Structure Therapeutics Inc. (GPCR)
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Morgan Stanley 22nd Annual Global Healthcare Conference

Sep 5, 2024

Terence Flynn
US Biopharma analyst, Morgan Stanley

Great. Thanks for joining us, everybody. I'm Terence Flynn, the U.S. Biopharma analyst at Morgan Stanley, and very pleased to be hosting Structure today. Just for important disclosures, please see the Morgan Stanley Research Disclosure website at www.morganstanley.com/researchdisclosures. Very pleased to have Ray Stevens, the company's CEO, and Jun Yoon, who's the company's CFO, both are co-founders of the company. So really appreciate you both taking time today to join us. Again, I think, you know, maybe just the best place to start out would be if you could just give a high-level overview of the company, as well as the strategy and pipeline, and then I've got a number of questions that we can drill into. But again, thank you both for joining us today.

Ray Stevens
CEO, Structure Therapeutics

Absolutely, Terence. Thank you for, for having us. Really appreciate it. So Structure Therapeutics, many of you in the room know, we started this company with a passion around accessibility, healthcare inequality. We- what we love to do, my background, structure-based drug discovery, is we love to go after validated targets that have biologics. I'm gonna use peptides as part of that, and we love to use structure-based drug discovery to convert them into oral small molecules. We started working on GLP-1, it was a good, good place to sort of start working on, about fifteen years ago. We had a breakthrough, particularly in the incretins, including GLP-1, back around 2015, and, and that led to one of our lead assets, GSBR-1290, which is an oral small molecule, GLP-1 receptor agonist, for diabetes and, and metabolism.

So, you know, with that passion of accessibility, we think this has been a great place to sort of anchor down. We think we have probably one of the strongest and broadest portfolios in the incretins for oral small molecules. So we have an oral small molecule, multiple scaffolds for GLP-1, GSBR-1290 being one of those. We have an oral small molecule for amylin. We'll be announcing a DC by the end of this year. We have an oral small molecule for GIP, and an oral small molecule for GCG, glucagon receptor, as well as our apelin small molecule, which is more for selective weight loss, that's finished phase one already, phase two ready. GSBR-1290, lead asset, we had a data release back in June. Very positive data release.

We showed strong efficacy, no safety issues, at all, so we think we have the safest oral GLP-1 out there. Very proud of our rat NOEL of a thousand mgs per kg. We'll be going into a phase IIb in Q4, so right around the corner, and excited about that phase IIb study to get started. We do have both what we consider to be second and third generation molecules in this space. We think this is sort of important. This is a very competitive space. It's becoming more and more competitive, it feels like almost every week. And so having those, taking that multi-generational approach and already being, having, second and third generation molecules, puts us in a really good position.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. Okay, great. Well, we'll drill into a number of these points, but appreciate the backdrop. I guess, you know, on 1290, obviously, as you mentioned, an oral GLP-1 receptor agonist. You know, one of the questions we get frequently from investors related to all the orals is just, you know, manufacturing ease and scalability, given obviously, some of the ongoing supply challenges.

Ray Stevens
CEO, Structure Therapeutics

Yeah

Terence Flynn
US Biopharma analyst, Morgan Stanley

injectable peptides. And so, as you think about the profile of 1290 from the, you know, manufacturing scalability standpoint, just maybe high level, how should we think about this? And again, where are you in kind of, you know, building that process out as you get ready for the phase IIb?

Ray Stevens
CEO, Structure Therapeutics

Yeah.

Jun Yoon
CFO, Structure Therapeutics

So I'm gonna interject here. This is a question that is-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Jun Yoon
CFO, Structure Therapeutics

-Ray's favorite, but, I'll go ahead and take this.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. No problem.

