Company Overview
December 2017 NASDAQ: MDGL
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Company Overview December 2017 NASDAQ: MDGL 1 Forward Looking - - PowerPoint PPT Presentation
Company Overview December 2017 NASDAQ: MDGL 1 Forward Looking Statements Any statements, other than statements of historical facts, made in this presentation regarding our future financial or business performance, conditions, plans, prospects,
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2 Any statements, other than statements of historical facts, made in this presentation regarding our future financial or business performance, conditions, plans, prospects, trends, or strategies and other financial and business matters; our ability to obtain additional financing; the estimated size of the market for our product candidates, the timing and success of our development and commercialization of our anticipated product candidates; and the availability of alternative therapies for our target market, are, or may be deemed, forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. In some cases, you can identify forward-looking statements by terms such as “may,” “will,” “could,” “should,” “would,” “anticipate,” “believe,” “estimate,” “continue,” “design,” “expect,” “intend,” “plan,” “potential,” “predict,” “seek” or the negative of these words and similar expressions and their variants may identify forward-looking statements. These forward-looking statements reflect management’s current expectations, are based on certain assumptions and involve certain risks and uncertainties, which change over time. Our actual results may differ materially from the results discussed in these forward-looking statements due to various factors. Important factors that may cause actual results to differ materially from the results discussed in these forward-looking statements include, but are not limited to, risks related to securing and maintaining relationships with collaborators; risks relating to our clinical trials; risks relating to the commercialization, if any, of our proposed product candidates (such as marketing, regulatory, product liability, supply, competition, and other risks); dependence on the efforts of third parties; dependence on intellectual property; and risks related to our cash resources and ability to obtain working capital to fund our proposed operations. Further information regarding on the factors that could affect our business, financial conditions and results of operations are contained our filings with the U.S. Securities and Exchange Commission, which are available at www.sec.gov. These forward-looking statements represent management’s expectations as of the date hereof only, and we specifically disclaim any duty or obligation to update forward-looking statements as a result of subsequent events or developments, except as required by law.
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Paul Friedman, M.D. Chairman and CEO Former CEO of Incyte Former President of R&D at Dupont Pharmaceuticals Marc Schneebaum CFO, SVP Former CFO, SVP at Synta Former CEO at Predictive Biosciences Rebecca Taub, M.D. CMO, EVP R&D Founder of Madrigal Aided in discover of Eliquis and MGL-3196 at Roche
Compound Indication Pre- Clinical Phase 1 Phase 2 Phase 3 Upcoming Catalysts
MGL-3196
Thyroid Hormone Receptor-β (THR-β) Agonist Nonalcoholic Steatohepatitis (NASH) Phase 2 liver biopsy data Phase 3 initiation Familial Hypercholesterolemia (FH) Topline Phase 2 data Phase 3 initiation
MGL-3745
THR-β Agonist NASH and FH
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6 ~3-5% of the US population has NASH NAFLD is the most common liver disease world-wide ~25% of US population Rapid progression, <2 years 25% of NASH Stage 3 fibrosis progress to cirrhosis
NASH is the most severe form of nonalcoholic fatty liver disease (NAFLD)
Characterized by inflammation and damage caused by a buildup of fat in the liver that leads to cirrhosis, fibrosis, and cell death Develops most often in patients with obesity/metabolic syndrome, diabetes and dyslipidemia
NASH represents an indication with significant unmet need
Estimated to affect 3-5% of the US adult population Expected to be the leading cause of liver transplant There are currently no approved therapies for the treatment of NASH
American Liver Foundation, Aliment Pharmacology Therapy WGO (World Gastroenterology Organization) 2012
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Clinical Gastroenterology,2003;37(4):340-343 J Clin Endocrinol Metab.2016; 101(8:3204-3211
Cell Biosci (2016) 6:46
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*** *** *** ***
p<.05* p<.01** P<.001***
*** *** *** *** *** **
T3 MGL-3196
