                                                             Natural

                                             +                                                            Prosthetic, 48mm pitch

•    Spatial resolution matching the pixel pitch, at least up to 50 µm
     (equivalent of 20/200 acuity in a human eye).

                                                                                            17mm   48mm
                                                      KOL Meeting - Paris - March 5, 2019                                          12
Pilot clinical trial of the PRIMA system in patients with
geographic atrophy
                                                                               2x2 mm array, 30 µm thick, 100 µm pixels
       1 month post surgery

                Implant appears thicker in OCT
               due to refractive index difference
                                                                           All patients perceive bright white-yellow patterns
                                                                            of retinotopically correct shapes and locations.

                                             KOL Meeting - Paris - March 5, 2019                                            13
Tests of Prosthetic Vision
                       •   Patients preferred frequency: 10 Hz and above (30 Hz).
                       •   Minimum bar width: 1 pixel in all 4 patients with subretinal placement, 2 pixels in
                           one patient with intra-choroidal placement of the implant.
                       •   Bar orientation: 88-96% correct in all 4 patients with subretinal placement.
                       •   Visual acuity measured with Landolt C is only 10-30% below the theoretical
                           minimum for the 100 µm pixel size:

                           Theoretical maximum with 100 µm pixels                    20/420 (1.32 logMAR), 1.0 pixel
                           Patient 2, pre-op: 20/800 (1.6 LogMAR)                    20/550 (1.44 logMAR), 1.35 pixels
Opaque video goggles       Patient 3, pre-op: 20/1000 (1.7 LogMAR)                   20/500 (1.40 logMAR), 1.23 pixels
   with a camera
                           Patient 5, pre-op: 20/500 (1.4 LogMAR)                    20/460 (1.37 logMAR), 1.15 pixels

                                               KOL Meeting - Paris - March 5, 2019                                       14
Smaller pixels enabled by honeycomb arrays
                                                                                       0.5 A/cm2
                                                        mm
                                                        40                           INL               INL

                                                         20
                                                         0
                                                                                             -50   0   50 mm

•    Stimulation thresholds greatly reduced
•    Penetration depth and stimulation threshold do
     not depend on pixel width!
            DV=E·l=j · r · l,
j - current density, r - tissue resistivity,
l – length of the cell.
                                               KOL Meeting - Paris - March 5, 2019                             15
Honeycomb Arrays
        40 mm                             30 mm                                          20 mm

                    6 weeks post implantation in RCS rats

                                                          DAPI – all nuclei, IBA1- microglia, GS -Müller glia
RGC

IPL

INL
Array

                            KOL Meeting - Paris - March 5, 2019                                           16
Summary

✓ Subretinal pixels larger than 70 µm provide
  sufficient penetration of electric field into the inner
  retina.
✓ Clinical results with PRIMATM (100µm pix) are
  very encouraging.
✓ Pixels smaller than 50 µm will be based on
  honeycomb arrays.
✓ Ultimate goal: to achieve visual acuity >20/100
  using 20 µm honeycomb pixels. About 10,000
  pixels in a 2 mm array.

                                       KOL Meeting - Paris - March 5, 2019   17
First in human study PRIMA in AMD

José-Alain Sahel, MD

Professor and Chairman of the Department of Ophthalmology at
University of Pittsburgh Medical Center (UPMC), USA
Director of the Institut de la Vision (Sorbonne-Université/Inserm/CNRS),
Paris
Chairman of the Department of Ophthalmology at Centre Hospitalier
National d’Ophtalmologie des XV-XX, and Fondation ophtalmologique
Rothschild, Paris

                           KOL Meeting - Paris - March 5, 2019        18
PRIMA System

▪ Designed to restore central vision within
  geographic atrophy.
▪ Wireless subretinal chip with photodiodes
  activated by near-infrared (NIR) light projected
  from video glasses, Invented by Daniel
  Palanker (Stanford)
▪ PRIMA chip replaces the lost photoreceptors
  and stimulates the bipolar cells in the INL.
▪ The remaining retinal network preserves many
  features of the natural signal processing.

                                    KOL Meeting - Paris - March 5, 2019   19
PRIMA system
                                                Images captured by the camera integrated
                                                into the augmented reality glasses are
                                                projected onto the retina using pulsed near-
                                                infrared (NIR) light.
                         NIR beam
                                                Subretinal wireless photovoltaic chip converts
                                                pulsed light into pulsed electric current in each
                                                pixel to stimulate the adjacent inner retinal
                                                neurons.