Jun Yoon
CFO, Structure Therapeutics

But yeah, so, you know, from our perspective, you know, we think oral small molecules is gonna be the ultimate winners for obesity and metabolism. This is a small molecule game. The peptides have, you know, taken a small market share, but you're already seeing the challenges there in scalability and manufacturability with peptides in this space. There's more than 800 million patients worldwide, you know, close to a billion, more than 100 million in the U.S. And we've been able to demonstrate in our scalability, the ability to manufacture or have the capacity to manufacture greater than 6,000 metric tons, and that'll translate to more than 120 million patient supply.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Jun Yoon
CFO, Structure Therapeutics

So-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay

Jun Yoon
CFO, Structure Therapeutics

... from our perspective, this is a normal small molecule game.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Jun Yoon
CFO, Structure Therapeutics

... and being able to manufacture-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay

Jun Yoon
CFO, Structure Therapeutics

the deal there.

Terence Flynn
US Biopharma analyst, Morgan Stanley

One-

Ray Stevens
CEO, Structure Therapeutics

By the way, Jun and I have been working together for only about 25 years.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah, right.

Ray Stevens
CEO, Structure Therapeutics

He did take my favorite question.

Terence Flynn
US Biopharma analyst, Morgan Stanley

It's like any good relationship. There's puts and takes, right?

Ray Stevens
CEO, Structure Therapeutics

Yep.

Terence Flynn
US Biopharma analyst, Morgan Stanley

On both sides.

Ray Stevens
CEO, Structure Therapeutics

Absolutely.

Terence Flynn
US Biopharma analyst, Morgan Stanley

I guess the, you know, to drill a little deeper into that, maybe because, again, there's been some questions, like Lilly gets this question all the time, and Orforglipron is just like it's a more complicated small molecule. And again, I think there's competitor companies that talk about, "Oh, it's gonna result in lower yields," and these kind of things. So when you look at your structure, you know, again, is it fairly straightforward chemistry, or are there any nuances that make it a little bit more challenging than a traditional small molecule?

Ray Stevens
CEO, Structure Therapeutics

Yeah, so the, you know, I think part of the root of the question is, people keep talking about number of chiral centers.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. Right.

Ray Stevens
CEO, Structure Therapeutics

First, Lilly is a great company. I do not have any doubt whatsoever that they will be able to manufacture the oral small molecule. They've already committed to building manufacturing plants at risk, already to the state. It was part of our design principle. So our design principles were, you know, efficacy, safety, but we also thought at the very beginning, about manufacturing, and one of the elements that we did not wanna have to deal with was chiral separation.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

So when we designed the molecule, we made sure that we would not have that. So that gives us, you know, that alone is a 50% sort of loss in step. So those are the elements that we thought about, was to make sure that we could, you know, we could manufacture this at the scale needed today. And as Jun said, 6,000 metric tons today, 120 million patients.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

That's, you know, that's a big part of the U.S. market-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

that we can provide to today.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay, great. And again, you talked about the, you know, phase 2 data that you reported in June. Maybe just walk us through that data and kind of the key takeaways. I mean, obviously, everyone's focused on weight loss, you know, Hemoglobin A1c, safety, tolerability, discontinuation rate, so all those key metrics, maybe just.

Ray Stevens
CEO, Structure Therapeutics

Yeah

Terence Flynn
US Biopharma analyst, Morgan Stanley

-take us through those and how you think about, you know, the ultimate profile here.

Ray Stevens
CEO, Structure Therapeutics

Yeah.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Obviously, you know, replicating that in the phase IIb.

Ray Stevens
CEO, Structure Therapeutics

Yeah. So in terms of efficacy, the number that everybody keeps watching, what we reported out was between 6.2% and 6.9% at 12 weeks. That makes us very competitive. The closest comparator that we make is to Orforglipron. Again, a lot of respect for that molecule. One of the things that we were very pleased to see is that we have the ability to go up in dose, and so we saw that dose proportionality sort of continue. So, what we'll be looking for in our phase IIb, we have what we consider to be our first product being regular strength, GSBR-1290, that's a 120 milligram dose. We're excited to go up in dose.

