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Jefferies Global Healthcare Conference 2025

Jun 4, 2025

Akash Jawhari
Analyst, Jefferies

Alrighty. Good morning, everyone. Really appreciate you joining us. My name's Akash Jawhari. I am a pharma and biotech analyst here at Jefferies, and this is day one of our wonderful New York Healthcare Conference. I've got Cameron from Spyre. Cameron, why don't I hand it off to you for some brief introductory remarks, and then we'll get started with the Q&A?

Cameron Turtle
CEO, Spyre Therapeutics

Sounds good. Thanks for having me, as always. The brief background on Spyre is that we launched the company about two years ago with a pretty straightforward goal, which was to develop a set of products that we believe could address the unmet need in inflammatory bowel disease, which we really saw as two things. One, the efficacy in inflammatory bowel disease is still dramatically lacking relative to other large INI categories, with most approved products delivering a placebo-adjusted clinical remission rate rarely above 25%, and that leads to patients and physicians having to cycle through many medications to get to lasting remission, which in many cases they never achieve. Then second, despite this being a disease that affects more than two million people in the U.S.

and many more in the rest of the world, we still have, I would say, relatively inconvenient product profiles on the market today as well. Things that are dosed as frequently as every week or two weeks subcutaneously, or having patients still come in and get intravenous therapies quite regularly. We thought we could address both of these things with our portfolio, and really that's in two ways. One, we're going to develop longer-acting versions of what we think are the best biologics in this space: Alpha-4 Beta-7, TL1A, and IL-23, which we think can meaningfully extend the dosing interval and get to quarterly, if not twice-annual subcutaneous dosing, which is a much better profile than what's on the market today.

We can both adjust the dosing of these products as well as dose them together in combinations, which we think the two of those things together has the potential to dramatically improve the efficacy compared to today's standard of care. We are developing these together in what we think is a pretty ambitious and exciting phase two study that is starting imminently.

Akash Jawhari
Analyst, Jefferies

Love it. All right, let's get started. We've had this discussion before. In terms of our own fundamental diligence, bispecifics versus co-formulations, higher ADAs, I don't necessarily see a benefit, especially when you have different half-lives or different levels of target engagement. Some of these are soluble targets, some of these are not. I don't see a clear advantage of a bispecific over a well-run co-form. That's why we like Spyre. The one fair critique that I think investors bring, and I think you've seen some of the strategists think about this too, contribution of care. How do you get to novel, novel combos and the FDA comfortable with that in a very quick competitive environment? Talk to me about how Spyre is thinking about those challenges, particularly in terms of your phase two design that's coming up.

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, so I start actually with where you started as well, which is if we look forward kind of a few years to the end of these development programs, which approach for developing combination therapies is likely to lead to the superior product profile. I think you have to start there because it's a long-term game in terms of having how long these products are on the market. When we at the outset here looked at the opportunity to look at a bispecific versus a co-formulation, we thought there's really no argument that the bispecific will be better than a co-formulation and quite a few reasons why it could be inferior to a co-formulation. You highlighted them as well.

I think it's most importantly the ability to have the right amount of target engagement for each of them versus being fixed in a one-to-one ratio and not necessarily getting the same in vivo activity that you sometimes see in vitro for bispecifics. The immunogenicity risk that you highlighted is the second point. I particularly like to look back at the history of the TNF bispecifics, where this isn't the first time people tried to make multispecific antibodies. There were a dozen TNF bispecifics that were made, and they all got discontinued after phase one or phase two for one of these two reasons that I just described. We think if you look forward, the long-term winner here is likely to be co-formulated antibodies.

To get there, as you highlighted there, you do have to go through more to get there, which I'm not sure makes sense scientifically, but that's the reality that we have to show that our combination shows contribution of components, that our combinations beat our monotherapies and our monotherapies beat our placebo. That's what our phase two is designed to test. It is a platform study that includes a placebo arm, it includes our three monotherapies, and it includes the three pairwise combinations thereof. We think the study is adequately designed and powered to test that, that our combos can beat our monos, our monos beat placebo, and then hopefully have the ability to move forward whatever the winner is from that study to a pivotal program.