    Subretinal implant

                          KOL Meeting - Paris - March 5, 2019                                       20
Generating an ex vivo model of a degenerated primate retina

                             Vibratome section of the retina
  ONL
                                                      Implant

  INL

  GCL
                                                      ?
  NF

                                             Multi-electrode array

                        KOL Meeting - Paris - March 5, 2019          21
Surgical procedure

      Vitrectomy and        Additional manual
      Sub-retinal BSS        detachment, if
          injection              needed

                            Subretinal insertion
    Retinotomy outside
                            of the 2x2mm wide
    of the atrophic area,
                            chip using specially
    preserving the PRL
                             designed forceps

     Positioning of the
                             Exchange of the
      chip at the pre-
                            PFCL with air and
    determined location
                            final tamponade.
        under PFCL

                                         KOL Meeting - Paris - March 5, 2019   22
Early feasibility study design: safety and functionality
                                       FEASIBILITY STUDY

           Restoration of visual function in patients with advanced atrophic dry age related
            macular degeneration using the PRIMA system: open-label, non-randomized

                      CRITERIA                                     PRIMARY ENDPOINT

                                                        Safety and elicitation of visual perception by
        • 5 eyes of 5 patients                           electrical stimulation of the PRIMA implant
        • VA < 20/400                                        measured by Octopus Visual Field.
        • GA of at least 3 Optic Disc
          Diameters without any other                 Microperimetry to :
          pathology
                                                             – Confirm the absolute scotoma in the
        • No light perception in the
                                                               atrophic area
          atrophic area
        • Fellow eye with useful vision                      – Identify the main PRL to ensure its
                                                               preservation

                                          KOL Meeting - Paris - March 5, 2019                            23
PRIMA implant in the atrophic macula                            PRIMA implant:
           1 month post surgery
                                                                2x2 mm array, 30 µm thick,
                                                                with 378 pixels of 100 µm

                                                        Implant is located in the middle
                                                        of the geographic atrophy area,
                                                        in close proximity to the INL.
                          KOL Meeting - Paris - March 5, 2019                                24
Results
▪ 5 consecutive patients successfully implanted between December 2017 and June
  2018 in Paris:
   – 3 with silicone oil removed at week 4 / 2 with gas (C2F6 and SF6).
▪ Surgery duration < 2 hours.
▪ Complications:
   – 1 intraoperative complication: movement of the patient head under local
     anesthesia during implantation led to thin subretinal bleeding, which resolved
     after 6 weeks.
   – 1 SAE at day 1 - acute hypertony resolved 2 days later without consequence.
   – 1 small migration of the chip due to early posture change after surgery. The chip
     remained within the atrophic area.
   – 1 retinal detachment one year after surgery, retina reattached, no impact on
     implant

                                   KOL Meeting - Paris - March 5, 2019                   25
Anatomical Results
      P1                                   P4

             6M                                            1M

      P2                                   P5

              6M                                           6W

      P3
                                                The implant appears in OCT twice thicker
              6M
                                                due to higher refractive index of Si
                                                compared to that of the retinal tissue.
                                                Dashed line indicates position of the back
                                                side of the implant resting on Bruch’s
                                                membrane.

                     KOL Meeting - Paris - March 5, 2019                                     26
Visual acuity (ETDRS) Pre vs. Post implantation
     Average VA without System - ETDRS

      Pre-op Baseline         Post-op 1st
       measurement         measurement after
                               surgery

       PRIMA can be safely implanted under the atrophic macula while preserving the
       residual natural peripheral visual acuity, measured via ETDRS
                                               KOL Meeting - Paris - March 5, 2019    27
Results

▪ No other serious post-operative complications during the follow up currently ranging from 4 to
  10 months.
▪ No decrease in natural vision compared to pre-operative acuity.
▪ Patients are trained to use the system and progress to describe patterns, objects, letters, etc.
  elicited via the PRIMA chip in atrophic areas of the macula.
▪ Objective vision tests were conducted using opaque glasses to prevent confusion with
  residual natural vision.
                                        KOL Meeting - Paris - March 5, 2019                          28
PRIMA central visual perception at 6 Months

• Octopus Visual Field Measurement*
• Fully opaque glasses: light perception via PRIMA chip only
                                      P1                  P2                   P3              P4                  P5

          System ON

          System OFF

          *performance of the PRIMA chip and system without use of any peripheral remaining vision (only with fully opaque glasses)
                                                      KOL Meeting - Paris - March 5, 2019                                             29
Tests of Prosthetic Vision

