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PRIDE-HD
on behalf of the HSG PRIDE-HD
Investigators
HSG Presentation of Trial Results
November 3, 2016
HART
on behalf of the HSG HART
Investigators
HDCRS Presentation of Trial
Results
October 16, 2010
Pridopidine represents a novel therapeutic class of
agents: dopamine stabilizers
High
Low
Normal
psychomotor activity
Pridopidine
High
Low
Normal
psychomotor activity
Standard antipsychotic
Phase II Trial in Huntington
Disease
• Randomized, double-blind, placebo
controlled trial
• n = 58
• Pridopidine 50 mg/d (n = 28)
• Followed for 28 days
*Component of Modified Motor Score
Components of the Total Motor
Scale of the UHDRS, with
Modified Motor Score Highlighted
Ocular Pursuit
Saccade Initiation
Saccade Velocity
Dysarthria*
Tongue Protrusion*
Finger Taps*
Pronate/Supinate Hands*
Luria (Fist-hand-palm test)*
Rigidity – arms*
Body bradykinesia*
Maximal Dystonia
Maximal Chorea
Gait*
Tandem Walking*
Retropulsion Pull Test*
Clinical motor improvement by pridopidine –
HART and MermaiHD studies results
5
• Phase III study with 437 patients in eight European countries
• Significant effects on TMS after 26 weeks; -3.0 points (p = 0.004)
• The primary endpoint (mMS) was not met
• Phase IIb study with 227 patients in the United States and
Canada
• Significant effect on TMS after 12 weeks; -2.8 points (p =
0.039)
• Primary endpoint (mMS) was not met
HART studyMermaiHD study
Huntington Study Group HART Investigators. Mov Disord. 2013 Sep;28(10):1407-15.
Yebenes JG, et al. Lancet Neurol. 2011 Dec;10(12):1049-57.
Disclaimer
–Data presented here is based on topline phase 2
analysis
–Further analysis is being undertaken
–Additional data will be presented at forthcoming
meetings
–Teva plans to submit results for publication
6
Initial PRIDE-HD design: Evaluation of safety, tolerability and efficacy of higher
doses (≥45mg bid) for symptomatic (motor) effects
– Global Ph2, dose-ranging study to build on HART and MermaiHD’s findings
– Study Duration: 26 wks; adequate for evaluation of motor effects
– 4 doses (45, 67.5, 90, 112.5) and placebo – x2.5 higher that HART and MermaiHD
– Population: 400 patients no HD stage restrictions – subjects had minimal TMS ≥
25
– 52 sites
– Endpoints: focused on motor symptoms (TMS, mPPT)
7
PRIDE-HD Chronology of Events:
–26-week protocol finalization: May 2013
–Type C meeting: July 2013
–First subject first visit: Jan 2014
–52-week amendment: October 2014
–Enrolment Completion: June 2015
–26-week readout: January 2016
–52-week readout: August 2016
–Press release: September 2016
8
Based on new insights into Pridopidine MoA
9
Pridopidine may have broader effect
beyond symptomatic relief
Phase 2 protocol modified
to explore long-term effect on
function and rate of progression (52wks) & safety and tolerability
Total Functional Capacity* is an established endpoint to assess function and disease
progression in HD: pre-specified and collected at 26 and 52 weeks
* Shoulson et al. Neurology 1981
PRIDE-HD recruited all stages of HD
10
• Steepest rate of natural decline
• Most sensitive to current clinical measures
• HD-CAB and TRACK-HD assessments designed
specifically for this period and earlier
• Difficulty completing assessments
• Floor and ceiling effects limit ability to track
change
• Very significant brain tissue loss
yrs
3
5
5-8
>8
No significant effect on TMS in the Full Analysis Set (FAS) at
week 26
11
• All groups showed
improvement from
baseline
• Large placebo effect
was observed
• Similar effects seen at
52 wks
-10
-8
-6
-4
-2
0
2
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
Adj. means ± SEM
Week 26
Improvement
45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 75 79 81 81
Wk26 ∆ to placebo 1.42 1.71 0.67 2.1
p value 0.3199 0.2235 0.6282 0.1337
