All right. Good morning, everyone. Welcome to the Jefferies Global Healthcare Conference. My name is Conor Fagan. I'm with the Jefferies team here. It's my pleasure to introduce Christer Ahlberg, CEO and President of Cinclus Pharma. Okay. Thank you. Thanks a lot. Today we're going to talk about Cinclus Pharma and our lead candidate, linaprazan glurate. We are in the reflux disease area, we have a unique substance called linaprazan glurate. We are in the phase III program just currently. The uniqueness with our product is that we can offer a 24-hour acid control, which is a must for the severe patient, which are our target population, severe patients within erosive GERD. Despite that this is a niche market, we are talking about approximately 10 million patients in the U.S. and in Europe and 90 million globally. This is definitely a blockbuster potential market but also it's a specialty commercial possibility. We can commercialize it, go towards the specialist. We are, as I said, in the phase III, already ongoing. The phase III program is ongoing, and we're expecting to have the first readout of the first trial in the end of this year in the Q4. I'll come back to that more later in the presentation. Actually, it's interesting to see and follow this market, looking into the P-CABs where they have been launched, especially in Asia. We started in Japan. We can see that P-CABs taking over the markets where they have been launched, taking over it from the old PPIs, the proton-pump inhibitors like Nexium and Prilosec. It's a very promising market to go forward here. We have partners in Europe with Zentiva, so they're going to commercialize this in Europe. We also have partners in Asia, specifically in China, where we actually have an ongoing launch just currently as we speak. Let's go into the disease a little bit. I'm not going to go through this so in depth, the disease is very easy to understand. You have the acidic content in the stomach normally, the disease is actually that this content goes in the wrong direction, up in the esophagus instead of downwards. That's down due to that your sphincter between the stomach and the esophagus doesn't work as it should. The acidic content actually fry holes and fries up the mucosa in the esophagus and also ending up with erosions and also with symptoms and pain. What you do there now is actually you try to reduce the acid production, that's have been done over the decades with PPIs and before that H2 blockers and now P-CABS. What we see now with the PPIs, despite that they are good for the milder patient mainly. You can see that up to 50% of these patients are not healed so they still suffer from this disease. What we also see that almost every second patients are suffering from pain during nighttime, and that's of course, something that has a big impact on the quality of life. Also this is a progressive disease. If you don't heal the patient, there is of course, a risk that the disease is also developing into something more severe, like cancer. You want really to heal the patients. The market potential, as I mentioned, is definitely a blockbuster. The disease is very common. Almost 20% of the population in the West are actually suffering from this but the more erosive part where you get the erosions in the esophagus is approximately one-third of these. We're talking about up to 30 million patients in Europe and U.S. Our target population is the most severe among these erosive GERD patients, so that's C and D classification. Here we're talking about approximately 10 million, and in U.S., it's approximately 4 million out of the 10 million. It's a really good potential. Also the good thing with this market, it's good for us, maybe not the best for the patients, though. This is a chronic disease and you never get better. Actually, you get worse normally, by age. The patients are in circle around in the system for the rest of their life. You get also a lot of relapse in this disease, so the patients coming back to the physician's office. It's big, it's dynamic, and the patients are chronic. You have a lot of switch opportunities. The ambition for us is, of course, to deliver best-in-class P-CAB. If you do that, you have great chances actually to get into the market quite fast when you are there, because there is always a reason to believe that you can offer the patient something else. That's important to mention in this case. Looking into the disease overall, there is a fantastic biomarker in this market. Here you can see a linear correlation between acid control defined by pH above four over 24 hours, the percentage of the time of the 24 hours in correlation with healing of the erosions in the esophagus. This is done, we have 1,000 and 1,000 patients in different meta-analysis done by McMaster University in Canada, and that have been ongoing for decades now, and they are also adding up new patients all the time in this analysis. As you can see, it's not very common that you see a linear correlation like this. If you can improve the acid control, you also know that you will improve the healing of the patient. That's something that when we have developed linaprazan glurate from the beginning, that has been our ambition, to come as close as ever possible to the 100% acid control because that's the most important thing to actually reach, especially for the severe patients. Next slide will illustrate the differences between the different classes and the evolution of this market for the last 30, 40 years. On the top row there, you can see the acid control defined by pH above 4 the time in percentage of the 24 hours. You can see that we have with H2 blockers, they were very big when they came. You can see they started with 30+% and we are ending it up now with 96% of acid control. If you think about it, the opposite, if you look at it from the other side, here you have the diagram showing what you can see here in red, you can see below pH 4, that's the time when actually the acidic cause the erosions and actually cause the symptoms. You want to reduce the number of hours here. When H2 blockers came to the market, it was dramatic revolution actually compared to what you have before, more or less nothing, 16 hours. When PPIs were introduced, you can see the giant leap, the step downwards in number of hours, where you could reduce the number of hours you were below pH 4. Now when the first generation of P-CAB has entered the market, you can see approximately the same step downwards in number of hours. That has