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AGM 2018

May 16, 2018

Speaker 1

Good morning, and welcome, ladies and gentlemen, to the Cytokinetics 2018 Annual Stockholders Meeting. At this time, I would like to inform you that this meeting is being recorded and that all participants are in a listen only mode. I will now turn the meeting over to Pat Gage, the Chairman of Cytokinetics' Board of Directors. Please go ahead.

Speaker 2

Good morning, ladies and gentlemen. My name is Pat Gage. I'm Chairman of Cytokinetics' Board of Directors, and it is a pleasure to welcome you to our 2018 Annual Meeting of Stockholders. The meeting is now called to order. I've asked Pete Roddie, our SVP, Chief Accounting Officer and Assistant Corporate Secretary to record the minutes.

Before proceeding to the formal business, let me introduce members of the Cytokinetics Laboratory with us today as well as management. First of all, Robert Blum, of course, our CEO and President, and he will be making remarks later after the end of formal business. Our Independent Director is John Henderson, Sandy Costa, Wendell Ryanga, Ed Kaye, Lynn Parshall and Sandy Smith are also here. Joining from the company's management today are Qing Zhao, our Executive Vice President and Chief Financial Officer Pete Roddie, who I introduced earlier Diane Weiser, Vice President of Corporate Communications and Investor Relations Joanna Segal, Senior Corporate Communications and Investor Relations Specialist David Craig, Senior Vice President of Human Resources Doctor. Fady Malik, Executive Vice President of Research and Development and Dan Casper, Vice President of IT.

In addition, let me introduce Rich Ramko, partner from Ernst and Young and Mike Tenta, outside counsel for the company from Cooley LLP. Now I'd like to turn the meeting over to Pete Roddy to conduct the formal business of today's meeting and as set forth in our notice of annual meeting and proxy statement. After the formal part of this meeting, as I mentioned before, we will review the company's business activities and provide you with an opportunity to ask questions that you may have. Thank you.

Speaker 3

Thank you, Pat. Good morning. I have proof by affidavit that notice of this meeting has been duly given and that the notice of annual meeting of stockholders, proxy statement and proxy were mailed on April 6, 2018 to all stockholders of record at the close of business on April 3. This affidavit together with copies of the notice proxy statement and proxy will be filed with the minutes of the meeting. In addition, the Inspector of Election, James Kirkland of Computershare has signed his oath of office.

The Oath of Inspector of Election will be filed well with the minutes of this meeting. The Inspector of Election has advised me that we have present in person or by proxy a sufficient number of shares to constitute a quorum, so the meeting is duly constituted. We will vote by proxy and written ballot today. If you have turned in a proxy and do not intend to change your vote, then it is not necessary that you vote because we will count your proxy. Those of you who did not turn in a proxy or who wish to change your vote and have your proxy card with you, you should raise your hand.

Are there any additional proxies to be submitted at this time? Is there anyone present whether or not you had already submitted a proxy who wants to now vote in person? Then the polls are now open for voting this May 16, 2018, at approximately 10:35 a. M. The polls will be closed to voting after we go through the matters to be voted upon.

The first item of business is the nomination and election of directors. The following 3 directors are nominated by the Board of Directors as Class 2 Directors of the company to serve until our 2021 Annual Meeting: Robert I. Blum Robert M. Kalief, MD and Sanford D. Smith.

The second item of business is the ratification of our independent auditors. The Audit Committee of the Board of Directors has selected Ernst and Young LLP to serve as our independent registered accounting firm for the year ended December 31, 2018. The Board of Directors recommends that the stockholders ratify this appointment. The 3rd and final item of business is the approval on an advisory basis of the compensation of the named executive officers as disclosed in the company's proxy statement for the 2018 Annual Meeting of Stockholders. The Board of Directors recommends that the stockholders approve this proposal.

