Professional Documents
Culture Documents
Ohr Pharmaceutical
Initiating Coverage
March 2, 2015
We are initiating on Ohr with an Outperform and $25 PT. Our rating is predicated
on the potential for OHR-102 to be successfully developed in wet AMD. If it has a
competitive efficacy profile and is ultimately approved, our consultants suggest that
the vast majority of treated wet AMD patients will be on OHR-102 therapy as it has a
superior product profile relative to other development candidates.
Ken Cacciatore
646.562.1305
ken.cacciatore@cowen.com
Sal Rais, M.D.
646.562.1420
sal.rais@cowen.com
OHR-102 Could Become The First Eye Drop For The Treatment Of Wet AMD
Key Data
Symbol
NASDAQ: OHRP
52-Week Range:
$20.00 - 6.01
$195.3
$(13.2)
Cash/Share:
$0.52
33.5
NA
ROE (LTM):
NA
BV/Share:
$0.90
Dividend:
NA
FY (Sep)
2014A
Consultants Believe Early Visual Acuity Data Are Surprising And Intriguing
2015E
2016E
$(0.41)
$(1.00)
$(1.85)
NM
NM
NM
$0.0
$0.0
$0.0
The ongoing Phase II IMPACT study has enrolled 142 patients and is designed to
measure the impact of twice-daily OHR-102 on visual acuity in combination with
PRN Lucentis injections versus placebo drops plus PRN Lucentis. At interim (n=62),
the mean change in visual acuity at the end of 9 months for OHR-102 eye drops
plus Lucentis PRN was +10.4 letters versus +6.3 letters for placebo plus Lucentis
PRN a mean +4.1 letter improvement in visual acuity (p=0.18). Additionally, 48.3%
of OHR-102-treated patients showed BCVA gains of >3 lines (Phase III primary
endpoint confirmed with the FDA) compared with 21.2% in the placebo arm, which
was statistically significant (p=0.025). This result simply needs to be repeated to be
successful. Overall, our consultants suggest that the visual acuity results look very
much like Ophthotech's and the curves and outcomes look remarkably similar.
A Risk/Reward Play Skewed Towards The Upside
We assume a potential US OHR-102 approval and launch in early 2019 with a peak
penetration of treated wet AMD patients eligible for anti-PDGF treatment just above
35% by year 7, which assumes other PDGF competition. This results in a peak US
sales potential of $1B+. Ex-US, we assume an early 2020 launch and an ultimate peak
penetration of 25% by year 6-7 factoring in other PDGF competition. This results in
a peak Ex-US sales potential of $750MM+. Providing a necessary high discount rate
given the still early stage of development to these estimates yields an equity value of
$800MM+ or $25 per fully-diluted share, which is the basis of our price target. If the
final Phase II data are successful, our discount rate would correspondingly decrease
resulting in a higher equity value. Worth noting, our valuation does not give any credit
to OHR-102s follow-on indications of RVO, PVR, and DME, or the Alcon-partnered
sustained-release programs.
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Equity Research
Ohr Pharmaceutical
Equity Research
March 2, 2015
Forthcoming Catalysts
We assume a potential US OHR-102 approval and launch in early 2019 with a peak
penetration of treated wet AMD patients eligible for anti-PDGF treatment just above
35% by year 7, which assumes other PDGF competition. This results in a peak US
sales potential of $1B+. Ex-US, we assume an early 2020 launch and an ultimate peak
penetration of 25% by year 6-7 factoring in other PDGF competition. This results in
a peak Ex-US sales potential of $750MM+. Providing a necessary high discount rate
given the still early stage of development to these estimates yields an equity value of
$800MM+ or $25 per fully-diluted share, which is the basis of our price target. If the
final Phase II data are successful, our discount rate would correspondingly decrease
resulting in a higher equity value. Worth noting, our valuation does not give any credit
to OHR-102s follow-on indications of RVO, PVR, and DME, or the Alcon-partnered
sustained-release programs.
