Form: 8-K

Current report filing

October 14, 2022


Exhibit 99.1

 Ocuphire KOL Event: APX3330  October 14, 2022 
 

 Disclosures and Forward-Looking Statements      This presentation contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements include, but are not limited to, statements concerning the success and timing of planned regulatory filings, including planned NDA filings, pre-commercial activities, commercialization strategy and timelines, business strategy, product labels, cash runway, scalability, future clinical trials in reversal of mydriasis (RM), presbyopia (P), dim light/night vision disturbance (NVD) and diabetic retinopathy (DR)/diabetic macular edema (DME), and the potential market opportunity in DR/DME. These forward-looking statements are based upon the Company’s current expectations and involve assumptions that may never materialize or may prove to be incorrect. Actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of various risks and uncertainties, including, without limitation: (i) the success, costs, and timing of regulatory submissions and preclinical and clinical trials, including enrollment and data readouts; (ii) regulatory requirements or developments; (iii) changes to clinical trial designs and regulatory pathways; (iv) changes in capital resource requirements; (v) risks related to the inability of Ocuphire to obtain sufficient additional capital to continue to advance its product candidates and its preclinical programs; (vi) legislative, regulatory, political, and economic developments, (vii) changes in market opportunities, (viii) the effects of COVID-19 on clinical programs and business operations, (ix) the success and timing of commercialization of any of Ocuphire’s product candidates, including the scalability of Ocuphire’s product candidates, and (x) the maintenance of Ocuphire’s intellectual property rights. The foregoing review of important factors that could cause actual events to differ from expectations should not be construed as exhaustive and should be read in conjunction with statements that are included herein and elsewhere, including the risk factors detailed in documents that have been and may be filed by the Company from time to time with the SEC. All forward-looking statements contained in this presentation speak only as of the date on which they were made. The Company undertakes no obligation to update such statements to reflect events that occur or circumstances that exist after the date on which they were made.    The Company makes no representation or warranty, express or implied, as to the accuracy or completeness of the information contained in or incorporated by reference into this presentation. Nothing contained in or incorporated by reference into this presentation is, or shall be relied upon as, a promise or representation by the Company as to the past or future.  The Company assumes no responsibility for the accuracy or completeness of any such information. This presentation also contains estimates and other statistical data made by independent parties and by us relating to market shares and other data about our industry. This data involves a number of assumptions and limitations, and you are cautioned not to give undue weight to such estimates.  The trademarks included herein are the property of the owners thereof and are used for reference purposes only. Such use should not be construed as an endorsement of such products.  
 

 Ocuphire APX3330 KOL Event: Agenda & Speakers  Speakers  Speakers  Agenda  Time (EDT)  Mina Sooch, MBA  President & CEO and Founder  Introductions & Company Overview  11:00 am – 11:10 am  Caroline Baumal, MD  Disease of Diabetic Retinopathy  11:10 am – 11:20 am  Peter Kaiser, MD  Current DR/DME Treatment Landscape   11:20 am – 11:35 am  David Lally, MD  APX3330, Paradigm-Shifting   Oral Treatment Option   11:35 am – 11:50 am  Caroline Baumal, MD  ZETA-1, Phase 2b Trial in Diabetic   Retinopathy and Masked Safety Data   11:50 am – 12:00 pm 
 

 Speakers  Agenda  Time (EDT)  ZETA-1 Trial Design and Data Expectations  12:00 pm – 12:15 pm  Q&A  Closing Remarks  Q&A Moderator: Corey Davis, PhD  12:15 pm – 12:30 pm  Ocuphire APX3330 KOL Event: Agenda & Speakers  Peter Kaiser, MD  Caroline Baumal, MD  David Lally, MD  Mina Sooch, MBA  Peter Kaiser, MD  Caroline Baumal, MD  David Lally, MD  President, CEO, and Founder  Mitch Brigell, PhD  Head, Clinical Strategy  Mark Kelley, PhD  APX Program Scientific Advisor 
 

 Company Overview  Presenter: Mina Sooch, CEO and Founder of Ocuphire Pharma  Over 25 years of pharmaceutical and biotech experience as CEO, entrepreneur, venture capitalist, and strategy consultant  Successful track record of hundreds of millions of capital raised for leading private/public biotech companies  Experience across multiple diseases (cardiovascular, oncology, renal, NASH, CNS, etc.) prior to ophthalmology  Recipient of numerous awards, including Deal Makers of the Year in 2016 and Alumni Commencement Speaker WSU College of Engineering in 2021  Mina Sooch, MBA  Harvard University 
 

 Upcoming Catalysts in 4Q22:  Topline Results APX3330 ZETA-1 P2b trial for DR/DME  NDA Filing for Nyxol for RM  P = Presbyopia  RM = Reversal of Mydriasis   NVD = Night Vision Disturbances  DR/DME = Diabetic Retinopathy/Diabetic Macular Edema   Ocuphire PharmaNasdaq: OCUP  Founded in 2018, Acquired 2 Lead Assets for Front & Back of Eye Therapies with Novel MOAs & Patent Coverage to 2034+  Nyxol eyedrops  Reversal of Mydriasis (“RM”) – eye dilation  Presbyopia – age-related blurry near vision  Night Vision Disturbance (“NVD”) – halos, glares, starbursts  APX3330 oral tablets  Diabetic retinopathy (“DR”) – diabetes-related retinal (eye) disease  Successful Execution of 5 Trials in last 2 Years with 6 Positive Phase 3 & Phase 2 Data Read-outs for Nyxol in RM, Presbyopia, and NVD  Potential 2023 commercialization opportunities in RM  Near-term initiation planned for Presbyopia VEGA Phase 3 program with Nyxol alone and Nyxol with 0.4% Low Dose Pilocarpine as adjunctive therapy  Four Large Markets (~$20B US total) w/Unmet Needs and Limited to No Competition 
 

