EX-99.1 2 ef20028889_ex99-1.htm EXHIBIT 99.1

 Exhibit 99.1 
 

 NPDR Subset Analysis of ZETA-1 Phase 2 Trial  A moderate to severe NPDR-qualifying subgroup analysis to inform future clinical trials   NPDR, non-proliferative diabetic retinopathy. 
 

 Primary endpoint: % of subjects with a ≥ 2 step improvement in monocular ETDRS DRSS at Week 24  Study eye: DR graded moderately severe to severe NPDR or mild PDR (monocular DRSS 47, 53, or 61)   Fellow eye: No exclusion*  Baseline DRSS Scores  APX3330  (n=51)  Placebo (n=52)  DRSS Score – Study Eye  47  Moderately severe NPDR  22 (43%)  18 (35%)  53  Severe or very severe NPDR  25 (49%)  28 (54%)  61  Mild PDR  4 (8%)   6 (12%)  DRSS Score – Fellow Eye  43 or Lower  Mild to moderate NPDR or better  15 (29%)  12 (23%)  47  Moderately severe NPDR  15 (29%)  22 (42%)  53   Severe or very severe NPDR  14 (28%)  11 (21%)  61  Mild PDR  1 (2%)  4 (8%)  65 or Higher  Moderate to severe PDR  4 (8%)  3 (6%)  Note: 15 fellow eyes had CST>320 microns (center-involved DME)  *Two APX3330 subjects did not have available DRSS scores in the fellow eye at screening.  BID, twice-daily;  CST, central subfield thickness; DME, diabetic macular edema, DRSS, Diabetic Retinopathy Severity Scale; ETDRS, Early Treatment of Diabetic Retinopathy Study; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.  Source: ZETA-1 Table 14.1.2.1.  APX3330   600mg/day (BID)  Placebo   (BID)  1:1  randomization  Week 0 Week 4 Week 12 Week 24   Primary Endpoint  ZETA-1 Phase 2 Study Design and Demographics  N = 103 ​  3 
 

 ZETA-1 Actual Compared to NPDR Subset  Difference Between Baseline Characteristics for ZETA-1 Actual and NPDR Subset   ZETA-1 Actual (n)  NPDR Subset (n)  Population with both eyes evaluable for DRSS1  971  59  Subjects with PDR  22  0  Subjects with DME  15  0  Subjects with PDR or DME2  35  0  Subjects with one eye better than 43 and no DME  3  0  Source: ZETA-1 Table 16.2.6.1 and Table 16.2.6.2  1 One subject did not have DRSS evaluation in the fellow eye at baseline  2Two subjects had PDR and DME at baseline  BCVA, best-corrected visual acuity; CI-DME, center-involved diabetic macular edema; DME, diabetic macular edema; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.  Statistical validation conducted by Summit Analytical, LLC  “ZETA-1 Actual” dataset included 97 patients with evaluable DRSS in both eyes at baseline  “NPDR Subset” is a moderate to severe NPDR-qualifying subgroup analysis to inform future clinical trials:  DRSS Level 43, 47, or 53 in both eyes, with Level 47 or 53 in at least one eye and no CI-DME at baseline  Post-hoc analysis of 3 step worsening/improvement on a Binocular DRSS Person-Level Scale, BCVA, and development of PDR  4  38 subjects excluded; NPDR Subset includes subjects at high risk for progression to PDR 
 

 NO DR  NPDR  PDR  ETDRS monocular  severity scale1  Binocular person-level scale1  Very mild  Mild  Moderate  Moderately  severe   Severe or very severe  Mild  Patients graded by a central reading center based on fundus photography.   DR, diabetic retinopathy; DRSS, Diabetic Retinopathy Severity Scale; ETDRS, Early Treatment Diabetic Retinopathy Study; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.  1. Chew EY, et al. N Engl J Med. 2010;363:233-44.  Binocular DRSS is a Validated and Well-Established Scale to Evaluate Systemic Therapies for Diabetic Retinopathy  5  10  20  35  43  47  53  60-61  65  71+  Moderate  Severe  2,3  4,5  6,7  8,9  10,11  12,13  14,15  16,17+  1  ≥ 3 step worsening on the binocular DRSS is considered clinically meaningful 
 

 NPDR Subset Amplifies 3 Steps or Greater Worsening on the Binocular DRSS Person-Level Scale  ZETA-1 Actual  NPDR Subset  ≥ 3 Step Worsening from Baseline on Binocular DRSS Person-Level Scale   DRSS, Diabetic Retinopathy Severity Scale; NPDR, non-proliferative diabetic retinopathy.   Source: ZETA-1 Table 14.2.2.7.3 and Table 14.2.2.7.6.  6 
 