      Acuity measured with Landolt C
       Theoretical limit with 100 µm pixels       20/400 (1.30 logMAR), 1.0 pixel
       Subject A : PRE-OP : CF                    20/550 (1.44 logMAR), 1.35 pixels
       Subject B : PRE-OP : HM                    20/500 (1.40 logMAR), 1.23 pixels
       Subject C : PRE-OP LogMAR 1.4              20/460 (1.37 logMAR), 1.15 pixels

      15-35% below the theoretical limit of resolution for 100 µm pixels
                                       KOL Meeting - Paris - March 5, 2019            30
Control: System ON vs OFF

                      KOL Meeting - Paris - March 5, 2019   31
Conclusions

 ▪ Subretinal implantation of the wireless PRIMA chip in atrophic dry AMD
   is feasible and safe.
 ▪ No decrease in residual natural vision compared to pre-operative
   visual acuity.
 ▪ ALL 5 patients reached the functional primary end point of the
   feasibility study (visual perception in the former scotoma).
 ▪ PRIMA provided the best prosthetic visual acuity to date: 20/460 – only
   15% below the theoretical limit for 100mm pixels.
 ▪ Most subjects recognize complex patterns close to the theoretical limit
   of the implant resolution.

                               KOL Meeting - Paris - March 5, 2019           32
Next Steps

 ▪ Similar feasibility study initiated in Pittsburgh, USA
   (J. Martel, J.A. Sahel).
 ▪ European multicenter pivotal study is planned for 2019.
 ▪ Implants with smaller pixels are being developed and tested in
   preclinical studies (Palanker’s group at Stanford).

                           KOL Meeting - Paris - March 5, 2019      33
Real world unmet medical need: Atrophic dry-AMD

Frank G. Holz, MD

Chairman and Professor, Department of Ophthalmology, University of
Bonn, Germany
President Elect of European Society of Retinal Specialists
(EURETINA)

                          KOL Meeting - Paris - March 5, 2019        34
Dry AMD /Geographic Atrophy
            Frank G. Holz
       University of Bonn, Germany

       KOL Meeting - Paris - March 5, 2019   35
AMD Progressive Visual Impairment
                                                                                      Loss of High Contrast BCVA

                                                                                          Metamorphopsia
                                                                                            (distortion)

                                                                Neovascular AMD
         Early AMD            Intermediate AMD                                                Scotoma
                                                                      Geographic         (central blind spot)

                                                                       Atrophy

» Late AMD severe loss of vision, independence, and quality of life, increased
   rates of falls, depression, and institutionalization

                                                KOL Meeting - Paris - March 5, 2019                                36
Therapy neovascular AMD
            Introduction anti-VEGF-Therapy 10 years ago

                         KOL Meeting - Paris - March 5, 2019   37
Age-related macular degeneration (AMD)
  Dry AMD – major unmet need

   • Leading cause of blindness
   • Even with effective treatments for neovascular AMD,
     atrophy is still the long-term outcome
   • Chronic progressive neurodegenerative disease
   • Many challenges including multifactorial pathogenesis

                         KOL Meeting - Paris - March 5, 2019   38
Macular Function

        Courtesy S. Trauzettel-Klosinski

                                     KOL Meeting - Paris - March 5, 2019   39
KOL Meeting - Paris - March 5, 2019   40
“Dry” Age-related macular degeneration (AMD)

                                                              “Geographic atrophy“

              Drusen
        Pigment abnormalities

       Early/intermediate AMD                                  Late-stage AMD

                                KOL Meeting - Paris - March 5, 2019                  41
Loss of RPE on FAF correlates with photoreceptor loss on
SD-OCT

          S Schmitz-Valckenberg, M Fleckenstein, AP Göbel, TC Hohman, FG Holz. IOVS 52:1-6;2011

                                        KOL Meeting - Paris - March 5, 2019                       42
Loss of RPE in FAF images correlates with loss of
photoreceptor function on microperimetry

                        KOL Meeting - Paris - March 5, 2019   43
Spectri and Chroma Pooled Outcome:
Change in Best-Corrected Visual Acuity from Baseline to Week 48

                                0
Mean Change From Baseline in
  ETDRS BCVA Letter Score

                                                                                                                                                  ETDRS letter score ∆
                                                                                                                                                       from BL

                                                                                                                                                  Lq4 −4.1 (n = 601)

