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8-K - FORM 8-K - Tonix Pharmaceuticals Holding Corp.v392279_8k.htm

 

Exhibit 99.01

 

October 2014 © 2014 Tonix Pharmaceuticals Holding Corp. NASDAQ: TNXP

 
 

Safe harbor s tatement Certain statements in this presentation regarding strategic plans, expectations and objectives for future operations or results are “forward - looking statements” as defined by the Private Securities Litigation Reform Act of 1995 . These statements may be identified by the use of forward - looking words such as "anticipate," "believe," "forecast," "estimate" and "intend," among others . These forward - looking statements are based on Tonix’s current expectations and actual results could differ materially . There are a number of factors that could cause actual events to differ materially from those indicated by such forward - looking statements . These factors include, but are not limited to, substantial competition ; our ability to continue as a going concern ; our need for additional financing ; uncertainties of patent protection and litigation ; uncertainties of government or third party payer reimbursement ; limited sales and marketing efforts and dependence upon third parties ; and risks related to failure to obtain U . S . Food and Drug Administration (the “FDA”) clearances or approvals and noncompliance with its regulations . As with any pharmaceutical under development, there are significant risks in the development, regulatory approval and commercialization of new products . The forward - looking statements in this presentation are made as of the date of this presentation, even if subsequently made available by the Company on its website or otherwise . Tonix does not undertake an obligation to update or revise any forward - looking statement, except as required by law . Investors should read the risk factors set forth in the amended Annual Report on Form 10 - K for the year ended December 31 , 2013 , as filed with the Securities and Exchange Commission (the “SEC”) on March 28 , 2014 and future periodic reports filed with the SEC on or after the date hereof . All of the Company's forward - looking statements are expressly qualified by all such risk factors and other cautionary statements . 2

 
 

New approaches to treating CNS disorders First - in - class medicines for common disorders of the central nervous system (CNS) Innovative treatment paradigms Late stage candidates Large unmet medical needs To enter 2015 with three clinical development programs 3 Fibromyalgia Post - Traumatic Stress Disorder Episodic Tension - Type Headache TNX - 102 SL TNX - 201 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication.

 
 

Pipeline led by TNX - 102 SL for fibromyalgia Preclinical Phase 1 NDA Market Candidate Indication Phase 2 Phase 3 TNX - 102 SL 2019E TNX - 102 SL Fibromyalgia 2018E TNX - 201 2019E 4 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication. 2018E 2017E 2018E Begin 1H15 Begin 4Q14 4Q14 Begin 1H15

 
 

Fibromyalgia market opportunity * Lawrence et al, Arthritis Rheum 2008;58:26 - 35; Vincent et al, Arthritis Care Res 2013;65:786 - 792. ** Estimates based on information from publicly - available sources SNRI = Serotonin Norepinephrine Reuptake Inhibitor Three FDA approved prescription medications: Tonix is pursuing a different approach: Class Product Company Approval Year in FM 2012 U.S. S ales in FM** Membrane Stabilizer Lyrica ® Pfizer 2007 $475 million SNRI Cymbalta ® Eli Lilly 2008 $600 million Savella ® Forest 2009 $100 million Sleep Quality TNX - 102 SL Tonix 2017E 5 E stimated to affect 5 - 15 million U.S. adults*

 
 

Restorative sleep improves pain and other fibromyalgia symptoms >90% of fibromyalgia patients complain of poor sleep quality* Sleep quality improvement is not a feature of approved therapeutic options Proof - of - concept study Phase 2a results with very low dose oral cyclobenzaprine (CBP) published in 2011 TNX - 102 SL: sublingual tablet formulation of CBP Pharmacokinetic profile well - suited to bedtime administration and chronic use Preliminary top line results from Phase 2b BESTFIT trial reported in September 2014 Provides basis for advancing into Phase 3 development * Swick , Ther Adv Musculoskel Dis 2011;3:167 - 178. ** Moldofsky et al., J Rheum 2011;38:2653 - 63. TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication. Sleep quality is a new target for fibromyalgia therapy 6

 
 