This concludes the formal business of the meeting. If you have voted today, there aren't any, would you please pass your proxy cards in front of the file, etcetera. It's now approximately 10:40 and the polls for each matter to be voted upon on this meeting are now closed. No additional ballots, proxies or votes and no changes or revocations will be accepted. At this time, I would like to report on the results of the voting as tabulated by the Inspector of Elections, James Kirkland.

Thank you, Mr. Kirkland. There were present and in person 45,336,697 shares of common stock voted, representing 84% of the total shares eligible to be cast, constituting a majority. Regarding Proposal 1, the election of directors, each of Robert Blum, Doctor. Robert Kalief and Sanford Smith have been elected as Class 2 Director.

Regarding Proposal 2, the ratification of Ernst and Young LLP as the company's independent registered accounting firm, Ernst and Young has been ratified as the company's independent registered accounting firm for the year ending December 31, 2018. Regarding Proposal 3, the company's stockholders have approved the compensation of the named executive officers as disclosed in the company's proxy statement for the 2018 annual meeting of stockholders. We expect to report our voting results on a current report on Form 8 ks to be filed with the Securities and Exchange Commission within 4 business days after the end of this meeting. This concludes the formal business of the meeting, and we would like to now begin our report to stockholders. Before we begin, the following discussion, including the Q and A, contains forward looking statements under the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995.

Our actual results might differ materially than those projected in these statements. Factors that could cause our actual results to differ materially are contained in our SEC filings, including our most recent Annual Report on Form 10 ks, quarterly report on Form 10 Q and our current reports on Form 8 ks. Copies of these documents may be obtained from the SEC or by visiting the Investor Relations section of our website. These forward looking statements speak only as of today. You should not rely upon them as representing our views in the future, and we undertake no obligation to update those statements.

I'll now turn the meeting over to Robert Blum, our President and CEO.

Speaker 4

Thank you, Pete. In my role as President and CEO, I'm pleased to be addressing you at Cytokinetics' 13th Annual Stockholder Meeting and as we mark the 20th anniversary of our company operations. I'm happy to see that we have several of our stockholders here in person with us today, and I'd also like to welcome those of you who are dialed into this meeting. 2017 was a year that tested our resolve. In light of negative results from our first Phase 3 clinical trial in people living with ALS, we rededicated ourselves to our fundamental mission and values and advanced and expanded our innovative pipeline of muscle biology directed drug candidates.

The power of our science and the benefits of a diversified pipeline strategy came into clear focus during the past year. We now press forward with 2 1st in class muscle activators in mid and late stage clinical trials, as well as next generation compounds proceeding in early development. Also, with productive collaborations with Astellas and Amgen and a reinforced balance sheet, all of which provides a solid foundation on which we are planning for a prosperous future for Cytokinetics. In 2017, we suspended development of Tirasemtiv, our 1st generation skeletal muscle activator, following review of results from VITALITY ALS, the Phase III clinical trial, which evaluated its effects in patients with ALS. To be clear, we were profoundly disappointed that VITALITY ALS did not deliver on either its primary or secondary endpoints.

However, we also believe that data from Vitality ALS lend validation to the mechanism of action of fast skeletal troponin activation and that our next generation skeletal muscle activator reldesemtiv, formerly known as CK-two twelve-seven thousand one hundred and seven may address certain limitations of curasemtiv. Reldesemtiv is the subject of a broad clinical trials program under our collaboration with Astellas. Cytokinetics is conducting neuromuscular trials and Astellas is conducting non neuromuscular trials. In 2017, we began FORTITUDE ALS, a Phase II clinical trial designed to assess effects on respiratory and other measures of muscle function after treatment with reldesemtiv in patients living with ALS. We also continued conduct of a Phase 2 clinical trial to assess effects of reldesemtiv on multiple measures of muscle function in ambulatory and non ambulatory patients with SMA.

