I'm Alice Nettleton, one of the associates in Tim Anderson's U.S. Large Cap Biopharma team. We're excited to host Metsera today for a 15-minute presentation. We have various members of the team here at the conference, but today we're going to hear from Whit Bernard, who's the CEO of Metsera. We're very excited to hear more about Metsera and the updates from earlier this week. Thank you so much, Whit, and the floor is yours. Welcome. Great to see you all and good to be out here. We'll be making forward-looking statements and would refer you all to our SEC disclosures and risk factors on our website. Metsera, we're a leading clinical stage obesity company taking on what we think may become one of the largest markets in the history of biopharma. We are exclusively focused on nutrient-stimulated hormone analogs, the family of hormones around GLP-1, which is a space we feel is in its early innings really for two reasons. One, ultimately, we believe we need to be combining these pathways, and we are looking at multiple missable and combinable pathways on top of what we believe is a best-in-class GLP-1 backbone. Two, maybe most importantly, we are in the very early innings of engineering these peptides to be scalable. We will talk a little bit about how we do that from the perspective of ultra-high potency, which improves manufacturability, a category-leading half-life, which improves convenience and tolerability, lots of ways we can actually modify the way we hit these targets with peptides to scale. If we look at the portfolio, three assets in the clinic: an ultra-long-acting GLP-1, which is in phase 2, a monthly amylin combinable with the GLP-1 in the clinic in phase 1, both alone and in combination with our GLP-1, and then a range of orals, a tool compound that is in the clinic right now, and two entering the clinic mid-year, which was an update we gave this week. We built the company with the capabilities really to go all the way to market. We have what we believe is one of the leading peptide engineering capabilities in the industry, and I think that shows through in the quality of our assets, a very productive translational engine around that that has been cranking assets very efficiently into the clinic. A development engine, much of which came out of the Medicines Company, which is a group that was known for doing very efficient large-scale clinical development, positioning us to run major phase 3 trials at high levels of efficiency. A really rich library that gives us multiple sources of renewal across the portfolio, 20,000 peptide analogs in the ZyHIP library that we acquired at the outset of Metsera. A lot of clinical data coming, and we'll talk through some of the catalysts in this presentation. First, as we look at the kind of market backdrop here along the left, we think a lot about where this market is headed and the attributes we see in the potential future market leaders. Interestingly, we see basically this focus on weekly injectables. If we look at the next generation, most of the injectables are dosed weekly. We see this persistence of complex titration schemes, which creates a certain amount of friction, especially in a highly prevalent market. We see tolerability issues, and we see in the case of some of the orals in development, we're asking patients really to take a step backward on tolerability in exchange for the advantages of an oral. All of this for us, maybe most importantly, ladders into scalability limitations. In a market with hundreds of millions of potential patients, can we really scale weekly injectables? Can we scale orals with fundamental tolerability challenges? Can we scale complex titration? Against that backdrop, in our portfolio, what you'll see is a focus on monthly or longer-than-monthly dosing in all of our injectable peptides, a focus on scalable oral peptide delivery that we believe can deliver injectable-like performance with the convenience of an oral, a focus over time on multi-hormone combinations, which we think are going to get us to higher levels of efficacy and improved tolerability, all of that laddering into category-leading scalability. We will close with some data on that at the end of the presentation. Quick snapshot of the pipeline, and I'll do a whistle-stop tour through each of these, given we have a very short slot today. Fully biased, monthly GLP-1 in multiple phase 2 studies, all ongoing. First reading out mid-year, our monthly amylin, MET-233, being studied as a monotherapy. We'll have that data this quarter, actually, and then in combination with MET-097, with data coming later this year. On the oral front, ongoing phase 1 of our prototype peptide, and then two potential leads, MET-224 and MET-097, entering the clinic mid-year, and a range of next-generation programs behind that. We'll quickly talk through each of the most advanced candidates. MET-097, first, our most advanced asset. I think the single fundamental differentiating feature of MET-097 is its durability, as we'll see in a minute, as a half-life that is longer than any peptide in development, which enables monthly dosing, enables tolerability advantages, also enables titration-free dosing for patients who need it or want it. It's an incredibly potent peptide. We're seeing dual agonist-like efficacy at one-tenth the dose of a tirzepatide, for example. It's fully biased, which is part of what drives that potency. As a 41-amino acid