Total
Functional
Capacity (TFC)
Total Functional Capacity is the most widely accepted tool for
assessing functional decline in HD
13
• A well established endpoint for trials
aiming to slow clinical progression
• Range: 0-13
• Floor and ceiling effects make this more
sensitive to change in early HD, than
late HD
Source: Shoulson et al. Neurology 1981
Annual rates of decline in TFC are higher in earlier stages of
disease
14 Source: K. Marder et al. Neurology 2000;54:452
HD1 (11-13) HD2 (7-10) HD3 (3-6) HD4 (1-2)
A ‘significant’ slowing of functional decline as measured by TFC is
seen
15
45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 59 54 56 58
Wk52 ∆ to placebo 1.16 0.36 0.71 0.27
p value 0.0003 0.2704 0.0239 0.4144
Improvement
Adj. means ± SEM
-1.6
-1.2
-0.8
-0.4
0
0.4
0.8
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
Week 52
45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 75 79 81 81
Wk52 ∆ to placebo 0.87 0.11 0.19 0.24
p value 0.0032 0.7042 0.5099 0.4061
Improvement
Adj. means ± SEM
-1.6
-1.2
-0.8
-0.4
0
0.4
0.8
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
Week 52
Full Analysis Set - pre-specified Early Stage (HD1 and HD2) - post-hocTFC annual
decline in
placebo as
expected
The effect on TFC first observed at 26wks
16
-1.6
-1.2
-0.8
-0.4
0
0.4
0.8
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
-1.6
-1.2
-0.8
-0.4
0
0.4
0.8
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
Improvement
Improvement
Full Analysis Set Early Stage (HD1 and HD2)
Adj. means ± SEM Adj. means ± SEM
45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 75 79 81 81
Wk26 ∆ to placebo 0.34 0.21 0.33 0.42
p value 0.1474 0.3639 0.1465 0.0676
45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 59 54 56 58
Wk26 ∆ to placebo 0.56 0.33 0.61 0.67
p value 0.0359 0.215 0.0199 0.0125
Responder Analysis: significant difference in the proportion of subjects that
showed no decline in TFC over 52wks between Pridopidine and placebo arms
17
Responder Analysis Questions Observed Data Analysis
45mg bid
N=37
Placebo
N=41
1. What proportion of early stage subjects
had no deterioration on TFC (score ≥0) at
52 weeks?
30(81%) 20(49%)
Nominal P-value (Chi-Square) 0.003
1. What proportion of early stage subjects
had an improvement of ≥1 points on TFC at
52 weeks?
10 (27%) 5 (12%)
Nominal P-value (Chi-Square) 0.099
-2
-1
0
1
2
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
ChangefromBaseline
Adj. means ± SEM
Improvement
Timed Up and Go Test (sec): Early HD at 52 wks
18
Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid
N 62 59 54 56 58
Baseline 10 11.7 9.7 9.8 9.8
Wk52 ∆ to placebo -1.61 -1.64 -1.46 -0.96
p value 0.1348 0.1369 0.171 0.3827
Summary:
Pridopidine shows potential effect on functional decline as measured by TFC
• TFC - an accepted endpoint for functional decline in HD
• Effect on TFC was more pronounced in early HD, and also was
observed in responder analysis
• The placebo arm declined as expected
• Effects were observed primarily with 45mg bid and 90mg bid,
suggesting a non-linear dose response
• Improvement in ambulation may be contributing to TFC effect
19
Safety and
Tolerability
PRIDE-HD: Summary of safety and tolerability
No new findings – Safety and tolerability profile fully compatible
with Phase 3 development
ECG
• QTcF analysis ongoing
Vital Signs
• Dose dependent increase of heart rate
• No effect on blood pressure
Labs
• No clinically significant abnormalities observed
Psychiatric AEs: Summary & Conclusions
• Psychiatric events reported in all arms
• Irritability (most frequently observed psychiatric event) was more prevalent
in placebo group (9%)
• Depression (relatively small number of events) reported in all arms
• Suicidality (relatively small number of events) reported in active arms
