Today, and welcome to the PHAXIAM Therapeutics business update and financial highlights of Q3 2023. At this time, all participants are in listen- only mode. Later, we will conduct a question- and- answer session, and instructions will be given at that time. As a reminder, this call is being recorded. I would like to turn the call over to Thibaut du Fayet, company CEO. You may begin. Thank you very much. Yes, good morning to all of you. Thank you for joining for our conference call today, whose objective is to present PHAXIAM business and financial update. I'm here with Eric Soyer, our COO, CFO, and also with Pascal Birman, our CMO, and three of us, we will perform this presentation and will be available for Q&A afterwards. We have disclosed yesterday evening a post-market press release, and you will find both with the presentation. These two documents can be found on the IR page of PHAXIAM website. Okay, if you are moving to the presentation, just as an agenda, we are proposing to you first to make an overview on our strategy, PHAXIAM strategy, to afterwards business update and clinical update. And then Eric will present the financial update, I mean, the mainly the Q3 financial results. And then we'll be ready for to present, I mean, to answer your questions. Okay, if we move to PHAXIAM strategy on slide number 5. Our ambition is really to create a global leader in phage therapy, and this this ambition relies on different aspects. The first one is to position PHAXIAM as a global player. First, leveraging through clinical operations, and currently, we have been clearly positioned as the main European player. Within our PhagoDAIR trial, we have open site in France and Spain, and very recently we opened also site in Germany and Netherlands. It's why we are clearly positioned as a European phage player. Thanks to ERYTECH base and team presence in the U.S., we are also having objective extending our position to the U.S. I think that the first interaction we had with FDA is clearly demonstrating our ambition in the U.S. as a future global player. The second point, and I will come back to this afterwards, is really to expand our clinical portfolio in high value indication associated with severe resistant infection for which we could claim for high price. But I will come back to this in a minute. The third point of this strategy is really to intensify BD activities and market access strategy. We consider strategic alliance with complementary biotech in Europe and in the U.S., considering that in this industry, there is a lack of economy of scale, and it's why we should leverage on alliance with competitor partners. And that, that's the first aspect. We are considering another example of this kind of alliance in the IVD industry, as we have developed the Phagogram, which is a kind of phage susceptibility testing capability. Here, we are currently discussing with IVD strategic players to set up a alliance. And I would also comment the market access strategy, which is a very important aspect. In Europe, and mainly in France, we received a regulatory status related to compassionate treatment. And currently, we're in a position to sell our treatment for this compassionate use. Our strategy is really to extend this, you know, compassionate selling status in other European countries. It's not the case in all of them, but we could extend our revenues. Also to be prepared for early access, because thanks to this first regulatory status, we are eligible to early access, which could enable us to pre-commercialize our treatment once we have generated proper and robust phase 2 clinical data. It's that this market access consideration is of high importance to us. The fourth point relates to the implementation of a global manufacturing strategy. Our first objective is to consolidate existing industrial partnerships which are already in place with a strategic partner, because we are currently outsourcing our manufacturing, but which is a major competitive advantage for our company so far, due to the exclusivity that we have within this agreement, and also with the very low cost that it's providing to PHAXIAM. Beyond this objective to consolidate this manufacturing partnership, we will develop a global manufacturing strategy in line with our international development. In other words, as we are currently considering going for global clinical development, global phase 2, Europe, U.S., we also have to adapt and to design a consistent manufacturing strategy to have access to U.S. capabilities. The last point, which is also of high importance, is the ambition is to boost R&D capabilities and expand our phage platform. A few weeks ago, we have disclosed that we are now working on a fourth target, which is Klebsiella, very complementary to the first three pathogen on which we are working. Beyond this, we are also extending our phage portfolio, our phage cocktail. We're also preparing in research future development programs. We are at the preclinical stage, working on bacteremia, which is a potential clinical indication on which we could develop a candidate. Beyond this, we have also in research announced, as we were merging with ERYTECH, that we wanted to develop drug-based bacteriophage and bacteriophage-derived enzyme endolysins, considering that endolysins are a very complementary technology pillar to phage to be developed. It's what we are currently starting in research. I would say in any case, again, to reinforce these capabilities, we intend to leverage on strategic research alliance, and I would say as a