All right, great. Hey everyone, good afternoon, and welcome to day two of the 2024 Bank of America Healthcare Conference. Thank you for joining this session with Adverum. My name is Alec Stranahan. I'm Vice President and Senior Biotech Analyst here at B of A, and I'm pleased to be joined by Laurent Fischer, President and Chief Executive Officer of Adverum. And I believe, Laurent's going to run through some, some slides in a presentation, so I'll hand it over to you. Thank you, Alec, and thank you to Bank of America for inviting us to present. I look forward to giving you an update on Adverum Biotechnologies. We are a Redwood City-based biotechnology company focusing on gene therapy for large, prevalent ocular diseases, and we're currently in phase II with a aflibercept coding vector that has the unique attribute of being delivered intravitreally, like the standard of care, for wet age-related macular degeneration. We presented data recently at Macula Society, and that I will walk you through. Our next catalyst is essentially the interim analysis, the landmark analysis of 26 weeks' data we'll present at ASRS in July. We are planning to provide updates on our phase III plans later this year and start a phase III in the first half of next year. Company's well capitalized with $193 million in the first quarter, with cash into 2025. So, as you probably know very well, Eylea and Vabysmo are the leading treatments for this disease that impacts 1.5 million people in the U.S., with 200,000 new cases every year. The challenge for this lifelong disease is that it requires lifelong injections. And while these are high treatment burden, somewhat painful, they also are very costly for the healthcare system. More than 13% of Medicare Part B spent solely on anti-VEGF for AMD, and there's an indirect cost of $138 billion due to vision loss. So what if we could actually administer Eylea as a single intravitreal gene therapy by transducing the retinal cells to become biofactories to make aflibercept for life, and by that saving vision and potentially also saving healthcare costs? So the current standard of care is actually a bolus injection that requires frequent injections every four to eight weeks, with a newest agent every 12-16 weeks. But the problem with that is that between those injections, you keep accumulating fluid in the eye, something known as a trampoline effect, which is actually bad for long-term vision. And because it's a high burden of treatment, we know that in the real world, you can see that there's actually, over time, after an initial gain in vision and a loss in vision, with patients within three to five years going back to baseline, losing vision. So we'd like to bend that curve and actually preserve vision for life for most of these patients by delivering steady levels of aflibercept for life. In fact, you can see that with the most recently approved anti-VEGF, Vabysmo is actually on its way to becoming a $4 billion product, a bispecific antibody that Roche and Genentech developed that actually provides maybe slightly better vision or maybe greater interval between injections, a modest improvement that leads to a massive undertaking and rapid adoption by retina specialists, showing the high unmet medical need to improve the current standard of care. However, as you can see, these patients, while they initially gain a significant number of letters, six to eight, over a period of two years, there's a slight reduction in vision, and that's in a perfect setting of clinical trials. Eylea is very similar to that. So we believe that, you know, there's been great progress in the treatment of wet AMD, but a very high burden of treatment, and that despite the multiple programs entering phase III, some of the TKIs that may actually extend the interval between injection by up to six months, we can only deliver lifelong benefit with regenerative medicine like gene therapy. And, the only way to do that efficiently with the settings to that in an outpatient basis requires intravitreal injection. So this is our first in-man study. That study has been published this year, the two-year endpoints, looking at two doses of Ixo-vec with a relatively short prophylactic regimen. These are patients that require frequent treatment injections. In fact, you can see they get on an annualized basis 10 injections per year, one every five to six weeks. You can see that their vision is about 20/50 with a significant amount of fluid, as measured by CST, which is the thickness of the central subfield thickness. These patients have been followed up, some of them up to five years, but on average three point seven years. What we've been able to show after single injections is that the vision is actually maintained at both doses, up to three years. Those patients had the year prior nine injections. You can see on an annualized basis, overall, 0.2-1.6 injection that represents an 83% reduction in treatment burden. You can see that CST actually drops initially pretty significantly and stays low, so these eyes stay dry throughout the three-year of the follow-up. So what does that look like as far as treatment burden? For these patients, overall, 83% reduction in annualized anti-VEGF, but 53% free of injection at year two and year three. Again, this is a lifelong disease that requires lifelong treatments, and we think the goal of getting to half of the patients free of injection is what we should be focusing on. You can see that despite a short prophylaxis, there was minimal inflammation, which was actually observed as easily identifiable cells in the anterior chambers with a slit-lamp exam that are measurable with steroid eye drops. So very minimal safety signal, very measurable in the real world for a very significant benefit. So we know that these fluctuations in fluid in the retina, also known as a trampoline effect, are not good for the retina, for the health of the retina. They create a lot of pro-fibrotic signals. Across multiple studies, it's been shown that the greater that variability, the worse the long-term vision. You can easily see that in real-world examples like this 90-year-old woman, who actually, the year prior to entering into her study with Ixo-vec, received multiple injections of aflibercept. At 90 years old, she was hospitalized once. You can see when she was hospitalized that there was a significant increase in the fluid in the retina, 200 microns. That patient, obviously, would benefit from having a steady level of aflibercept. So what happened, you can see on the top chart that the vision was actually stable and even improved, up to three lines of vision. You can see that the CST of the fluid went down and stayed down through three years without any injections. That patient went from 10 injections per year to zero injections every three years. That's a very meaningful impact for these patients. There's an interesting case here, which is a patient that received an injection every five weeks for the year prior to entering into the study. And if I was the retina specialist, I would probably say that the patient is actually resistant to anti-VEGF because you can see that despite getting an injection every five weeks, that patient has a significant amount of fluid. This is a massive amount of fluid, 600 microns, so healthy is about 270-300 microns. And so what we do before we enter patients in a gene therapy trial is make sure they respond. And you can see that on