In 2017, Astellas also conducted clinical trials of reldesemtiv in patients with COPD, as well as in elderly adults with limited mobility. In both cases, to assess measures of physical function and exercise stamina. We remain enthusiastic about the potential of reldesemtiv to increase muscle force, power and time to muscle fatigue in rare diseases and conditions associated with aging, and we look forward to seeing results from these trials later this year. We also continue to conduct joint research activities with Astellas and expect to advance yet another skeletal muscle activator into development in 2018. GALACTIC HF, the global Phase III outcomes clinical trial of omecamtiv mecarbil, our cardiac muscle activator, continued to enroll patients in 2017 and is proceeding on schedule.

This 8,000 patient clinical trial is designed to determine if omecamtiv mecarbil when added to standard of care can reduce the risk of cardiovascular death or heart failure events in patients with high risk heart failure. GALACTIC HF is being conducted by Amgen in collaboration with Cytokinetics. The first patient was dosed in Japan in 2017 that prompting a $10,000,000 milestone payment from Amgen to Cytokinetics. Additionally, in 2017, we sold to Royalty Pharma a 4.5 percentage royalty on potential worldwide sales of omecamtiv mecarbil in a $100,000,000 transaction. You may recall that we had previously exercised our option to co invest $40,000,000 in the Phase III development of omecamtiv mecarbil in exchange for an incremental royalty of up to 4% on increasing worldwide sales outside of Japan.

And as such, we gained the right to co promote omecamtiv mecarbil in institutional care settings in North America with reimbursement by Amgen for certain of our sales force activities. Our 2017 deal with Royalty Pharma provided important non dilutive capital to fund our continuing operations. With Amgen, we also continued joint research activities and recently advanced a next generation cardiac muscle activator in development. In the corporate presentation that will now follow, I plan to share highlights of the progress I just mentioned that we achieved in 2017, but more importantly, share some of our more recent activities related to these development programs and the outlook for 2018. Like the courageous people fighting devastated diseases of muscle dysfunction like ALS, like SMA and like heart failure, those who inspire us with their hope and optimism and who personify resilience every day, Cytokinetics demonstrated extraordinary resilience in 2017, and we look forward to continued perseverance as we execute against our vision 2020 this year and beyond.

For those of you joining us by webcast, you can find a PDF of the presentation slides under the Downloads tab in the webcast window. And with that review of 2017, I'll now begin my update on the company now for 2018. And afterwards, I'll open it up for questions. Again, I'll be making forward looking statements. I refer you to our SEC filings for caveats to those statements, and we do not undertake obligation to update those statements, but instead refer you to those filings.

This is a picture of patients we know, patients like Corey, patients like Ryan, patients like others who have come to our laboratories who have inspired us and who have met with our scientists and other members of the team at Cytokinetics and told their stories, including a woman named Sarah, who joined us last week. Every day, we're motivated by people like those depicted in this slide, their courage, their selflessness and their inspiration guide us in our fight against these diseases of muscle dysfunction. Here is a picture Slide 5 of our late stage pipeline of novel muscle biology directed compounds, all of which were discovered by Cytokinetic Sciences in our labs or those of our partners. We view that omecamtiv mecarbil is our most valuable program now in Phase 3. Omecamtiv mecarbil is the subject of a collaboration, as you know, with Amgen that dates back to 2,006.

As you'll hear in a minute, we are not only approaching the halfway mark in the 8,000 patient Phase III trial, the first GALACTIC conducted and funded by Amgen, the second study that will be underway we expect hopefully later this year to be conducted by Cytokinetics, but also is funded by Amgen. But this represents the leading edge of a vertical in cardiac muscle for which 2 other compounds have advanced recently from our research into IND enabling studies and in early development we expect could move to Phase 1 later this year. 1 is a next generation cardiac sarcomere activator, also partnered with Amgen, jointly discovered under our research collaboration. This is a compound with a different mechanism of action than omecamtiv mecarbil. We have not yet communicated what is its mechanism of action.

We expect we may be able to do that later this year at an R and D day we expect to be holding in New York potentially in Q4. More to say about that later in the year. We're very excited about that compound as it represents a potential another vector for value creation under our leadership in cardiac muscle and the research and development that's ensued. We also have another compound you see here depicted as cardiac sarcomere directed compound. That compound also originated in our research.