role on open innovation, to accelerate and complement our internal research portfolio. I would take an example on this. We have disclosed two months ago strategic research alliance with Vetophage, which is a European biotech, developing phage and endolysins in the field of animal health, and with which we negotiate option license rights at minimal cost so that we can, you know, have access to more phage, more endolysins, to be applied to human health. In a nutshell, that these are the main five important points on which we rely to develop this global leadership ambition in phage therapy. I would maybe comment the following slide, which is the slide number six, explaining our ambitious clinical strategy. The first point, we target, and that's a change that we have explained, when we merged with ERYTECH, I mean, Pherecydis and ERYTECH, 6 months ago, 5 months ago. The idea is really to target this high-value indication, targeting severe resistant infection with high unmet medical need. And this kind of indication may be associated with high mortality rate to be decreased. Can take the example of endocarditis infection, for which we are this month initiating a clinical trial in Europe and mainly in France. But also, ventilated acquired pneumopathies, for which we are preparing also an investigator-sponsored trial, whose mortality rate reach around 30%-40%. It means that here there is a major medical, clinical challenge to reduce this mortality. Another aspect is that we could target, and it's what we are doing, we are targeting high budget impact indication, like PJI, prosthetic joint infection. This indication has very high cost: cost of surgery, rehabilitation cost, in that the global budget impact for the health system is very high. And here, the objective is to reduce significantly this budget impact so that, you know, we can claim high price, thanks to, you know, the mortality rate decrease or the budget impact decrease. That's the first aspect. The second point, our clinical strategy consists in accelerating our path to registration. As we can leverage on, you know, large, and Pascal will comment on this, large compassionate clinical data, compassionate real-life data, demonstrating tolerance, but also activity, demonstrating clinical benefits. This enables us to accelerate our plan, and it's why the first aspect is that we prepare the first global phase 2 study for patients in prosthetic joint infection as requiring DAIR. DAIR, it's a standard of care, so debridement, antibiotics, and implant retention. Our U.S. competitor currently are mainly positioned in the U.S., and they are not currently able to conduct a global clinical development. And it's why, and we will come back to this, we received very recently an FDA feedback on our clinical plan, and we are currently in a position to prepare for global phase 2 clinical development. And that's the first aspect. The second point is to say, in this move to registration, that in Europe, we could leverage after this phase 2 early access pathway in some European countries like France, Germany, and some others. But, independently on a potential phase 3 or pivotal trial. That was the second aspect. And beyond this, we intend to gradually diversify our clinical portfolio to other high-value indication, and to extend this portfolio to indication like, you know, endocarditis infection, which is the phase 1 PK trial that we're initiating this month. Beyond this, we have also other option, other high-value indication, for which we could consider clinical development. But, what's important in this, I would say first reason, is to remain a tight focus on this indication. These are the three main aspects of this clinical strategy, and I would move to and to move on the following slide, slide number 7. I would like, before handing over to Pascal, our CMO, to explain why we consider that prosthetic joint infection, PJI, is a very high-value indication. First, because the standard of care is really insufficient, as it remains challenging to treat. It requires heavy doses of systemic antibiotics in addition to surgery for many months, even up to 10 years. The second aspect is that the unmet medical need remains very high. There is still a failure rate of the standard of care, standard treatment, again, which is amounting to 50%-55%, in that there is still important room for improvement. For this indication, there is still a very high risk of reinfection, 60%, amputation, 11%, and even mortality at 5 years, at around 25%. It's been that the level of unmet medical need is still very high on the top of, I would say, a very high budget impact indication, but I will come on this. Then the third point making this indication as an attractive indication. It's a relatively high incidence, you know, in U.S. and Europe 5 and 27, we are assessing the incidence amounting to 60,000-70,000 patients. And of course, due to the aging population, this incidence is growing. To come to the last aspect, which is a high budget impact, it's still in the U.S. and in Europe, a substantial economic burden. In the U.S., an average cost of treatment is in this range of $150,000. In Europe, it's of course, at a lower price, but still in the range of EUR 50,000-EUR 70,000, depending on the country. That's why the budget impact and the is massive and the opportunity of reducing this burden could enable our company to claim high price. And just, I would like just as a conclusion on this, I would like to take a concrete example. Currently, in France, as we have this compassionate