The other piece that came from the data that we released, back in June 3rd, was. And again, I know this is small n, but we saw 10% weight loss in 34% of the participants. That was significant. You know, that tells us we're already getting into, you know, that upper range. And then in our second subset of participants, we saw 9% weight loss. So I think very competitive weight loss efficacy. In terms of tolerability, this is a question that we get a lot of times. Our tolerability numbers at twelve weeks is comparable to Orforglipron. Everybody knows in this field, when you go from, you know, a twelve-week study to a twenty-six or thirty-six-week study, you can spread out the titration. And as you spread out the titration, the tolerability improves, goes down.

So we saw that with Orforglipron. We're gonna- you know, we, we fully expect there's no reason not to think that's what's gonna happen with us. We, we have made the decision that we're gonna go in our phase IIb to once every four-week titration. That's where everybody ends up anyway, is four weeks. When they get to the phase III, Lilly, in their phase III, they're doing four-week. We decided just to jump to, "Let's start titrating every four weeks.

Terence Flynn
US Biopharma analyst, Morgan Stanley

And you did, just remind us, you did weekly in the-

Ray Stevens
CEO, Structure Therapeutics

Yeah, in-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Twelve-week study.

Ray Stevens
CEO, Structure Therapeutics

Yeah, in the twelve-week study, and everybody looks at these four-week study, twelve-week study.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... and then you get to 26, 36. Twelve weeks, you have to do weekly titration. You don't have a choice. And why do we do 12-week titration? We have three months of tox data first, so that's our window. That's why everybody does it. But it's rushed, there's no question, and we're really looking forward to doing the once every four-week titration and starting out lower as well.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. Okay, great. What about, you know, liver tox is obviously another focus, just given the Orforglipron and some of the, you know, questions there. And so, as you guys look at your liver safety profile, just remind us kind of what you saw and how you think about that-

Ray Stevens
CEO, Structure Therapeutics

Yeah

Terence Flynn
US Biopharma analyst, Morgan Stanley

Relative to some of the other drugs.

Ray Stevens
CEO, Structure Therapeutics

Yeah, Terence, and this is a great question. What you always, as a chemist, worry about with small molecules is tox.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

Particularly when I mention tox, I'm talking about off-target tox, not the GI side effects that we consider.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

to be on target.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

So what we saw was, we actually had three cases of very low elevated signals. One was in placebo, so we can easily sort of dismiss that, that was in the placebo group. The second individual had an elevated AST, no elevation in ALT, and then the other real clincher for us was they had a highly elevated creatine kinase, all telltale signs that it's coming from muscle. When we followed up, the individual had a very aggressive workout schedule, so we do not believe there was... And again, with the no elevation in the ALT, there was nothing coming from liver. And then, the third participant, there was a mild elevation. We tested them four days later, it came straight back down, so we think it was just sort of a sporadic event, not dose related.

Because we looked at, very carefully, the full twelve weeks, and there was that small spike, but came right back down. So no-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay

Ray Stevens
CEO, Structure Therapeutics

... no liver tox issues at all.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay, got it. You know, I think you're gonna present some additional data here at Obesity Week, which is coming in November. Just high level, you know, what else can we expect to learn beyond what you provided back at ADA?

Ray Stevens
CEO, Structure Therapeutics

Yeah, so we haven't disclosed yet. Obesity Week, I think this year is gonna be exciting. You know, it's a meeting that is growing, and so we will have some presentations there. More to come on that.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Okay, fair enough. The, you know, next step, as you-

Ray Stevens
CEO, Structure Therapeutics

Mm-hmm

Terence Flynn
US Biopharma analyst, Morgan Stanley

... talked about is the phase IIb obesity trial. You're gonna be kicking off here in the, in the fourth quarter. Maybe just, again, you talked about the titration schedule difference. Anything else that we should think about as we think about translatability from that phase IIa to the phase IIb study? Obviously, the duration is the, the other difference, but anything- any other big features that we should be aware of?