Upside Scenario
Downside Scenario
Price Performance
Company Description
$20
18
16
14
12
10
Ohr Pharmaceutical
8
6
May-14
Aug-14
Nov-14
Feb-15
Source: Bloomberg
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Ticker
Price (02/27/2015)
Price Target
Rating
OHRP
$7.69
$25.00
Outperform
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At A Glance
Ohr Pharmaceutical
Equity Research
March 2, 2015
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Ohr Pharmaceutical
Equity Research
March 2, 2015
number of injections a year, or better compliance as recent agents have largely failed
to meaningfully increase visual acuity in long-term studies. However, this dogma
appears to be changing with advent of anti-PDGF agents. PDGF agents in the case
of OHR-102 and Fovista have demonstrated significant visual acuity gains on top of
anti-VEGF treatments when used in combination. We would remind investors that for
wet AMD, a disease where patients ultimately lose their vision, increased visual acuity
is paramount. Ultimately, our consultants suggest that the vast majority of treated
AMD patients (2/3 and up) will want better visual acuity and therefore go on PDGF
treatment. Lastly, our consultants note that as many as 10-20% of their patients are
not adequately managed by the current anti-VEGF options, and therefore there is also
a need for more potent alternatives to help better manage the disease in refractory
patients
Consultants Believe Early OHR-102 Visual Acuity Data Are Surprising And
Intriguing; Final Phase II Data Due Mid-to-Late March
In June 2014, Ohr announced positive interim topline clinical results of a Phase II
study in wet AMD. Prior to the positive data release, few had any expectations for the
program much less an observed visual acuity benefit. However, since the data
which produced significant visual acuity benefits and our consultants believe is very
surprising and intriguing that perception has changed and we now approach the
final Phase II data readout in mid-to-late March with the expectation of a visual acuity
benefit. While there is still substantial risk to any wet AMD data readout, OHR-102
appears to have a strong possibility of repeating the interim data. If this occurs, not
only would the perception of the program be strengthened even more, but it would be
significantly de-risked as its head into Phase III with the exact same clinical endpoint.
The ongoing Phase II IMPACT study has enrolled 142 patients (completed in April
2014) and is designed to measure the impact of twice-daily OHR-102 on visual acuity
in combination with PRN (as needed) Lucentis versus placebo drops plus PRN
Lucentis. Per the study plan, a pre-specified interim analysis was conducted with
~50% of the planned total patient enrollment completing the study protocol. 62
patients 29 and 33 in the OHR-102 and placebo arms, respectively completed the 9
month treatment period at interim. Not surprisingly, the primary endpoint, the
difference in the frequency of Lucentis injections, did not meet statistical significance
at interim. Given our knowledge of PRN studies (no difference in year 2 of the VIEW
studies with Eylea/Lucentis) and the fact that no study has shown the ability to reduce
Lucentis injections including Ophthotechs Phase II program we were not
surprised by this result. Furthermore, the panelists at our March 2014 Health Care
Conference stated that a fewer injections endpoint largely isnt clinically relevant.
Thus, based on the data (6.2 Lucentis injections for the OHR-102 arm and 6.4 for the
placebo arm), we find it improbable that this endpoint will meet statistical significance
in the final data set nor do we care. Sure a reduction in injections would be an
improvement but ultimately what matters to clinicians is improving visual acuity.
However, when analysis was conducted on the more clinically relevant visual acuity
endpoints, the data suggested a strong visual acuity benefit across the two most
common endpoints mean visual acuity and the proportion of >3 line gainers. The
mean change in visual acuity at the end of 9 months for OHR-102 eye drops plus
Lucentis PRN was +10.4 letters versus +6.3 letters for placebo plus Lucentis PRN a
mean +4.1 letter improvement in visual acuity. Our consultants note that this 65%
visual acuity benefit is impressive, especially considering the potential ceiling effect for
enrolling a good amount of patients with relatively mild disease. However, it was not
statistically significant (p=0.18) given the small study size. With that in mind, our
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Since the interim readout, Ohr has met with the FDA and received confirmation that
the Phase III endpoint will be the proportion of patients with >3 line visual acuity
gains, which was the exact secondary endpoint that hit statistical significance at the
interim readout per above in only 62 patients. Moreover, our consultants suggest that
this endpoint also has a good chance of reaching statistical significance when the
larger, final 142-patient Phase II data set reads out by the end of March 2015 as the
data in 62 patients gives us a good feel for OHR-102s efficacy. One consultant
remarked that it would be shocking if the final data showed no visual acuity benefit
as the first 62 patients are very typical looking and he would put the odds of success
on the >3 line gainers endpoint pretty high. If it does, our consultants would also
consider the final Phase III program employing the exact same endpoint to be
significantly de-risked. In fact, they believe that upon a successful readout, OHR-102
would have the same probability of success in Phase III as Ophthotech which per
previous physician surveys has been pegged at around 75%. One consultant
believes that successful Phase II wet AMD results tend to have an 80% chance of
translating to Phase III. At the very least, we believe the early interim results suggest
that OHR-102 treats the back of the eye and may cause a significant increase in visual
acuity in wet AMD patients. Overall, our consultants suggest that the mean change in
visual acuity and >3 line gainer results look very much like Ophthotechs and the
curves and outcomes look remarkably similar. While some skepticism will always
remain through the final Phase III data, consultants appear to be looking at the
program very differently now following the interim data.