It is not partnered with Amgen, entirely separate and not subject to rights, responsibilities and shared economics with Amgen. This is a compound that we expect could also be entering Phase 1 later this year and represents for us not only an inflection point and value for increasing our investment in cardiac muscle, but also represents for us an opportunity for a further monetization like we've done historically so well at the company to potentially attract non dilutive capital to advance another program forward, representing other upside in shareholder value. That's the left side of the company, the cardiac muscle vertical. On the right side of the company, another vertical in skeletal muscle. Here, in light of the fact that we've suspended development of Tirasemtiv, we think that Reldesemtiv represents the next major value inflection point for shareholders.

We're developing Reldesemtiv as I'll detail in a moment in 4 indications, as you heard, 2 neuromuscular and 2 non neuromuscular. The first of those studies is expected to read out in just a few weeks that in patients with spinal muscular atrophy, the others later this year. And under our joint research with Astellas, we've identified yet another next generation fast skeletal troponin activator and that's also moving from research to early development and represents another potential bifurcation in value. You can imagine we might eventually develop one of these compounds for rare neuromuscular diseases, another for other indications that are more primary care in their nature. And all this is happening at Cytokinetics.

At the same time, our research engine continues to be very productive and high yield. And you'll be hearing about other activities in our research, both with regard to Astellas, but also in unpartnered areas over time. Cytokinetics fundamentally believes in investing in the promise of our leadership position in research. And that's inherently important to our Vision 2020 5 year strategic roadmap, which we've discussed at these shareholder meetings in the past. We're getting closer to 2020 and we're also getting closer to realizing potential commercial value from 1st in class novel mechanism muscle biology directed drug candidates, all the while we continue to maintain quality and integrity in our R and D activities and as we continue to advance these drug candidates together in line with what matters most to patients and regulatory authorities.

Over the long term, as we've discussed our longer term strategy at shareholder meetings, our focus is on capitalizing on these two verticals such that we're developing 1st in class small molecule compounds initially in severe diseases associated with muscle dysfunction and over time also extending that leadership position to syndromes associated with muscle weakness and aging identifiable to what we hope to be our leadership position as a biopharmaceutical company bringing novel products to an aging demographic focus to increasing health span. To do this and to do it well speaks to how we have and should continue to develop the corporation not relying on dilutive financings, but rather a mix of financings, but also leveraging partnerships, partnerships for access to capital, access to technologies, infrastructure and geographic and other reach that goes beyond our current capabilities. We think we've done an unusually good job relative to peer group companies, over half of the capital invested in our programs to date have come from non dilutive sources of strategic partners' capital and we think that's important on a go forward basis as well. Even as we've already earned over 600,000,000 dollars in paid in capital from strategic partners, we're still eligible for over $1,000,000,000 in milestone payments, half of which are pre commercial as well as royalties on sales and other expense reimbursement.

So we believe our highly productive R and D engine coupled with our sophisticated approach to corporate development has enabled us to establish this broad pipeline and also progress that in a prudently responsible way. With respect to Omecamtiv mecarbil, here at this meeting in the past, we've underscored how this disease of heart failure with reduced ejection fraction is an epidemic and it's getting worse. It's getting worse because the cost of treating these patients are going up, the number of these patients is rising, the morbidity and mortality associated with heart failure with systolic dysfunction continues to climb and the mortality risk here is higher than that of many cancers. As such, we need to do a better job with new medicines that can address impaired cardiac performance, but do it safely. And that's where I would argue we and Amgen are very well positioned with omecamtiv mecarbil and the ongoing Phase 3 program.