 Ocuphire Overview  Two Late-Stage Clinical Assets Addressing Unmet Needs in Multiple Large Markets  Source: Eisai and Apexian Data; GlobalData Market Research Report, 2020; Company Estimates for US Market Size; Ocuphire internal estimates  11  Completed  Phase 1 and Phase 2 Trials  >340Subjects Dosed  Patent Coverage2034+   12  Completed  Phase 1,Phase 2, and Phase 3 Trials  >650Subjects Dosed  Exposure in Humans  28  Days  Patent Coverage2034+  Exposure in Humans  365  Days  Retina   Refractive   Presbyopia  Reversal of Mydriasis   Night Vision  Disturbances  Diabetic Retinopathy  Diabetic Macular Edema  Phase 2​b  Last PatientLast VisitCompletedAug 22  ~128 M  ~100 M  ~2.4 M  ~8 M  1st Phase 3  Positive Data  Phase 2  Positive Data  Single & Combo  2 Phase 3  Positive Data & Ped P3  ~36 M  APX3330  Oral REF-1 Inhibitor  New Chemical Entity  Phase 2b Data 4Q22  DevelopmentMilestone  Prevalence (US)  Nyxol  Novel α1/ α2 Blocker   505(b)(2)  NDA-Filing Ready  DevelopmentMilestone  Prevalence (US) 
 

 Track Record of Achieving Milestones  Multiple Positive Data Readouts with Multiple Catalysts Ahead  Ongoing Partnering Discussions with Leading Ophthalmic Companies (including Europe and Asia)  2021 – 1H 2022  2H 2022 – 2023  Submit Nyxol NDA for RM   Report APX3330 Phase 2b Data for DR/DME (ZETA-1)  Initiate VEGA Phase 3 Presbyopia Program  Potential Nyxol Approval and Commercialization 
 

 Disease of Diabetic Retinopathy   Presented by: Caroline Baumal, MD  Professor of Ophthalmology at Tufts Medical Center   Co-Director of the Retina Service and Medical Retina Fellowship at New England Eye Center  Authored over 170 publications, 33 book chapters on retinal diseases, and edited the book Treatment of Diabetic Retinopathy   Recognized by the American Society of Retinal Surgeons, The Retinal Hall of Fame and received such honors as the Donald J. Gass Beacon of Sight Award from the Florida Ophthalmologic Society and the ASRS Crystal Apple award from the Vit-Buckle Society.  Caroline Baumal, MD  University of Toronto 
 

 Diabetic Eye Disease is Common Cause of Blindness  Diabetes and Diabetic Retinopathy (DR)  https://webeye.ophth.uiowa.edu/eyeforum/tutorials/diabetic-retinopathy-med-students/Classification.htmhttps://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011   https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193   Two Types of DR  Non-Proliferative Diabetic Retinopathy (NPDR) – most common form of DR – early stages of edema and exudates, blurred central vision  Proliferative Diabetic Retinopathy (PDR) – later stage of DR, marked by abnormal blood vessels and scar tissue on retina  Diabetic Macular Edema (DME) can occur at any stage of DR  Diabetes Mellitus is a group of diseases characterized by high blood glucose levels. Diabetes results from defects in the body's ability to produce and/or use insulin  Diabetic retinopathy (DR) occurs when fluctuations or instability in blood glucose levels damages blood vessels in the retina   Type 1 diabetes (T1D): The body produces very little or no insulin, which means that patients need daily insulin injections to maintain blood glucose levels  Type 2 diabetes (T2D): The most common form of diabetes - either the body does not produce enough insulin, or resists insulin  Normal Retina  Diabetic Retina 
 

 Diabetes is a Growing Global Health Epidemic  Diabetes Cost Burden Over $900 Billion Dollars in Worldwide Health Expenditure  Source: International Diabetes Federation, Diabetes Atlas 10th Edition, 2021, https://diabetesatlas.org/atlas  
 

 Diabetic Patients Usually Present with Complex Co-Morbidities  Diabetic Patients are Young and Face Life-long Systemic and Ocular Complications   1. Petrella RJ, et al. J Ophthalmol 2012;159167; 2. International Diabetes Federation, Diabetes Atlas 6th Edition, http://www.idf.org/diabetesatlas; 3. National Diabetes Fact Sheet, 2011 http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf; 4. Rodbard HW, et al. Endocr Pract 2007;13:4-69; 5. Wong TY, et al. JAMA 2002;288:67-74; 6. Nguyen-Khoa B, et al. BMC Ophthalmol 2012;12:11  Patients with DME have an even greater risk of complications than diabetes patients without DME5,6  DR is the most common cause of vision loss or blindness in working-age adults, usually affecting both eyes  DME is a vision threatening complication caused by DR where excess fluid leaks near fovea and triggers swelling of the macula  Treating DR leads to control of DME  Oral options have the potential to reach other vascular beds to treat kidney and neuropathic   co-morbidities   Diabetic retinopathy1  Stroke1  Diabetic neuropathy1  Diabetic nephropathy1,2  Cardiovascular disease2  Dyslipidemia2 
 

 DR: 11M*  DME: 7M*  DR: 16M*  DME: 6M*  DR: 4M*  DME: 4M*  DR: 7M*  DME: 4M*  DR: 18M*  DME: 8M*  DR: 15M*  DME: 5M*  DR: 32M*  DME: 14M*  USA  DR: 8M2  DME: 0.75M2  North America & Caribbean   Global Prevalence of Diabetes-Associated Retinal Disease  DR Affects 1 in 3 People with Diabetes; DME Affects 1 in 13 People with Diabetes1  *Global estimates are provided by the National Eye Institute, FactSheet, Global Data, Research and Markets, American Academy of Ophthalmology, and PLOS One  1. Holekamp N. M. (2016). Overview of diabetic macular edema. The American journal of managed care, 22(10 Suppl), s284–s291.  2. American Diabetes Association; American Journal of Managed Care, International Diabetes Federation; Healthline; Ocuphire internal analysis and assumptions 
 