 NPDR Subset Amplifies 3 Steps or Greater Improvement on the Binocular DRSS Person-Level Scale    ≥ 3 Step Improvement from Baseline on Binocular DRSS Person-Level Scale  DRSS, Diabetic Retinopathy Severity Scale; NPDR, non-proliferative diabetic retinopathy.   Source: ZETA-1 Table 14.2.2.7.3 and Table 14.2.2.7.6.  ZETA-1 Actual  NPDR Subset  APX3330 (n=29)  Placebo (n=30)  APX3330 (n=47)  Placebo (n=50)  7 
 

 NPDR Subset Shows Enhanced Treatment Benefit on the Binocular DRSS Person-Level Scale  ≥ 3 step improvement  < 3 step change  ≥ 3 step worsening   Placebo  ≥ 3 step improvement  < 3 step change  ≥ 3 step worsening   APX3330  DRSS Change from Baseline  DRSS, Diabetic Retinopathy Severity Scale; NPDR, non-proliferative diabetic retinopathy.   Source: ZETA-1 Table 14.2.2.7.3 and Table 14.2.2.7.6.  APX3330 (n=29)  Placebo (n=30)  APX3330 (n=47)  Placebo (n=50)  ZETA-1 Actual   NPDR Subset  8 
 

 ZETA-1 Actual: Fewer APX3330 Subjects Worsened and More Improved Compared to Placebo Subjects  DRSS, Diabetic Retinopathy Severity Scale  Source: ZETA-1 Table 14.2.3.7.1.  9  Worsening  Improvement 
 

 NPDR Subset Exhibits Increased Treatment Benefit in Subjects with 3 Steps or Greater Worsening  DRSS, Diabetic Retinopathy Severity Scale.  Source: ZETA-1 Table 14.2.3.7.3.  10  Worsening  Improvement 
 

 NPDR Subset Demonstrates Enhanced Treatment Effect with Fewer APX3330 Subjects Developing PDR Compared to Placebo   Development of PDR in Either Eye (DRSS ≥ 61 after Baseline)  NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.  *One placebo subject did not have evaluable post-baseline data due to discontinuation of study drug.   Source: ZETA-1 Table 14.2.6.7.3 and Table 14.2.6.7.5.  ZETA-1 Actual   NPDR Subset  APX3330 (n=29)  Placebo (n=30)  APX3330 (n=47)  Placebo (n=49*)  11 
 

 BCVA Comparable Between Treatment Groups at Week 12 and Week 24  7+ letters worsening  <7 letters change  7+ letters improvement   Placebo  7+ letters worsening  <7 letters change  7+ letters improvement   APX3330  BCVA Change from Baseline  BCVA, best-corrected visual acuity, study eye; NPDR, non-proliferative diabetic retinopathy.   *One APX3330 subject had study eye data only.  Source: ZETA-1 Table 14.3.6.6 and Table 14.3.6.8.  ZETA-1 Actual   NPDR Subset  APX3330 (n=29)  Placebo (n=30)  APX3330 (n=48*)  Placebo (n=50)  12 
 

 Ocular AEs similar between APX3330 and placebo  Pruritis and rash were typically mild and self-limited  Participants with DR continued routine medications to manage comorbid conditions   AE, adverse event; DME, diabetic macular edema, DR, diabetic retinopathy.  Source: ZETA-1 Tables 14.3.1.1, 14.3.1.7, 14.3.1.10, 16.2.7.  Placebo (n=52)  APX3330 (n=51)  Total AEs  120  91  Total treatment-related AEs  14  14  Participants with treatment-related AEs  10 (20%)  10 (19%)  Withdrawals due to treatment-related AEs  1 (2%)  1 (2%)  AEs in >5% of Participants  All AEs  Treatment-related AEs  Placebo (n=52)  APX3330 (n=51)  Placebo  (n=52)  APX3330  (N=51)  Ocular AEs  DME  5 (10%)  2 (4%)  1 (2%)  0  DR  6 (12%)  1 (2%)  1 (2%)  0  Vitreous detachment  3 (6%)  0  0  0  Cataract  1 (2%)  3 (6%)  0  0  Non-ocular AEs  Pruritus (itching)  1 (2%)  6 (12%)  1 (2%)  3 (6%)  Rash  1 (2%)  3 (6%)  1 (2%)  2 (4%)  COVID-19  5 (10%)  1 (2%)  0  0  SARS CoV-2 test positive  3 (6%)  0  0  0  APX3330 was Well-Tolerated in ZETA-1  13 
 

 NPDR Subset Demonstrates Potential Benefit of APX3330 in Patients with High Risk NPDR   NPDR subset suggests treatment effect on 3 steps or greater worsening on the binocular DRSS person-level scale  3% of APX3330 subjects compared to 20% of placebo subjects had 3 steps or greater worsening at Week 24   NPDR subset suggests enhanced treatment effect on development of PDR   7% of APX3330 subjects compared to 27% of placebo subjects developed PDR (DRSS ≥ 61 after baseline in either eye) at Week 24   APX3330 was well-tolerated  NPDR subset informs planned clinical trial investigating APX3330 in slowing PDR conversion in high risk NPDR patients  DRSS, Diabetic Retinopathy Severity Scale; NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.  14