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Cautionary Note on Forward-Looking Statements Cautionary Note on Forward - Looking Statements UC | 2026 2 This presentation may include forward looking statements that are based on our management’s beliefs and assumptions and on information currently available to our management. The inclusion of forward-looking statements should not be regarded as a representation by Cosmo that any of its plans will be achieved. Actual results may differ materially from those set forth in this presentation due to the risks and uncertainties inherent in Cosmo’s ability to develop and expand its business, successfully complete development of its current product candidates and current and future collaborations for the development and commercialization of its product candidates and reduce costs (including staff costs). This presentation includes some information about Cosmo’s clinical development pipeline which is not intended for promotional purposes. There can be no guarantee that pipeline candidates will receive regulatory approval or that they will prove to be commercially successful. Any statements regarding the development of the market for drugs, Cosmo’s anticipated future revenues, capital expenditures, financial resources and other similar statements, may be “forward looking” and as such involve risks and uncertainties and risks related to the collaboration between Cosmo and its current or future partner and/or any business activities that are integrated into Cosmo’s business and risks following any potential for delays in the development programs for its products. No assurance can be given that the results anticipated in such forward-looking statements will occur. Actual events or results may differ materially from Cosmo’s expectations due to factors which include, but are not limited to, a lack of information regarding any future partners or acquisitions, increased competition, Cosmo’s ability to finance expansion plans, the results of Cosmo’s research and development activities, the success of Cosmo’s products and partnerships, regulatory, legislative and judicial developments or changes in market and/or overall economic conditions. Cosmo assumes no responsibility to update forward looking statements or to adapt them to future events or developments. You are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date here of, and Cosmo undertakes no obligation to revise or update this presentation.
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Disease Overview & Unmet Need01 Agenda UC | 2026 Rifamycin TAG: MoA & Advantages02 Phase II Topline Data03 Closing Remarks & Q&A04 3
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Distal Ulcerative Colitis and Proctitis Optimizing local treatment strategies to improve outcomes UC | 2026 4
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DUC: CLINICAL BACKGROUND & UNME T NEED Ulcerative Colitis: A Lifelong Disease with Significant Patient Burden Ulcerative Colitis: A Lifelong Disease with Significant Patient Burden Ulcerative Colitis (UC) is an Inflammatory Bowel Disease Affecting the Colonic Mucosa It is a Chronic and Relapsing Condition That Requires Long - term Management and Substantially Affects t he Patients’ Quality of Life Symptoms Commonly Include Rectal Bleeding, Diarrhea , Urgency and Abdominal Discomfort UC | 2026 5
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DUC: CLINICAL BACKGROUND & UNME T NEED ~70% of UC Patients Have Distal Disease or Proctitis at Diagnosis, and Urgency Drives Their Burden ~70% of UC Patients Have Distal Disease or Proctitis at Diagnosis, and Urgency Drives Their Burden Urgency and Rectal Symptoms Remain Major Drivers of Patient Burden and Treatment Dissatisfaction At Diagnosis, ~70% of Patients Present Distal Involvement 1 : • Rectum - U lcerative P roctitis • Left-side colon - Di stal UC 30 - 60% of patients Symptoms Rectal bleeding, tenesmus, urgency 16 - 45% of patients Symptoms Proctitis plus diarrhoea, abdominal cramping Proctitis Distal UC 1 Fumery M. et al. Clin Gastroenterol Hepatol. 2018. 16(3): 343-356.Image adaptedfrom Ungaro R, et al. Lancet. 2017;389 (10080):1756-1770 UC | 2026 6 Proctitis Accounts for ~40% of UC Cases, but This Condition Has Historically Been Neglected
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Distal UC a nd Proctitis Affect ~3.5 Million People Worldwide Distal UC And Ulcerative Proctitis Potentially Affect Approximately 2.4 Million Patients in US and EU Distal UC: Worldwide ~3.5M UC: Worldwide 5M DUC: CLINICAL BACKGROUND & UNME T NEED UC | 2026 7 (The Lancet. 2023. Link: Ulcerative colitis - The Lancet) (Fumery et al. 2018. Clin Gastroenterol Hepatology.2018. Link: Natural History of AdultUlcerative Colitis in Population-based Cohorts: A Systematic Review - Clinical Gastroenterology and Hepatology (cghjournal.org))