Omecamtiv mecarbil to remind you was designed specifically to address liabilities of existing drugs used in the treatment of heart failure, many of which have been around for decades. And with omecamtiv mecarbil, we believe it has the potential to increase cardiac function and performance, reduce cardiac dimensions and volumes, do so in an oxygen and energy sparing way without adversely affecting blood pressure and addressing the side of the equation, which right now is in urgent need of new medicines despite introduction of medicines that address afterload in heart failure patients. You can see that our scientists over 15 years ago had a very thoughtful comprehensive way of thinking about what might be the commercial need in heart failure down the road. And so far omecamtiv mecarbil we believe has delivered on all of these properties, we believe has delivered on all of these properties, which render it unlike any other drug in development for the treatment of this disease. As I mentioned, GALACTIC is approaching the 50% enrollment mark in the trial that is due to enroll a total of 8,000 patients.

Think about that for a minute. That means that over 4,000 patients have now received omecamtiv mecarbil between Phase 2 and Phase 3 studies. And in Phase 3 we would expect about 2,000 patients have already received omecamtiv mecarbil in 35 countries and in approximately 900 centers around the world. Recently, the data monitoring committee of this study met and recommended to the sponsor that the trial continue and we believe that that underscores the promise and the potential safety for this mechanism as we now proceed towards completing of enrollment we expect in approximately 1 year. I'll remind you that that's a study that is driven by the accrual of events and as such we expect we may approach the 1st interim analysis for what could be the potential of futility in 2019.

We don't hope that we stop the study then, but rather the and which could enable the study to stop early for overwhelming efficacy. If it goes to its full term, we'd expect that might be in 2021 that sufficient number of events are accrued to enable the breaking of the blind and the analysis of results. Along the way, we will be conducting a second Phase 3 study, again this one to be conducted by Cytokinetics as reimbursed by Amgen. This is a study designed to assess whether use of omecamtiv mecarbil in patients with heart failure may translate into extended time to exercise fatigue or increased exercise endurance or stamina. We believe that if this study is successful alongside of GALACTIC and this drug is ultimately registered for marketing that this trial could contribute to a differentiated positioning and a labeled statement for indication that we believe could confer significant advantage to omecamtiv relative to other drugs in the treatment of that disease and especially as would be deemed meaningful by payers.

You know about our collaboration with Amgen, it continues now 11 years later and we expect that this will continue to be fruitful as we not only will be progressing omecamtiv through to the conclusion of Phase 3, but also as we are moving a next generation cardiac muscle activator into development as could extend the franchise and offer both lifecycle management as well as other potential indications for this mechanism over time. I already mentioned how in last year, we sold a piece of our royalty to Royalty Pharma in a relatively uncommon transaction, certainly for the fact that Omecamtiv is still several years away from potential commercialization, it's unusual that a royalty fund would purchase a royalty. I think that underscores their enthusiasm for the mechanism and the potential commercial upside. They're having paid $100,000,000 for 4.5 percent royalty plus a small equity stake, we believe sets for Cytokinetics as pertains to shareholder value a new reference standard or benchmark and by itself that suggests that the company's current market cap undervalues our retained economics in Omecamtiv alone, much less other programs advancing under our supervision. So important milestones for 2018.

We expect conclusion of enrollment in GALACTIC in approximately 1 year, we expect to finalize preparations for a second Phase III trial of omecamtiv mecarbil that could be underway by the end of the year or early in the next year. Now turning to Tirasemtiv. I'm not going to dwell on Tirasemtiv because, as you know, we've suspended development, but I do believe there are certain lessons from the Phase 3 trial that inform strategy with reldesemtiv. As you know, vitality ALS was a 2nd large international study we did with Tirasemtiv, in each case over 700 patients enrolled and Vitality was assessing the potential for Tirasemtiv to alter the decline of slow vital capacity as measured at 24 weeks. We are looking at change from baseline at 24 weeks.

Patients were randomized either to standard of care or 1 of 3 dose strategies for tirasemtiv. And unfortunately in this study, despite measures we took to try to address this potential risk, we saw that patients did not tolerate tirasemtiv as well as we would have wanted to see. About a third of the patients down titrated and early terminated during the period in which we were evaluating the primary efficacy endpoint, such that that 1 third of patients contributed in an intent to treat analysis to the final data and for the most part they were not on study drug. And you can see on the left hand panel that there was a modest but durable observable effect, not sufficient we would argue to warrant submitting at that time for registration, but enough to suggest there is a biologic activity for those patients who were randomized into the study. That includes all patients, including those who dropped out of the study early.

