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NASDAQ: AVXL AAT Presenta3on
Christopher U. Missling, PhD President & CEO
2016
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.
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Anavex™ Mission
Developing Differen,ated Therapeu,cs for the Treatment of
Neurodevelopmental and Neurodegenera,ve Diseases
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ANAVEX™ 2-‐73: Confirmed Targeted Indica3ons: From Rare Disease Indica3on to Largest CNS Indica3on …
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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
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
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
ANAVEX™ 2-‐73 Efficient Clinical Trial Execu3on Plan
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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
▪ 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
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ANAVEX 2-‐73: Phase 2a with Adap3ve Trial Design
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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)
Baseline Pa3ent Characteris3cs and Disposi3on
10 * Donepezil
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
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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
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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
Summary Dose-‐Response Analysis
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§ 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
Quan3ta3ve Dose-‐Response Analysis
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§ 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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§ 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
EEG/P300/ERP Highlights Target Engagement of ANAVEX 2-‐73 and Poten3al Correla3on with Cogni3ve Effect on a Cellular Level
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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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§ 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
Computerized Cogstate Test BaWery
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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
ANAVEX 2-‐73 Significantly Improves Components of Cogstate Tasks at Week 5: Change from Baseline
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Cogni3ve Improvement Cogni3ve Decline
*p<0.05, **p<0.001
Magnitude of Effect Size (d) change from baseline
Comparable Baseline of SoC (AIBL-‐AD) and ANAVEX 2-‐73 Trial
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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
# 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)#
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PART B: 52-‐Week Open-‐Label Extension & New 104 Week Study
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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
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
Summary
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§ 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
Future Development
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§ 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
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.