peptide, it's also BLA-eligible. We've looked at MET-097 and disclosed data from an SAD and MAD and a 12-week extension phase 2a study. We'll talk mostly about the 12-week data today. The first insight out of the SAD, maybe the most important that came to us on this asset, was the human half-life, 380 hours, roughly 15-16 days as a terminal half-life, 17-18 days from an apparent half-life perspective. You can see that sort of is right in range of meritide, which is the only other monthly construct in development, and substantially differentiated from every other GLP-1 dual, triple agonist, or amylin construct that we know of that's in the clinic right now. Competitive weight loss, our expectation going into this trial was that the fully biased nature of MET-097 would drive dual agonist-like performance. Our thesis is that most of the efficacy difference we see with the dual agonist is driven by the fact that they're biased. This 12-week data confirmed that. At the high end of the dose range, you saw 10-11% placebo-adjusted weight loss in range with the highest doses of dual agonist tested out to 12 weeks. Of course, at the low end with titration, 6.3% placebo-adjusted weight loss, which essentially overlaps with the SURMOUNT-1 titrated tirzepatide data. Very much in the range of dual agonist-like performance, as expected. I think what was really exciting for us in this trial was the tolerability. What you can see in the orange shaded column is essentially placebo-like tolerability. What's happening here is that when you dose a two-week half-life weekly, you have accumulation. That accumulation smooths the trough-to-peak variability that we believe is what drives most of the tolerability issues for early dosing. Here we see clinical data with one case of nausea, two cases of vomiting in a 20-patient cohort that shows you that you can almost engineer out the tolerability challenges of this mechanism with that smooth onset of pharmacokinetics. Of course, the other aspect of that long PK is that it enables one to get to monthly dosing. This slide illustrates the modeling and some of the data behind how we do that. We believe tolerability matters most in this category. We induce tolerability, if you will, with weekly dosing over 12 weeks with MET-097. That is modeled to the left of the chart here. Once we've kind of crossed an EC70 to EC90 range where we think we've more or less saturated the physiology, we switch to an exposure-matched monthly dose. In this study that's illustrated on the right, we took a 1.2 milligram dose of MET-097 and switched to a 4.8 milligram candidate monthly dose, and a 0.8 milligram weekly dose of MET-097 and switched to a 3.2 milligram candidate monthly dose. What you can see on the right is that weight loss continued on track out to 14.2% placebo-adjusted at week 16. Again, very much at the high end of the competitive landscape of dual agonists at that point, 12.5% with the 0.8 to 3.2 milligram. The switch was also well tolerated. The expectation was because we've saturated the physiology and we're above this EC tolerability level, we shouldn't see a major nausea or vomiting signal. We saw vomiting and nausea rates that were well below week one and more or less consistent with the background rate. Very much on track for monthly dosing. Stepping back on MET-097, we've taken most of the steps we need to take, we believe, to de-risk monthly dosing. The last will be InVesper 3, which is an ongoing phase 2 study where we'll look at multiple monthly doses. We've established a signal of class-leading tolerability, which we'll look to confirm in our phase 2 studies. We've also confirmed titration-free dosing in some of the higher doses and weight loss, which is consistent with the high end of the competitive landscape. We'll talk about milestones at the end, but a lot coming on this asset. MET-233, our amylin, has been a big focus at this conference. We updated investors this week that we'll have data this quarter on MET-233 from our monotherapy MAD trial. I think the single most important attribute of MET-233, like MET-097, is its durability. This was engineered to be an ultra-long-acting peptide using our HALO technology that should set up monthly dosing in combination with MET-097. Also highly potent, enabling efficacy at low doses, combinable with MET-097, so soluble in the same pH range, and we'll show you that data in a minute, and in combination with MET-097, BLA-eligible. Some quick preclinical data that just kind of characterizes each of those points you can see here in a PIG model, which is the primary model we use for preclinical pharmacokinetics. Essentially, the dose curves for MET-233 and MET-097 overlap. Of course, we've already established MET-097 to have a 380-hour half-life, so we're expecting similar performance from MET-233. Competitive potency. Here we are comparing preclinically the combination of MET-097 and MET-233 with Cagrisema at similar doses, two- to threefold more potent. That was, again, as expected, given the potency of the peptide. Very importantly, soluble across a broad range of pH. Unlike Cagrisema, where you have this challenge of a dual chamber device, here it will be combinable in formulation. In terms of MET-233, I think the key step-back points for us: very potent molecule, and we have a lot of in vivo data supporting that. A durable molecule, and I think this is the number one thing folks should be looking