Ray Stevens
CEO, Structure Therapeutics

Yeah, I think probably the biggest is, you know. And again, I remember we love our SAB. You know, these are all thought leaders in the field of GLP-1s and metabolism. They were always repeating this mantra of start low and go slow, and so that's the philosophy of what we're doing. So we'll be starting out at 5 mg dose. We will be in our standard dose study. We'll be going up to 120 mg-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Mm-hmm

Ray Stevens
CEO, Structure Therapeutics

... in steps of four weeks per titration step. So that's another sort of element. And then what we're excited about is then doing additional study on going up in dose as well, because we have that room, both we have the safety window to go up, and we also want to explore, you know, how the goal of a phase IIb is dose range finding. You know, how high can we go to really sort of see the maximum efficacy?

Terence Flynn
US Biopharma analyst, Morgan Stanley

And so that would be a separate trial going above one hundred and twenty mgs right now?

Ray Stevens
CEO, Structure Therapeutics

Right now, the sort of strategy is we have our standard dose-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... and then we have our extra strength dose.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. And what would be the scope or timing around that extra-strength trial?

Ray Stevens
CEO, Structure Therapeutics

To be determined.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay, got it. So would you wait to see... Is it fair to assume you'd wait to see some data from the phase, the-

Ray Stevens
CEO, Structure Therapeutics

There's no reason. You know, the way that we look at this, we are trying... Our goal is to get to market as fast as possible.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

And so we view speed as the essence, and so we're trying to figure out any way that we can accelerate things, and this includes parallel processing studies.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. And again, you mentioned your animal tox, 1000 mg per kg. What does that imply for, like, an upper-- like, how high above 120 mg could you go if you wanted to?

Ray Stevens
CEO, Structure Therapeutics

Yeah, we are. There's no way we're gonna-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... sort of even come close. We're already 150x over-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... our safety margin, so we are-- we would never go up to the-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay

Ray Stevens
CEO, Structure Therapeutics

... the maximum level.

Terence Flynn
US Biopharma analyst, Morgan Stanley

So how do you pick that level to go up? Do you just kind of do, like, push it as far as you can and see what tolerability is? Is that how you choose the upper dose, or how do you, how do you-

Ray Stevens
CEO, Structure Therapeutics

Yeah

Terence Flynn
US Biopharma analyst, Morgan Stanley

... figure that out?

Ray Stevens
CEO, Structure Therapeutics

Yeah. Again, the goal of Phase IIb, dose range finding.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

We've done a lot of modeling.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

Already, the 120 mg dose, 12-week, we're already seeing between 7, you know, 6.2%-10% weight loss. And so we're still working on the exact sort of upper dose that we sort of want to go to. That's also a discussion with the agency.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

More to come on that.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay, and then I think you're also doing the tablet versus capsule. Is that right?

Ray Stevens
CEO, Structure Therapeutics

We've already finished that.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

So one of-

Terence Flynn
US Biopharma analyst, Morgan Stanley

But for the phase IIb, that's-

Ray Stevens
CEO, Structure Therapeutics

Okay

Terence Flynn
US Biopharma analyst, Morgan Stanley

... gonna be the other.

Ray Stevens
CEO, Structure Therapeutics

We will do-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

So we're. Again, one of the big pieces we're really happy about this summer was we're really happy with our tablet formulation.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

There's always this sort of risk. Our goal in that study was really just: Do we have similar PK?

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

We saw exactly the PK, the QD dosing once a day.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

The effects that we wanted, so we will all of our future work in obesity will be with the tablets.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. Okay, understood. And then maybe just remind us of, like, kind of the diabetes portion, like, where that stands, and then how to think about the next steps on that part.