also given them the market leadership in the markets where they have been launched. H2 blocker actually built Glaxo and these products became the most sold drug in the world. PPIs built Astra and AstraZeneca, they became the most sold drug in the world. Actually vonoprazan in Japan was the most sold drug in Japan during 2021. It's matter if you can reduce the number of hours when you're actually causing the disease. You see in the last bar here, we have one hour and we can see the possibility now to play this song and to play this video again. You see that this is as good as you can actually reach in the acid control. This is a good opportunity and especially the severe patient who has more or less an open wall between the stomach and esophagus, and each hour you can reduce there is of importance, of course. This is how we are going to differentiate our product compared to the rest of the market. Of course, we need to deliver good clinical data in healing and symptom relief as well, which is important. Of course, we have an ongoing phase III trial now. We also have data from a phase II. We just wanted to plot out and see if this biomarker works as it is. Now we see that other P-CABs, vonoprazan and tegoprazan, they actually have good data, very good data from U.S. Now where you can see the results. Actually it's interesting to see and follow if this biomarker is working. We plotted out the data that we have on eight weeks of the C and D patients into this graph. Actually, you can see if the correlation with acid control is there, 63% on lansoprazole, which they used as active comparator in both trials, and we are using that as well. You can see there, approximately 70% healing for the C and D after eight weeks. Tegoprazan just announced their results of a little bit more than 80%, with the acid control approximately what we've seen in data of 75%. Vonoprazan up to 85% acid control delivered close to 92% of healing of these patients. We don't have eight weeks data yet. We have 96% acid control. It will be interesting to see if the data will cope with this correlation in the future. We have four weeks data, though. In the phase II data we presented, in our best cohort in that dose-finding study, we have 93% after four weeks, I should say. All the patients that didn't reach full healing, they reached level A or grade A. Of course, that's a good signal if they would have been on the drug for another weeks, might have been improvement there as well. That is in absolute figures. Healing in absolute figures is important, of course, but also the incremental benefit compared to the comparator of PPIs is also important. What you as a physician want to see is, of course, that if you go from a PPI and to something else, you want to see that you have an incremental effect of the new drug. Of course, the delta is also, of course, important. I would say that in our phase II, of course, that's a phase II, but we saw a fantastic delta compared to the active comparator of lansoprazole with more than 50%. If we look at the other P-CABs, we see a delta. As I already mentioned, they have absolute figures in the C and D patients after eight weeks. We also saw a delta similar actually to each other on approximately 20% versus lansoprazole. That's interesting to see. It will be very interesting to see our delta in the future. Of course, you can ask yourself if these were data of eight weeks and we had four weeks, and of course, maybe the differences are bigger in the beginning since P-CABs are faster onset compared to the PPIs. We checked that as well. The data on two weeks of the other P-CABs is similar, actually, I would say, as we see in eight weeks. There is something here that could be of interest to follow, and soon we actually will know what effect we will have in the phase III trial so we can have indirect comparison since we're going to use the same comparator as the other P-CABs. Because what we have here ongoing now is the first of the two phase III trials, and actually yesterday we announced that we have screened the last patient in the first one. The first one study, we have the top-line result in the end of this year in Q4. Then, of course, we know exactly what absolute figures we will have in healing and also the delta compared to lansoprazole. Other endpoints we are looking into here is, of course, this is a study investigating four weeks and eight weeks, and we will look into healing of all patients, all grades in the erosive GERD patient group. We also will look into our target population of the C and D, the most severe patients. Of course, we also are eager to deliver something more than only healing. The patients are coming to the physicians due to their symptoms. Of course, we want to deliver symptom relief. Our ambition is, of course, to deliver superiority versus lansoprazole when it comes to symptom relief. All these endpoints will be presented in Q4. Going forward, when it comes to the timelines and what is needed actually to get all the way to approval. As you can see here, the first phase III trial, the HEEALING 1, on top there, we will have the readout now coming in the end of the year. Directly after that, as seamless as possible, we will introduce the last HEEALING 2 study then. Here we also will investigate both HEEALING but also the maintenance. That will be introduced and initiated as fast as ever possible. Thereafter, of course, it's submission time. We are actually looking into an approval in 2030. Okay. I think I stop there. As you understand now, just to summarize, what we try to do here is to introduce a best-in-class P-CAB, and where we are focusing very much on have developed a product that actually can give us as long duration as ever possible, also where we can actually optimize the dosing to get the full acid control. We have a chance actually to help and heal the patient, the suffering most from this. Also where you also have unmet medical need still. That group is defined as the most severe erosive GERD patients and classified as the C and D patients. I think we have a very good chance actually to reach that. In six months, we know a little bit better what kind of data we have but it definitely looks promising if you look at the phase II data that we already have. We're looking forward at that readout session in the end of the year. With that, I stop. Thank you very much. Open up for questions. Okay. No questions, then we stop. Thank you for coming. Thank you
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