As we head towards the final results, it is also important to consider that while 62
patients wasnt enough to hit on the mean visual acuity endpoint, 142 patients with
the observed +4.1 letter increase in visual acuity is just reaching the boundary
where there might be enough powering to reach statistical significance, per our
consultants. Of course, a 300-400 patient study would be ideally powered, but the
potential to hit statistical significance on mean visual acuity in the final dataset is a
source of additional upside and would further help to dispel any skeptics. However, it
is important to keep in mind that even if mean visual acuity doesnt hit which could
be a perceived negative all that matters is that the >3 line gainers Phase III endpoint
hits.
Upon potential successful final Phase II data, Ohr has stated that they would be able
to initiate the Phase III program by the end of Q2:2015. We estimate that the time to
topline data could be 2-2.5 years accounting for 12-18 months of enrollment and the 9
month primary endpoint. 2.5 years would put the topline data readout at late 2017.
Since OHR-102 has Fast Track status, it could begin filing a rolling NDA submission
during the trial and then submit the final topline 9 month primary endpoint data last in
early 2018. In essence, Ohr could receive approval even before the ultimate 2 year
study time point just like Eylea. This would allow for a potential approval and launch
by early 2019. Lastly, we would note that this timeline could potentially be conservative
by 6 months.
For Europe, Ohr plans to meet with regulators soon to nail down the requirements for
the Phase III program. However, we would note that Ohr will be measuring the primary
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consultants note that it is still too early and in too few patients to believe that
OHR-102 wont reach statistical significance on visual acuity once the final data reads
out. Additionally, 48.3% of OHR-102-treated patients showed BCVA gains of >3 lines
(>15 letters) on a standard ETDRS eye chart compared with 21.2% in the placebo arm
(p=0.025) a statistically significant observation. Our consultants view both the mean
visual acuity and >3 line gain results as impressive particularly if they hold up when
the final data reads out in the second half of March.
Ohr Pharmaceutical
Equity Research
March 2, 2015
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endpoint out to 12 months in Phase III in case they require the standard 12 month
endpoint. Additionally, it will be a global trial with clinical sites in the US and EU. It is
quite possible that the EU submission could come shortly after the US submission, but
we conservatively assume a year delay in the European launch.
Ohr Pharmaceutical
Equity Research
March 2, 2015
2013A
2014A
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
U.S. We t A MD
Prevalence of moderate-advanced wet AMD pt.s ('000)
% diagnosed
# diagnosed patients ('000)
% of diagnosed pt.s Tx with anti-VEGFs
# treated patients ('000)
% growth
454
80%
361
95%
343
+6%
476
80%
381
96%
364
+6%
500
80%
400
96%
384
+6%
525
80%
420
96%
403
+5%
552
80%
441
96%
424
+5%
579
80%
463
96%
445
+5%