 Measuring the Severity of Diabetic Retinopathy   DRSS is Regularly Used For FDA Approvals; Not As Widely Used in Everyday Practice  Arcadu, F., Benmansour, F., Maunz, A. et al. Deep learning algorithm predicts diabetic retinopathy progression in individual patients. npj Digit. Med. 2, 92 (2019). https://doi.org/10.1038/s41746-019-0172-3.   Diabetic Retinopathy Severity Scale (DRSS) was developed to differentiate proliferative DR (PDR) from non-proliferative DR (NPDR) 
 

 DRSS Predicts Vision-Threatening Complications (PDR/DME)  Percent of Eyes Progress to PDR at 1-Year, 3-Year, and 5-Year Visits by Baseline DR Severity   Early treatment diabetic retinopathy study research group. ophthalmology. 1991;98(5 suppl):823-33.   Diabetes control and complications trial research group. N Engl J Med. 1993;329(14):997-86.  Fathy C, Patel S, Sternberg P Jr, Kohanim S. Disparities in adherence to screening guidelines for diabetic retinopathy in the United States: a comprehensive review and guide for future directions. Semin Ophthalmol. 2016;31(4):364–377. doi: 10.3109/08820538.2016.1154170  Early screening and treatment for DR can reduce vision loss by up to 94%  1 Year Follow-up  3 Year Follow-up  5 Year Follow-up  Percentage of Eyes that Worsen to PDR  Regardless of severity, all eyes worsen over time  
 

 Vision Loss  Other Eye Problems  Amputation, Losing a Leg  Cardiovascular/Heart Problems  Foot Problems  Kidney Problems  Vision Loss is #1 Concern of Diabetic Patients  Diabetic Retinopathy is a Progressive Vision-Threatening Disease  Source: Patient survey adapted from Lions International Foundation and International Diabetes Foundation-Europe; Meltzer 2000  N=2702  What are the top concerns for diabetic patients? 
 

 Early Management of Diabetic Retinopathy  Poor Adherence to Medical Management and Lifestyle Options Worsen DR  Source: Zhang X et al. Cell Biosci. 2014;14:4:27  Control of Blood Sugar  Control of Blood Pressure  Smoking Cessation  Control of Lipids  Medical and lifestyle management is first line of treatment 
 

 Majority of Physicians Use a “Wait and Monitor” Approach for DR Patients  Over 90% of DR Patients Are Not Treated Proactively and Anti-VEGF Use is Limited  Source: ASRS 2021 Preferences and Trends (PAT) Survey  How do physicians treat patients with severe NPDR without DME?  Closely monitor retinopathy and encourage systemic glycemic control  Consider anti-VEGF in some patients with poor glycemic control and/or other risks  Consider anti-VEGF in some patients with good glycemic control and compliance  Consider anti-VEGF therapy in all or most patients  Other  
 

 Diabetic Retinopathy At a Glance  Current Treatment Landscape Demonstrates Need for Less Invasive Therapies  Source:1. American Diabetes Association; International Diabetes Federation; Healthline; *Ocuphire internal analysis and assumptions;  2. Das UN. DME, retinopathy and age-related macular degeneration as inflammatory conditions. Arch Med Sci. 2016;12(5):1142-1157. doi:10.5114/aoms.2016.61918  3. Patient survey adapted from Lions International Foundation and International Diabetes Foundation-Europe; Meltzer 2000  4. Guidehouse Triangulation of Global Data, Market Scope and Investor Forecasts (2020) AMD = Age-Related Macular Degeneration; DME = Diabetic Macular Edema ; BRVO = Branch Retinal Vein Occlusion   The number of people with DR expected to increase more than 14M by 2050  There are ~8M adults in the U.S. with DR1  DR is the leading cause of blindness among working-age adults  If untreated, DR can rob people of their vision prematurely2,3  56% of patients   reported anxiety related to anti-VEGF treatment  DR/DME affects about 1 in 4 people with type 1 and type 2 diabetes  Majority of moderate to severe patients with DR are not treated with anti-VEGF due to injection fear and burden  $13B  (2020)  Global Intravitreal Injection Revenues in AMD, DME and BRVO4 
 

 Current DR/DME Treatment Landscape  Presented by: Peter Kaiser, MD  Chaney Family Endowed Chair in Ophthalmology Research, Professor of Ophthalmology, Cleveland Clinic Lerner College of Medicine and Cole Eye Institute  Clinical research expert, serving as a Study Chairman of 5 major, multi-center, international trials, and principal investigator for numerous studies for AMD, DR, and other retinal disorders.  Major contributions to medical literature having authored 7 textbooks, more than 250 peer-reviewed papers  Recognized by American Academy of Ophthalmology and American Society of Retina Specialist with Senior Achievement Awards.  Peter Kaiser, MD  Harvard Medical School 
 

 2004  2006  2011  2012  Ranibizumab  nAMD  2014  2019  Aflibercept  DME  2022  MOA focused on VEGF and local delivery have demonstrated efficacy for approved treatments, are the current standard of care, and have been highly effective for wAMD/DME. However, these therapies have limited use in DR  AfliberceptnAMD  Faricimab-svoa  nAMD/DME  Pegaptanib nAMD  $9b+  2021 Revenue  $2b+  2021 Revenue  Ranibizumab  DME  Brolucizumab-dbll  AMD  IVT Anti-VEGF Therapies are Standard of Care for AMD/DME  Anti-VEGF Therapies Over the Decades; Limited Use in DR Patients  Source: Company websites 
 