Akash Jawhari
Analyst, Jefferies

Got it. Now, as we think about that phase two, and I think people think, okay, there's one combo that it's going to get tested in these phase two studies, there is kind of the optionality that you could have multiple combinations added into that phase two. This could end up being kind of a larger program. I don't think that's necessarily well appreciated with the streets. Can you talk about the flexibility you anticipate in that phase two design if you want to try the Entivio or if you want to try the IL-23 in combination with, let's say, TL1A? What's going on there?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, so the study is designed as a platform study, meaning it is a one-master protocol that includes the same site, same investigator, same inclusion/exclusion criteria for these arms. We will be activating sites actually starting now, basically over the next year or so, to start enrolling patients across all of these different arms. The study is designed to test our entire portfolio in a single platform study. The three monotherapies and the three pairwise comparisons. I think we and most of the experts in this field do not yet know which combos are likely to be best, and we think this is the best way to evaluate them, to test them head-to-head and see in the same population which one is superior so that we can pick the winner to move forward.

I say winner a little bit flippantly in that I think it is possible that there's more than one winner coming out of this trial. We'll talk about the rationale for each of these, I'm sure, but in general, we think these are the three best biologic targets in this space. We have compelling evidence from human genetics, from animal studies, or even just the basic biology of these targets that there's likely additive efficacy to be had between each of our three targets. We think for the most part, these are the safest targets in IBD as well, particularly Alpha-4 Beta-7, but then IL-23. TL1A, we know the least about its safety, but so far it looks very clean as well.

Akash Jawhari
Analyst, Jefferies

Actually, I want to hit on that because I remember you and I talked about this, and you said, you're like, "Look, TL1A is a TNF superfamily. We don't have long enough durability data." You said it's notable that we're thinking about the Alpha-4 Beta-7, IL-23 combo and not necessarily the TL1A in combination yet. That was a year ago. Now we do have across the board, whether it's Teva, whether it's Merck, whether it's Roche, we have durability data. We're not necessarily seeing a severe infection signal show up with the TL1A class. How does that change your priorities in terms of exploring TL1A in a combination setting now?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, I think we've always been excited about TL1A as a class, and I think the longer-term data continues to support that it probably has the best efficacy of any individual biologic class in IBD, and we haven't yet seen, to your point, the safety downsides that we've seen with other classes like the TNFs or like the JAK class, certainly. That said, it's still nowhere close to the amount of exposure that we have for Vedolizumab or for the IL-23 classes where you have tens of thousands of patients dosed across the clinical studies there and in the commercial setting. I think the relative order of certainty is still the same, though I'm increasingly feeling confident that the TL1A class has a nice safety profile as well as we see greater and greater exposure with that class.

Akash Jawhari
Analyst, Jefferies

Okay, understood. Now, in terms of how do you see the TL1A class play out? Because I think Teva has a very potent drug. I do not think Teva has a very great half-life. I think you look at the original Roivant compound issues in terms of co-formulation, getting this into a subQ and then potentially ADAs. And then Prometheus looks like a viable compound, but maybe there was some potency left on the table. When you think about you have two TL1As that you have, how do you think, given it is a very competitive space and there is already billions of dollars invested ahead of you, that you can have a compound that would differentiate here?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, I mean, I think you highlighted where we started, which was we did not think any of the first-generation TL1As had the set of properties that would be an ultimately best-in-class molecule against a target that I think we and everyone who spent the amount that they have to buy those assets and develop them believes this is probably not just a single indication target. There are many potential indications to go after, and the evidence at least in IBD now is that it is not just like TNF, it is maybe better than TNF in that indication at least, and we might see that play out in adjacent indications as well. When we looked at this, we saw none of the TL1As that had developed had that optimal set of properties.