status, and as you know, we are supplying the physician and the patient with our treatment, we are selling our product. And we are selling our, you know, our phage, in the range of 20-30K EUR, still demonstrating our ability to price at a high level in infectious disease. It's why we consider that the PJI, as a first lead indication, is very attractive, as, as a first, indication. Okay, it's why I propose now to hand over to Pascal, our CMO. We will give a bit more detail regarding the last update of our clinical plan. Please, Pascal. Thank you, Thibaut. So I hope everybody can hear me well. So I'm on slide number eight. So we got the feedback from the FDA on our first proposal for a PJI study, and which confirmed the regulatory pathway in the U.S. They confirm the value of a clinical development in this indication, and in particular, they confirm that our non-clinical and pharmaceutical current package is adequate to support a clinical development in the U.S., which is, of course, of most importance. And also, they provide clear development guidelines for a phase two study in the U.S. We are waiting for also the feedback that we expect to get from the European Medicines Agency, the EMA. We expect to get this feedback from a scientific advice meeting, which should take place in January next year. Based on both FDA and EMA feedback, we should be in a position to finalize the design of our next global phase 2 study in prosthetic joint infection. If we move now to the next slide, slide number 9. In addition to this, PJI indication, we have another important indication with our phages against Staphylococcus aureus, which is endocarditis. Endocarditis infection with Staphylococcus aureus, where we are planning to start very soon, the phase 1 PK and safety study. This study will take place in patients who have infection due to Staphylococcus aureus endocarditis infection, with an indication of surgery. The objective will be when we will administer the phages by intravenous administration to assess the concentration of these phages in the blood, but also in the valve, which is infected by the bacteria. To identify what is the optimal method to administer the phages by IV route, which will be important for the next efficacy data, studies that we plan to perform in, endocarditis, but also in potential other indications, where there is a need to administer the drug also by IV route. We already obtained the agreement from the French Medical Health Authority, the ANSM, to perform the study, which will be performed in France, and we expect to get a first patient by the end of this year, with data expected by the middle of next year. If we move to the next slide, slide number 10. It is also important to understand that we can also, I would say, expect some good results from all these data, from all these studies, because we already have quite a substantial number of data from real-life administration of our phages related to compassionate access. Since 2017, we have treated more than 90 patients on this compassionate access. And actually since June 2022, we have obtained from the French agency, a specific authorization for compassionate access with our phages against Staphylococcus aureus in osteoarticular indications. And overall, we have now reviewed data from about 77 patients, most of them treated for prosthetic joint infections due to either Staphylococcus aureus or Pseudomonas aeruginosa. And coming to this data, we can show that there has been no safety issue. No, serious adverse reactions have been reported from the prescribers. In terms of activity in this population, which is in therapeutic impasse, which is a very severe population, where previous treatments have failed. We have seen at least some elements of activity in combination with antibiotic therapy, with above three quarter of the patients, around probably 75% of the patients, who have seen no recurrence of infection three months after administration of the drug. Drug, which is administered, for example, for PJI by intra-articular administration, directly into the site of infection. So there's been also some publication of these individual cases, which has been performed in the, in the literature. So based on this data, we have some, I would say, quite, promising data, which, make us very confident about the outcome of the trials we are doing. The last point I wanted to mention also on slide 11, is about our Phagogram platform. Phagogram is an in vitro diagnostic test, which is designed to, assess the in vitro activity of our phages, on the patient's bacterial strains. So, for, our phages against Staphylococcus aureus, we have performed now more than 100 Phagograms. We have two phages, available against Staphylococcus aureus, and we have been able to show that quite all, in all cases, actually, in 98% of the cases, at least one of the two phages is active in vitro against this Staphylococcus bacterial strain from the patients. So we demonstrate that we have a high spectrum of activity of our phages, and that probably in almost all patients, we are able to have at least one. And most, in most of the cases, two phage, there are two phages which are active in vitro against these bacterial strains. So that's really a very competitive advantage. And this bacteriophage, sorry, this Phagogram platform also will help us also to develop other phages in the near future. I think I have completed my presentation, and then I hand over to Eric. Thank you. Thank you. Thank you very much, Pascal. Good morning, everyone. A few words on the