608
80%
486
96%
467
+5%
632
80%
506
96%
486
+4%
658
80%
526
96%
505
+4%
684
80%
547
96%
525
+4%
711
80%
569
96%
546
+4%
740
80%
592
96%
568
+4%
769
80%
615
96%
591
+4%
Avastin
% Avastin patient penetration
# patients receiving Avastin each year ('000)
Average # vials per patient per year
Avastin price per dose
U.S. A va s tin Sa le s In We t A MD ($MM)
26%
89
5.6
$50
$2 5
33%
120
5.5
$50
$3 5
37%
142
5.5
$50
$4 0
40%
161
5.5
$50
$4 5
40%
169
5.5
$50
$4 5
41%
182
5.5
$50
$5 0
42%
196
5.5
$50
$5 5
42%
204
5.5
$50
$5 5
42%
212
5.5
$50
$6 0
42%
221
5.5
$50
$6 0
42%
229
5.5
$50
$6 5
42%
239
5.5
$50
$6 5
42%
248
5.5
$50
$7 0
+757%
+40%
+14%
+13%
+0%
+11%
+10%
+0%
+9%
+0%
+8%
+0%
+8%
35%
120
5.6
$1,950
$1 ,3 1 0
23%
84
5.5
$1,950
$9 0 0
17%
65
5.5
$1,950
$7 0 0
16%
65
5.5
$1,950
$6 9 0
15%
64
5.5
$1,950
$6 8 0
15%
67
5.5
$1,950
$7 1 5
15%
70
5.5
$1,950
$7 5 0
15%
73
5.5
$1,950
$7 8 0
15%
76
5.5
$1,950
$8 1 5
15%
79
5.5
$1,950
$8 4 5
15%
82
5.5
$1,950
$8 8 0
15%
85
5.5
$1,950
$9 1 5
15%
89
5.5
$1,950
$9 5 0
+4%
-31%
-22%
-1%
-1%
+5%
+5%
+4%
+4%
+4%
+4%
+4%
+4%
39%
53%
134
5.4
$1,850
$1 ,3 3 4
44%
66%
160
5.2
$1,850
$1 ,5 4 0
46%
73%
177
5.2
$1,850
$1 ,7 0 0
45%
74%
182
5.2
$1,850
$1 ,7 4 5
45%
75%
191
5.2
$1,850
$1 ,8 3 5
44%
75%
196
5.2
$1,850
$1 ,8 8 0
43%
72%
201
5.2
$1,850
$1 ,9 3 0
43%
66%
209
5.2
$1,850
$2 ,0 1 0
43%
59%
217
5.2
$1,850
$2 ,0 9 0
43%
53%
226
5.2
$1,850
$2 ,1 7 5
43%
50%
235
5.2
$1,850
$2 ,2 6 0
43%
48%
244
5.2
$1,850
$2 ,3 5 0
43%
46%
254
5.2
$1,850
$2 ,4 4 5
+64%
+15%
+10%
+3%
+5%
+2%
+3%
+4%
+4%
+4%
+4%
+4%
+4%
66%
226
66%
240
66%
254
66%
266
66%
280
66%
294
66%
308
2%
6
11.0
$750
66%
321
8%
24
10.7
$750
66%
333
15%
50
10.5
$750
66%
347
23%
78
10.3
$750
66%
361
28%
99
10.0
$750
66%
375
32%
120
10.0
$750
66%
390
36%
140
10.0
$750
% growth
Lucentis
% Lucentis patient penetration
# patients receiving Lucentis each year ('000)
Average # vials per patient per year
Lucentis price per dose
U.S. Luc e ntis Sa le s In We t A MD ($MM)
% growth
Eylea
% Eylea patient penetration
% penetration of non-Avastin market
# patients receiving Eylea each year ('000)
Average # vials per patient per year
Eylea price per dose
U.S. Ey le a Sa le s In We t A MD ($MM)
% growth
OHR-1 0 2
% treated patients eligible for anti-PDGF treatment
# treated patients eligible for anti-PDGF treatment ('000)
% OHR-102 patient penetration
# patients receiving OHR-102 each year ('000)
Average # bottles per patient per year
OHR-102 price per dose
U.S. OHR-1 0 2 Sa le s In We t A MD ($MM)
$5 0
% gr ow th
$1 9 5
$3 9 5
$6 0 0
$7 4 5
$9 0 0
+2 9 0 %
+1 0 3 %
+5 2 %
+2 4 %
+2 1 %
2 0 2 5 E 5 Y CG R Com m e nts
$1 ,0 5 5
$1,310
$900
$700
$690
$680
$715
$750
$780
$815
$845
$880
$915
$950
% growth
Eylea Sales ($MM)
+4%
$1,334
-31%
$1,540
-22%
$1,700
-1%
$1,745
-1%
$1,835
+5%
$1,880
+5%
$1,930
+4%
$2,010
+4%
$2,090
+4%
$2,175
+4%
$2,260
+4%
$2,350
+4%
$2,445
+64%
+15%
+10%
+3%
+5%
+2%
+3%
$50
+4%
$195
+4%
$395
+4%
$600
+4%
$745
+4%
$900
+4%
$1,055
% growth
T OT A L U.S. WET A MD SA LES ($MM)
% gr ow th
+2%
+3% - Ma r k e t le a de r
+1 7 %
U.S. We t A MD
Lucentis Sales ($MM)
% growth
OHR-102 Sales ($MM)
$2 ,6 4 4
$2 ,4 4 0
$2 ,4 0 0
$2 ,4 3 5
$2 ,5 1 5
$2 ,5 9 5
$2 ,7 3 0
+290%