None, of course, incorporated the half-life extending approach that we've taken across all of ours, but you highlighted the three weaknesses that we saw as well: the low potency for the Prometheus molecule, the immunogenicity, formulation, and bioavailability issues with the Roche molecule, and the short half-life with the Teva molecule. Really, we thought, look, we can go make a better version than any of those, and I think in the next few weeks here, we'll report data from our two phase one studies on these molecules that I think should do a pretty good job of demonstrating whether we've achieved that goal of really ticking all those boxes of a highly potent, long-acting, full target engagement and low immunogenicity molecule.

If we have at least one of those, I think we would be very excited not just to add it to our IBD phase two study, but as we have announced, we are interested in testing TL1A in rheumatology as well.

Akash Jawhari
Analyst, Jefferies

I want to hit on, okay, so understand the comments. Let's think about your competitors and make some hot takes. Teva, okay, so you have a very good response rate. They dose the drug quite frequently every two weeks. You're now going into maintenance and you've got two populations. You've got UC and you've got Crohn's. I want you to call your shot a bit. When you think of, because we're figuring this out too, as you think about going into monthly dosing with the Teva molecule, how do you expect efficacy to drop? Because there is another side which says, look, once you've done the induction, you don't need to press on the lever as potently and you might not see efficacy drop that much. What gives you, what's your view on how that Teva dataset evolves?

Cameron Turtle
CEO, Spyre Therapeutics

Yes, so I think I will refer to the other two TL1A datasets because I think they're quite informative for how the Teva one's likely to play out. I think in general, we've seen now three induction TL1A datasets that the properties of the molecules are all different and the dosing has been dramatically different from as low as 50 milligrams in the Pfizer study initially to the Teva molecule over the induction setting is dosing more than 5 grams. Really a very wide range of dosing there. I think it's fair to say that at the high end, the placebo-adjusted clinical remission for those molecules doesn't look that different. The enrollment populations look quite different. The placebo rate varied quite a bit between those three studies, but the placebo-adjusted efficacy looked quite similar.

I don't think we saw a meaningful dose response for any except Teva in the induction setting. In the maintenance setting, I think the story might be a little bit different in that both of the first two molecules that have reported maintenance data, both Roche and the Merck molecule now, they showed dose responses. Not on every endpoint in the study, but I think on the most objective endoscopic endpoints, we saw a dose response in the maintenance setting. When you see that your highest dose tested was your most efficacious dose, you never know if you actually hit it completely, if you're already at the plateau of efficacy or if you might have missed it.

I think we actually see that Merck probably believed that as well because when they went to their phase three study in Crohn's, they actually dropped the dosing interval from every four weeks to every two weeks. It looks like they believe they might have missed the maximal efficacy in the maintenance setting as well. Now we're kind of read through to Teva. As you mentioned, they have the shortest half-life of the three. The other two have about a 19-day half-life and the Teva molecule's half-life is less than 10 days, and they're all dosing monthly. There's a big difference in a half-life when you double the dosing interval. It's not a linear effect. You lose a full half-life or two there. I think they will have a harder time covering the target in the maintenance setting.

I don't think that will be the case for ours. We'll see our half-life here in the next few weeks of our molecules, but if we have the potency and the half-life that we would expect based on our NHP studies, then I think we have a pretty good probability of being able to fully cover the target, not just in induction, but in the maintenance setting as well. Even if we extend the dosing interval out to quarterly, again, that half-life translates quite well as you get to those long dosing intervals.

Akash Jawhari
Analyst, Jefferies

Understood. Now let's talk a bit about, and again, it's funny, as much as you're generating data, it's what's going on in the space broadly that I think is also equally relevant. You've got the Duet studies. Actually, look, you have multiple approaches with that kind of TNF combo studies that J&J is running. Talk to me about what expectations are, because this is, I think, the number one thing I worry about is you look at some of the early studies and this is what J&J talks about too. It looks like one plus one equals two. That's in a biologically naive population. I think there's a lot of differences between naive and experienced patients, especially if you look at some of the methotrexate or TNF studies historically.