the right-hand side, these are images of the macula and the retina. These gothic arches is actually this black is actually fluid inside the macula of the retina. But that patient does respond after two weeks of a single IVT injection. There's limited fluid. So in fact, what that patient would need is an injection every two weeks, which is not either reimbursed or practiced in the real world. However, with a single injection of Ixo-vec and steady levels of aflibercept over three years, that patient is completely dry and actually has gained almost one line of vision, again, a significant benefit. And that's what we believe is the transformational impact of what we see with gene therapy. So we had a lot of key learnings from this trial, is that we can actually deliver significant treatment benefit with very measurable safety with steroid eye drops. And that's how we designed our LUNA trial, which was designed to identify the optimal dose to take into the phase III in the market and the optimal prophylactic regimen. We actually tested the same dose that we tested in OPTIC, and the lower dose of 60/10. Similarly, those were very treatment-experienced patients and had the same retreatment criteria, so we can compare across studies, same that you would use in phase III. And we looked at two different topical, or local steroid prophylactic regimen, one with Ozurdex, a dexamethasone biodegradable implant, and the other one with eye drops, with or without oral steroids. We identified early on that Ozurdex alone doesn't have a half-life that is quite long enough, so we added steroid eye drops on the back end as well. And that seems to result in improved inflammation control compared to what we saw in OPTIC, which again, we believe is very acceptable from a, market and adoption perspective. So this is actually the, Macular Society. You can see that about half of the patients were at 26 weeks, so we'll show at ASRS in July, all, you know, most of the patients there at 26 weeks. And also interestingly enough, that a lot of these patients had multiple anti-VEGF, including Vabysmo, which in 10 patients was used, as one of the anti-VEGF the year prior. So we'll see how these patients are doing. So if you compare the population across OPTIC on the right-hand side and LUNA, right next to it, you can see very similarly, those are called frequent flyers because they actually get injections every five to six weeks, about 10 annualized. Slightly better vision compared to OPTIC, slightly drier eyes, so better fluid control, but still patients who need frequent injection. And that's the majority of patients, about, you know, 60% of the patients get about 8.8 injections per year, and that, controls their disease. So if you look at the reduction in annualized anti-VEGF the year prior compared to what we see at 14 and 26 weeks, roughly 90%-94% reduction in treatment burden, very comparable to what we saw in OPTIC at the same dose. If you look at the higher, more, I think, stringent way to look at, the treatment benefit as injection-free, it was 68%-85% at week 26, so at six months, compared to 73% in OPTIC. Maybe a start of a dose response, we'll see, but only half of the patients reach that 26-week time point, so, that's what we'll be presenting. Really a best-in-class efficacy of any products that are in development or on the market. So this is kind of all patients. There's a called swim lane plot. You can see on the left-hand side all the different treatments they received the year prior. They get a single dose of Eylea to make sure they respond to anti-VEGF. And on the right-hand side, we follow them, the empty dots when they're free of injection. You can see several patients past six months and some to one year free of injections, and nine patients only with a single top-up, you know, for either, disease activity increase, fluid, BCVA, or subretinal hemorrhage. And then only less, you know, 10% of the patients with more than one injection, still with a treatment benefit. So this is really quite remarkable as an improvement for this patient. Obviously, the primary endpoint for phase III trials, as always, BCVA and generally speaking, a non-inferiority compared to Eylea every eight weeks. You can see that vision is stable at both doses as it was compared in OPTIC and the dotted line. And you can see that the fluids are well controlled also through week 26, and I showed you earlier that through three years, this fluid is also well controlled. We looked at the patients free of injections to make sure that was not a bias of the supplemental injection. We can see also vision and fluid are stable through week 26. And if you look at one thing that's quite remarkable is the level of aflibercept that we can measure in the front of the eye. In blue is what we measure in OPTIC, out to four and a half years. After a single injection, you can see that we measure levels that are completely stable in all patients. That actually is not the case with all ocular gene therapy programs. There's a subretinal program that's in phase III that I show a drop in expression between six months and two years. You can see actually the two different purple colors are the two doses we're evaluating in LUNA that provide also therapeutic levels, but with the uniformity to show these levels both individually and long-term. And we believe that we have the best expression of any ever. Looking at the safety, you can see that compared to OPTIC, we have actually improved the safety profile with a go-forward regimen with minimal and well-controlled anterior cell and pigmentary changes that we see. And obviously, that is an important part of making sure that the benefit-risk long-term continues to be observed. The IOP was stable in all patients as we were hoping for and predicting. You can see that where the patient had a high fluid at baseline, we can see a drop in fluid that stays down, which is what you want to see. Again, not something that's seen with all programs. If patients came in with dry eyes instead of that darker green, they actually maintain that. We talked about all the patients, but what if we only look at patients who were on Vabysmo? How did these patients do with that new bispecific antibody? Well, you can tell that so far, all of them were free of injection. That's really something that is transformational. Just comparing to the landscape, again, if we look at the highest bar of being free of injection, you can see that compared to the two other outpatient programs, we have significantly better efficacy. We also are the only ones that have that long-term efficacy. We have, you know, at two and three years, more than half of the patients free of injections with stable vision. We're very excited about our ability with our go-forward regimen to actually show we can actually manage very well this immune response that we anticipate. We have actually shown efficacy and protein levels out to four and a half years. We are very excited about this best-in-class reduction profile in a large market with rapid innovators in a way that fits into the current buy-and-bill model. We look forward to providing updates on the program, as I mentioned, later this year in July with our 26-week data and then with the updates on the phase III design as well as additional data on the one-year endpoints coming, you know, in the first quarter of next year. Thank you.
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