 Panorama Study Further Emphasizes Need for Proactive Treatment of NPDR  Eyes Treated with Aflibercept Showed a >2-step Improvement in DRSS Level at 24 and 52 Weeks  Brown DM, Wykoff CC, Boyer D, Heier JS, Clark WL, Emanuelli A, Higgins PM, Singer M, Weinreich DM, Yancopoulos GD, Berliner AJ, Chu K, Reed K, Cheng Y, Vitti R. Evaluation of Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy: Results From the PANORAMA Randomized Clinical Trial. JAMA Ophthalmol. 2021 Sep 1;139(9):946-955. doi: 10.1001/jamaophthalmol.2021.2809. PMID: 34351414; PMCID: PMC8343518.  Population: Adults with severe NPDR w/o DME  225 Male; 177 Female  Mean Age: 56 years (10.5)   Setting: Global, Multi-Center Study  Intervention: 402 Eyes randomized to 3 arms  (1 eye per participant)  IVT Aflibercept 2q16   2 mg monthly x 3 doses then every 8 weeks x 1 dose, followed by every 16 weeks through week 100   IVT Aflibercept 2q8 as needed   2 mg monthly x 5 doses then every 8 weeks through week 52 then as needed through week 100   IVT Sham   Observation with sham IV injections  Primary Endpoint:  Proportion of participants with ≥2 step improvement in the DRSS scale at 24 and 52 weeks  24  52  100  24  52  100  24  52  100  Weeks  Proportion of Eyes  Aflibercept 2q8/PRN  n = 133  n = 135  n = 134  Proportion of Eyes With ≥ 2-Step Improvement in DRSS Score   From Baseline Through Week 100 (n = 133) 
 

 AAO-Preferred Practice Pattern Reveals High Unmet Need in Mild, Moderate, and Severe NPDR Patients  Unmet Need Remains High in Mild, Moderate and Severe NPDR Patients  Source: Diabetic Retinopathy Preferred Practice Pattern – AAO 2019; LTFU: Lost To Follow-up; IVT: Intravitreal Injections; PRP: Panretinal Photocoagulation  Physicians have limited non-invasive treatment options   An oral option for DR strengthens treatment options across all stages  
 

 Current Conventional Treatment is Challenging for Patients  Access and Time Burden are Further Barriers for DR Patient Compliance  Lu AJ, et al. Analysis of patient-reported barriers to diabetic retinopathy follow-up. Ophthalmic Surg Lasers Imaging Retina. 2019;50(2):99-105.  Prenner J et al. Am J Ophthalmol, 2015;160(4):725-731.e1.  Patient-Reported Barriers to Follow-Up Treatment (N = 209)  Office Visit Time Commitments  Mean: 90 min  Range: 13 - 261 min  * adjusted for age, gender, insurance type, severity of DR   DR patients are generally asymptomatic which contributes to poor adherence and compliance   Reported Barriers  Adjusted Odds Ratio (95% CI)*  Long waiting times  1.22 (0.63-2.00)  Other medical or physical condition  1.91 (1.02-3.57)  Forgot to come  4.35 (2.14-8.86)  Unable to leave work responsibilities  1.15 (0.41-3.22)  Other incidental obligations  1.81 (0.59-5.51)  Lack of an escort  2.14 (0.60-7.58)  Unhappy with previous care  0.92 (0.27-3.12)  Financial cost  0.70 (0.20-2.41) 
 

 Multiple Targets in DME/DR Treatment Landscape  Anti-VEGF Therapy is Mainstay, but Under/Non-Responders Remain, and Early Treatment is Limited  https://www.reviewofophthalmology.com/article/a-peek-into-the-diabetic-retinopathy-pipeline   Longer Duration IVTs  Extended Release  Combination Therapies  Oral Therapies  Topical  Gene Therapies  Emerging therapies that could shape industry:  Anti-VEGF IVT:  Aflibercept (Eylea®)  Ranibizumab (Lucentis®)  Bevacizumab (Avastin®)  IVT Steroids:   Dexamethasone (Ozurdex®)  Available Commercialized Therapies: 
 

 Intravitreal Injections Landscape (DR patients)  Eylea/Lucentis Approved, But Not Used in Patients with Mild NPDR and Mild PDR  Company websites; www.clinicaltrials.gov   Company  Drug  Target/MOA  Route of Administration  Phase 1  Phase 2  Phase 3  Commercial  Eylea  (aflibercept)  VEGF-A/B; PIGF  Intravitreal  ✓  ✓  ✓  ✓*1  Lucentis (ranibizumab)  VEGF-A  Intravitreal  ✓  ✓  ✓  ✓*2  KSI-301  (Tarcocimab)  VEGF  Intravitreal  ✓  N/A  ◌  EYP-1901  Voloronib  (TKI)  Intravitreal  ✓  ◌  BI 764524  Anti-Sema3A  Ischemia modulator  Intravitreal  ✓  ◌  OTX-TKI  Axitinib  (TKI)  Intravitreal  ✓  ◌  RGX-314  AAV8-VEGF  Suprachoroidal  (Gene Therapy)  ✓  ✓  *Trials to Support Approval  1 Panorama Clinical Trial  2 Protocol I & T and Rise & Ride  ✓ Completed ◌ Ongoing X Discontinued or Failed study 
 

 Topical Eyedrops in Clinical Development for DR/DME  Inflammation MOAs in Phase 2 with Novel Eyedrops  Company websites; www.clinicaltrials.gov   Company  Drug  Target/MOA  Indication  Route of Administration  Phase 1  Phase 2  Phase 3  Commercial  OCS-01  Steroid  DME  Eyedrop  ✓  ✓  OTT166  Integrin inhibitor  DR  Eyedrop  ✓  ◌  ✓ Completed ◌ Ongoing X Discontinued or Failed study 
 