$2 ,9 8 5
+103%
$3 ,3 0 0
+52%
$3 ,6 2 0
+24%
$3 ,8 8 5
+21%
$4 ,1 6 5
+17%
$4 ,4 5 0
+2 7 %
-8 %
-2 %
+1 %
+3 %
+3 %
+5 %
+9 %
+1 1 %
+1 0 %
+7 %
+7 %
+7 %
+2%
+3%
+78% - Assumes PDGF competition
+ 4%
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Ohr Pharmaceutical
Equity Research
March 2, 2015
2013A
2014E
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
Ex-U.S. We t A MD
Prevalence of moderate-advanced wet AMD pt.s ('000)
% diagnosed
# diagnosed patients ('000)
% of diagnosed pt.s Tx with anti-VEGFs
# treated patients ('000)
% growth
681
80%
541
95%
514
+6%
715
80%
572
96%
546
+6%
750
80%
600
96%
576
+6%
788
80%
630
96%
605
+5%
827
80%
662
96%
635
+5%
869
80%
695
96%
667
+5%
912
80%
730
96%
700
+5%
949
80%
759
96%
728
+4%
986
80%
789
96%
758
+4%
1,026
80%
821
96%
788
+4%
1,067
80%
854
96%
819
+4%
1,110
80%
888
96%
852
+4%
1,154
80%
923
96%
886
+4%
Avastin
% Avastin patient penetration
# patients receiving Avastin each year ('000)
Average # vials per patient per year
Avastin price per dose
Ex-U.S. A va s tin Sa le s In We t A MD ($MM)
55%
282
5.6
$50
$7 9
48%
262
5.5
$50
$7 0
44%
254
5.5
$50
$7 0
43%
260
5.5
$50
$7 0
43%
273
5.5
$50
$7 5
43%
287
5.5
$50
$8 0
43%
301
5.5
$50
$8 5
43%
313
5.5
$50
$8 5
43%
326
5.5
$50
$9 0
43%
339
5.5
$50
$9 5
43%
352
5.5
$50
$9 5
43%
366
5.5
$50
$1 0 0
43%
381
5.5
$50
$1 0 5
-11%
-11%
+0%
+0%
+7%
+7%
+6%
+0%
+6%
+6%
+0%
+5%
+5%
38%
195
5.6
$1,950
$2 ,1 3 3
36%
197
5.5
$1,950
$2 ,1 1 0
34%
196
5.5
$1,950
$2 ,1 0 0
32%
194
5.5
$1,950
$2 ,0 7 5
30%
191
5.5
$1,950
$2 ,0 4 5
29%
193
5.5
$1,950
$2 ,0 7 5
28%
196
5.5
$1,950
$2 ,1 0 5
27%
197
5.5
$1,950
$2 ,1 1 0
26%
197
5.5
$1,950
$2 ,1 1 5
25%
197
5.5
$1,950
$2 ,1 1 5
24%
197
5.5
$1,950
$2 ,1 1 0
23%
196
5.5
$1,950
$2 ,1 0 0
22%
195
5.5
$1,950
$2 ,0 9 0
+10%
-1%
-0%
-1%
-1%
+1%
+1%
+0%
+0%
+0%
-0%
-0%
-0%
7%
16%
37
5.4
$1,850
$3 7 0
16%
31%
87
4.7
$1,850
$7 6 0
22%
39%
127
4.3
$1,850
$1 ,0 1 0
25%
44%
151
4.3
$1,850
$1 ,2 0 5
27%
47%
172
4.3
$1,850
$1 ,3 6 5
28%
49%
187
4.3
$1,850
$1 ,4 8 5
29%
51%
203
4.3
$1,850
$1 ,6 1 5
30%
52%
219
4.3
$1,850
$1 ,7 4 0
31%
49%
235
4.3
$1,850
$1 ,8 7 0
32%
46%
252
4.3
$1,850
$2 ,0 0 5
33%
44%
270
4.3
$1,850
$2 ,1 5 0
34%
43%
290
4.3
$1,850
$2 ,3 0 5
35%
43%
310
4.3
$1,850
$2 ,4 7 0
+1847%
+105%
+33%
+19%
+13%
+9%
+9%
+8%
+7%
+7%
+7%
+7%
+7%
66%
339
66%
360
66%
380
66%
399
66%
419
66%
440
66%
462
66%
481
1%
5
11.0
$500
$2 5
66%
500
6%
30
10.8
$500
$1 6 0
66%
520
13%
65
10.5
$500
$3 4 0
66%
541
18%
97
10.3
$500
$5 0 0
66%
562
22%
124
10.0
$500
$6 2 0
66%
585
25%
146
10.0
$500
$7 3 0
+5 4 0 %
+1 1 3 %
+4 7 %
+2 4 %
+1 8 %
% growth
Lucentis
% Lucentis patient penetration
# patients receiving Lucentis each year ('000)
Average # vials per patient per year
Lucentis price per dose
Ex-U.S. Luc e ntis Sa le s In We t A MD ($MM)
% growth
Eylea
% Eylea patient penetration
% penetration of non-Avastin market
# patients receiving Eylea each year ('000)
Average # vials per patient per year
Eylea price per dose
Ex-U.S. Ey le a Sa le s In We t A MD ($MM)
% growth
OHR-1 0 2
% treated patients eligible for anti-PDGF treatment
# treated patients eligible for anti-PDGF treatment ('000)
% OHR-102 patient penetration
