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Jefferies 2024 Global Healthcare Conference

Jun 5, 2024

Jean-Pierre Sommadossi
Chairman and CEO, Atea Pharmaceuticals

Good morning. I'm JP Sommadossi, Chairman and CEO of Atea Pharmaceuticals. Before I begin, I would like to thank Jefferies for the opportunity to present today. We have very exciting new data that presented on the same time at EASL Congress in Milan, which is the European for liver studies. I'm very pleased today to share with you those exciting new phase II data. Before any further information, as you know, can be found in our most recent regulatory filing. So far this year, we have a really tremendous clinical progress across our program for COVID-19 and HCV.

I'll present first, an overview of our COVID program and, and, anticipated key milestones. As you know, COVID-19 is here to stay, even if we don't like to, especially in the United States. You may have the latest report from California, and we anticipate, unfortunately, probably another surge for this summer. Variants are continuing to evolve, and this winter we had actually a surge with a JN.1 variant, and which allowed with our strong operational execution to the rapid and successful enrollment of the only global phase III trial exclusively conducted in high-risk patients. And this several ahead, several months ahead of our guidance. We randomized a total of almost 2,300 patients. Actually, what's amazing is that we had only 74 patient in the combination cohort.

This was an add-on study to a standard of care, and 77% actually of the patients were enrolled in the United States. This is really striking to really emphasize by this small numbers of enrollment in the combination cohort that investigators continue to really see a major unmet medical need with COVID, especially with oral treatments in these high-risk patients. And we believe that Bemnifosbuvir has really the potential to address many of these key limitations of these current COVID-19 therapies, in particular, safety, tolerability, and drug interaction that we all know is Paxlovid.

So, we see that, potentially we will be able to deliver Bemnifosbuvir to millions of patients, and, we anticipate, top-line results, as you see in this slide, in the second half of this year. Now, let's turn to, our phase II program for Hepatitis C. This, we have new SVR12 efficacy data. This is the primary endpoint, which is, fully accepted by all regulatory authorities around the world, including the, the FDA. And as I said, we are presenting this new data also at EASL, in Milan, and we believe that this data, really demonstrate the potential for a best-in-class profile that combine really the, most compelling attributes of the two current approved treatment, Epclusa and Mavyret, and you will see with, some limitations for both.

We are in the process to select the final fixed-dose combination. This is ongoing as a phase I in the United States, and which will be used in the phase III and for commercialization as well. And we anticipate to initiate the phase III after our end of phase II meeting around the end of the year or early 2025. In addition, as you can see, we have a very strong financial position with more than $541 million at the end of March, and we anticipate that the cash runway will take us well into 2027, and this was accounting for a full phase III program being covered by Atea.

Let's move now to review the data from our phase II lead-in cohort. As you may know, actually today, really we have significant challenges toward our goal of HCV elimination in the U.S. You may have heard from the NIH, it was Dr. Francis Collins, that eradication should have been a goal for 2030 in the U.S. But it's clear that with the change of demographic and the current and the current drug available, this is not going to be a goal that will be achievable. It's clear today that we have more than 2 million chronically infected patients with hepatitis C. Actually, some figure go up even to 4 million, depending on the authorities.

And it's important to know that we have more diagnosed patients chronically infected every year than we are treating in the United States. It's very interestingly a market research that we did around the end of 2023 really emphasized the need for new treatment. And this was performed with 150 of the most the highest prescriber from all specialties. You soon can see a hepatologist, ID doc, gastroenterologist, and primary care. And what's really fascinating is that you see that only 6% actually acknowledge that there is no unmet medical needs. So, 94% of them, high prescriber, do indicate that they need a new treatment if we want to achieve this eradication in our countries. And what do we see?

Yeah, shorter treatment, especially with fewer contraindications, so drug-drug interaction. And those are really two of the major requests. And we see that basically, also this is one of the reason why 17% of the patient actually today do not complete the treatment. And we see with our data that in this phase II, that nonadherence of this patient demographic, which is totally different than what we had at the introduction of the direct-acting antiviral 10 years ago, really require a new drug or new drug combination, which will address both at the same time, a shorter lengths of treatment and a lack of drug-drug interaction.