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DUC: CLINICAL BACKGROUND & UNME T NEED Current Treatments are Suboptimal and Leave Important Gaps in Care Current Treatments are Suboptimal and Leave Important Gaps in Care Some Patients Remain Non - responsive , or Insufficiently Controlled by First - line Topical Treatments Rectal Therapies Present Retention and Adherence Limitations Escalation Often Requires Rectal/ Systemic Corticosteroids or Advanced Immunosuppressive Therapies Patients with Ulcerative Proctitis are Excluded from Most Phase 3 Programmes, Resulting in a Limited Evidence Base for Treatment Decisions UC | 2026 8 US and EU Guidelines Recommend Topical Treatments as First - line for Distal UC and Proctitis 1,2 1 Rubin D. T. et al. American Journal of Gastroenterology 120(6): 1187-1224. 2 Gisbert J. P. et al. J. Crohns Colitis. 2026. 7(20), jjag066
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DUC: CLINICAL BACKGROUND & UNME T NEED Rifamycin 1% Topically Acting Gel (TAG): Addressing Key Treatment Gaps Rifamycin 1% Topically Acting Gel (TAG): Addressing Key Treatment Gaps Novel Multi - target Mechanism of Action Innovative Gel Formulation Optimized for Distal Delivery Rigorous Phase 2 Trial, Designed According to the FDA Guideline Proprietary Formulation & IP Assets – Beyond 2044 UC | 2026 9
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One Therapy Targeting Gut-Bacteria Imbalance and Immune Dysregulation One Therapy Targeting Gut - Bacteria Imbalance and Immune Dysregulation Sandborn et al. Lancet 2012; 380: 1606–19. UC Key Contributing Factors • Dysbiosis (altered microbioma) • Dysregulation of immune responses (inflammation) • Defective permeability of intestinal barrier • Environmental factors • Genetic predisposition DUC: CLINICAL BACKGROUND & UNME T NEED UC | 2026 10
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Commercial formulation DUC: CLINICAL BACKGROUND & UNME T NEED Limitations of Current Rectal Formulations Limitations of Current Rectal Formulations UC | 2026 11 Liquid suspension No adherence Lack of adhesiveness Acidic
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DUC: CLINICAL BACKGROUND & UNME T NEED Innovative Rectal Therapy for Improved Patient Experience Innovative Rectal Therapy for Improved Patient Experience Our Formulation Advantages Rifamycin 1% topically acting gel UC | 2026 12 In situ gelling High adhesiveness Physiological pH Designedto improve long-term adherence
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A Phase 2, Placebo-Controlled Study Designed with the FDA Gold-Standard Primary Endpoint A Phase 2, Placebo - Controlled Study Designed with the FDA Gold - Standard Primary Endpoint Placebo Screening (Up to 28 days) Excluded from study Treatment phase (6 weeks) Follow-up (8 weeks) Rifamycin 1% TAG (800 mg/day) Primary endpoint: proportion of patients achieving clinical remission after 6 weeks of treatment with Rifamycin 1% TAG as compared to placebo1 24 Sites in 7 EU countries ~4.5 mo Per subject (6 wks treatment) Includes KOLs in IBD No Inflammation Primary objective: efficacy of Rifamycin 1% locally acting gel as compared to placebo in inducing the clinical remission Secondary objectives: efficacy in inducing clinical improvement, endoscopic remission and improvement and bowel urgency improvement, safety and tolerability of Rifamycin 1% TAG as compared to placebo Patients with mild - to - moderately active UC Inflammation confirmed Randomization 2:1 13 UC | 2026 1 FDA Guidance for Industry – Ulcerative Colitis: Developing Drugs for Treatment. April 2022
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Clinical remission is a high bar: symptoms and endoscopy must both clear Clinical remission is a high bar: symptoms and endoscopy must both clear 14 UC | 2026 FDA guidance defines clinical remission as a total modified Mayo score ≤2 — only when every component below is satisfied SYMPTOM Stool frequency ≤ 1 Increased stool frequency must be controlled - a residual symptom score above 1 fails remission. SYMPTOM Rectal bleeding = 0 No rectal bleeding is allowed — even minimal bleeding means the primary endpoint is not met. OBJECTIVE OUTCOME Endoscopy ≤ 1 Mucosal disease must be near absent; a score of 1 is allowed only, without friability. AND AND All three thresholds must be achieved concurrently — failure on any one component means the patient does not meet clinical remission. Source: FDA Guidance for Industry — Ulcerative Colitis: Developing Drugs for Treatment (April 2022)
