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NASDAQ: AVXL AAT Presenta3on Christopher U. Missling, PhD President & CEO 2016

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Page 1: NASDAQ:’AVXL’ AAT’Presenta3on’ · SigmaM1’R:’Pluripotent’Modulator’Against’Chronic’Stress’ %% Ca2+ dysfuncon Amyloid% Plaques% Mitochondrial% Dysfuncon ROS%

NASDAQ:  AVXL  AAT  Presenta3on  

Christopher  U.  Missling,  PhD  President  &  CEO  

2016  

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Safe  Harbor  

This   presenta,on   contains   forward-­‐looking   statements   made   within   the   meaning   of   the  Private   Securi,es   Li,ga,on   Reform   Act   of   1995   by   Anavex™   Life   Sciences   Corp.   and   its  representa,ves.   These   statements   can   be   iden,fied   by   introductory   words   such   as  ``expects,''   ``plans,''   ``intends,''   ``believes,''   ``will,''   ``es,mates,''   ``forecasts,''   ``projects''  or  words   of   similar  meaning,   and  by   the   fact   that   they   do   not   relate   strictly   to   historical   or  current   facts.   Forward-­‐looking   statements   frequently   are   used   in   discussing   poten,al  product   applica,ons,   poten,al   collabora,ons,   product   development   ac,vi,es,   clinical  studies,  regulatory  submissions  and  approvals,  and  similar  opera,ng  maNers.  Many  factors  may   cause   actual   results   to   differ   from   forward-­‐looking   statements,   including   inaccurate  assump,ons  and  a  broad  variety  of  risks  and  uncertain,es,  some  of  which  are  known  and  others  of  which  are  not.  Known  risks  and  uncertain,es  include  those  iden,fied  from  ,me  to  ,me   in   the   reports   filed   by   Anavex   Life   Sciences   Corp.  with   the   Securi,es   and   Exchange  Commission,  which  should  be  considered  together  with  any  forward-­‐looking  statement.  No  forward-­‐looking  statement  is  a  guarantee  of  future  results  or  events,  and  one  should  avoid  placing   undue   reliance   on   such   statements.   Anavex   Life   Sciences   Corp.   undertakes   no  obliga,on   to  update  publicly  any   forward-­‐looking  statements,  whether  as  a   result  of  new  informa,on,  future  events  or  otherwise.  Anavex  Life  Sciences  Corp.  cannot  be  sure  when  or  if  it  will  be  permiNed  by  regulatory  agencies  to  undertake  clinical  trials  or  to  commence  any  par,cular  phase  of  clinical  trials.  Because  of  this,  statements  regarding  the  expected  ,ming  of  clinical  trials  cannot  be  regarded  as  actual  predic,ons  of  when  Anavex  Life  Sciences  Corp.  will  obtain  regulatory  approval  for  any  ”phase”  of  clinical  trials.  We  also  cannot  be  sure  of  the   clinical   outcome   for   efficacy   or   safety   of   our   compounds.   Poten,al   investors   should  refer  to  the  risk  factors  in  our  reports  filed  on  Edgar.    

2  

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Anavex™  Mission  

Developing  Differen,ated  Therapeu,cs  for  the  Treatment  of  

Neurodevelopmental  and  Neurodegenera,ve  Diseases  

3  

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ANAVEX™  2-­‐73:  Confirmed  Targeted  Indica3ons:  From  Rare  Disease  Indica3on  to  Largest  CNS  Indica3on  …  

4  

Reducing  mitochondrial  dysfunc,on  Reducing  protein  misfolding  Reducing  oxida,ve  stress  Reducing  inflamma,on  