• Columbia suicidality score change from “Negative” to “Positive” reported in all arms
including placebo
• Rates consistent with published literature
Summary: Pridopidine shows effect on functional decline
measured by TFC, an index of clinical progression
• First of 12 trials to show slowing of functional decline as measured by TFC - the
gold standard scale for measuring HD clinial progression
Effect on TFC was significant at 52wks in the full analysis set and in early stage HD at
both 26 and 52wks
• Preclinical data generated in the last 3yrs support the effects on functional
decline
• Large placebo response masked motor effects in the full analysis set
• Motor effects were observed in early HD subpopulations
• No new safety and tolerability issues
• PRIDE-HD supports further development
23
Acknowledgements
–Patients and their families
–The clinical investigators and sites
–The PRIDE-HD Steering Committee: Karl Kieburtz, Bernhard
Landwehrmeyer, Ralf Reilmann, Andy McGarry
–Teva clinical development team led by Spyros Papapetropoulos:
Katie Blatt, Igor Grachev and Juha Savola
24
Investigators Slide 1 or 2
12 Countries, 52 sites:
Australia
Andrew Churchyard
Anita Goh
Clement Loy
Peter Panegyres
Austria
Klaus Seppi
Raphael Bonelli
Canada
Blair Leavitt
Mark Guttman
Tilak Mendis
Denmark
Anette Torvin Moller
Lena Hjermind
France
Anne Catherine Bachoud-Levi
Christophe Verny
Clemence Simonin
Fabienne Calvas
Jean-Philippe Azulay
Pierre Krystkowiak
Germany
Carsten Saft
Josef Priller
Michael Orth
Ralf Reilmann
Italy
Ferdinando Squitieri
Giuseppe De Michele
Paola Soliveri
Sandro Sorbi
Investigators Slide 2 or 2
Netherlands United States
Nasir Ahmad Aziz Andrew Feigin
Poland Christopher Ross
Daniel Zielonka Claudia Testa
Grzegorz Witkowski David Shprecher
Jaroslaw Slawek Francis Walker
Monika Rudzinska Jody Corey-Bloom
Russia Karen Anderson
Alexander Gustov Karen Marder
Sergey Illarioshkin Kevin Biglan
Zuleykha Abdullazarovna Zalyalova Pinky Agarwal
United Kingdom Susan Perlman
Andrea Nemeth Valarie Suski
Anne Rosser Victoria Segro
David Craufurd
Hugh Rickards
Oliver Quarrell
Roger Barker
Suresh Kumar Komati

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PRIDE-HD on behalf of the HSG PRIDE-HD Investigators

  • 1. PRIDE-HD on behalf of the HSG PRIDE-HD Investigators HSG Presentation of Trial Results November 3, 2016
  • 2. HART on behalf of the HSG HART Investigators HDCRS Presentation of Trial Results October 16, 2010
  • 3. Pridopidine represents a novel therapeutic class of agents: dopamine stabilizers High Low Normal psychomotor activity Pridopidine High Low Normal psychomotor activity Standard antipsychotic
  • 4. Phase II Trial in Huntington Disease • Randomized, double-blind, placebo controlled trial • n = 58 • Pridopidine 50 mg/d (n = 28) • Followed for 28 days *Component of Modified Motor Score Components of the Total Motor Scale of the UHDRS, with Modified Motor Score Highlighted Ocular Pursuit Saccade Initiation Saccade Velocity Dysarthria* Tongue Protrusion* Finger Taps* Pronate/Supinate Hands* Luria (Fist-hand-palm test)* Rigidity – arms* Body bradykinesia* Maximal Dystonia Maximal Chorea Gait* Tandem Walking* Retropulsion Pull Test*
  • 5. Clinical motor improvement by pridopidine – HART and MermaiHD studies results 5 • Phase III study with 437 patients in eight European countries • Significant effects on TMS after 26 weeks; -3.0 points (p = 0.004) • The primary endpoint (mMS) was not met • Phase IIb study with 227 patients in the United States and Canada • Significant effect on TMS after 12 weeks; -2.8 points (p = 0.039) • Primary endpoint (mMS) was not met HART studyMermaiHD study Huntington Study Group HART Investigators. Mov Disord. 2013 Sep;28(10):1407-15. Yebenes JG, et al. Lancet Neurol. 2011 Dec;10(12):1049-57.