 Oral Treatments in Clinical Development (DR)  Most Drugs Target Only Inflammation  Company websites; www.clinicaltrials.gov   Most Drugs Target Only Inflammation  Company  Drug  Target/MOA  Indication  Route of Administration  Phase 1  Phase 2  Phase 3  LY333531  Protein Kinase C inhibitor  DR  Oral  ✓  ✓  X  2006  APX3330  Ref-1 inhibitor  (Anti-VEGF and Anti-inflammatory)  DR  Oral  ✓  ◌  BAY1101042  Guanylate Cyclase activator  DR  Oral  ✓  ◌  AKST4290   CCR3 Eotaxin inhibitor  DR  Oral  ✓  ◌  RG7774  CB2 receptor  (cannabinoid)  DR  Oral  ✓  ◌  BI 1467335  AOC3  DR  Oral  ✓  X  2021  HCB 1019  (Xiflam)  Connexin 43 (inflammasome)  DR  Oral  ✓  ◌  OPL-0401  ROCK 1/2 inhibitor  DR  Oral  ✓  ◌  RZ402  Plasma Kallikrein  DME  Oral  ✓  GT005  Increasing production of CFI protein (anti-inflammatory)  GA  Oral  ✓  ◌  CU06-RE  Endothelial dysfunction blocker  wAMD  Oral  ✓  ✓ Completed ◌ Ongoing X Discontinued or Failed study 
 

 APX3330 is Different Than Past Oral Failures in Retina  APX3330 Targets Dual, Validated Retinal Disease Pathways with Favorable Human Safety Data  Bhatwadekar 2020 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265898/pdf/nihms-1594067.pdf  Bryant 2009 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905712/pdf/nihms786745.pdf   Eylea® and Lucentis label ARED & AREDS2 study  Phase 3  Commercial  Plasma Kallikrein  MOA targets inflammation  Oral failed due to systemic toxicity (liver, cardiovascular monitoring2)  Protein Kinase C  VEGF MOA  Phase 3 endpoint was visual acuity  FDA requested more data for approval. Eli Lily did not pursue additional clinical trials   Phase 1  Phase 2  Phase 3  Approved  TKIs   VEGF MOA  Oral failed due to dose limiting organ toxicity (e.g., hepatic)  OTC Oral Successes  Nutritional Supplements: Ocuvite®, PreserVision, EyePromise, Oral Vit C & E, Zn, Cu, Lutein, Zeaxanthin5  Iptacopan  Oral Complement inhibitor for GA  Safety in Ph2 PNH study:  headache (31% of patients)  abdominal discomfort (15%)  blood alkaline phosphatase increase (15%)  cough (15%), oropharyngeal pain (15%)  pyrexia (raised body temperature; 15%), and   upper respiratory infection (15%)  Iptacopan 
 

 New MOAs/therapies are needed to:  Provide non-invasive options for early disease management  Decrease in Diabetic Retinopathy Severity Score (DRSS)  Decrease in macular edema  Reduce vision threatening complications (VTC)  Improve in macular ischemia  Improve compliance by longer acting drugs  Manage inflammation  Address non-responders  APX3330 offers:  A novel, dual MOA  A novel and non-invasive route, where oral medication allows for early intervention   Opportunities for New Therapies in Retina  Unmet Needs in Retina Especially in NPDR 
 

 APX3330: Paradigm Shift Oral Treatment Option  Presented by: David Lally, MD  Director of the Retina Research Institute at New England Retina Consultants  Retina Surgeon at Baystate Medical Center  Assistant Professor of Ophthalmology at the University of Massachusetts Medical School-Baystate  Published in over 25 peer-reviewed ophthalmic journals and delivered over 25 presentations at national meetings  Active member of the American Society of Retina Specialists with the Fellow of the American Society of Retina Specialist (FASRS) award designation  David Lally, MD  Jefferson Medical College 
 

 APX3330 – Novel and Dual-Acting MOA in an Oral Pill  Ref-1 Involved in Multiple Key Pathways that Contribute to Diabetic Retinopathy and DME  Logsdon et al (2018), Li et al (2014).  Rangasamy S, McGuire PG, Das A. Middle East Afr J Ophthalmol 2012;19:52–59; Sohn HJ et al. Am J Ophthalmol 2011;152:686–694.   Mechanism of Action – Ref-1 Inhibition  Lucentis®  EYLEA®  Ref-1 (reduction-oxidation effector factor-1) is a novel target discovered by Dr. Mark R. Kelley at Indiana University School of Medicine  APX3330 is a small molecule oral drug candidate and a first-in-class inhibitor of Ref-1  APX3330 previously developed by Eisai for multiple hepatic inflammatory indications and later by Apexian for advanced solid tumors  Similar oncology origin as approved anti-VEGFs  MOA uniquely decreases both abnormal angiogenesis and inflammation by blocking pathways downstream of Ref-1  Hypoxia  Ref-1  HIF-1α  VEGF  (Signaling Cascade)  Inflammation  Ref-1  NF-κB  Other Growth Factors  (Signaling Cascade)  TNF-α  Chemokines  Neovascularization  Anti-VEGF  Steroids  APX3330 
 

 In Vitro Validation of APX3330 Mechanism of Action  APX3330 Reduces VEGF levels and Inflammatory Cytokines; Provides Neuronal Protection  Tao Yan et al. APX3330 Promotes Neurorestorative effects after stroke in type one diabetic rats. Aging and Disease. Vol 9, Oct 2018  Apurinic/Apyrimidinic endonuclease 1 regulates inflammatory response in macrophages. Jedinak A, Dudhgaonkar S, Kelley MR, Sliva D. Anticancer Res. 2011 Feb;31(2):379-85. PMID: 21378315  Fehrenbacher, J. C., Guo, C., Kelley, M. R. & Vasko, M. R. DNA damage mediates changes in neuronal sensitivity induced by the inflammatory mediators, MCP-1 and LPS, and can be reversed by enhancing the DNA repair function of APE1. Neuroscience 366, 23-35, doi:10.1016/j.neuroscience.2017.09.039 (2017).  APX3330 reduces VEGF protein expression in preclinical stroke model  APX3330 reduces pro-inflammatorycytokines in LPS stimulated macrophages  Increasing APX3330 dose  VEGF  Control  APX3330  APX3330 increases DNA oxidative repair and neuronal protection  APX3330 enhances Ref-1 endonuclease activity in dorsal root ganglion neurons  APX3330 (µM)  Percentage increase in APE1 repair activity  N = 4 
 