ANAVEX  2-­‐73  Sigma-­‐1  Receptor  Agonist  A  Pluripotent  Modulator    

 Modula,ng  Ca2+   Neuroprotec,ve  

ReW  Syndrome  (RTT)  Rare  neurodevelopmental  disease    

Preclinical  valida,on  Planning  blinded  controlled  Phase  2    

þ ☐

Alzheimer’s  Disease  (AD)  Neurodegenera,ve  disease  

Clinical  valida,on  Phase  2a  Planning  blinded  controlled  Phase  2/3  

þ ☐

Epilepsy  (seizures) Preclinical  valida,on  þ

Anxiety Preclinical  valida,on  þ

Mul3ple  Sclerosis  (MS)    Preclinical  valida,on   þ

Depression Preclinical  valida,on  þ

Schizophrenia  w.  cog.  imp.##  Clinical  valida,on   ☐

Parkinson’s#  Preclinical  valida,on  ☐

#  Michael  J  Fox  Founda1on  (MJFF)  currently  tes1ng  ANAVEX  2-­‐73  in  Parkinson’s  disease  models,  ##  EEG/ERP  clinical  data  in  AD  also  relevant  in  schizophrenia  with  cogni1ve  impairment          

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Sigma-­‐1  R  Resolving  Protein  Misfolding  Caused  by  ER  Stress  

§  Addi3onal  Therapeu3c’s  Poten3al  Mode  of  Ac3on  -­‐  mixed  muscarinic  /  Sigma-­‐1R  agonist  targe3ng:  −  Calcium  (Ca2+)  modula,on  −  Mitochondrial  dysfunc,on  −  Reducing  oxida,ve  stress  −  Reducing  inflamma,on  −  Reducing  A-­‐beta  and  Tau  

ANAVEX  2-­‐73    

Miki  et  al,  Dec  9.  doi:  10.1111/neup.12080  Neuropathology  2013  Glembotski  et  al.,  Circula1on  Research.  2007;101:975-­‐984   5  

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Sigma-­‐1  R:  Pluripotent  Modulator  Against  Chronic  Stress  

   

Ca2+  dysfunc,on  

Amyloid  Plaques  

Mitochondrial  Dysfunc,on  

ROS  

Synap,c  Dysfunc,on  

Proteosome  Tangles  

Hyper-­‐Phospho  Tau  

Healthy  Cell:  Quick  Removal  Aber  U3liza3on  

Monomer  

Aß  plays  important  role  in  hippocampal  memory  forma,on  

Chronically  Distressed  Cell:  

Misfolded  Proteins  Sigma-­‐1R  Helping  /  S3mula3ng  Own  Body  to  

Regain  Func3onality  –  Analogy  to  Cancer  

Immunotherapy  

6  Source:  M  Alberini  Learn.  Mem.  2009.  16:  267-­‐272,  F  LaFerla,  Nature  Reviews  Neuroscience  8,  499-­‐509  (July  2007)  adapta1on  

ANAVEX 2-73

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ANAVEX™  2-­‐73  Efficient  Clinical  Trial  Execu3on  Plan  

7  

ANAVEX™2-­‐73-­‐001  Study:    • Phase  1  (oral)  • Single  Ascending  Dose  (SAD)  • Healthy  subjects  

ANAVEX™2-­‐73-­‐002  Study:    • Phase  2a  (oral)  • Mild-­‐to-­‐moderate  AD  pa,ents  • Adap,ve  trial  with  Popula,on  PK  • Bioavailability,  dose  finding  (PART  A),  and  exploratory  efficacy  with  52  week  open-­‐label  extension  (PART  B)  

ANAVEX™2-­‐73-­‐00X  Study:  • Phase  2/3  (oral)  • Mild-­‐to-­‐moderate  AD  pa,ents  • Double-­‐blind,  placebo  controlled  study    • 6/12  month  efficacy  

Completed  

PART  A:  Preliminary  Data  Nov  CTAD  2015  PART  A:  Dose-­‐Response  PART  B  52  weeks:  Ongoing  Extension  study:  ANAVEX™2-­‐73-­‐003:  104  weeks  aber  PART  B  

Prepara3on  underway  

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▪  Phase  2a  study  of  32  pa,ents  with  mild-­‐moderate  AD  

▪  5  weeks’  dura,on,  randomized,  open-­‐label,  adap,ve  design,  dosing  regimen  without  dose  op,miza,on  

▪  Main  inclusion  criteria  

▪  Baseline  MMSE  16-­‐28    

▪  CT  or  MRI  within  12  months  consistent  with  AD  

▪  Either  on  a  stable  donepezil  dose  for  at  least  3  months  (n  =  25)  or  donepezil-­‐naïve  (n  =  7)  