We believe that, as you can see in this cartoon, that the combination of Bemnifosbuvir and Ruzasvir has the potential to be a best-in-class regimen that combines the most compelling attributes, as I said, of current HCV treatment. So it is protease free, but most importantly, that's why protease free is important for drug-drug interaction. So no drug-drug interaction, no food effect, but also and most importantly, with a short 8-week treatment duration. It's going to be very difficult, and we will have data at AASLD by the end of the year with viral kinetics that will really demonstrate that it'll be quite impossible based on those viral kinetics, even in the best-case scenario, that you will have a treatment shorter than eight weeks.

We believe that with this attribute, we are in a very good position to increase the market, to expand the market, and see what could be the potential value in the United States of already a very mature market today, with more than $1.5 billion of revenue as a net sales only in the United States, in excess of $3 billion worldwide. You see that this is a market demand that is growing as well, and still we have not addressed the major issues that we have in these countries. Hopefully, with U.S. new U.S. government initiatives, with an optimal product profile, and this is what we believe will really increase the patient treatment.

Today, you have 75% of diagnosed HCV patient in the United States who are not treated because they do not have an optimal product profile. Also, it's important to understand that we will have to remove some of those HCV prescribing barrier by the payer, which actually will require a very simple, very convenient, no need to genotype the patients, and regardless of the stage of the liver disease, like we anticipate, our combination will address. So let's go and share the data with you today. This slide outline the phase II study which is ongoing. It is a single-arm, open label of 550 mg once a day of Bemnifosbuvir and 180 mg once a day of Ruzasvir.

We plan to enroll up to 280 naive patients, so those are non-cirrhotic patients, for the lead-in cohort, and now we are enrolling also cirrhotic patients across all genotypes. So for the initial 60-patient cohort, which is a very good size already, we had used the SVR week four, which we had reported a few months ago as a decision criteria to continue enrollment, and which we did, and re-enrolled patients in late January, early February. And today, I'm happy to share the data with you on the primary endpoint of this study at week 12, including the safety as well. So before we review this data, just to let you know that...

So this patient demographic, as I said, totally different than what we are dealing with 10 years ago, but including non-cirrhotic patients and also some with advanced stage of fibrosis with F3, which is a borderline with cirrhosis. What's important in this slide is that regardless of the baseline viremia, so whether that you are at one million copy or 10 million or 20 million, it's important that for comparison, go to the early trials, including the label with Epclusa, you will see that any actually baseline viral load above one million copy, which is the number six in this slide, you will see that the SVR12 will not be in the high 90s anymore, and only if you have a viremia of 1 million or below.

Here, what you see is regardless of this amount of virus at the beginning, you see that all patients regardless genotype, including the historically hard-to-treat patient genotype 3, within four weeks, they're all below limit of quantitation, which basically is consistent with eight-week treatments. So those very rapid kinetics are basically the reason, the rationale why you are going to see this high, really, SVR12, so those are cure patients. So we have all patients of this lead-in cohort, 97% SVR12, which is quite amazing. But even more amazing is that the two subjects that at the post-treatment relapse, as you will see, actually have relapsed because of lack of adherence.

To make really story short here, and Wall Street likes the numbers, it's 100% on all patients that are basically following protocol, taking a drug, a combination of a drug every day, for eight weeks, and any of those patients will be cured. So, this challenge of drug adherence, especially in the patient that we are dealing with today, you will see, we're going to give you a little bit some more examples and demonstrate the challenge that we have today with hepatitis C drug as compared to the one that has been already used. So here, even more exciting, as you can see, we show a 100% SVR12 rate in patients with genotype 3.

As I said, this is a historically difficult to treat genotype of Hepatitis C. It's about 10%-15%. So you're talking about 200,000-300,000 of those Genotype 3 in the United States still today. This is this slide, so the slide 13, as I mentioned, those two patients are genotype 1b and genotype 2b, experience post-treatment relapse in this lead-in cohort. And what you see here is the viral kinetics, the plasma drug levels, and the resistance data. So that mean that the virus is being sequenced at baseline and then at SVR12, when basically you see the rebound, the relapse in viremia. And what's really critical here is that you can see this patient, for example, definitely took the drugs for four weeks.

We don't know between four and six weeks, but you see that, after six weeks, basically the drugs are not there, at least in an efficient way. So it's clear that the adherence is not there anymore, and it is confirmed. If you had a relapse due to a viral breakthrough to a resistance, you will see new mutations in the sequencing of the SVR12. Here, what you can see is that it's exactly the same virus. It's exactly the same virus. That mean that the patient was not adherent and relapse. But most importantly also is that the lack of emergence of resistance by our drug will allow actually physician to retreat the patients because you have exactly the same virus that you have at baseline.