 Abnormal Conditions  (e.g., hypoxic):  Increased level of VEGF activity  Normal Conditions:  Physiological level of VEGF activity  APX3330 VEGF Effects in Normal Cells  APX3330 Restores Normal Levels Unlike Biologic Anti-VEGFs that Reduce VEGF Below Normal   Kamba 2007; Girardi 2010; Li 2014; APX3330 Investigator Brochure  Biologic Anti-VEGF Treatment  APX3330 Anti-Ref-1 Treatment  Biologic anti-VEGF agents inactivate VEGF directly and reduce VEGF levels below normal levels   Inhibition of Ref-1 by APX3330 returns VEGF levels to normal levels  VEGF is a growth factor that is necessary for normal function of multiple cell types including vascular endothelium and neurons  By returning VEGF levels to normal, APX3330 can reduce neovascularization, vascular leakage and the inflammatory response without adverse systemic effects     The safety profile of APX3330 to date in over 300 subjects has not shown any of the adverse effects that has been seen with systemic administration of anti-VEGF biologics such as cardiovascular pathology, hypertension, arteriothrombotic events, or renal dysfunction  APX3330  ARPE-19 cell line  APX3330 prevents VEGF overproduction in ARPE-19 cells 
 

 APX3330 Preclinical & IND-Enabling Studies  Completed Over 20 Clinical Trials Across Healthy, Hepatic and Cancer Patients  Extensively Evaluated in Over 20 Studies by Large Japanese Pharma Eisai   Toxicology   Studies  PK, Absorption, Distribution, & Excretion Studies  Safety Pharmacology Studies  Geno Tox,   Repro Tox & Antigenicity Studies   Pharmacology Models of Retinal Disease Studies  11  1  6  4  3  Extensively Studied in Over 20 In-Vitro and Animal Studies with Favorable Efficacy and Safety 
 

 Silva et al. ARVO 2021 Annual Meeting  *Published data on EYLEA. This study was performed independently from APX3330 study and is a cross-study comparison.  **Li 2014; *** Pasha 2018; ****Jiang 2011 (Vldlr -/- : Very Low-Density Lipoprotein receptor knock-out mice)  Preclinical Data: Oral APX3330 Blocks Neovascularization  Lesion Volume Decrease with Oral APX3330 in Murine Laser CNV Model Similar to EYLEA® Data  *EYLEA  Lesion Size and Corresponding Fluorescent Stains in L-CNV Models Treated with APX3330 at 25 mg/kg oral gavage  -55%  L-CNV Mouse Retina Model   Silva et al, 2021  Vehicle  25 mg/kg  50 mg/kg  APX3330 Gavage OCT  Lesion Volume  L-CNV Mouse Retina Model   APX3330  Efficacy was also seen after single intravitreal injection of 20 µM APX3330 in mouse L-CNV model**  Efficacy was also seen after dosing intraperitoneal injection of 50 mg/kg twice daily, 5 days on/2 days off, for 2 weeks in mouse L-CNV model***  Efficacy was also seen after single intravitreal injection of 20 µM APX3330 in Vldlr -/- mice model****  -44% 
 

 Summary of APX3330 Prior Clinical Trials  Completed 11 Clinical Trials Across Healthy, Hepatic and Cancer Patients  Phase 1​  Study ID​  Patient Population​  Treatment Groups​  APX_CLN_0001​  Healthy Subjects​  APX3330, Placebo​  APX_CLN_0002​  Healthy Subjects​  APX3330, Placebo​  APX_CLN_0003​  Healthy Subjects​  APX3330​  APX_CLN_0004​  Healthy Subjects​  APX3330​  APX_CLN_0008​  Healthy Subjects​  APX3330, Placebo​  Phase 2​  Study ID​  Patient Population​  Treatment Groups​  APX_CLN_0005​  Chronic Hep B​  APX3330​  APX_CLN_0006​  Chronic Hep C​  APX3330​  APX_CLN_0007​  Chronic Hep C​  APX3330, Placebo​  APX_CLN_0009​  Acute severe hepatitis​  APX3330​  APX_CLN_0010​  Alcoholic hepatitis​  APX3330​  APX_CLN_0011​  Cancer (solid tumors)​  APX3330​     Phase 1 Studies  Phase 2 Studies  Extensively Studied in 11 Clinical Trials across Phase 1 and Phase 2 by Eisai and Apexian  5     6 
 

 Phase 1 Clinical Trials: PK Data Supporting the ZETA-1 Trial  APX3330 has Oral Bioavailability and a Sustained PK Profile  Apexian preclinical data (unpublished)  APX3330 Investigator Brochure  Eisai PK clinical data APX_CLN_0002  Favorable Oral Bioavailability   Sustained Pharmacokinetic Profile​  Tmax 3-4 hours​  Linear dose-proportional PK   Dose-proportional increase in Cmax/AUC exposure​  Half-life elimination of 45 hours (steady state [SS] 5-6 days)   Meals have no clinically meaningful impact on the PK of orally administered APX3330  Sufficient APX3330 Exposure  Plasma levels observed after 120 and 240 mg/day dosing is multiple times higher than what was required for efficacy in preclinical studies  planned clinical dose is 600 mg/day  2 µg/ml in mouse plasma at 2hrs; 25 mg/kg oral single dose  ~20 µg/ml (120 mg/day) in human plasma   ~40 µg/ml (240 mg/day) in human plasma  Plasma concentration of APX33302  z  MEAN±SEM  120 mg  240 mg 
 