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Patient Demography Patient Demography Rifamycin 1% topically acting gel N=39 Placebo N=21 Sex, n (%) Female Male 17 (43.6) 10 (47.6) 22 (56.4) 11 (52.4) Age, years Mean (SD) 46.8 (14.6) 41.4 (16.2) Previous treatment, n (%) Naïve 0 (0) 1 (4.8) Failure to standard treatment 36 (92.3) 18 (85.7) Failure to biologics 3 (7.7) 2 (9.5) Disease extent, n (%) Distal ulcerative colitis Ulcerative proctitis 26 (66.7) 13 (61.9) 13 (33.3) 8 (38.1) Disease duration, years Mean (SD) 7.0 (7.2) 7.9 (7.2) Concomitant medication Mesalamine 36 (92.3) 19 (90.5) Glucocorticoids Budesonide 0 (0) 2 (9.5) Prednisolone 1 (2.6) 0 (0) Methylprednisolone 1 (2.6) 1 (4.8) Other UC therapy 5 (12.8) 0 (0) 15 UC | 2026
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Primary Endpoint Met: Rifamycin Significantly Increased Clinical Remission Rates Compared with Placebo Primary Endpoint Met: Rifamycin Significantly Increased Clinical Remission Rates Compared with Placebo 14.3% 46.2% % patients achieving clinical remission rate at Week 6 ∆ = 31.9% P = 0.0190 Clinical remission of ulcerative colitis is defined as a total modified Mayo score ≤2 including the following subscores: o Stool frequency subscore ≤1 o Rectal bleeding subscore = 0 o Endoscopy subscore ≤1 (score of 1 without the component “friability”) PlaceboRifmycin 1% topically acting gel UC | 2026 16
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Significant Clinical Remission Achieved Even in Patients with Moderate Disease Activity, a Population with Greater Disease Burden Significant Clinical Remission Achieved Even in Patients with Moderate Disease Activity, a Population with Greater Disease Burden 11.1% 48.3% % patients with baseline Mayo score 5 - 7 achieving clinical remission rate at week 6 ∆ = 37.2% P = 0.0145 Clinical remission of ulcerative colitis is defined as a total modified Mayo score ≤2 including the following subscores: o Stool frequency subscore ≤1 o Rectal bleeding subscore = 0 o Endoscopy subscore ≤1 (score of 1 without the component “friability”) PlaceboRifmycin 1% topically acting gel UC | 2026 17
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Patients Reported a Positive Overall Experience Patients Reported a Positive Overall Experience Questionnaire Item Rifamycin 1% topically acting gel N=39 % Placebo N=21 % Overall satisfaction (very satisfying/satisfying) 74.3 66.6 Ease of administration (very easy/easy) 69.2 47.6 Ease of retention (very easy/easy) 71.8 66.7 No post-dose need to use toilet 84.6 61.9 No burning sensation 87.2 90.5 No itching 97.4 76.2 No post-dose pain 94.9 81.0 Willingness to resuse 82.1 71.4 UC | 2026 18
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Few Treatment-Emergent Adverse Events Related to Rifamycin Few Treatment - Emergent Adverse Events Related to Rifamycin n (%) patients [n adverse events] Rifamycin 1% topically acting gel N=51 Placebo N=24 Adverse event related to IMP 4 (7.8) [8] 1 (4.2) [1] Adverse events by SOC and PT Gastrointestinal disorders Abdominal distension Anal incontinence Diarrhoea Vomiting 1 (2.0) [1] 1 (2.0) [1] 1 (2.0) [2] 0 (0.0) [0] 0 (0.0) [0] 0 (0.0) [0] 0 (0.0) [0] 1 (4.2) [1] General disorders and administration site conditions Chills Condition aggravated Malaise 1 (2.0) [1] 1 (2.0) [1] 1 (2.0) [1] 0 (0.0) [0] 0 (0.0) [0] 0 (0.0) [0] Investigations Hepatic enzyme increased 1 (2.0) [1] 0 (0.0) [0] UC | 2026 19
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SUMMARY & NEXT STEPS Primary Endpoint Met Phase 2 Success Support Advancing Towards Phase 3 Differentiated Novel MOA with Local Delivery Differentiated Novel MOA with Local Delivery Large, Underserved Population Positive Safety Profile UC | 2026 20
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Disclaimer Disclaimer The product featured in this video is investigational and has not been approved by any regulatory agency. The images displayed are illustrative only. The information within this video is confidential and not intended for promotional purposes. This video and all its contents, including but not limited to images, audio, logos, trademarks, and any information disclosed herein, are the exclusive property of Cosmo. Any unauthorized use, reproduction, modification, or distribution, in whole or in part, is strictly prohibited. UC | 2026 21
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