BESTFIT Phase 2b trial in fibromyalgia complete 7 BESTFIT = BEdtime Sublingual TNX - 102 SL as Fibromyalgia Intervention Therapy Randomized, double - blind, placebo - controlled trial 2010 American College of Rheumatology diagnostic criteria for fibromyalgia 205 participants were randomized 1:1 at 17 U.S. sites One sublingual tablet of TNX - 102 SL 2.8 mg or placebo daily at bedtime for twelve weeks Primary efficacy endpoint M ean change from baseline in the daily diary pain score during week 12 11 - point (0 - 10) Numerical Rating Scale (NRS) to assess prior 24 - hour average pain intensity First Patient – First Dose September 2013 Last Patient – Last Dose August 2014 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 102 SL improved pain in fibromyalgia in the BESTFIT study 8 Outcome Measure at Week 12 Intent - to - Treat Population † p value Method Daily Pain Diary, NRS Mean Change** 0.086 0.172 MMRM JTC - MI Daily Pain Diary, NRS Proportion Achieving 30% Improvement* 0.030 LR Clinic NRS 7 - day pain recall Mean Change 0.029 MMRM FIQ - R Pain Item Mean Change 0.004 MMRM NRS = Numeric Pain Scale; FIQ - R = Fibromyalgia Impact Questionnaire - Revised MMRM = Mixed - Effect Model Repeated Measure; JTC - MI = Jump to Control - Multiple Imputation (FDA - preferred analysis); LR = Logistic Regression ** Declared primary endpoint; was primary endpoint for FDA approvals of Lyrica and Cymbalta * Declared secondary endpoint; was primary endpoint for FDA approval of Savella † N=205 (TNX - 102 SL N=103, placebo N=102) p < 0.05 ; a chieved statistical significance Source: Phase 2b BESTFIT preliminary top line results TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 102 SL improved sleep quality in fibromyalgia in the BESTFIT study 9 Outcome Measure at Week 12 Intent - to - Treat Population p value Method Daily Sleep Quality Diary, NRS Mean Change* <0.001 MMRM PROMIS Sleep Disturbance T - score Change* 0.003 0.004 MMRM JTC - MI FIQ - R Sleep Quality Item Mean Change <0.001 MMRM PROMIS = Patient - Reported Outcome Measures in Sleep * Declared secondary endpoint p < 0.05 ; a chieved statistical significance Source: Phase 2b BESTFIT preliminary top line results TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 102 SL broadly improved fibromyalgia symptoms in the BESTFIT study 10 Outcome Measure at Week 12 Intent - to - Treat Population p value Method Patient Global Impression of Change Responder Analysis* 0.025 LR FIQ - R Total Score Mean Change* 0.014 0.015 MMRM JTC - MI FIQ - R Symptom Domain Mean Change 0.004 MMRM FIQ - R Function Domain Mean Change 0.060 MMRM FIQ - R Anxiety Item Mean Change 0.015 MMRM FIQ - R Sensitivity Item Mean Change 0.017 MMRM FIQ - R Stiffness Item Mean Change 0.039 MMRM * Declared secondary endpoint p < 0.05 ; a chieved statistical significance Source: Phase 2b BESTFIT preliminary top line results TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 102 SL was well - tolerated in the BESTFIT study 11 No serious adverse events (SAE) reported Most frequent local adverse events were administration site reactions Previously reported in TNX - 102 SL Phase 1 studies; no detectable bias on efficacy results Transient tongue numbness (41.7% TNX - 102 SL vs. 1.0% placebo) Abnormal taste (7.8% TNX - 102 SL vs. 0.0% placebo) Trial completion rates of 86% with TNX - 102 SL vs. 83% with placebo Systemic adverse events reported by at least 3.0% of the total study population TNX - 102 SL (N=103) Placebo (N=101) Total (N=204) Somnolence 1.9 6.9 4.4 Dry Mouth 3.9 4.0 3.9 Back Pain 4.9 3.0 3.9 Source: Phase 2b BESTFIT preliminary top line results TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