Can you talk about some of the datasets you're watching from J&J over the next year and the read across you think they're going to have to the combo approaches you're taking into the clinic?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah. I think J&J is running three studies now that I think we're paying attention to. The two that are most relevant, of course, are the two Duet studies in Crohn's and UC. I think those studies have completed now. I think I would expect they know the data in the upcoming weeks, if not the next couple of months. When we see it publicly, that's a little bit less certain to know, but I think we will see those data in the upcoming quarters here. Beyond the Duet studies, I think we're also interested in the same combination in psoriatic arthritis. They're running a study called the Affinity Study, which is looking at all TNF refractory patients, and then they're either getting IL-23 or the TNF and IL-23 together.

I think the combination of those three studies, I think, will help us answer a lot of questions really about the future of combination therapy, mostly in IBD, but then also kind of expanding to other hard-to-treat I and I diseases. I think the main questions that we're trying to answer, so far we have a clear answer for how well the combinations perform in naive ulcerative colitis patients. I think in the Duet studies, we're going to see how the combinations perform in refractory UC and Crohn's patients. I think what we're really most interested in is, okay, what's going to come next from this study? Are they going to go to a phase three study? I think for now, a reasonable assumption is that will be a mixed population, a mix of naive and refractory patients.

That's how most drugs have been approved in IBD. I think what we're interested in is what do we expect the overall profile to look like for that J&J combo in a truly mixed population of about a 50-50 naive biorefractory population, that mix of the Vega result in the naive population, and then what we'll see in Duet in the refractory population.

Akash Jawhari
Analyst, Jefferies

Okay, and now let's talk about expectation setting, because I think that's important. I think historically, and by historically, I mean just last year, people think, okay, if a combo can show a 10% delta over a monotherapy, great, there's evidence of additive benefit. I think that's a, we need to delineate that between in a naive setting and in a refractory setting, and also into some of those indications that J&J is pursuing here, because it also seems like body language is different depending on what, like maybe psoriatic arthritis is a little more bullish than, let's say, Crohn's. How would you set the bar?

If you're going to say, as an investor and you're looking at this dataset, what would be a delta in a refractory population in some of these disease states that would say to you, hey, I am seeing combination activity that justifies the risk-benefit profile here?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, so I look at kind of two data points that help us guide what the benchmark should be. One is our work with prescribing physicians in this space, so we kind of just do surveys here to see what a meaningful difference would be that would lead to a change in prescribing patterns. Then second, looking at precedents in this space as well. There have been plenty of head-to-head studies, or at least a handful of head-to-head studies run in this space that have led to changes in practice with differing levels of clinical remission deltas. I think between the two of those, I think it lines up reasonably well that once you get to a double-digit difference overall, in the overall population, that mixed population, if you have a double-digit difference, we see a meaningful shift in prescribing preferences.

I think that's comparable to what we see in the head-to-head studies of the IL-23 P19 inhibitors compared to the P40 inhibitors that have led to a substantial practice shift. That's more than what was seen in the Varsity study comparing alpha-4 beta-7 compared to TNF, which also led to a meaningful practice shift. I think we know that even in that kind of high single-digit to low double-digit % range, that's where you see physicians change their prescribing patterns and believe that something's clinically meaningfully different. Now to back out to your original question, we think that's what you need overall. We think kind of if you're in that double-digit % overall in a mixed naive and refractory population, that would lead to a meaningful practice shift.

We know in the Vega study, it was more than a 20 percentage point difference between the monotherapies and the combos. I think we want to see something in the refractory population too, but it could actually be slightly below 10%, and I think you would still have a high probability of seeing a more than double-digit % in a phase three study where you mix those populations together. That is really what we are looking for is, okay, if we read through to what phase three are they going to run, what is the delta they are going to see, and therefore are they going to be able to move many patients?