for in the upcoming phase 1 readout, is what does the pharmacokinetics look like and how differentiated is that from others in the category. Of course, mixable and is being tested now in combination with MET-097. We'll have the monotherapy out very shortly in the second quarter, and we'll have co-administration data out later this year, as well as longer-term follow-up on the monotherapy. On top of that, we are doing some early-stage work looking at additional hormone pathways on top of GLP-1 and amylin. I think the most advanced of these is MET-34, our mono GIP agonist. The theory here is that we should actually be able to substantially improve tolerability with relatively high ratios of GIP to GLP-1, and we'll be exploring that data later this year. You can see here on the right, again, in the PIG model, all of the dosing curves of the GIP, the glucagon, the amylin, and the GLP-1 overlap. Very much the design of all of these peptides to be combinable and to have well-matched pharmacokinetics. Very briefly on the orals. Orals are a very important part of our strategy, and we think there are very, very significant gaps in the future competitive landscape around orals. We obviously saw some very exciting data from Lilly around orforglipron, really the first small molecule that we believe will launch. We think the challenge with small molecules is going to be there's an efficacy ceiling, which is below what we're hitting with the injectables, and there may be some tolerability limitations. We think both of those are really just driven by the short half-life of a small molecule. It's an incredible achievement to get a small molecule to a 24-hour half-life. We are never going to approach the seven-day half-lives we have with current injectables or the 15, 16-day half-life we're seeing with Metsera's injectables. Meanwhile, oral peptides to date haven't been scalable. It's just too much API given the low bioavailability. Our approach is to make modest but important improvements in bioavailability through our momentum platform, but more importantly, leverage the intrinsic potency and durability of our peptides to get to scalable dosing. This chart illustrates how we do that. You can see 50 milligrams of oral semaglutide, which has been validated clinically to deliver Wegovy-like weight loss. In our case, 0.6 milligrams of injectable MET-097 performs like 2.4 milligrams of injectable sema. That is a four-fold improvement in efficiency just from potency and half-life. That gets you down to 12 milligrams. Our target is to improve bioavailability threefold versus sema. That gets us into the single digits. You can see that combination of potency and bioavailability improvements gets you to a level that is actually quite scalable. A lot of data coming, and we have quite a broad approach to these orals. We'll have two leads, MET-224 and MET-097, entering the clinic mid-year very soon with phase I data for the selected lead later this year. I think that was an important update this week that we've actually accelerated the oral formulation of MET-097 so that we'll be able to look at both MET-097 and MET-224 orally through comparative phase I data later this year. Some exciting early work on an oral amylin and an oral triple agonist, and we'll have more updates on those preclinical programs later this year. On manufacturing, an incredibly important topic in this category and one that we took very seriously at the outset of building Metsera. I think, first of all, manufacturing for us starts with the peptide. Because of our high levels of potency and our durability, our peptides are an order of magnitude more scalable than other peptides in development. We think stepping back, this may be the most important differentiating asset across our portfolio. You can see here, 42 mg of MET-097 delivers a 15%-20% weight loss annually. Compare that to 520 mg of tirzepatide, 75% fewer devices. Of course, on the oral side, really dramatic comparisons in terms of the API requirements to deliver meaningful weight loss versus other oral peptides in development. We are also quite excited about our partnership with Amnio Pharmaceuticals, one of the leading high-end generics manufacturers globally. Joint investment in a greenfield plant for API and devices that will be coming online to support launch. Also an ability, importantly, to leverage Amnio's global network, much of which is in the U.S., which gives us a lot of flexibility, of course, in the current environment to flex our supply chain as needed alongside a networked approach with other suppliers as well. Finally, we'll just close with a recap of our catalysts. We will have monthly GLP-1 data or sort of weekly GLP-1 data through Vesper 1, mid-year Vesper 3, which will impact monthly dosing later this year alongside phase 3 initiation happening in tandem on the amylin. As mentioned, this quarter, expecting five-week weight loss and tolerability data and then additional data on the monotherapy and the combo later this year. Data on our selected lead oral by the end of the year and output of our GIP GLP-1 tolerability experiment later this year as well. A lot of data coming, moving very, very quickly across a broad portfolio into the clinic. I know there is no Q&A in this format, but feel free to reach out to us over email, and we're happy to connect after the conference. Thanks a lot.
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