# patients receiving OHR-102 each year ('000)
Average # bottles per patient per year
OHR-102 price per dose
Ex-U.S.OHR-1 0 2 Sa le s In We t A MD ($MM)
% gr ow th
Ex-U.S. We t A MD
Lucentis Sales ($MM)
% growth
Eylea Sales ($MM)
% growth
OHR-102 Sales ($MM)
% growth
T OT A L Ex-U.S. WET A MD SA LES ($MM)
% gr ow th
2 0 2 5 E 5 Y CG R Com m e nts
+ 0% - Ma r k e t le a de r
+ 11%
$2,110
$2,100
$2,075
$2,045
$2,075
$2,105
$2,110
$2,115
$2,115
$2,110
$2,100
$2,090
+0%
+10%
$370
-1%
$760
-0%
$1,010
-1%
$1,205
-1%
$1,365
+1%
$1,485
+1%
$1,615
+0%
$1,740
+0%
$1,870
+0%
$2,005
-0%
$2,150
-0%
$2,305
-0%
$2,470
+11%
+1847%
+105%
+33%
+19%
+13%
+9%
+9%
+8%
$25
$2 ,5 0 3
$2 ,8 7 0
$3 ,1 1 0
$3 ,2 8 0
$3 ,4 1 0
$3 ,5 6 0
$3 ,7 2 0
$3 ,8 7 5
+7%
$160
+7%
$340
+7%
$500
+7%
$620
+7%
$730
+540%
$4 ,1 4 5
+113%
$4 ,4 6 0
+47%
$4 ,7 6 0
+24%
$5 ,0 2 5
+18%
$5 ,2 9 0
+15%
+8%
+5%
+4%
+4%
+4%
+4%
+7%
+8%
+7%
+6%
+5%
W.W. We t A MD
Lucentis Sales ($MM)
$3,443
$3,010
$2,800
$2,765
$2,725
$2,790
$2,855
$2,890
$2,930
$2,960
$2,990
$3,015
$3,040
% growth
Eylea Sales ($MM)
+7%
$1,704
-13%
$2,300
-7%
$2,710
-1%
$2,950
-1%
$3,200
+2%
$3,365
+2%
$3,545
+1%
$3,750
+1%
$3,960
+1%
$4,180
+1%
$4,410
+1%
$4,655
+1%
$4,915
% growth
OHR-102 Sales ($MM)
+105%
+35%
+18%
+9%
+8%
+5%
+5%
$50
+6%
$220
+6%
$555
+6%
$940
+6%
$1,245
+6%
$1,520
+6%
$1,785
+340%
$6 ,8 6 0
+152%
$7 ,4 4 5
+69%
$8 ,0 8 0
+32%
$8 ,6 4 5
+22%
$9 ,1 9 0
+17%
$9 ,7 4 0
+6%
+9%
+9%
+7%
+6%
+6%
% gr ow th
$2,133
+27%
% growth
T OT A L W.W. WET A MD SA LES ($MM)
$5 ,1 4 7
+27%
$5 ,3 1 0
+3%
$5 ,5 1 0
+4%
$5 ,7 1 5
+4%
$5 ,9 2 5
+4%
$6 ,1 5 5
+4%
$6 ,4 5 0
+5%
+1%
+7%
+98% - Assumes PDGF competition
+ 4%
For our DCF valuation, we included the peak sales potentials from above and assumed
gross margins of 90%+. We also assumed the Phase III program will cost $75MM and
include SG&A expense within the range of normal industry standards. We expect that
Ohr will begin hiring commercial employees in mid-2016 and hire an initial OHR-102
US sales force of 50 reps upon approval, which will be later expanded. Similar
assumptions are made for an EU launch, although we suspect that Ohr may look to
partner Ex-US, similarly to the Fovista/Novartis deal, which resulted in ~$1B in
potential milestones and royalties on Ex-US sales. Providing a necessary high discount
rate given the still early stage of development to these estimates yields in an equity
value of $800MM+ or $25 per fully-diluted share, which is the basis of our price
target. If the final Phase II data are successful, our discount rate would
correspondingly decrease resulting in a higher equity value. Additionally, OHR-102 is
the only late-stage, unpartnered anti-PDGF program and we expect it to receive a lot
of interest from large ophthalmology players if the results are successful in March. Put
simply, as OHR-102 moves through the clinic, we expect the valuation gap between
OHRP and OPHT (~$1.6B currently) will narrow. We also note that our valuation does
not give any credit to OHR-102s follow-on indications of RVO, PVR, or DME or the
Alcon-partnered sustained-release programs.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
On the following pages, we provide our Ohr Pharma annual P&L and DCF.