  • 6. Disclaimer –Data presented here is based on topline phase 2 analysis –Further analysis is being undertaken –Additional data will be presented at forthcoming meetings –Teva plans to submit results for publication 6
  • 7. Initial PRIDE-HD design: Evaluation of safety, tolerability and efficacy of higher doses (≥45mg bid) for symptomatic (motor) effects – Global Ph2, dose-ranging study to build on HART and MermaiHD’s findings – Study Duration: 26 wks; adequate for evaluation of motor effects – 4 doses (45, 67.5, 90, 112.5) and placebo – x2.5 higher that HART and MermaiHD – Population: 400 patients no HD stage restrictions – subjects had minimal TMS ≥ 25 – 52 sites – Endpoints: focused on motor symptoms (TMS, mPPT) 7
  • 8. PRIDE-HD Chronology of Events: –26-week protocol finalization: May 2013 –Type C meeting: July 2013 –First subject first visit: Jan 2014 –52-week amendment: October 2014 –Enrolment Completion: June 2015 –26-week readout: January 2016 –52-week readout: August 2016 –Press release: September 2016 8
  • 9. Based on new insights into Pridopidine MoA 9 Pridopidine may have broader effect beyond symptomatic relief Phase 2 protocol modified to explore long-term effect on function and rate of progression (52wks) & safety and tolerability Total Functional Capacity* is an established endpoint to assess function and disease progression in HD: pre-specified and collected at 26 and 52 weeks * Shoulson et al. Neurology 1981
  • 10. PRIDE-HD recruited all stages of HD 10 • Steepest rate of natural decline • Most sensitive to current clinical measures • HD-CAB and TRACK-HD assessments designed specifically for this period and earlier • Difficulty completing assessments • Floor and ceiling effects limit ability to track change • Very significant brain tissue loss yrs 3 5 5-8 >8
  • 11. No significant effect on TMS in the Full Analysis Set (FAS) at week 26 11 • All groups showed improvement from baseline • Large placebo effect was observed • Similar effects seen at 52 wks -10 -8 -6 -4 -2 0 2 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline Adj. means ± SEM Week 26 Improvement 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 75 79 81 81 Wk26 ∆ to placebo 1.42 1.71 0.67 2.1 p value 0.3199 0.2235 0.6282 0.1337
  • 13. Total Functional Capacity is the most widely accepted tool for assessing functional decline in HD 13 • A well established endpoint for trials aiming to slow clinical progression • Range: 0-13 • Floor and ceiling effects make this more sensitive to change in early HD, than late HD Source: Shoulson et al. Neurology 1981
  • 14. Annual rates of decline in TFC are higher in earlier stages of disease 14 Source: K. Marder et al. Neurology 2000;54:452 HD1 (11-13) HD2 (7-10) HD3 (3-6) HD4 (1-2)
  • 15. A ‘significant’ slowing of functional decline as measured by TFC is seen 15 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 59 54 56 58 Wk52 ∆ to placebo 1.16 0.36 0.71 0.27 p value 0.0003 0.2704 0.0239 0.4144 Improvement Adj. means ± SEM -1.6 -1.2 -0.8 -0.4 0 0.4 0.8 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline Week 52 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 75 79 81 81 Wk52 ∆ to placebo 0.87 0.11 0.19 0.24 p value 0.0032 0.7042 0.5099 0.4061 Improvement Adj. means ± SEM -1.6 -1.2 -0.8 -0.4 0 0.4 0.8 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline Week 52 Full Analysis Set - pre-specified Early Stage (HD1 and HD2) - post-hocTFC annual decline in placebo as expected
  • 16. The effect on TFC first observed at 26wks 16 -1.6 -1.2 -0.8 -0.4 0 0.4 0.8 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline -1.6 -1.2 -0.8 -0.4 0 0.4 0.8 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline Improvement Improvement Full Analysis Set Early Stage (HD1 and HD2) Adj. means ± SEM Adj. means ± SEM 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 75 79 81 81 Wk26 ∆ to placebo 0.34 0.21 0.33 0.42 p value 0.1474 0.3639 0.1465 0.0676 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 59 54 56 58 Wk26 ∆ to placebo 0.56 0.33 0.61 0.67 p value 0.0359 0.215 0.0199 0.0125