▪  Maximum-­‐tolerated  dose  popula,on  pharmacokine,c  study  with  primary  endpoints  of  safety,  tolerability  and  bioavailability  

▪  Cogni,ve  exploratory  items  as  secondary  endpoints  included:  MMSE,  Cogstate,  EEG  P300,  ERP  task  performance  

▪  PART  B  open-­‐label  extension  with  daily  oral  dosing  (26  weeks,  extended  to  52  weeks  at  pa,ent/caregiver  request,  now  extended  by  further  104  weeks  aoer  end  of  PART  B)    

▪  All  PART  A  completers  volunteered  to  con,nue  in  PART  B  

Proof  of  Concept  Study:  ANAVEX  2-­‐73  Protocol  Summary  

8  

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ANAVEX  2-­‐73:  Phase  2a  with  Adap3ve  Trial  Design    

9  

ANAVEX  2-­‐73  star,ng  dose  30mg/50mg  (oral)  or  3mg,  5mg  (IV)    

Donepezil/  AchEI#    

ANAVEX  2-­‐73  star,ng  dose  30mg/50mg  (oral)  or  3mg,  5mg  (IV)  +  Donepezil  Mild-­‐Mod  AD  pa,ents  

No.  of  Pts:   §  32  mild-­‐moderate  AD  pa,ents  (MMSE  16-­‐28),  M/F  =  19/13  

Sites:   §  5  

Alloca,on:   §  Randomized  

Dura,on:   §  PART  A:  5  weeks;  PART  B:  52  weeks;  Extension:  104  weeks  

Endpoints:   §  Safety,  tolerability,  bioavailability  (PK  study)  §  Exploratory  cogni,ve  measures  (EEG/ERP,  MMSE,  Cogstate)  and  

ADCS-­‐ADL  §  Exploratory  add-­‐on  therapy  to  AD  standard  of  care  

§  Design  embraces  both  adap3ve  trial  features  and  popula3on  pharmacokine3cs  §  Captures  all  relevant  informa,on  required  for  a  larger  Phase  2/3  study  

#  Comparison  to  published  SoC  (Standard  of  Care)  data  (AIBL)  

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Baseline  Pa3ent  Characteris3cs  and  Disposi3on    

10    *  Donepezil  

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PART  A:  Bioavailability  Cross-­‐Over  Design  and    PART  B:  52-­‐Week  Open-­‐Label  Voluntary  Extension  

Screening     Randomiza,on    

ORAL    

IV    

wash  out  

1st  Period   2nd  Period  

Part A Part B PK - Study Extension

12d   12d   12d  [,me]  

52  week  

IV    

ORAL    

ORAL    

ORAL    

IV    

26  week  5  week  

▪  Once  daily  oral  or  IV  dosing  except  during  wash  out  period  ▪  PART  A  is  5  weeks  with  on-­‐off-­‐on  dosing  of  ANAVEX  2-­‐73  star,ng  dose  of  30mg/50mg  (oral)  and  3mg,  5mg  (IV)    

▪  Dosing  regimen  without  any  dose  op,miza,on  

Completed Ongoing

11  

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ANAVEX™  2-­‐73  Safety  from  Phase  2a  

§  Safety  profile  §  The  most  common  AE  was  dizziness  followed  by  headache

§  Events  were  mild  or  moderate  and  reversible  with  80%  being  grade  1

§  There  were  no  drug  related  AEs  Grade  3,  4  and  5  

§  Most  (94.4%)  observed  within  first  8  days     §  AE  profile  similar  to  that  of  healthy  volunteer  Phase  1  data §  No  differences  in  blood  pressure  or  res,ng  heart  rate §  Clinical  laboratory  parameters,  vital  signs,  and  12-­‐lead  ECG  did  

not  show  any  clinically  relevant  or  dose-­‐dependent  changes

Voges  et  al.,  presented  at  CNS  Summit  2014;  Macfarlane  et  al.,  presented  at  CTAD  2015    