This report is intended for world-cowen-morningnotesdistribution@cowen.com. Unauthorized redistribution of this report is prohibited.
2014
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
2025E
$50.0
$195.0
$395.0
$600.0
$745.0
$900.0
$1,055.0
+290%
+103%
+52%
+24%
+21%
+17%
$25.0
$160.0
$340.0
$500.0
$620.0
$730.0
$ 220. 0
$ 555. 0
5YR C GR C om m ent s
O HR- 102
U.S. Wet AMD Sales ($MM)
% Growth
Ex-U.S. Wet AMD Sales ($MM)
% Growth
Tot al O hr Rev enues
+540%
NM
NM
NM
NM
NM
+ 340%
+ 152%
+ 69%
+ 32%
+ 22%
+ 17%
$0.0
$0.0
$0.0
$0.0
$5.0
$22.0
$50.0
$84.6
$99.6
$121.6
$125.0
Gross Profit
$0.0
$0.0
$0.0
$0.0
$0.0
$45.0
$198.0
$505.1
$855.4
$1,145.4
$1,398.4
$1,660.1
NM
NM
NM
NM
NM
90.0%
90.0%
91.0%
91.0%
92.0%
92.0%
93.0%
$5.1
$7.5
$15.0
$20.0
$25.0
$50.0
$90.0
$150.0
$240.0
$290.0
$340.0
$390.0
% of Revs
% of Revs
$ 940. 0
$ 1, 245. 0
$ 1, 520. 0
$ 1, 785. 0
NM
NM
NM
NM
NM
100.0%
40.9%
27.0%
25.5%
23.3%
22.4%
21.8%
$4.0
$20.0
$40.0
$30.0
$20.0
$15.0
$15.0
$10.0
$10.0
$10.0
$10.0
$10.0
NM
NM
NM
NM
NM
30.0%
6.8%
1.8%
1.1%
0.8%
0.7%
0.6%
$9.1
$27.5
$55.0
$50.0
$45.0
$65.0
$105.0
$160.0
$250.0
$300.0
$350.0
$400.0
NM
NM
NM
NM
NM
130.0%
47.7%
28.8%
26.6%
24.1%
23.0%
22.4%
($9.1)
($27.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
NM
NM
NM
NM
NM
NM
42.3%
62.2%
64.4%
67.9%
69.0%
70.6%
Interest Income
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
Interest Expense
(0.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Other Income
(0.0)
(2.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Non-Operating Income
($0.0)
($2.0)
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
Pretax Income
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
NM
NM
NM
NM
NM
NM
42.3%
62.2%
64.4%
67.9%
69.0%
70.6%
$32.6
$120.8
$211.9
$295.9
$366.9
$441.0
35.0%
35.0%
35.0%
35.0%
35.0%
35.0%
Operating Expenses
% of Revs
Operating Income
% Operating Margin
+18%
$0.0
R&D
$ 50. 0
+24%
C ost of Goods
SG&A
$ 0. 0
+47%
$ 0. 0
Gross Margin
$ 0. 0
+113%
$ 0. 0
% Grow t h
$ 0. 0
- Final Phase II data by end of March; Potential Q2:2015 Phase III start
+ 98% - Rapid upt ake ex pect ed; assum es P DGF com pet it ion
+31%
NM
Non-Operating Income
% of Revs
Income Taxes
Income Tax Rate
Net Income - Operations
% Net Margin
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$224.3
$393.5
$549.5
$681.5
$819.0
NM
NM
NM
NM
NM
NM
27.5%
40.4%
41.9%
44.1%
44.8%
45.9%
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$224.3
$393.5
$549.5
$681.5
$819.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
($ 0. 41)
($ 1. 00)
($ 1. 85)
($ 1. 60)
($ 1. 40)
($ 0. 60)
$ 1. 80
$ 6. 40
$ 10. 95
$ 14. 85
$ 17. 95
$ 21. 00
NM
NM
NM
NM
NM
NM
NM
+256%
NM
NM - Assumes no NOLs
- Standard U.S. corporate tax rate
NM
Extraordinary Items
Adjusted Net Income
Interest Add-Back
E P S (N on- GAAP ) - B ef ore E x . It em s
% Growth