  • 17. Responder Analysis: significant difference in the proportion of subjects that showed no decline in TFC over 52wks between Pridopidine and placebo arms 17 Responder Analysis Questions Observed Data Analysis 45mg bid N=37 Placebo N=41 1. What proportion of early stage subjects had no deterioration on TFC (score ≥0) at 52 weeks? 30(81%) 20(49%) Nominal P-value (Chi-Square) 0.003 1. What proportion of early stage subjects had an improvement of ≥1 points on TFC at 52 weeks? 10 (27%) 5 (12%) Nominal P-value (Chi-Square) 0.099
  • 18. -2 -1 0 1 2 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid ChangefromBaseline Adj. means ± SEM Improvement Timed Up and Go Test (sec): Early HD at 52 wks 18 Placebo 45 mg bid 67.5 mg bid 90 mg bid 112.5 mg bid N 62 59 54 56 58 Baseline 10 11.7 9.7 9.8 9.8 Wk52 ∆ to placebo -1.61 -1.64 -1.46 -0.96 p value 0.1348 0.1369 0.171 0.3827
  • 19. Summary: Pridopidine shows potential effect on functional decline as measured by TFC • TFC - an accepted endpoint for functional decline in HD • Effect on TFC was more pronounced in early HD, and also was observed in responder analysis • The placebo arm declined as expected • Effects were observed primarily with 45mg bid and 90mg bid, suggesting a non-linear dose response • Improvement in ambulation may be contributing to TFC effect 19
  • 21. PRIDE-HD: Summary of safety and tolerability No new findings – Safety and tolerability profile fully compatible with Phase 3 development ECG • QTcF analysis ongoing Vital Signs • Dose dependent increase of heart rate • No effect on blood pressure Labs • No clinically significant abnormalities observed
  • 22. Psychiatric AEs: Summary & Conclusions • Psychiatric events reported in all arms • Irritability (most frequently observed psychiatric event) was more prevalent in placebo group (9%) • Depression (relatively small number of events) reported in all arms • Suicidality (relatively small number of events) reported in active arms • Columbia suicidality score change from “Negative” to “Positive” reported in all arms including placebo • Rates consistent with published literature
  • 23. Summary: Pridopidine shows effect on functional decline measured by TFC, an index of clinical progression • First of 12 trials to show slowing of functional decline as measured by TFC - the gold standard scale for measuring HD clinial progression Effect on TFC was significant at 52wks in the full analysis set and in early stage HD at both 26 and 52wks • Preclinical data generated in the last 3yrs support the effects on functional decline • Large placebo response masked motor effects in the full analysis set • Motor effects were observed in early HD subpopulations • No new safety and tolerability issues • PRIDE-HD supports further development 23
  • 24. Acknowledgements –Patients and their families –The clinical investigators and sites –The PRIDE-HD Steering Committee: Karl Kieburtz, Bernhard Landwehrmeyer, Ralf Reilmann, Andy McGarry –Teva clinical development team led by Spyros Papapetropoulos: Katie Blatt, Igor Grachev and Juha Savola 24
  • 25. Investigators Slide 1 or 2 12 Countries, 52 sites: Australia Andrew Churchyard Anita Goh Clement Loy Peter Panegyres Austria Klaus Seppi Raphael Bonelli Canada Blair Leavitt Mark Guttman Tilak Mendis Denmark Anette Torvin Moller Lena Hjermind France Anne Catherine Bachoud-Levi Christophe Verny Clemence Simonin Fabienne Calvas Jean-Philippe Azulay Pierre Krystkowiak Germany Carsten Saft Josef Priller Michael Orth Ralf Reilmann Italy Ferdinando Squitieri Giuseppe De Michele Paola Soliveri Sandro Sorbi
  • 26. Investigators Slide 2 or 2 Netherlands United States Nasir Ahmad Aziz Andrew Feigin Poland Christopher Ross Daniel Zielonka Claudia Testa Grzegorz Witkowski David Shprecher Jaroslaw Slawek Francis Walker Monika Rudzinska Jody Corey-Bloom Russia Karen Anderson Alexander Gustov Karen Marder Sergey Illarioshkin Kevin Biglan Zuleykha Abdullazarovna Zalyalova Pinky Agarwal United Kingdom Susan Perlman Andrea Nemeth Valarie Suski Anne Rosser Victoria Segro David Craufurd Hugh Rickards Oliver Quarrell Roger Barker Suresh Kumar Komati

Editor's Notes

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