End - of - Phase 2 clinical/non - clinical meeting held with FDA in February 2013 Acceptable to submit 505(b)(2) New Drug Application ( NDA) Required clinical studies to support NDA: • Two adequate and well - controlled efficacy and safety trials in fibromyalgia patients Primary endpoint based on change in weekly mean pain scores • One - year exposure data to support chronic use label • Definitive repeat dose pharmacokinetic “bridging” study Phase 2b BESTFIT study confirmed a ctivity and tolerability Statistically - significant improvements across key fibromyalgia symptoms were observed Systemic tolerability similar to placebo was observed 2.8 mg daily dose confirmed for future development Phase 3 program to initiate in 1H 2015 To seek guidance from FDA on 30% responder analysis as prospective primary endpoint Approval of Savella ® (2009) was based on a 30% responder analysis Registration program for TNX - 102 SL in fibromyalgia 12 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 102 SL to enter Phase 2 for PTSD this quarter Preclinical Phase 1 NDA Market Candidate Indication Phase 2 Phase 3 Post - Traumatic Stress Disorder TNX - 102 SL 2019E TNX - 102 SL 2018E TNX - 201 2019E 13 2018E 2017E 2018E Begin 1H15 Begin 4Q14 4Q14 Begin 1H15 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication.

 
 

Post - traumatic stress disorder is a chronic, debilitating condition High incidence among soldiers and veterans, but experiencing any trauma can lead to PTSD Associated with suicide and unpredictable, violent behaviors Patients desperate despite two FDA approved drugs; no new treatment in >10 years Among 8.5 million U.S. patients, approximately half are receiving medical treatment * FDA approved prescription medications: Tonix is pursuing a different approach: PTSD: a significant and growing public health problem 14 Class Product Company Approval Year in PTSD SSRI Paxil ® Glaxo 2001 Zoloft ® Pfizer 1999 Sleep Quality TNX - 102 SL Tonix 2019E * Kessler et al, Arch Gen Psych 2005;62:617 - 627; Wang et al., Arch Gen Psych 2005;62:629 - 640. SSRI = Selective Serotonin Reuptake Inhibitor

 
 

Rationale for developing TNX - 102 SL for PTSD 15 Overlap between PTSD and fibromyalgia ~50 % of fibromyalgia or PTSD patients meet criteria for the other disorder Patients experience disturbed sleep Widespread pain is considered “co - morbid” with PTSD Opioid, benzodiazepine, other sedative - hypnotic drug misuse common TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

Poor sleep quality after trauma is linked to onset of PTSD PTSD patients complain of poor sleep quality as a core symptom Distressing dreams (nightmares) are part of “re - experiencing” Restless sleep is part of “hyper - arousal” Correlated with depression, substance abuse and suicide Military - related PTSD is an unmet need Evidence suggests that SSRIs may be ineffective in military - related PTSD Response of PTSD in men to SSRIs has not been adequately studied Insufficient evidence to recommend treatment with sertraline or paroxetine TNX - 102 SL targets mechanisms associated with treating disturbed sleep in PTSD Sleep quality is a new target for PTSD therapy 16 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

17 TNX - 102 SL acts on neurotransmitter systems intrinsic to sleep physiology Serotonin and Norepinephrine Antagonist and Reuptake Inhibitor (SNARI) Blocks serotonin and norepinephrine reuptake Selectively b locks serotonin 2A and α - 1 adrenergic receptors TNX - 102 SL TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

18 Mechanistic relationship of TNX - 102 SL with trazodone and prazosin Trazodone blocks serotonin reuptake and 2A receptors Prazosin blocks α - 1 adrenergic receptors TNX - 102 SL TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

PTSD program with TNX - 102 SL 19 P hase 2 study of TNX - 102 SL in military - related PTSD (“ AtEase ”) to begin in 4Q 2014 Fibromyalgia program informs development of TNX - 102 SL in PTSD Safety data from fibromyalgia studies are potentially supportive for PTSD program Efficacy data support potential for activity in PTSD Improvements in several analyses of BESTFIT that relate to PTSD core symptoms: sleep; FIQ - R sensitivity; and FIQ - R anxiety 2.8 mg dose supported by BESTFIT study results TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

“AtEase” Phase 2 trial of TNX - 102 SL in PTSD Randomized , double - blind, placebo - controlled trial i n military - related PTSD N=220; approximately 25 U.S. clinical sites Primary efficacy endpoint: D ifference in Clinician - Administered PTSD Scale (CAPS) score between TNX - 102 SL 2.8 mg and placebo TNX - 102 SL at bedtime once - daily Placebo at bedtime once - daily 12 weeks N = 88 20 To begin enrollment in 4Q 2014 TNX - 102 SL at bedtime once - daily N = 88 N = 44 2.8 mg 5.6 mg open - label extension TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg is an Investigational New Drug and is not approved for any indication.