Ray Stevens
CEO, Structure Therapeutics

Yeah. And so I've mentioned sort of regular strength. I've mentioned the-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... sort of extra strength. The third is formulation that we're working on, and the way that we sort of look at this, there are some individuals that are more sensitive to GLP-1s than others, and individuals living with Type 2 diabetes is one subset of that. Now, why are they more sensitive? Many are on metformin. You know, many are on a thousand milligrams, a gram of metformin per day. They're on other medications like statins. So those are all things that can aggravate the GI system. And so we've been developing an alternative formulation for the more sensitive population, and so that includes individuals living with Type 2 diabetes. And so we'll also. That's another parallel study that we'll be kicking off as well, particularly for that population.

Terence Flynn
US Biopharma analyst, Morgan Stanley

That would be a phase IIb as well?

Ray Stevens
CEO, Structure Therapeutics

That's still work in progress.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Okay, got it, and what would be the kinda timelines around that, approximately?

Ray Stevens
CEO, Structure Therapeutics

What we're trying to target everything for is completion by the end of 2025.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

So we feel comfortable with kicking off our phase IIb regular strength study with the data readout by Q4 2025.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

Same thing with sort of extra strength, and we're trying to tie in the formulation as well.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

So we finish everything by 2025.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... teeing us up for the phase III.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. What... And can you comment at all about what specific changes making to the formulation that would make it more amenable to this population?

Ray Stevens
CEO, Structure Therapeutics

Yeah, there's a lot of different, and again, formulation technology has been around for a long time. There's immediate release, there's gastric restriction, there's extended release, all of these things. So we're exploring, and we know that Pfizer and Lilly is also exploring.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

You know, to me, I look at this as it's all about the molecule, it's about the formulation, and it's about the titration. You have to tie all these together, to really have the patient experience be, you know, as good as possible.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Would there be, like, another IP play there as well? Is that-

Ray Stevens
CEO, Structure Therapeutics

Absolutely

Terence Flynn
US Biopharma analyst, Morgan Stanley

... something you should consider?

Ray Stevens
CEO, Structure Therapeutics

Yeah, absolutely.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Okay, got it.

Ray Stevens
CEO, Structure Therapeutics

And that's, you know, that's another point that we do think constantly about the IP in this space. Again, very competitive, so both on all the levels.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Maybe just, you know, the next topic is just the phase III development plan. So, you know, how should we think about, you know, that, and how does the phase II fit into that, and anything you can share at this point around-

Ray Stevens
CEO, Structure Therapeutics

Yeah, let me, let me give that one to Jun.

Jun Yoon
CFO, Structure Therapeutics

Yeah, and I can jump in there. So, you know, as Ray said, you know, developing our molecule as fast as possible is priority number one, and so we are looking for ways to accelerate smoothly into a phase III with our phase IIb study. So that's ongoing, that's something that we're working with, you know, the agency on, and we'll look for ways to rapidly go into phase III. But phase III also is gonna be very significant. So partnership is something that we've talked about. It's an active process. We are looking for a strategic partner that will enable us to do late-stage development, commercialization. Obesity metabolism is a space that's very large and is a primary care commercialization space.

So we, from our standpoint, wanna do everything that we can to be phase III ready. So the phase IIb studies, the one twenty max, the high dose formulation, drug-drug interaction studies, ADME tox studies, manufacture phase III registrational product, so that when it comes to phase III, we're going to be ready to move right into it. And with a partner, we want to do a lot of different parallel studies, right? You know, it's this is a space that's not just going to be for obesity, but there's combination studies to explore as well in adjacent areas.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yep. Okay. Is it? Should we look to Lilly's Orforglipron program as kind of a potential proxy? I mean, again, they're focused obesity, Type 2 diabetes, but it sounds like you guys even maybe want to go broader than that. But is that like a good kind of first step that we should look at?

