NGM282 in NASH: 3 mg QD (phase 2)

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Presentation transcript:

NGM282 in NASH: 3 mg QD (phase 2) Design W2 W12 Liver biopsy with NASH NAS * ≥ 4 with a score ≥ 1 for each component Stage 1-3 of fibrosis Liver fat content ≥ 8% (MRI-PDFF) N = 19 NGM282 3 mg NGM282 3 mg + rosuvastatin (if needed) Assessments Screening W6 W12 W18 Liver Biopsy X - MDRI-PDFF LiverMultiScan * NAFLD Activity Score: steatosis (0 to 3), lobular inflammation (0 to 3), ballooning (0 to 2) NGM282: engineered variant of human FGF19, administered subcutaneously qd Rosuvastatin: started at W2 if LDL-cholesterol rise of 10 mg/dl observed Endpoints Primary: decrease in absolute liver fat content ≥ 5% at W12 Exploratory: change in liver histology at W12 NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014 1

NGM282 in NASH: 3 mg QD (phase 2) Baseline characteristics, mean or N or % NGM282 3 mg N = 19 Age, years (SD) 51.4 (12.6) Male / Female, N 4/15 Diabetes mellitus, N 7/12 Liver fat content, MRI-PDFF (proton density fat fraction), % (SD) 17.1% (5.6) AST, U/l (SD) 65 (32) ALT, U/l (SD) 82 (39) Fibrosis stage (SD) 2.5 (0.8) NAFLD activity score (SD) 5.7 (1.5) Liver-Inflammation-Fibrosis (LIF) score (SD) 2.80 (0.43) LDL cholesterol, mg/dL (SD) 97 (27) Statin naïve/experienced 13/6 7α-hydroxyl-4-cholesten-3-one (C4), ng/ml (SD) 35.1 (24.2) NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014 2

NGM282 in NASH: 3 mg QD (phase 2) Effect on FGF19 targets (N = 19) Mean C4 levels, ng/mL Mean Total serum bile acids, µmol/L 40 35 30 25 20 15 10 5 Baseline W6 W12 p < 0.0001 Δ at W12 Mean (SD) Absolute -33.2 (24.4) Relative -93% (10) 6 5 4 3 2 1 Baseline W6 W12 p < 0.0001 Δ at W12 Mean (SD) Absolute -3.5 (2.5) Relative -64% (41) C4 = 7α-hydroxyl-4-cholesten-3-one Lower limit of C4 quantitation = 0.9 ng/ml NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

NGM282 in NASH: 3 mg QD (phase 2) Primary endpoint: mean % absolute change in liver fat content at W12 (N = 19) 20 15 10 5 Baseline W6 W12 p < 0.0001 Δ at W12 Mean (SD) Absolute -11.2% (4.2) Relative -67% (17) 100% of subjects achieved primary endpoint of ≥ 5% absolute liver fat content reduction and a decreased of relative liver fat content ≥ 30% at W12 12 (63%) subjects normalized liver fat content (≤ 5%) by W12 NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

NGM282 in NASH: 3 mg QD (phase 2) Fibrosis markers changes at W12, N = 19 Mean PRO-C3 levels (ng/mL) ELF Score and components 6 5 4 3 2 1 Baseline W6 W12 p < 0.01 p < 0.05 Δ at W12 Mean (SD) Absolute -11.1 (18.4) Relative -33% (47) Mean (SD) Baseline W6 W12 ELF score 10.1 (1.0) 9.6* (0.8) 9.5* (1.0) Hyaluronic acid 91.4 (79.7) 67.3 (60.2) 72.1 (90.3) PIIINP 13.4 (4.6) 9.7* (3.5) 10.3* (3.4) TIMP-1 270.8 (67.7) 233.6* (51.4) 232.0* (62.5) *p < 0.01 Subjects with severe disease (ELF ≥ 10.1) decreased ELF score by 0.8 at W12 NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

NGM282 in NASH: 3 mg QD (phase 2) NAS histological response at W12, N = 19 % 100 90 80 70 60 50 40 30 20 10 -2.3 (1.8) -1.1 (0.9) -0.5 (0.8) -0.7 (0.9) NAS Steatosis Inflammation Ballooning Mean change at W12 (SD) 84% 74% 42% 53% 11% 26% 5% 0% Worsened Improved No change NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

NGM282 in NASH: 3 mg QD (phase 2) Fibrosis evolution at W12 (liver biopsy), N = 19 42% 47% 11% Worsened Improved No change Mean change from baseline in fibrosis stage: - 0.5 3 subjects had a 2-stage improvement in fibrosis: all F3 changed for F1 Mean decrease in NAS in subjects with improved fibrosis: -3.5 NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

Mean transaminases (U/L), N = 19 NGM282 in NASH: 3 mg QD (phase 2) Mean transaminases (U/L), N = 19 Δ at W12 ALT AST Absolute -53* -37* Relative -60%* -52%* 100 90 80 70 60 40 20 10 30 50 Baseline W2 W4 W6 W8 W10 W12 *p < 0.0001 NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

LDL-cholesterol (mg/dL) changes during treatment NGM282 in NASH: 3 mg QD (phase 2) LDL-cholesterol (mg/dL) changes during treatment 200 150 100 50 Baseline W2 W4 W6 W8 W10 W12 LDL-C levels return to baseline and/or target of < 100 mg/dL with statin treatment NGM282 3 mg NGM282 3 mg Rosuvastatin (if needed) Decreased C4 and increased LDL-cholesterol reflect potent CYP7A1 inhibition Lipid particle change primarily driven by increase in large LDL particles Significant reductions in serum triglycerides (56%) and no change in HDL NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

Safety and tolerability NGM282 in NASH: 3 mg QD (phase 2) Safety and tolerability Favorable safety and tolerability profile consistent with other NGM282 studies (no new safety signals identified) Mild gastrointestinal symptoms (loose/frequent stools) remain the most common treatment emergent adverse events Majority were mild and resolved during treatment phase No subject withdrew from treatment due to any drug-related adverse events Gastrointestinal symptoms were largely mitigated with separating the timing of injection around meals and decreasing meal size Three severe adverse events, all unrelated to study drug: Pleurisy Chest tightness Cardiac arrest (non myocardial infarction) NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014

NGM282 in NASH: 3 mg QD (phase 2) Summary Potent C4 and bile acid suppression consistent with FGF19 hormone activity Significant and clinically meaningful reductions across non-invasive markers of NASH-related disease Large percentage of patients demonstrated histological improvement at W12 Statin co-administration rapidly mitigates LDL-cholesterol elevations Treatment was safe and well tolerated NGM282-Phase 2 Harrison SA, EASL 2018, Abs. GS-014