 
 

TNX - 201 in development for episodic tension - type headache Preclinical Phase 1 NDA Market Candidate Indication Phase 2 Phase 3 TNX - 102 SL 2019E TNX - 102 SL 2018E TNX - 201 Episodic Tension - Type Headache 2019E 21 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication. 2018E 2017E 2018E Begin 1H15 Begin 4Q14 4Q14 Begin 1H15

 
 

Episodic tension - type headache (ETTH) * Schwartz et al., JAMA 1998;279:381 - 383; Chowdhury, Ann Ind Acad Neurol 2012;15:83 - 88; company analysis of public literature. ** Scher et al., Cephalalgia 2010;30:321 - 328; company analysis of public literature. 70 million adults in the U.S. experience frequent episodic tension - type headaches* Constant band of pressure on the back/sides of head; “squeezed in a vice” feeling “Frequent” = one to 15 headaches per month over a three - month period Approximately 60% receive treatment** All of the FDA approved prescription medications contain barbiturates Over - the - counter medications are inadequate for many No new medications introduced for >40 years Class Product Company Regulatory Status Approval Year in ETTH Barbiturate Fiorinal ® Actavis Approved NDA 1990 Fioricet ® Actavis Approved NDA 1992 Barbiturate + Opiate Fioricet with Codeine ® Actavis Approved NDA 1992 22

 
 

TNX - 201 to enter clinical development in 2014 Novel molecular mechanism Based on proprietary discoveries by Tonix Non - barbiturate, non - opioid Mechanism of action distinct from acetaminophen and barbiturates Comparative pharmacokinetic and safety study to be conducted in 4Q 2014 TNX - 201 IND cleared by FDA in October 2014 Large Phase 2 efficacy study to begin in 1H 2015 23 TNX - 201 ( isometheptene mucate single isomer) is an Investigational New Drug and is not approved for any indication.

 
 

Intellectual property Composition - of - matter (eutectic) Patents filed Protection expected to 2034 Pharmacokinetics (PK) Patents filed Protection expected to 2033 Method - of - use Fibromyalgia: patents issued, 3Q 2020 expiry PTSD: patents filed TNX - 102 SL Fibromyalgia, PTSD TNX - 201 H eadache Composition - of - matter (isomer) Patents filed Protection expected to 2033 All IP wholly - owned by Tonix without obligations to others 24 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication.

 
 

Financial summary NASDAQ: TNXP Cash reported at June 30 , 2014* $ 43.9 million Net cash used in operations in 2Q14 $ 5.7 million Shares outstanding † 10.8 million * Does not include $7.2 million in net proceeds from stock offering in July 2014. 25 † As of October 27, 2014

 
 

Bruce Daugherty, PhD Chief Scientific Officer Seth Lederman, MD Chief Executive Officer Management team Leland Gershell, MD, PhD Chief Financial Officer Don Kellerman, PharmD SVP, Clinical Development & Regulatory Affairs 26

 
 

Milestones – recent and upcoming TNX - 102 SL – Fibromyalgia □ September 2014 – Reported top line results from Phase 2b BESTFIT study □ 1H 2015 – Begin Phase 3 program TNX - 102 SL – Post - Traumatic Stress Disorder □ June 2014 – Received IND clearance □ 4Q 2014 – Commence Phase 2 AtEase study in military - related PTSD TNX - 201 – Episodic Tension - Type Headache □ October 2014 – Received IND clearance □ 4Q 2014 – Commence and complete clinical pharmacology study □ 1H 2015 – Begin Phase 2 program x x x 27 TNX - 102 SL (cyclobenzaprine HCl sublingual tablet) 2.8 mg and TNX - 201 (isometheptene mucate single isomer) are Investigational New Drugs and are not approved for any indication.

 
 

October 2014 © 2014 Tonix Pharmaceuticals Holding Corp. NASDAQ: TNXP