12  

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Fast  Onset  of  Ac3on  of  Sigma-­‐1  Receptor  Agonist    

§  Sigma-­‐1  agonists  increase  markedly  serotonin  (5-­‐HT)  neurons  firing  ac,vity  aoer  2  days  of  treatment  and  maintained  the  same  increased  firing  rate  aoer  long-­‐term  (21  days)  treatment  

Br.  J.  Pharmacol.  2001;134:691–699;  Curr  Neuropharmacol.  2008  Dec;  6(4):  344–366  13  

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Summary  Dose-­‐Response  Analysis  

14  

§  Pre-­‐planned  analysis  §  Collected  data  includes  both  efficacy  and  safety:  

§  Efficacy:  MMSE  and  ERP  (paired  for  each  pa,ent,  baseline  and  5  week)  §  Safety:  graded  AEs  for  each  pa,ent  

§  Depend  on  several  factors:  §  Binary:  Low-­‐High  dose,  Sex,  ApoE4;  Con,nuous:  Baseline  values,  Age  §  They  must  be  taken  into  account  simultaneously  

§  Mul,-­‐factorial  ANOVA  is  the  adequate  sta,s,cal  analysis  

§  Outcome:  §  Low-­‐High  dose  was  the  only  factor  that  was  sta,s,cally  significant  to  

affect  MMSE-­‐Δ  and  ERP-­‐Δ  scores  with    MMSE-­‐Δ  (p=0.0285)  and  ERP-­‐Δ  (p=0.0168),  respec,vely  

§  These  results  were  confirmed  by  Bayesian  hierarchical  analysis  and  bootstrap  resampling  analysis  

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Quan3ta3ve  Dose-­‐Response  Analysis  

15  

§  The  change  in  Mini  Mental  State  Examina,on  score  (MMSE-­‐Δ)  (MMSE  difference  recorded  for  every  single  study  subject  at  the  beginning  and  the  end  of  the  5  week  period)  as  a  func,on  of  ANAVEX  2-­‐73  dose  was  examined  using  linear  regression  analysis  

§  32  pa,ents  treated  with  doses  (not  op,mized)  of  ANAVEX  2-­‐73  ranging  from  3mg  to  50mg/day,  MMSE-­‐Δ  data  showed  a  posi,ve  slope  with  confidence  intervals  not  including  the  zero-­‐value,  consistent  with  a  dose  dependent  improvement  in  MMSE  scores  over  5  weeks  

§  The  effect  was  unidirec,onal  and  also  posi,ve  for  another  pharmacodynamic  marker,  ERP-­‐Δ  P300  amplitude  

§  The  dose-­‐response  results  were  robust  to  sta,s,cal  resampling  (bootstrap  analysis  x  10,000  resamples).    Analysis  of  variance  and  post  hoc  tests  as  well  as  Bayesian  hierarchal  analysis  further  confirmed  that  the  higher  ANAVEX  2-­‐73  doses  achieved  a  sta3s3cal  significant  improvement  in  both  the  MMSE-­‐Δ  and  the  ERP-­‐Δ  over  5  weeks,  respec,vely,  compared  to  the  lower  doses  

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16  

§  Slope  =  0.1418    95%  CI  =  0.0527-­‐0.2309  §  Posi3ve  slope  with  increased  ANAVEX  2-­‐73  dose  §  Indicates  a  significant  effect  on  MMSE-­‐Δ  

MMSE-­‐Δ  (Delta)  vs.  ANAVEX  2-­‐73  Dose  M

MS

E Δ

-sco

re

AV2-73 Dose [mg]

§  A  minimum  dose  of  14  mg  AV2-­‐73  required  to  achieve  a  therapeu,c  effect  and  to  keep  MMSE  score  unchanged  

§  Similar  posi,ve  MMSE  score  effect  and  no  notable  difference  between  AV2-­‐73  alone  and  AV2-­‐73  with  donepezil  

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EEG/P300/ERP  Highlights  Target  Engagement  of  ANAVEX  2-­‐73  and  Poten3al  Correla3on  with  Cogni3ve  Effect  on  a  Cellular  Level  