                                -5                                                                                                                Lq6 −4.9 (n = 604)
                                                                          ∆ Means
                                         vs Sham Pooled                   (95% CI)            P value                                             Sham −4.9 (n = 604)

                                         ▬ Lampalizumab            0.8 ETDRS letters (−0.4,
                                         q4w                                2.1)               0.20

                                         ▬ Lampalizumab            0.1 ETDRS letters (−1.2,
                                         q6w                                1.3)               0.94

                               -10
                                     0                    12                     24                     36                    48

                                                               Time Since Randomization, weeks
                                                                                                        Holz FG, Sadda SR, Busbee B, Chew EY, Mitchell P, Tufail A, Brittain C,
                                                                                                        Ferrara D, Gray S, Honigberg L, Martin J, Tong B, Ehrlich JS, Bressler NM;
                                                                                                        Chroma and Spectri Study Investigators. JAMA Ophthalmol. 2018 May 2
                                                                                                                                                                                     44
Structural Assessment - Imaging Modalities

         Colour fundus photography   Fundus autofluorescence               Near-infrared reflectance

            OCT-Angiography          Fluorescein angiography                   SD-OCT/SS-OCT

                                     KOL Meeting - Paris - March 5, 2019                               45
KOL Meeting - Paris - March 5, 2019   46
KOL Meeting - Paris - March 5, 2019   47
Geographic Atrophy Assessment
Fundus Autofluoresence Imaging

                      KOL Meeting - Paris - March 5, 2019   48
Geographic Atrophy – Disease progression

                       KOL Meeting - Paris - March 5, 2019   49
Geographic atrophy - Prognostic markers for disease
progression

                 1 mm²/year                          2 mm²/year                        5 mm²/year

             ➢High variability in GA progression rate
           AREDS Lindblad et al. 2009, BDES Klein et al. 2008, BMES Joachim et al. 2013, FAM Holz et al. 2007,
               GAIN Biarnes et al. 2015, GAP Schmitz-Valckenberg et al. 2016, GAS Sunness et al. 1999,

                                              KOL Meeting - Paris - March 5, 2019                                50
Geographic Atrophy: Fundus Autofluorescence
Automated Detection and Quantification

              Schmitz-Valckenberg S, Brinkmann CK, Alten F, Herrmann P, Stratmann NK, Göbel AP, Fleckenstein M, Diller M, Jaffe GJ, Holz FG. Invest Ophthalmol Vis Sci. 2011;52:7640-6

                                                                   KOL Meeting - Paris - March 5, 2019                                                                                   51
Geographic atrophy (GA) - Morphologic markers for disease
progression

      ➢ Prognostic information for future disease progression
      ➢ Identification of patients at high risk loosing visual acuity / reading ability
      ➢ Unequal distribution of patients with risk-features in clinical trials may
        counterfeit / obscure a therapeutic effect
                  Fleckenstein M, Mitchell P, Freund B, Sadda SR, Holz FG, Brittain C, Henry EC, Ferrara D.
                                   Review. Ophthalmology 2017 S0161-6420(17)30968-5

                                               KOL Meeting - Paris - March 5, 2019                            52
Geographic atrophy (GA) - Heterogeneity

          Fleckenstein M, Adrion C, Schmitz-Valckenberg S, Göbel AP, Bindewald-Wittich A, Scholl HP,
             Mansmann U, Holz FG, FAM-Study group. Invest Ophthalmol Vis Sci. 2010;50:3915-21

                                            KOL Meeting - Paris - March 5, 2019                        53
Visual Function Outcome Measures

                      KOL Meeting - Paris - March 5, 2019   54
Interventional GA trials
              Oxidative stress                         Genetic predisposition                          Environment
        Brimonidine        2   α-Lipoic Acid   2
        OT-551                 Tandospirone
                                                                                                                   2       Phase 2
                                                                                                                   3       Phase 3

                                               Accumulation of cellular by-products
                                       Emixustat              MC-1101         2   GSK933776
                                       Fenretinide            ALK-001             RN6G

                 Inflammation                          Complement Cascade                            RPE impairment
        Fluocinolone           Metformin       2     APL-2         2    LFG316               CPCB-RPE1        2   MA09-hRPE
        Oracea         3       Minocycline     2     CLG561        2    Eculizumab           CNTO 2476        2   HuCNS-SC
        Copaxone               Sirolimus             Zimura        2    Lampalizumab     3   NT-501