However, if you focus to those patients who remained in the study and who tolerated the drug, roughly 2 thirds of the patients, their data on the right side suggests that there is a dose dependent effect biologically consistent with the mechanistic hypothesis and sufficiently robust that we would say borderline statistically significant, at least validating the mechanism of action, if not the molecule. And we believe this is telling and in particular for the fact that still approximately 100 patients who can continue their treatment completed the study and insist on staying on this study drug in the open label extension suggests to us that for those patients who can tolerate the off target light headedness, this is a drug that seems to be at least as they would assess conferring treatment benefit. And if you look at the AEs across the 48 weeks of double blind treatment, you see that dizziness or light headedness accounted for the majority of the AEs and we know that to be an off target effect, a derivative of the fact that that compound crosses the blood brain barrier and tickles a GABA receptor that mediates this light headedness. So VITALITY did not meet its endpoints, but we do believe there is an evidence of effect that warrants further investigation of the mechanism of action as a viable therapeutic strategy in patients with ALS.

And hence to the credit of our scientists years ago, knowing that tirasemtiv had this liability with respect to Blood Brain Barrier, they designed and optimized reldesemtiv from entirely different chemical scaffold, a different chemical class, different intellectual property. This compound formerly known as CK-one hundred and seven has been advancing as a backup now in lead position relative to Tirasemtiv and it's the subject of our collaboration with Astellas. We studied it in 5 Phase 1 studies. We know it to be more potent, have a higher free fraction plasma, therefore, more is expected to penetrate muscle. We also believe it to be substantially more well tolerated in Phase 1 despite administering gram quantities of reldesemtiv, we did not identify a dose limiting effect and we know that it's been specifically designed so as to not cross the blood brain barrier to the same extent.

So we and Acelis made a major commitment to the study of reldesemtiv and in 2016 2017 we got underway studies that are described in these next slides. 2 that we're doing at their expense and 2 that they're doing at their expense. The SMA study we're doing and should read out very soon. In fact, we expect it to be data presented publicly on June 16 in Dallas at the Cure SMA Conference. This is a study of a muscle directed therapy in a disease where gene directed therapies have made monumental advances for patients suffering from primarily type 1 disease, but increasingly also other types and older patients.

But we believe this approach could be quite complementary, mechanistically supplemental, and we think that this is a good study to test the hypothesis of fast skeletal troponin activation in adolescents and adults with Type 2 and Type 3 disease. This study is divided approximately 72 patients into 2 cohorts, a lower dose and a higher dose, half ambulatory, half non ambulatory, and it is a hypothesis generating study, no single primary efficacy endpoint. And in fact, as you can see on this slide, number 27, we're looking at assessments across different measures of ambulatory, respiratory and other functions in order to be able to understand how best potentially to design a Phase 3 program. So we're very interested to see these data very soon and we'll make certain that they're communicated publicly promptly. However, this is one of 4 studies we're conducting with reldesemtiv and the others I'll mention briefly.

The ALS study is the one we might expect should have the highest probability of potential positive data in large part because of the work we've already done with this mechanism in these types of patients. This is a large study, 445 patients enrolling now to either receive placebo or 1 of 3 doses of reldesemtiv and we're measuring change from baseline and slow vital capacity at 12 weeks following randomization. This is a study that's now enrolling in the U. S. And Canada and soon will be enrolling patients in other countries and we hope to see data from this study later this year.

As I mentioned Astellas is doing 2 studies on its own, 1 in patients with COPD, 1 in patients with frailty. We expect to see data from these two studies also later this year. In each case, we're assessing with reldesemtiv a different population, but in both cases looking at measures of exercise performance, stamina and endurance. So this could potentially open up a window on the use of this type of mechanism in patients who are seeking increased health span as they age. I won't go into this slide in any more detail.