Jun Yoon
CFO, Structure Therapeutics

Yeah, I think that's a good proxy. But, you know, the way we think, you know, strategics are looking at this too, is this broader cardiometabolic play, right? So how does a GLP-1, as a backbone therapy, fit in with other cardiometabolic combinations-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Jun Yoon
CFO, Structure Therapeutics

Right? To really make a difference in this space. It's not just about weight loss, it's about what difference you can make in other cardiometabolic diseases, in addition to combinations with incretins, right? And that's going to go into GIP, GCG, as well as amylin molecule-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Jun Yoon
CFO, Structure Therapeutics

- that we're also excited about.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Are co-formulations a possibility like we saw in the-

Jun Yoon
CFO, Structure Therapeutics

Absolutely

Terence Flynn
US Biopharma analyst, Morgan Stanley

Cholesterol market?

Jun Yoon
CFO, Structure Therapeutics

Absolutely. So, in addition to the formulation work that we're doing, we are looking at combinability-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay

Jun Yoon
CFO, Structure Therapeutics

... GSBR-1290 with-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Jun Yoon
CFO, Structure Therapeutics

- again, other agents.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

That's fixed dose combination.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

That's one example, though.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. Understood. Okay. Okay, great. I mean, it might be too early to speculate on this front, but it's a question we get oftentimes just for the space of just comparator arms for these phase III trials. Like, as you think about, you know, the evolution, obviously, because I think Lilly has made the point, at least in type 2 diabetes now, it's very hard to do a, you know, CVOT, placebo-controlled study, right? They're doing Mounjaro versus Trulicity, for example, using an active control. So as you think about that in the context of a broad phase III, I mean, how does that factor into plans, or is it still kind of too early to speculate?

Jun Yoon
CFO, Structure Therapeutics

It's a little early, but those are things that, you know, we're going to have to look at, right? I mean, what, what is the right comparator? Whether it's an, you know, an existing molecule that's out there, which isn't right now, just an oral peptide, right? There aren't any other oral small molecules out there, right?

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Jun Yoon
CFO, Structure Therapeutics

So, those are things that we'll look at.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Okay, great. Maybe just moving on to the earlier stage pipeline. Again, you know, Ray, you touched on some of these, but maybe just what are the next milestones here? Particularly, I guess there's, you know, some interest in the amylin axis in general. So maybe just remind us of kind of, you know, what you've done so far, and then what are kind of the next milestones we should look for? And then kind of the related question is just, you know, Novo's going to have some late-stage CagriSema data. You know, what are you going to be looking for to kind of learn more about this pathway?

Ray Stevens
CEO, Structure Therapeutics

Yeah. So Jun took one of my favorite questions, was on manufacturing. I'm taking this one.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay.

Ray Stevens
CEO, Structure Therapeutics

Amylin. And again, you know, for the investors, sometimes, you know, Ray's really excited about amylin. Does that mean, you know, he's not excited about twelve ninety? I'm still excited about twelve ninety. You know, that is going to be a drug.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

Amylin is fascinating. So we have, So what we have right now is an oral amylin small molecule. We had a big breakthrough about five years ago. Again, it was largely structure-based on structural biology and structure-based drug discovery. It is a more, much more challenging target than, I would say, the incretins, GLP-1, glucagon, GIP, bigger binding site, more complex biology. And so with all that, some people have even said it's not going to be possible to make a small molecule to amylin, and I can sit here and smile and say, "We've done it," so I know that it's possible. We will have a DC by the end of this year, so we're quite excited about that. And we won't just have one DC.

We're actually taking even when we were working, you know, in the early days of GLP-1, we took a multi DC approach. Twelve ninety just it shined, you know, again, with the safety window and the efficacy that we saw. So similarly with amylin. One of the differences, though, with amylin small molecule, it's. It'll be the first amylin small molecule in the clinic. To the best of our knowledge, we have one of the only oral amylin small molecules right now, but we know there's a lot of competition coming on this. So we shared in our 10-K earlier this year, molecule ACCG-184. That was. You know, you look at the curve that was in there, and we saw, you know, similar efficacy of ACCG-184, the amylin oral small molecule, to semaglutide.