17  

P300  Amplitude  (µV)   Task  Accuracy  (%)   False  Alarms  (%)   Reac,on  Time  (ms)  

Baseline   5.99±0.58   83.8±.3.9   3.4±1.0   559.0±24.0  

Week  5   7.09±0.72   92.6±2.4   1.0±0.5   492.6±23.8*  

Healthy  Control#   7.36±0.39   94.1±1.1   1.1±0.2   458.6±11.4  

Data  are  mean  ±  SEM  *p<0.0007  

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18  

§  Slope  =  0.055    95%  CI  =  0.012-­‐0.098  (AV2-­‐73  alone)  §  Slope  =  0.155    95%  CI  =  0.019-­‐0.029  (AV2-­‐73  with  10mg  donepezil)  §  Posi3ve  slopes  with  increased  ANAVEX  2-­‐73  dose  §  Indicates  a  significant  effect  on  ERP-­‐Δ  

P300/ERP-­‐Δ  (Delta)  vs.  ANAVEX  2-­‐73  Dose  

AV 2-73 Dose [mg]

P30

0/E

RP Δ-

scor

e

AV2-­‐73  with  donepezil  

AV2-­‐73  alone  

 

§  Marginal  addi,ve  effect  of  AV2-­‐73  with  donepezil  on  ERP-­‐Δ    

§  AV2-­‐73  alone  has  significant  posi,ve  effect  on  ERP-­‐Δ    

     

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Computerized  Cogstate  Test  BaWery  

19  

Cogstate’s  test  baNery  for  Alzheimer’s  disease  measures  the  following  core  cogni,ve  domains:      

§ Processing  speed  è  Detec,on  Test  

§ ANen,on  è  Iden,fica,on  Test  

§ Working  memory  è  One  Back  Test  

§ Visual  learning  è  One  Card  Learning  Test  

§ Verbal  learning  èInterna,onal  Shopping  List  Test  (ISLT)  

§ Verbal  memory  è  Delayed  Interna,onal  Shopping  List  Test  (ISLT-­‐delay)  

Cogstate’s  computerized  baNery  includes  tests  that  have  been  u,lized  previously  in  clinical  trials  and  have  demonstrated  repeated  tes,ng  reliability#  

#  Source:  Lim,  YY  et  al  (2014)  Alzheimer’s  &  Demen1a,10(6),  743-­‐751    www.cogstate.com  

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ANAVEX  2-­‐73  Significantly  Improves  Components  of  Cogstate  Tasks  at  Week  5:  Change  from  Baseline  

20  

Cogni3ve  Improvement  Cogni3ve  Decline  

*p<0.05,  **p<0.001    

Magnitude  of  Effect  Size  (d)  change  from  baseline  

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Comparable  Baseline  of  SoC  (AIBL-­‐AD)  and  ANAVEX  2-­‐73  Trial  

21  

SoC  (Standard  of  Care)  data  from  Australian  Imaging  Biomarkers  and  Lifestyle  (AIBL-­‐AD#)  study  tes,ng  Cogstate  baNery  in  Alzheimer’s  disease  pa,ents  

Baseline  data:   SoC  (AIBL-­‐AD)   AV  2-­‐73  

Par,cipants  (n)   43   32  

Age  (mean)   79.6   71  

MMSE  (mean)   22.16   20.5  

ApoE4  carrier   70.27%   53%  

AchEI  and/or  meman,ne##   100%   78%  

#  Source:  Lim  YY  et  al  (2013)  Arch  Clin  Neuropsychol.  Jun;28(4):320-­‐30;  ##  meman1ne  only  in  AIBL-­‐AD  study  

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#  Source:  Lim  YY  et  al  (2013)  Arch  Clin  Neuropsychol.  Jun;28(4):320-­‐30  

Standard  devia,on  difference  to  AIBL  study  at  same  ,me  point  

Detec,on  

Iden,fica,on  

One  Back    

Visual  Learning    

ISLT  

ISLT-­‐delay  

*p<0.05,  **p<0.001    

Cogni,ve   Improvement  

Cogni,ve Decline  

0.33  *  

0.40*  

0.86**  

Cogstate  Test:  ANAVEX  2-­‐73  Standardized  Change  from  Baseline  to  5  Week  Compared  to  4  Week  SoC  (AIBL-­‐AD#)  