High selectivety for THR- β may reduce toxicity, which is mediated through the systemic THR-α receptor Very high protein binding, low penetration of tissues outside the liver including brain, heart and bone also expected to limit toxicity MGL-3196 treated healthy volunteers and patients show normal central thyroid axis and vital signs Unlike thyroid hormone (T3), MGL-3196 decreases cholesterol without impact on bone or cartilage in preclinical studies Adverse Events (AEs) mostly mild, similar to control without safety or tolerability issues in Phase 1 and twelve week interim NASH Phase 2 readout
24d study in 40 week old diet-induced obese (DIO) mice on High Fat Diet (HFD) for 38 weeks Illustrative comparison of MGL-3196 to other molecules
Selective Mechanism of Action Strong Preclinical and Clinical Safety Data
J Med Chem. 2014;57(10):3912-3923 BMJ 2011;342:d2238
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Liver Triglycerides
* ** ** *
* * *
* p<0.05
* Insulin Tolerance Test (0.5 U/kg insulin) ALT
Liver Fat (Histology)
MGL-3196 Control Upper panels: 24d study in 17 wk old DIO mice (po, qd) on high fat diet (HFD) 13 wks; lower panels: 24d study in 40 wk old DIO mice on HFD 35 wks
Once daily oral treatment led to highly statistically significant and dose-dependent up to ~30% reduction of apolipoprotein B (ApoB), total, LDL, non-HDL cholesterol; Strong trends in triglyceride reduction up to 60%; Near maximal effect at 80 mg dose
Change from Baseline (CFB) by mean % CFB calculated for each individual subject 24h after 14th dose; baseline value obtained just prior to first dose; ApoB, apolipoprotein B; Chol, total cholesterol; LDL-C, LDL cholesterol directly measured; Non-HDL-C, non- HDL cholesterol; TG, triglycerides (median %CFB)
*** p<0.001 ** p<0.01 * p≤0.05 “p≤0.1
*** *** *** *** *** *** *** ** ** ** ** ** ** * * * * “ “
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Atherosclerosis 230 (2013) 373-380
Six dose cohorts, 36 total healthy volunteers dosed daily with MGL-3196 (5, 20, 50, 80, 100, or 200 mg) and 12 with placebo for 14 days Healthy volunteers with slightly elevated LDL cholesterol (> 110 mg/dL) Well-tolerated, appeared safe at all doses tested No effect on vital signs, heart rate, central thyroid axis, or liver enzymes
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NASH on liver biopsy: NAS≥4 with fibrosis ≥10% liver fat on MRI-PDFF Include diabetics, statin therapy
Comparator/Arms
MGL-3196 or Placebo, once daily
Primary Endpoint
Reduction of liver fat (MRI-PDFF) at 12 weeks
Secondary Endpoints
NASH biomarkers and lipids at 12, 36 weeks Repeat MRI-PDFF at 36 weeks Liver biopsy at 36 weeks - reduction/resolution of NASH in patients on drug; reduction of fibrosis
Design Stage Drug MGL-3196 Blinded 2:1 Phase 2 Number of Patients Centers Treatment Duration 125, Fully Enrolled ~30, USA 36 Weeks
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ALL MGL- 3196 HIGH MGL- 3196¹ Placebo Number of patients 78 44 38 Primary Endpoint:
Relative change in MRI- PDFF (% change from baseline, median) Significance relative to placebo
p<0.0001
p<0.0001
Percentage of patients attaining ≥30% liver fat reduction
Significance relative to placebo
60.3% p<0.0001 75.0% p<0.0001 18.4%
Statistically significant improvements in low-density lipoprotein cholesterol (LDL-C), triglycerides and lipoprotein (a) Lp(a)² Statistically significant improvements in liver enzymes in drug-treatment group² Very good all subject tolerability: mostly mild and a few moderate AEs, the numbers of which are balanced between placebo and drug-treated groups; 3 reported SAEs all considered unrelated to drug Two regularly scheduled DSMB meetings held May 2017 and September 2017 to review data from the Madrigal NASH Phase 2 trial. DSMB recommended to continue the trial with no changes to the protocol
¹ Prespecified group of patients (44/78) with relatively higher MGL-3196 drug levels ² These beneficial effects are more pronounced in the group of pre-specified patients with higher levels of MGL-3196
Excellent correlation between decline in fat content on MRI-PDFF and NAS score, steatosis and ballooning on biopsy
Pleiotropic and cardio-beneficial actions position MGL-3196 as potential best-in-class NASH therapeutic Opportunities for differentiation from other NASH agents Efficacy on NASH and cardiovascular endpoints position MGL-3196 to be used in combination with anti-fibrotic and/or anti- inflammatory agents 13
Target compound NAS Score Fibrosis Score Liver Lipids NASH Prevention Insulin Sensitivity LDL TGs CV Risk Side Effects FXR
✔ ✔ ✔ ✔ ✔ — LDL-C Pruritus
Anti-fibrotic
? ✔ — ✖ — — — ? Unknown
PPARαδ
✔ ✖ — ? ✔ PPARα/δ Well-tolerated
Anti-inflam
✔ ? — — — — — ? Well-tolerated
Pioglitazone
✔ ✔ ✔ ✔ ✔ PPAR CHF, bone,weight
MGL-3196
✔ ✔ ✔ ✔ ✔ CV Benefit Well-tolerated