You've seen it in the past. Our relationship with Astellas initially entered into in 2013, expanded in 2014, expanded again in 2016. The research collaboration expanded or extended again through 2019. This continues to be a very fruitful relationship between our companies as evidenced by the breadth of activities in research and development. So key milestones, Phase 2 data from patients with SMA in this quarter Q2 and other data from these mid stage studies in the second half of the year.

So now I'll wrap up with a brief overview of our corporate financials and outlook. As we recently reported our Q1 financials, you can see we have over $250,000,000 on the balance sheet, representing between 2 3 years of cash, even as our net burn this year is expected around $100,000,000 That's a little bit misleading in as much as there are some non recurring items in that burn, including about $18,000,000 that we are paying to Amgen as a co funding commitment towards our goal of $40,000,000 that will conclude this year, as well as there are some significant 7 figure wind down costs associated with the closure of the VITALITY study. So net $100,000,000 guidance, we're within that guidance and we're consistent with that as we peer out even with that representing still over 24 months of cash based on that guidance. You can see about 54,000,000 shares outstanding, 65,000,000 on a fully diluted basis and currently with the stock trading around $9 the company's market cap is about 2x cash, about $500,000,000 in market cap. Key milestones this year, as I mentioned, both for omecamtiv and reldesemtiv, but also with the advancement we expect of at least 2 compounds moving to Phase 1 later this year, and we're looking forward to lifting the veil on those programs at an R and D day, we expect in the second half of this year.

We're proud of our pipeline. It's a pipeline that represents, we would argue, the very best in muscle biology research and development, and that continues at the company and we appreciate very much the persistent support of our shareholders as we continue to advance these compounds and others towards our goal of bringing them forward for patients suffering diseases of severe muscle dysfunction and weakness. And with that, I'll close. Thank you for your interest in this presentation and open up the floor for any questions. Good morning.

Is this good? They're a little scattered, partially based on things I wrote down during the presentation. I'm a little unclear on the data monitoring committee for omecamtiv mecarbil that recently met is how does that relate to the interim analysis? Are those the same people? Or do you do the analysis after you get information from the data monitoring committee?

Study. The development program has an executive committee and a steering committee that lends oversight to all of the studies and activities. And each study has a data monitoring committee that is charged with reviewing unblinded data and with in particular focus to safety. The data monitoring committee meets with a regular cadence and there this was not their first meeting. They've met with some regularity to review the safety as well as other data to ensure that the study should be conducted and in other instances with other companies and other studies and as could be the case here but was not, the data monitoring committee could recommend, for instance, changing the dose or altering the way in which we titrate dose, etcetera.

And in this case, they did not rather than said continue the study as intended. The interim analyses are driven by the accrual of events. Once a sufficient number of events that represent an adequate sampling of the data have occurred. And you remember this study is event driven. We're looking at mortality and heart failure related events like rehospitalizations.

Once there is a critical mass of those, a certain minimum number, then a formal statistical analyses are performed as well as a review of safety to see whether or not the study should continue. That's something that's highly ordered with regard to a statistical plan. That's, as I mentioned, baked into the protocol and the plan. The 1st interim 2019 would be predicated around the potential early stopping were there to be no potential way the study could achieve its objectives and therefore would be stopped potentially for futility. We don't expect that should occur.

And then the next one would be based on the potential for such an overwhelming effect of efficacy that the committee may deem it unethical to continue the conduct of the study and therefore could conceivably recommend early stopping of the study. And that second one is in 2020. Again, it's event driven, but based on our projections of the accrual of events, we expect it could occur in 2020. Okay. With your co promotion rights with Amgen, with those potentially in your agreement with them, go with go to a company if they acquired Cytokinetics?

Very good question. Very sophisticated question. So the economics of our deal travel with a potential acquiring party, and the co promotion rights would not. Okay. On to reldesemtiv, I think today was the first time I heard you say that without any hedging whatsoever that it is more potent, which I'm assuming means milligram for milligram than tirasemtiv.