 Phase 1 and Phase 2 Clinical Trials performed by Eisai and Apexian   Safety Summary From Phase 1 and Phase 2 Trials  Low AEs Across 11 Trials, <5% Mild Drug Related AEs, Discontinuations Similar Across Arms   Totals Across ALL Phase 1 and Phase 2 Studies   (Among Healthy Subjects, Hepatitis Patients, and Oncology Patients)  APX3330  Placebo  Diarrhea/Soft Stool (mild)  14/346 (4%)  2/95 (2%)  Rash/Pruritis (mild)  14/346 (4%)   1/95 (1%)  Integrated Overall Summary of Adverse Events in Eisai Phase 2 Studies (Hepatitis)  APX3330 20-240 mg   (N=236)   Placebo   (N=68)       n (%)   # events   n (%)   # events   Any event   40 (16.9%)   52   11 (16.2%)   15   Mild or Moderate adverse Events   39 (16.5%)   50   9 (13.2%)   13   Serious adverse events   1 (0.4%)   2   2 (2.9%)   2   Adverse events leadingto discontinuation   10 (4.3%)   16   5 (7.4%)   7   % = proportion of subjects relative to N, where n = number of subjects with an event and N = the number of subjects in the enrolled population.   Note: This table was generated by Eisai which has slightly different event and sample size counts than the Ocuphire analysis. Ocuphire will be creating an integrated safety database. The overall conclusions between the Eisai and Ocuphire analyses are the same.  This includes over 2078 subject-days of exposure at doses ≥600mg and over 17,961 subject-days of exposure at doses <600mg.  
 

 ZETA-1 Phase 2b Trial in Diabetic Retinopathy  Presented by: David Lally, MD  David Lally, MD  Jefferson Medical College 
 

 ZETA-1 Phase 2b Design for DR/DME   Ongoing, Randomized, Double-Masked, Placebo-Controlled 24-Week Trial (Similar To Eylea P3 DR Trial)  NPDR = non-proliferative diabetic retinopathy (which includes non centrally involved diabetic macular edema)  PDR = proliferative diabetic retinopathy (which includes non centrally involved diabetic macular edema)  ZETA-1 Clinical Trial is Sponsored by Ocuphire Pharma https://clinicaltrials.gov/ct2/show/NCT04692688?term=ZETA-1&draw=2&rank=1   Primary: % of subjects with a ≥ 2 step improvement on the DRSS (Diabetic Retinopathy Severity Scale) score at week 24  Secondary:  Central subfield thickness (CST)  BCDVA (ETDRS)  DRSS change at week 12  Rescue subjects  Safety and tolerability  Exploratory:  Labs / PK   Endpoints  Enrollment of 103 DR Patients Completed (Apr 2021 to Mar 2022)  Top Line Data Expected in Q4 2022  Eligibility Screening  Randomization  APX3330 600 mg/day (BID)  Placebo BID  25 US sites  90-100 participants with moderately severe to severe NPDR or mild PDR  Noncentral DME is permitted  1:1  Week 0  Week 12  Week 24  Week 4  Primary Endpoint 
 

 Source: ZETA-1 trial  Key Eligibility Criteria in ZETA-1  Oral Medication Provides Binocular Treatment; DME Allowed in Fellow Eye 
 

 Why DRSS is an Important Endpoint?  FDA Accepted Endpoint for EYLEA® in PANORAMA Pivotal DR Trial - 2 Step Improvement on the DRSS Score  Eylea® Panorama study     Diabetic Retinopathy Severity Scale (DRSS) 
 

 ZETA-1 Trial: Demographics and Masked Safety Data  Presented by: Caroline Baumal, MD  Caroline Baumal, MD  University of Toronto 
 

 Baseline Characteristics for ZETA-1 Trial   Typical Demographics for Diabetic Population  Source: ZETA-1 Demographics and Baseline Characteristics  Parameter  Total   N = 103  Age (years):                  mean                                       (range)  56   (24-81)  Sex: n (%)   Male  50 (49%)  Female  53 (51%)  Race: n (%)   American Indian or Alaskan Native  4 (4%)  Asian  4 (4%)  Black or African American  11 (11%)  White  81 (79%)  Other  3 (3%)  BMI (kg/m2):                  mean                                        (range)  31  (21-40)  Systolic BP (mmHg):    mean                                        (range)  138  (100-180)  Diastolic BP (mmHg):   mean                                        (range)  80  (53-109)  Heart rate (BPM):         mean                                        (range)  77  (51-96)  Hemoglobin A1c:   8.1  (5.3-12.3) 
 

 Baseline Characteristics for ZETA-1 Trial (Continued)  DRSS Scores in Diabetic Study Population  Source: ZETA-1 Demographics and Baseline Characteristics  Parameter  Total N = 103  Total   N = 103  Study Eye DRSS n(%)  DRSS 47 (Moderately Severe NPDR)  39 (38%)  DRSS 53 (Severe NPDR)  53 (52%)  DRSS 61 (Mild PDR)  11 (11%)   Fellow Eye DRSS n(%)  DRSS 20-40 (Mild to Moderate NPDR)  29 (28%)  DRSS 47 (Moderately Severe NPDR)  34 (33%)  DRSS 53 (Severe NPDR)  22 (21%)  DRSS 61 (Mild PDR)  5 (5%)  DRSS 65-85 (Moderate to Severe PDR)  11 (11%)  Not Graded  2 (2%)  Note: 15 fellow eyes were CST>320 microns (center-involved DME eyes) 
 

 Baseline Characteristics for ZETA-1 Trial (Continued)  Key Visual Metrics in Diabetic Study Population  Source: ZETA-1 Demographics and Baseline Characteristics  * N=102 due to a fellow eye not being graded.   Parameter  Total  N = 103  Study Eye Screening CST (um): mean    (range)  270  (203-319)  Fellow Eye Screening CST (um)*: mean    (range)  289  (211-491)  Study Eye BCVA:    mean    (range)  Letters Read:  80  (60-93)  Snellen Equivalent:  20/25  (20/63-20/15)  Fellow Eye BCVA:    mean    (range)  Letters Read:  77  (0-91)  Snellen Equivalent:  20/32  (20/1000-20/15)  IOP Study Eye and Fellow Eye (mmHg): mean    (range)  15  (8-22)  Diabetic Status (Years): mean    (range)  16  (0-58)  Study Eye with anti-VEGF injectionswithin 6 months prior to Screening  None   Fellow Eye with anti-VEGF injectionswithin 6 months prior to Screening  15 
 