Lancet 385:956-65; 2015; Gastroenterology Feb 11 2016; pii:S0016-5085(10)00140-2 Tobira press release July 25, 2016; Ann Intern Med. doi:10.7326/M15-1774 2016
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HeFH and HoFH caused primarily by inactivating mutations in LDL receptor Early onset cardiovascular disease, HoFH < age 20 Associated with several of potentially severe cardiovascular diseases including coronary heart disease, carotid artery disease, and chronic kidney disease
1/200-1/500 HeFH; 1/250,000-1/1,000,000 HoFH Higher frequency in certain genetically homogeneous populations High prevalence for a genetic disease
Despite current and newer therapies, HoFH and most HeFH not achieving treatment goals on standard care Significant commercial opportunity for MGL-3196 in HoFH, refractory HeFH
European Heart Journal doi:10.1093/eurheartj/ehu274; 2014
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Inclusion/Exclusion HeFH on maximally tolerated statins (typically high dose), ezetimibe Comparator/Arms MGL-3196 or Placebo, once daily Primary Endpoint LDL cholesterol lowering Secondary Endpoints TGs, Lp(a), ApoB lowering Safety Design Stage Drug MGL-3196 2:1 Phase 2 Number of Patients Centers Treatment Duration 116, fully enrolled 13, Europe 12 weeks
Completion of long-term toxicology studies for MGL-3196 Completion of Phase 1 trial of MGL-3196 dosed with statins for NASH Initiation of Phase 2 trial
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Initiation of 12-week Phase 2 trial
Positive topline 12-week data from Phase 2 trial of MGL-3196 for NASH Upcoming Catalysts: 36-week topline liver biopsy data from Phase 2 trial of MGL-3196 for NASH Topline data from Phase 2 trial of MGL- 3196 for HeFH Phase 3 NASH Phase 3 HeFH Completed Milestones:
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have delayed liver regeneration, increased apoptosis (PLoS ONE 5(1): e8710, 2010)
fibrosis with age
reduces fibrosis in animal models of liver fibrosis (PNAS 113: 3451, 2016)
had done (simple receptor binding assay)
assay and, like thyroid hormone, activate the THR-α receptor equally well as the β receptor
long-term animal toxicology studies
increases in human studies
Thyroid Gland Liver T4 T3 T4 T3 Nuc Thyroid Hormone Receptor α or β
TSH
Thyroid Hormone Pathway T4 T4, prohormone T3, active hormone TSH, thyroid stimulating hormone less α potent
more ß selective
α-potency (nM) β/α relative to T3
5 10 15 20 25 30 35
500 1500 2500 3500 4500
Thyroid Hormone (T3) MB07811 (GC1) MGL-3196 Eprotirome KB GC-1
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J Med Chem. 2014;57(10):3912-3923
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TIMP1 tissue inhibitor metalloproteinase CTGF connective tissue growth factor SMA smooth muscle actin SAA serum amyloid A CRP C-reactive protein “HFD”, lane 1 mean HFD gene expression normalized to mean Lean; Lanes (2-7) mean gene expression normalized to mean of DIO; “Rosi” (rosiglitazone, 3 mg/kg, 24 wks) Red, higher expression; blue decreased expression
Inflammation
HFD Lean 0.1 0.3 1 3 Rosi
MCP-1/CCL2 MIP-2α/CXCL2 MIP-2ß/CXLCL3 A20/TNFaip3 CRP Annexin 2 SAA1
Fibrosis
Collagen 1 Galectin-3 TIMP1 Collagen 4a2 SMA Collagen 4a1 CTGF Keratin 18 Collagen 3 Galectin-1 25 week study in lean control mice and HFD mice treated with Vehicle, 0.1 to 3 mg/kg MGL-3196 or Rosiglitazone (3mg/kg)
Bad Good
1 2 3 4 5 6 7
MGL-3196 (mg/kg) 23
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feces via biliary excretion
3196
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Atherosclerosis 230 (2013) 373-380
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Baseline (BL); triglycerides (TG) (all) or >150 mg/dL at BL; Lp(a) shown only for subjects with measurable BL Lp(a)
p<.003 p <.0001
dosed with one-two days of a statin and multiple daily doses (9-11) of MGL-3196 (100 or 200 mg)
LDL-C), subjects reaching an average LDL-C of 70 mg/dL, ApoB of 59 mg/dL
MGL-3196 exposures did not demonstrate more lipid lowering.
p=.001
and near maximal by 6 weeks (PLoS One.2016; 11(4):E0153595)
Madrigal NASH Phase 2 trial
confidence
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HoFH
Mipomersen (Kynamro, anti-ApoB) may have safety issues
HeFH
still not achieving goal
intolerance in some and elevated Lp(a) HoFH Lipid Lowering Therapy LDL decrease Conventional Statins Up to 28% Ezetimibe <10% LDL apheresis 20-40% New Treatment Options Lomitapide Up to 50% Mipomersen 25% PCSK9 inh 23%
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*Kynamro, Juxtapid FDA label, prescribing information
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* Endocrinology 2012 Nov;153(11):5143-9 ** Lancet Diabetes Endocrinol2014; 2: 455–63
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