So there's different ways of assessing potency and I'm probably the last person who should be addressing that specific question. But what I'll say is that there's the biochemical potency where you're looking at it in artificial systems, there's also the in vivo potency and there's the potency with respect to in humans when you're also dealing with protein interactions and absorption. All of those things to us suggest that reldesemtiv is at least as potent as tirasemtiv as would be the case in humans in a study like we're doing now. And potentially more potent based on the fact that we respect more could be getting into muscle. Well, I'm probably the last person who should be asking scientific questions.

So we're in good shape. The question I then have is the FORTITUDE trial has significantly higher dosages than the tirasemtiv trials. So potentially, these patients could be getting much larger dosages, assuming they tolerate it, maximum of 900, I believe, and FORTITUDE for the highest titration group. So I wouldn't compare dose to dose between those. But what I would say is based on and I'll show you, come back to a slide in Phase 1, based on exposures between and this is not in the same study, it's the same protocol, but in different patients undergoing same protocol, we were getting more force frequency response with reldesemtiv relative to tirasemtiv at exposures that were comparable, suggesting to us that it could be more pronounced effect at similar exposures in humans.

Okay. I guess what I'm not understanding is the highest titration group with tirasemtiv was 500 milligrams in vitality, and we have 900 milligrams in FORTITUDE. So those two numbers can't be compared in some sort of linear way. I would not compare them in a linear way. What I would say is that the exposures that we were evaluating with tirasemtiv in clinical trials, we believe are nested within the exposures that reldesemtiv.

We may be able to get to more pronounced force frequency response with exposures we're assessing with reldesemtiv. Meaning, if it continues to demonstrate favorable tolerability, we may be able to up titrate reldesemtiv to levels that would achieve higher force frequency response than were achievable with tirasemtiv. Okay, that's very helpful. With the next generation drug that you're developing with Astellas, can you say whether it has the same mechanism of action as the prior drugs? It does.

Okay. And then so what benefits might you be looking for? So benefits could include ways in which it might ultimately be studied, including indications that might enable us to build 2 separate business units, 1 directed to rare diseases, 1 directed to more primary care indications, there could be similar benefits in terms of cost of goods, ease of synthesis and other things that might confer advantages down the road. It's our belief that it's always good housekeeping to develop a portfolio of these compounds recognizing the breadth of potential indications. Okay, great.

So you believe the SMA data or headline, I mean, not all of it, but some of it will be announced prior to the June 16 meeting? Either before or at, absent having the data in our hands, it's difficult to know whether it would be prompting us to make a disclosure before the meeting or rather concurrent with the meeting. Okay. I think that's all I've got. Thank you.

Excellent. More than last year. Appreciate it very much. Always very good questions and appreciate your continuing interest and support. Do we have any other questions?

There being no other questions, I'd like to thank investors here in attendance as well as those listening in on our conference call for your continued support of our company. In 2018, we believe we're well positioned to execute on our business objectives and to deliver on the trust of our stockholders and other stakeholders. We very much appreciate your continued support and interest. We look forward to keeping you updated on our progress and prospects throughout the year. Lastly, we're extremely grateful for the privilege to serve patients and caregivers who so importantly depend on our ultimate success.

And with that, I'll turn it back over to Pat Gage, and thank you very much.

Speaker 2

Thanks, Robert, and thank you for providing an update on the important progress Cytokinetics making on the development of our innovative portfolio of 1st in class muscle biology directed drug candidates. 2018 is an important year for us to advance new compounds in the development, expand the Phase 3 clinical trials program for omecamtiv mecarbil and begin to potentially chart a Phase III development path for reldesemtiv, depending on results that emerge from our broad clinical trials program. We remain committed to the patients, caregivers and shareholders who count on us to deliver continued progress against our goal of improving the lives and functionality of people living with diseases of impaired muscle function. I want to thank all of you who participated today in this stockholder meeting. There being no further business, the meeting is now adjourned at 11:20 am.

Thank you.

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