key financial results at the end of Q3 this year, and, indeed, we're on slide number 12 of the, of this presentation, and we're starting with key highlights on the P&L. My first comment is that in the context of the ERYTECH Pherecydis merger, PHAXIAM's consolidated financial statements include ex- Pherecydis's financial results as from the date of the merger, which was June twenty-third this year. Consequently, PHAXIAM's P&L information for the first nine months of this year includes nine months of ex- ERYTECH activities and approximately three months of ex- Pherecydis activities, i.e., since June twenty-third this year. With that in mind, P&L highlights are very much in line with the comments we already shared at the end of Q2, which are a strong reduction in operating expenses, which were EUR 18.6 million in the first nine months of 2023, and 40% lower, this is a EUR 12.6 million reduction, than in the previous year. The decrease is driven by a sharp reduction, -67% of R&D expenses, mostly related to the closing of ex-ERYTECH Princeton operations and the termination of ex-ERYTECH clinical development activities. At the same time, PHAXIAM's G&A expenses increased by EUR 1 million, +9%, versus the previous year, and that increase was related to the merger transaction and other merger-related costs. Finally, net loss for the first nine months of 2023 was EUR 17.9 million, compared with a net loss of EUR 6.2 million for the same period of 2022. But 2022 benefited from the exceptional EUR 24.4 million net gain on the sale of the Princeton facility back in April of 2022. We are now moving to the next slide, number 13, of the presentation of the cash position. As of September 30, 2023, PHAXIAM had cash and cash equivalents totaling EUR 15.6 million, which is approximately $16.5 million, compared with EUR 38.8 million as of December 31, 2022. This is a 23.2 million decrease in net cash position during the first nine months of 2023, which was the result of a EUR 20.5 million net cash utilization in operating and investing activities. EUR 2.6 million used in financing activities, mostly related to the reimbursements on schedule of the previous COVID loans, and the variation of the US dollar against the euro led to a small EUR 0.1 million negative currency exchange impact. The company believes that its current cash position can fund its current programs and plans operating expenses into the second quarter of 2024, which is exactly in line with the previous cash guidance we've given already, several months ago. Now, before we move to Q&A, a quick summary of our key strategic priorities for the coming months and upcoming key milestones. This is slide number 14 of the presentation. I'm starting with the bottom part of the graph on regulatory milestones. Thibaut du Fayet and Pascal Birman have already commented the feedback from the FDA, which we received very recently. This is the first and very important regulatory step, which clarifies and opens the regulatory path for PHAXIAM in the U.S. And as previously discussed, we're now expecting to have a scientific advice meeting with the European agency, the EMA, which we expect to have in January. And on that EMA plus FDA basis, we'll be able to finalize our global U.S. and EU clinical development strategy going forward in the PJI indication. With that in mind, we plan to be able to start a global phase 2 clinical development in PJI in the second half of next year, as mentioned in the upper part of this graph on clinical milestones. Staying on the clinical front and closer to us, we're launching imminently a phase 1 PK study in severe endocarditis infections, and that was already mentioned by Pascal. We expect to have the first patient in that study around year-end, with results approximately 6 months after, i.e., mid-2024. To summarize, quite a significant use of PHAXIAM on key clinical and regulatory milestones planned over the coming months. Stay tuned. With that, I would like to thank you already for your attention. We'll now open the call for any questions you may have. Operator Michelle, it's over to you. Thank you. If you'd like to ask a question, please press star one one. If your question has been answered and you'd like to remove yourself from the queue, please press star one one again. Again, that's star one one to ask a question. I'm not showing any questions. I'd like to turn the call back over to Thibaut for any closing remarks. Okay, Michelle, thank you very much. So, I hope that we have convinced you that of the ambition of this clinical plan that we have. As a major event, as a European biotech, I would highlight the very recent FDA feedback that we got, confirming all the value of, you know, our clinical development in PJI, but also in the U..S. Considering that we have now really an option as a European biotech to conduct clinical development in the U.S. And being, you know, preparing in this, in that context, you know, the first global trial, Europe-U.S., for phage therapy. That's our whole ambition, and that's still waiting for EMA feedback, but in any case, we are now anticipating the preparation of this future trial. I would like to thank you all for your attendance, and maybe we will organize another meeting for the, you know, final results presentation, final 2023 financial results, end of March. Goodbye. Thank you very much. Thank you all. Thank you. Bye-bye. Thank you for your participation. This does end the program. You may now disconnect. Everyone, have a great day.
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