                                                                    GA
                                                                                                                                     55
                   FG Holz, EC Strauss, S Schmitz-Valckenberg, M van Lookeren Campagne. Ophthalmology 121:1079-1091;2014
Lampalizumab: Selective Inhibitor of Complement Factor D, the Rate-limiting Enzyme of
the Alternative Complement Pathway

              Scientific rationale: genetic evidence implicates complement cascade
              dysregulation in GA/AMD1,2

              Complement factor D: rate-limiting enzyme of the alternative
              complement pathway with lowest plasma concentration of                   Complement Factor D     Lampalizumab
              complement proteins3,4
                                                                                          C3 Convertase

              Lampalizumab: an antigen-binding fragment of a humanized
              monoclonal antibody that inhibits complement factor D3,4

              Phase 2 Mahalo: GA area progression from baseline to                        C5 Convertase

              18 months was reduced by 20% in the monthly
              lampalizumab-treated group versus sham5

                                                                                     Membrane attack complex

                                                                                                                              56
GA Area Growth From Baseline Over Time to Week 48

                                                     2.5                                                     Wk 48 ∆ from BL
                                                               Pooled                                        Lq4 2.06 mm2                                                                     2.5
                                                                                                                                                                                                         Wk 48 ∆ from BL

                                                                                                                                                                  Mean Change from BL GA Area, mm2
            Mean Change From Baseline GA Area, mm2                                                           Lq6 2.05         mm2                                                                        Lq4 2.09 mm2
                                                                                                                                                                                              2.0        Lq6 2.02 mm2

                                                     2.0                                                     Sham 1.98         mm2                                                                       Sham 1.93 mm2

                                                                                                                                                                                              1.5

                                                                                                                                                                                              1.0

                                                                                                                                                                                              0.5
                                                     1.5
                                                                                                                                                                                              0.0
                                                                                                                                                                                                     0               12                24             36   48
                                                                                                                                                                                                                         Time Since Randomization, weeks

                                                     1.0
                                                                                                                                                                                              2.5
                                                                                                                                                                                                         Wk 48 ∆ from BL

                                                                                                                                                           Mean Change from BL GA Area, mm2
                                                                                                                                                                                                         Lq4 2.02 mm2
                                                                                                                ∆ Means               Relative                                                2.0        Lq6 2.09 mm2
                                                                                     vs Sham Pooled             (95% CI)             Reduction   P value
                                                                                                                                                                                                         Sham 2.04 mm2
                                                     0.5                                                                                                                                      1.5

                                                                                     ▬ Lampalizumab q4w   0.07 mm2 (−0.05, 0.19)      −3.6%      0.247
                                                                                                                                                                                              1.0

                                                                                     ▬ Lampalizumab q6w   0.07 mm2 (−0.05, 0.19)      −3.5%      0.255
                                                                                                                                                                                              0.5

                                                     0.0
                                                                                                                                                                                              0.0
                                                           0            12                 24                       36                           48                                                  0               12                24             36   48
                                                                                                                                                                                                                         Time Since Randomization, weeks
                                                                        Time Since Randomization, weeks

                                                                        FG Holz et al. JAMA Ophthalmol 2018, 136(6):666-77
                                                                                                                                                                                                                                                                57
Age-related macular degeneration (AMD)
Dry AMD – how to proceed
          • See how C3-inhibition works in phase 3

          • Role of the ARMS2/HTRA1 risk polymorphism?

          • Identify new targets

          • Restoring function with device

          • Define acceptable endpoints for earlier intervention

                                   KOL Meeting - Paris - March 5, 2019   58
KOL Meeting - Paris - March 5, 2019   59
Earlier Intervention?
          CFP           FAF                                     SD-OCT

                          KOL Meeting - Paris - March 5, 2019            60
State of the Art
16 Mio €

   Text
   • oder
   • Aufzählungen

                      11
Thank you

KOL Meeting - Paris - March 5, 2019   62
PRIMA device development plan in dry-AMD

  Feasibility study                                      Pivotal
                                                         study
                   6-m                                                               1-y                   CE
                  results                                                        follow-up                Mark*

      2018                       2019                   2020                       2021                         2022

                US FIH
             Feasibility study

                                                                    Accelerated Access Program                        PMA**

                                                                                    *CE Mark – EU regulatory approval to commercialize
                                                                                    **PMA – US FDA regulatory approval to commercialize

                                        Corporate Presentation - February 2019                                                            63
KOL EVENT MEETING
An update on promising results with PRIMA in
            advanced dry-AMD

            MARCH 5, 2018

                         KOL Meeting - Paris - March 5, 2019   64
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