Akash Jawhari
Analyst, Jefferies

5%-10%, you'd want to see in the refractory?

Cameron Turtle
CEO, Spyre Therapeutics

5%-10% in refractory, and it's where it was in the naive population. I think that's a dominant product. I think it's worth remembering they haven't seen any downside in safety yet. That will be critical. This is a TNF combo. We're seeing it for the first time in maintenance now, so safety will be critical. I also expect, which I think takes some education of the various stakeholders here, that I expect J&J like ours, I think it's more likely that these are priced like one product. This is one branded product. It's not going to be adding two branded things together. I think you're really comparing against the same properties as normal, efficacy, safety, and access. I think in this case, the efficacy is likely to be better. The safety hasn't been worse.

If you price it the same, I think that's a dominant product.

Akash Jawhari
Analyst, Jefferies

Should tell that to AbbVie, given where Rinvoq is priced versus Humira, but I digress. Okay, now let me, I'll give you the tough question. Let's say that that refractory delta is 0%-5% in, let's say, Crohn's. Does Spyre as an organization look at that study and say, we are still going to pursue combination in Crohn's? Or do they say, you know what, we have limited capital. We want to be smart about where we're exploring these studies. We're not going to go for it in that indication.

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, I think in general, I think first, I think there's many reasons that our combos are likely to outperform the J&J combo kind of regardless. I think we can talk to this specifically, but I think alpha-4 beta-7 beats TNF head-to-head in this population. TL1A has been tested head-to-head against TNF, but I think most would agree that TL1A is superior to TNF as well. I think regardless of what J&J shows in the Duet studies, I think our combos are likely to outperform them. That said, we're obviously going to learn from Duet. I mean, this is, as I mentioned, kind of two new populations that we're seeing this combo activity in. We can certainly adjust our development plan depending if they see a meaningfully different delta in those populations versus what they saw in Vega.

Whether we need to do a kind of a normal 50-50 mix or we want to adjust our population, how we decide to approach Crohn's. We've kind of only announced our ulcerative colitis trial, but we are interested in pursuing Crohn's in the long run here, of course, too. We'll learn quite a bit from these Duet studies, and of course, we'll incorporate that into our strategy here.

Akash Jawhari
Analyst, Jefferies

Makes sense. Now, just on TL1A, there are two angles here, right? There's the I and I indications that I think we all are familiar with from our large cap companies, but then you have signals in liver diseases, systemic sclerosis, et cetera, et cetera, and you have multiple TL1As. Can you talk about TL1A in a more orphan setting? What does that regulatory path look like? Where are you from a competitive perspective versus some of your peers? I think Merck's exploring some of those indications as well.

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, so I think beyond IBD, where we have, of course, seen three successful ulcerative colitis trials and one successful, I guess, two successful Crohn's studies, where Merck or Prometheus at the time had launched an SSC ILD study that I expect we'll read out next year as well in Merck's hands. Over the last few months, we've seen a flurry of additional trials get announced or launched, one in atopic dermatitis, one in HS, and one in MASH, as you highlighted. We announced that we'll be testing ours in rheumatoid arthritis as well. I think everyone's interested in a range of different applications here. This is a TNF superfamily protein, but it also hits, I think most interestingly, an antifibrotic angle as well.

We and others are interested in indications that have reasonable de-risking on the inflammatory side, but may also have an antifibrotic component that we think could be valuable too. You will see in these different indication selections a different prioritization of that antifibrotic kind of newer angle versus continuing to go after inflammation, where I think you have more de-risking now, given the positive results in both UC and Crohn's.