§  ANAVEX  2-­‐73  treatment  is  associated  with  improvement  in  psychomotor  func,on  (detec,on),  aNen,on  (Iden,fica,on)  and  working  memory  (One  back).  This  improvement  is  greater  than  that  with  comparable  AD  pa,ents  under  standard  of  care,  AChEIs  (AIBL-­‐ROCS)#  

22  

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PART  B:  52-­‐Week  Open-­‐Label  Extension  &  New  104  Week  Study    

23  

Screening    Randomiza,on    

Part B Part A PK Study - completed Extension - ongoing

[,me]  

104  week  

ORAL    

ORAL    

5  week   52  week  

ORAL    

ORAL/IV  

IV/ORAL  

ORAL    

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Interim  PART  B  Data:  Posi3ve  Effect  of  ANAVEX  2-­‐73  on  ADCS-­‐ADL  at  Week  12    

§  Interim  data:  ANAVEX  2-­‐73  improved  ADCS-­‐ADL  signal  in  11  out  of  14  (78.6%)  pa,ents  

ADCS

-ADL

scor

e

58.00

60.00

62.00

64.00

66.00

68.00

70.00

ADCS-ADL (Baseline PART B) ADCS-ADL (Week 12)

Δ = +3.21 points

Macfarlane  et  al.,  presented  at  CTAD  2015     24  

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Summary  

25  

§  Phase  2a  (PART  A)  results  demonstrate  a  favorable  safety,  bioavailability,  dose-­‐response  curve  and  tolerability/risk  profile  

§  Despite  the  rela,ve  small  sample  size  of  this  proof-­‐of-­‐concept  randomized  open-­‐label  study,  dose-­‐response  analysis  seem  to  indicate  a  cogni,ve  benefit  associated  with  ANAVEX  2-­‐73  (Cogstate,  MMSE,  EEG/ERP  improved  significantly  at  5  weeks  of  treatment)  §  Low-­‐High  dose  was  sta,s,cally  significant  to  affect  MMSE-­‐Δ  and  ERP-­‐Δ  

scores  with    MMSE-­‐Δ  (p=0.0285)  and  ERP-­‐Δ  (p=0.0168),  respec,vely  

§  Results  were  confirmed  by  Bayesian  and  bootstrap  analyses  §  A  minimum  dose  of  14  mg  ANAVEX  2-­‐73  required  to  achieve  a  therapeu,c  

effect  and  to  keep  MMSE  score  unchanged  

§  Similar  posi,ve  MMSE  score  effect  and  no  notable  difference  between  ANAVEX  2-­‐73  alone  and  ANAVEX  2-­‐73  with  donepezil  observed  

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Future  Development  

26  

§  Phase  2a  PART  B  52  week  extension  trial  is  ongoing  

§  New  Extension  study  of  Phase  2a  will  allow  collec,on  of  further  safety  data  of  up  to  104  weeks  

§  Phase  2a  Popula,on  PK/PD  and  PART  B  data  will  be  presented  once  available  

§  Guidance  received  from  the  FDA  supports  the  Company’s  plan  to  advance  ANAVEX  2-­‐73  for  the  treatment  of  Alzheimer’s  disease  in  a  larger  double-­‐blinded,  randomized,  placebo-­‐controlled  Phase  2/3  trial  

§  Poten,al  to  advance  ANAVEX  2-­‐73  in  a  Phase  2  exploratory  clinical  trial  for  rare  disease  indica,on,  ReN  syndrome  

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Contact  Us  

Corporate  Office:  Anavex™  Life  Sciences  Corp.  51  West  52nd  Street,  7th  floor  New  York,  NY  10019  (212)  332  4449  

Shareholder  &  Media  Rela3ons:  Toll-­‐free:  1-­‐866-­‐505-­‐2895  Email:  [email protected]  www.anavex.com    NASDAQ:  AVXL  

27  ANAVEX  is  a  trademark  of  Anavex  Life  Sciences  Corp.