Interestingly, so this is the next slide, on slide 14, it's exactly the same pattern, for the second patient. So, already probably, no adherence, even for the first, the first month or so. As you can see, very low plasma levels of both drugs and even lower, actually, after six weeks. And again, definitely, demonstrating that the observed relapse due to treatment, no adherence rather than viral resistance. This is another, actually, slide, slide 15, that continue to demonstrate the importance of, evaluating, having very potent drug combination, in these patients. Here, what you can see again is two patients that actually, despite the fact that mentioned that they were taking 100% of pill counts, they didn't take the drug for a months.

They only basically start in and the combination at day one, you see, take the drug, very nice drug levels for four weeks, and then absolutely undetectability of any drug. Despite this, this patient still achieved a cure. Still achieve an SVR12. That's really demonstrating the high potency of this combination that can also lead to positive outcome or still achieving SVR12. This is the type of drug combination that you want in the patient in 2024. High potency, that you know that you're not going to get a great adherence with these patients, and still you will have actually the possibility to get a high probability of a cure, SVR12.

As a summary of our safety, because obviously it's extremely important, we see that all patients completed the eight-week treatment. We have basically excellent tolerance, good safety, no SAE, and no other basically discontinuation. And basically, we have a pretty amazing drug combination here for hepatitis C. To summarize our HCV effort, we expect to enroll about 250-280 patients at 50 clinical sites around 15 countries, including the U.S. Now, we are enrolling patients in the U.S., and we expect the data in the second half of this year. We are also finalizing phase I, our fixed-dose combination, which will be selected for the phase III program and for the commercialization.

We anticipate, as I said before, that we will initiate, after end of phase II meeting with regulatory authorities, our phase III, in end of the year, early 2025. So let's just review quickly, our COVID-19 program with the, the phase III. You know that, COVID is here to stay, as we said, and it's clear that despite the fact that there is some vaccine and antiviral treatment options that have been approved, it's clear that especially for high-risk patients, we do not have yet today, a treatment that is safe, that is tolerable, and with lack of drug-drug interaction. We believe that our drug, Bemnifosbuvir, has a really robust target profile. We have shown the clinical efficacy, in a study called MORNING SKY.

We have a low risk of drug-drug interaction, a good safety and tolerability, and with a distinct MOI. And let's not forget that 90% of the market is in the United States. There is many reason why, obesity being one. We can see what Ozempic is doing today. We are talking about $4 billion-$5 billion, so not a negligible market than we'll see in the 2030s as well. This is basically confirmed by the script, which basically are really correlating with the infection rates, as you see in this slide, 2020 with a peak in December, January, and even February.

That's when we did enroll our SUNRISE 3 and continue to basically through IQVIA retail prescription data continue to indicate, as I said, that this will be a $4-$5 billion market for annual revenues with the two drugs right now, Paxlovid and Lagevrio, even with the issues that we all know today. So just to review our SUNRISE 3 global phase III trial, this is we have enrolled only high-risk patients. So if you see the Shionogi's release, the data recently was only 30% in the high-risk patient population trial. And this shows really our investigators can be really motivated with a drug like this.

This study was enrolling high-risk patients regardless of vaccination status, with symptom onset within five or less days. It's a randomized, double-blind, placebo-controlled with 550 milligram of Bemnifosbuvir twice a day. And this is, as I said before, an add-on to current standard of care. Primary endpoint is all cause of hospitalization or death through day 29 in monotherapy population. So we receive a fast track designation by the FDA, and we had several presentation at ESCMID Congress, with the strong, actually even more than what we expected, enrollment trends, with the monotherapy cohort.

We believe that actually, we hope to have some interesting data that we will discuss with the FDA in the second half of this year. As I said, we enroll about 2,300 patients within a short time period. And as I said, we believe that because we see as much as 77% of the patient enrolled in the United States, that this is clearly a full demonstration of the major unmet medical needs that we have also in this country. So in closing, we have made meaningful progress this year across both program, COVID-19 and HCV.

We have several key inflection points in the second half of this year for both program, which we believe have the potential to drive significant shareholder values. So, with that, I would like to thank you, and again-

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