Akash Jawhari
Analyst, Jefferies

Got it. Maybe just I want to touch a bit on the strategic stuff. You have two different developments. I mean, if anything, you have multiple huge indications that take huge sales forces, and then you also have an angle where you're trying TL1A in indications that have not occurred before. We'll save the larger partnership and strategic question, but let's just say about these more orphan niche indications, which still could be quite big, especially if you think about different price points. Why not partner out some of those now? Get more cash on the balance sheet, give you more strategic optionality, rather than take them forward yourself. Is that a decision we might get relatively quickly?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, that was not lost on us when we decided to take two molecules forward. The original idea was that, hey, there's not everything you can de-risk preclinically before you go into phase one and really just wanted to have the maximum chance that we have a great TL1A molecule coming out of it. The reality is we could have two great TL1As coming out of it, and I think the value maximizing strategy for us is probably to use them both, whether ourselves or through a partner. If you only have one, that option doesn't really exist because most larger companies wouldn't be interested in splitting indications with you for one molecule. If we have two excellent molecules, that is an option that we have on the table. I think in general, we're very well financed at this point. We still have $565 million on the balance sheet.

We're still fully funded for the full platform study in UC + our RA study. We're in no urgency to raise additional money, but I think particularly on the other side of phase two, I think there's a lot of potential phase threes that could come out of this portfolio, and I think we will have to be quite savvy about how we decide what things we're doing ourselves versus what things we may decide to partner on.

Akash Jawhari
Analyst, Jefferies

You answered for some of those other indications. I'll ask also for the big enchilada in terms of UC, Crohn's, atopic dermatitis. It seems like to me, when you think about a platform study and you've designed it this way, there is a speed advantage in terms of generating multiple combinations that I think you would have over a lot of your peers, even the bispecifics who are a little behind you right now. How important is getting that card flip, both for Spyre as a company, but maybe for strategics? What do you think is de-risked once you have all that data available to you?

Cameron Turtle
CEO, Spyre Therapeutics

I mean, I think it's critical, and I would look at the precedents in this space that you can enroll a study that's 200 patients across 100 sites in a year and a half or two years. Look at the Duet studies. Those studies enrolled 600 patients in not that different a timeframe because they went out much broader to more sites. They had a lower placebo allocation, and they had a high proportion of combinations enrolling in that study. Despite only enrolling refractory patients, those studies enrolled incredibly well. They enrolled in about a little over a year and a half for these huge studies. I think that kind of shows you the power of running larger studies with multiple active intervention arms that I think we'll likely see a similar advantage here.

Of course, we have very low placebo allocation in our study, a high proportion of combinations, and in fact, all of our combinations are being dosed on a quarterly basis, which will also make it the most convenient study to participate in as well. I think this, we only have to activate sites once in this study. The total number of patients we need is kind of on the order of, we say, 40% relative to running these as separate combo studies. I think it's massively efficient, and in a challenging biotech capital market, we're trying to be as thoughtful as we can about what's the most efficient way to generate answers that are the most valuable. In our view, that's how do we get to those three combination readouts with the cash we have. This is really the only answer.

I also think it's an answer that no one else can really do without the portfolio that we have.

Akash Jawhari
Analyst, Jefferies

Makes sense. Now, I want to hit on Entivio. We were talking about for Euler, where's the Morphic data? Where's, I guess, the Lilly data now? It's interesting. A lot of people don't talk about, I think, the alpha-4 beta-7, but there is one of the things we're thinking about is if there is an early critique on TL1A, obviously the N is low, what is the efficacy in TNF refractory patients, right? I think that's a fair discussion point to have. At the same time, Entivio is one of those targets which actually does perform particularly well in that population. When you think about combination approaches with your Entivio, A, do you think there's going to be an efficacy advantage because you're having higher potency?

Why should we be thinking about maybe the Entivio target as the optimal combo partner when you're thinking about an IL-23 or a TL1A versus maybe other approaches that you might have in the bench?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, I mean, when we start, there's a reason alpha-4 beta-7 is our first program, and that is, A, it's the number one product in IBD, so that's a good place to start. The most obvious reason is the safety of it. The safety, that's an unsurprisingly excellent safety because it's a gut selective mechanism. You don't expect to see those broader infection and malignancy risks that you see with other classes, and you don't. It doesn't have that risk in the label. We think it's the excellent molecule to start with, plus the biology is very orthogonal to the other targets that we're going after. It's a cell trafficking mechanism relative to the anti-cytokines that we're going after with TL1A and IL-23. We think alpha-4 is a very logical target to go after.