When you add these two together, that was my sort of holy shit, you know, 28% loss in a DIO mouse, you know, 28-day study. And so the synergistic effects are just really impressive. One of the questions that we're asking ourselves is: clearly, GLP-1 can be a monotherapy. We actually think amylin has the potential to be a monotherapy as well, so there's two different products there. What we like about amylin is this possibility of it can have better tolerability, it can have better selective weight loss. That's the hypothesis that's out there. But we also have the ability to combine them. And then, you know, whether GSBR-1290 is our backbone or our amylin is our backbone, we can look at both of those, and there's a lot of opportunities and lifecycle management and everything.

You know, you can expect we'll have multiple DCs in this space, looking at a number of different sort of properties as we develop it. DC by the end of the year and expect to be in the clinic by the end of 2025.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. And what are the CagriSema?

Ray Stevens
CEO, Structure Therapeutics

Yeah, so Novo will be releasing later this year the CagriSema data. And we just saw data from Zealand a few months ago, you know, with their pure amylin molecule as well, which is very, very good data. What I'm looking forward to with CagriSema, one, efficacy, obviously, we want to see that. Tolerability is kind of a bigger question. I'm not so obsessed with the percent weight loss number. I'm more gonna sort of be paying attention to the tolerability of CagriSema. I'm also quite curious. What they're doing in that study is they're also, at the end of the study itself, they're gonna be studying people, I think from week 68- 97. They're gonna be looking at when people go off drug, how do they respond?

And I think that's. I'm glad that Novo's been very, very thoughtful about looking and asking these questions when people go off drug, 'cause I think this is, you know, this is a bad tangent, but over the weekend, I had a lot of friends over, and several of them are on GLP-1s. Their biggest anxiety is: what happens when I stop taking this drug? Is it gonna be this rebound effect, and how is that gonna affect me? So I'm glad that Novo is asking this question. So that's the data that I'm looking forward to seeing. The cardiovascular data won't come out for a few years.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Right.

Ray Stevens
CEO, Structure Therapeutics

But those are the pieces that I'm really looking forward to watching. I do think that it's gonna be challenging with their co-injector system. I think that's. And this is where I think a fixed-dose combination. Again, Jun said this, you know, when he took my manufacturing question. At the end of the day, this field of metabolism, this is a small molecule field.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Mm.

Ray Stevens
CEO, Structure Therapeutics

Just the sheer magnitude, the size of this market, peptides just can't keep up. And the injectors, the plastic injectors, the waste, everything, fill, finish, this is a small molecule game, and this is perfectly, I think, suited, for an oral small molecule.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yep. From a biological basis, is there-- what's the rationale why an amylin might not see the same degree of rebound as a, as a GLP?

Ray Stevens
CEO, Structure Therapeutics

So different points in the sort of cascade. So, you know, I think about for, you know, my cartoon, I'm a chemist, so I'm not a biologist, but I think about how GLP-1 hits the beta cell. It releases insulin, it releases amylin. You know, you have a different biological response. I think of it as GLP-1 is like a hammer hitting really hard. Amylin is softer in terms of its touch. I think that helps with tolerability. I don't know whether it's really gonna help with the rebounding. I don't understand the hypothesis behind that, but I'm glad that they're asking the question, and it'll cause people to dig in deeper into that. And they must have had a reason for-

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah

Ray Stevens
CEO, Structure Therapeutics

... for sort of asking this question. Again, they're smart people, so we'll see when that data readout comes.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. Maybe just moving on to, you know, the oral landscape. We talked about Orforglipron, you know, Danoglipron still, I think, you know, TBD. We'll see some QD data next year, but maybe just, you know, the other players like Novo's Amicretin, the CB1, and then you've got, you know, Viking, Oral Peptide, and then Roche with the Carmot asset. So maybe just remind us kind of differentiated features of yours versus those others that we haven't talked about yet that are coming-

Ray Stevens
CEO, Structure Therapeutics

Yeah

Terence Flynn
US Biopharma analyst, Morgan Stanley

... kind of further behind.