 Comprehensive Laboratory Panels Collected in ZETA-1  Blood, Kidney, and Inflammatory Markers Evaluated  Chemistry   Albumin   Alanine aminotransferase (ALT)   Alkaline Phosphatase   Aspartate aminotransferase (AST)   Blood Urea Nitrogen (BUN)   Creatinine   Glucose (Random)   Sodium  Total bilirubin  Total protein  Test Panel ComponentsHematology(CBC without Differential)   WBC   RBC   HGB (Hemoglobin)   HCT (Hematocrit)   Platelet Count   Calcium   Carbon Dioxide (Bicarbonate)   Chloride   Cytokine Panel (Biomarker)  Interleukin-1 ß (IL-1ß)   Interleukin-6 (IL-6)   Interleukin-8 (IL-8)   Tumor Necrosis Factor α (TNF-α)   PK and Biomarkers  REF-1 ELISA 1  Pharmacokinetics  Kidney Function   eGFR  Creatinine 
 

 Masked Safety Findings from Ongoing ZETA-1 Trial  Favorable Safety Profile (as of 9/15/2022) Observed with 600 mg Oral Daily Doses in Diabetic Subjects  1. 12 events in 8 subjects: diarrhea, worsening DME (OD and OS), pruritis, urticaria, blurry vision, decrease in hemoglobin level, ischemic diabetic maculopathy and central vision scotoma (in same subject), photophobia (OD and OS) and hypoaesthesia (in same subject)  2. Cellulitis (2 events in same subject), dyskinesia, transient ischemic event, COVID-19 and acute respiratory failure (same subject), progression of multivessel coronary artery disease, cholelithiasis, osteomyelitis, vertigo, chest pain, infection of toe and ulcer of toe and embolism (3 events in same subject), multi-system organ failure, worsening bradycardia  3. DME, Dyspnea, Pre-Syncope.  Note: ZETA-1 Interim Data as of database 9/15/22 with monitoring to be completed before final database lock; assumes 50% subjects on APX3330   0  Treatment- Related   AEs involving    liver, heart, kidney, brain, lung, or vital signs   Oral APX3330 safety profile consistent with that seen in prior trials​  >7900Subject-Daysof Treatment at600 mg/day  APX3330 Exposure   16 SAEs in 12/103 Subjects  0  Treatment Related  16   Unrelated2  91Subjects completed thru week 24  103   Subjects Enrolled  95Subjects completed thru week 12   169 TEAEs   In 62/103 Subjects (60%)  149  Unrelated  30  Treatment-Related  12 Moderate1  0 Severe   92 Mild   48 Moderate    9 Severe  18 Mild  3  withdrew   due to an AE3  3  withdrew   consent or site closure  6  lost to  follow-up 
 

 APX3330 Product Candidate Profile for Multiple Retinal Indications  Oral, First-In-Class Ref-1 Inhibitor with Favorable Human Safety Data  *11 completed Phase 1 and Phase 2 clinical trials by Eisai and Apexian; along with ongoing ZETA-1 trial by Ocuphire (*includes ~103 subject)  Novel MOA for treating retina   ↓ Inflammation   ↓ Abnormal Angiogenesis  Convenient Oral Dosing for Patient Compliance   Allow Daily vs. Episodic Exposure  Oral pill may reduce the burden of   frequent anti-VEGF injections  ~10,000 Subject-exposure days* at ≥ 600 mg/day dose  Few Systemic Adverse Effects  ~ 5% Mild Diarrhea  ~ 5% Mild Skin Rash (reversible)  No Treatment-Related Organ Toxicity   (Liver, Cardiovascular {BP, HR}, Kidney,Neurologic, Pulmonary)  No Ocular Effects  No observed ocular AEs  APX3330: Well-tolerated Oral Dose up to 600 mg/day | Twice Daily Dosing  Expected Efficacy Data  Favorable Safety Profile 
 

 ZETA-1 Trial Design and Data Expectations 
 

 APX3330 has the Potential to be First Line of Therapy for DR Patients  Eylea® label; APX3330 Investigator Brochure, ZETA-1 clinical trial  Clinically meaningful decrease in diabetic retinopathy severity with APX3330  Early intervention with oral may reduce progression to vision threatening DR into DME  Efficacy Signal  Percent of patients on APX3330 with a ≥ 2 step improvement on the DRSS score at week 24 (and 52) compared to placebo in 2 well-controlled, multi-center clinical trials  Efficacy Signal  FDA Guidance  Physician/Patients  Safety  Non-Invasive Treatment Option  Safety  Approval depends on a product's benefit outweighing its risks in the intended population – this benefit should be evaluated in multi-center, 2-year clinical trials   FDA does not require comparative arm of approved anti-VEGF injections such as Eylea for DR  Non-Invasive Treatment Option  No major organ toxicities  Well-tolerated (e.g., AEs acceptable if mild and infrequent for oral)  Eylea®, although approved, is currently not used as standard of care because of the treatment burden for asymptomatic DR patients   Ability to be prescribed by all eye care doctors  Oral option increases global access, especially in underserved regions 
 

 APX3330 is Positioned to Fulfill a Significant Unmet Need in Diabetic Eye Disease  Favorable PK and safety data from clinical trials and overall masked safety data supports a potential oral treatment for diabetics with DR/DME  Dual mechanism of action may benefit inflammation from co-morbidities  DR/DME treatments are large attractive market opportunity  Oral therapeutic can be prescribed as early treatment option for diabetic patients who may otherwise fall under the “wait and see” treatment approach  Oral therapeutic decreases burden of treatment (invasive intravitreal injections, time devoted to treatment, etc.) which may strengthen adherence and overall favorable outcomes  Well-controlled, multi-center Phase 2b ZETA-1 for APX3330 topline results expected in 4Q22