I still think there is potentially a synergistic approach between TL1A and IL-23, whereas I view alpha-4 beta-7 as a more orthogonal biology than hitting those cytokines. As I mentioned previously, we see additive, if not synergistic, efficacy across a range of in vitro and animal models for our combinations. Because we have long-acting versions of each of these, we think we have quarterly plus combinations where the safety of each of these targets looks good individually and the efficacy looks good individually. I think they're most likely to be the best combos in this space.

Akash Jawhari
Analyst, Jefferies

Understood. Now, let's just hit on with the Entivio induction. Let's put it this way. Do you believe there is a dose response that Entivio shows across different ranges? Because again, I struggle with understanding receptor occupancy and its correlation on efficacy and maybe just the general MOA here. When you have a much more potent drug like you have where you're probably in the highest tertile of induction, do you expect there to be an efficacy advantage angle that Spyre is going to pursue beyond just dosing?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah, we see that we tend to position that as the upside case, but I think the data is reasonably strong here that both in the pivotal studies and in the real-world setting, we see that the more Vedolizumab you have on board in the induction setting, the higher your probability of clinical remission. That was something that the FDA highlighted to Takeda at the BLA time to say, hey, you should go test a higher dose. Because we are developing this from scratch, we have that opportunity to go test a higher dose. As you mentioned, we plan to put kind of all patients in our phase two study into that fourth quartile of exposure where Vedolizumab had much greater clinical remission rate.

Now, I think that's not likely to be doubling the efficacy of Vedolizumab, but I would be surprised if we're not able to improve the efficacy by having that greater coverage. We will see. We will test that in the phase two study and see if we deliver higher remission rates.

Akash Jawhari
Analyst, Jefferies

Got it. I'll talk more generally here because obviously we're a ways away from the pivotal combo studies at this point. From what you've seen across your profiles, what you've seen with your competitors, generally speaking, the investor bar is that in a refractory population, if a combination can show a 5%-10% benefit, that would be clinically meaningful. Are you comfortable with that bar with the Spyre combinations that you think you're going to be taking forward into the clinic? Or is it higher or lower?

Cameron Turtle
CEO, Spyre Therapeutics

Yeah. I mean, I think if you did not show a 5%-10% benefit of your combinations over your monos, you would not show contribution of components either. I think that is what you need to see to be clinically meaningfully better. I think that is what we are aiming for. We are aiming for a clinically meaningful improvement in efficacy without a downside in safety and do it all on a quarterly + basis.

Akash Jawhari
Analyst, Jefferies

Maybe to that point, on a phase two study or a phase three study, is there appetite on Spyre to run superiority studies versus some of the existing standard of care?

Cameron Turtle
CEO, Spyre Therapeutics

I think it's very likely that we will. I mean, we know two of our three monotherapies would beat the biosimilars today. Our alpha-4 beta-7 beats TNF head to head. Our IL-23 would likely beat the P40 head to head. So the two biosimilars in this class, we already know that our monotherapies would beat them. If our combos beat our monos in phase two, I think there's basically any product on the market, our combos would likely to beat head to head.

Akash Jawhari
Analyst, Jefferies

Understood. If I could stick in one more. In terms of the bispecifics, and again, call your shot here, there are a lot in China that large cap pharma has actually moved forward with differences in terms of inhibition, differences in terms of receptor turnover. Do you think the bispecifics are going to be able to be potent enough and dosed enough to have a quarterly profile and potentially a higher exposure advantage?

Cameron Turtle
CEO, Spyre Therapeutics

No.

Akash Jawhari
Analyst, Jefferies

Okay. We're out of time. Thank you so much for everyone for joining us. Cameron, always enjoy our conversations. Thank you, guys.

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