Jun Yoon
CFO, Structure Therapeutics

I'll jump in here. You know, with regards to the oral GLP-1s, we categorize them in three buckets, right? There's the peptides that have been formulated into oral. We still think that those are gonna be challenging because you've still got to scale peptides, right? Even if you can formulate it as an oral. We've seen those challenges with Rybelsus, right, for instance. The other two categories, which you mentioned, are the oral small molecules that are based on the Danoglipron scaffolds, and then the third category is the oral small molecules based on the Orforglipron-like scaffolds. The Danoglipron field is very crowded, as you can imagine. There's a lot of competition in that space. It's an easier scaffold to work with and to derivatize. We've worked on it ourselves.

We continue to build IP around it, and it's something that that's still very active. Twelve ninety molecule is gonna fall into the Orforglipron plus novel scaffold category, right? So we've got elements of Orforglipron in our molecule to get to the efficacy. We've been able to demonstrate that in our twelve-week studies, and we feel that's an area that's less competitive. There's just not a lot of other players in that space given the complexity around Orforglipron. But we've been able to overcome a number of those challenges there with our novel scaffolds, and we continue to build IP around it as well.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah. What is CB1?

Ray Stevens
CEO, Structure Therapeutics

Yeah, and exactly, Terence. I was just gonna... I- I've worked on CB1 for a lot, number of years.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Yeah.

Ray Stevens
CEO, Structure Therapeutics

And I'm fascinated by it, the whole endocannabinoid signaling system. But, you know, what makes me nervous is, you know, Rimonabant was pulled, and now if you sort of reduce that peripheral, you know, you reduce that sort of CNS effect, where's the effect coming from? That's one question. Second, the incretins just work so well. You know, what do we have to achieve with CB-1? Do you gotta get, you know, even more weight loss? Is that really necessary? We know incretins are safe. They've been on the market now, you know, Byetta, you know, it's now going on twenty years. Twenty-year anniversary will be coming up next year. And so, to me, I'm obsessed with safety. Again, a drug that's gonna be taken by more than a 100 million people for extended periods of time, do you really wanna take the risk on safety?

Incretins, GLP-1, amylin, I'm gonna sort of include in the incretin family. Why take the risk?

Terence Flynn
US Biopharma analyst, Morgan Stanley

Okay. All right, maybe just to wrap it up in the last minute, just, you know, what are you focused on this fall, you know, that you're excited about, either from, you know, your own pipeline or other things? We talked about, you know, CagriSema, but anything else, you know, internally that you have on-- that we should have on our radar screen and externally?

Ray Stevens
CEO, Structure Therapeutics

Yeah, I think the. You know, so obviously, the phase IIb, I'm kicking that off. Very excited about that. The amylin DC, excited about that. The combination advancement there that we're gonna start to see, and we didn't get a chance to talk about. You know, we are excited about, you know, GLP-1 small molecule with glucagon. We think that is a product, particularly for liver disease. And so, you know, we think that there's multiple products, all of which are progressing. So again, we come back to, we think we probably have one of the strongest and broadest pipelines in this area. Multiple scaffolds, multiple targets, all progressing really, really well through the pipeline. So a lot, a lot of activity through the end of the year, and twenty twenty-five is gonna be really busy.

Terence Flynn
US Biopharma analyst, Morgan Stanley

Great! Well, thank you, Ray, Jun, really appreciate the time today. Thanks for joining us.

Jun Yoon
CFO, Structure Therapeutics

Thank you.

Ray Stevens
CEO, Structure Therapeutics

Absolutely. Thank you, Terence.

Jun Yoon
CFO, Structure Therapeutics

Thank you.

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