EPS - Extraordinary Items
EPS - Adjusted
Shares Outstanding (MM)
+71%
36%
21%
NM
17%
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
($0.41)
($1.00)
($1.85)
($1.60)
($1.40)
($0.60)
$1.80
$6.40
$10.95
$14.85
$17.95
$21.00
22.1
29.0
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
39.0
NM
+3% - Aassuming some onward dilution from options
www.cowen.com
Ohr Pharmaceutical
Equity Research
March 2, 2015
Assumptions:
Output:
Increase in WC
Discount Rate
$829.1
19.5% E s t. Sha r e Pr i ce
$2 5 .0
33.5 Debt
$0.0
Cash
$35.0
Enterprise Value
Notes:
Netted $26-27MM from Feb 11 offering
Burned ~$2.8MM Q1; expected to be higher in Q2
$794.1
Total Revenues
% Change
Cost of Goods
Gross Profit
Gross Margin - Total
SG&A
% of Revs
R&D
% of Revs
Operating Expenses
2014
2015E
2016E
2017E
2018E
2019E
$0.0
$0.0
$0.0
$0.0
$0.0
$50.0
NM
-50%
+0%
$125.0
$142.8
$159.3
$175.0
$149.8
$87.5
$38.5
$14.0
$7.0
$7.0
$7.0
$0.0
$0.0
$0.0
$0.0
$0.0
$45.0
$198.0
$505.1
$855.4
$1,145.4
$1,398.4
$1,660.1
$1,897.2
$2,115.8
$2,325.0
$1,990.2
$1,162.5
$511.5
$186.0
$93.0
$93.0
$93.0
93.0%
93.0%
93.0%
93.0%
$50.0
$25.0
$20.0
$20.0
NM
$4.0
NM
$9.1
NM
$20.0
NM
$27.5
NM
$40.0
NM
$55.0
NM
$30.0
NM
$50.0
NM
$20.0
NM
$45.0
90.0%
$50.0
$90.0
100.0%
40.9%
27.0%
25.5%
23.3%
22.4%
21.8%
21.1%
20.9%
20.0%
21.0%
20.0%
22.7%
25.0%
25.0%
20.0%
20.0%
$15.0
$15.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$7.5
$5.0
$5.0
$5.0
$5.0
1.4%
2.5%
5.0%
5.0%
30.0%
$65.0
6.8%
$105.0
NM
NM
NM
NM
NM
130.0%
47.7%
($9.1)
($27.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
NM
NM
NM
NM
NM
NM
(0.0)
(2.0)
0.0
0.0
0.0
0.0
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
NM
NM
NM
NM
NM
NM
Adjusted EBIT
% of Revs
42.3%
1.8%
$160.0
28.8%
$345.1
62.2%
$240.0
1.1%
$250.0
26.6%
$605.4
64.4%
$290.0
0.8%
$300.0
24.1%
$845.4
67.9%
$340.0
0.7%
$350.0
23.0%
$1,048.4
69.0%
$390.0
0.6%
$400.0
22.4%
$1,260.1
70.6%
93.0%
$430.0
0.5%
$440.0
21.6%
$1,457.2
71.4%
93.0%
$475.0
0.4%
$485.0
21.3%
$1,630.8
71.7%
93.0%
$500.0
0.4%
$510.0
20.4%
$1,815.0
72.6%
93.0%
$450.0
0.5%
$460.0
21.5%
$1,530.2
71.5%
93.0%
$250.0
0.8%
$260.0
20.8%
$902.5
72.2%
93.0%
$125.0
$132.5
24.1%
$379.0
68.9%
5.0%
$55.0
$30.0
$25.0
$25.0
27.5%
30.0%
25.0%
25.0%
$63.0
$68.0
$68.0
63.0%
68.0%
68.0%
$131.0
65.5%
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
$1,457.2
$1,630.8
$1,815.0
$1,530.2
$902.5
$379.0
$131.0
$63.0
$68.0
$68.0
65.5%
63.0%
68.0%
68.0%
$45.9
$22.1
$23.8
$23.8
35.0%
35.0%
35.0%
35.0%
$85.2
$41.0
$44.2
$44.2
($3.0)
($3.0)
($3.0)
($3.0)
42.3%
Taxes
$32.6
35.0%
NOPAT
$150.0
93.0%
+0%
90.0%
% of Revenues
Other Income
2035E
$100.0
$121.6
Operating Income
% Operating Margin
2034E
$100.0
$99.6
92.0%
-64%
2033E
$100.0
+32%
92.0%
-56%
2032E
$200.0
$84.6
91.0%
-42%
2031E
$550.0
+69%
91.0%
-14%
2030E
$1,250.0
$50.0
NM
+10%
2029E
$2,140.0
+152%
$25.0
+12%
2028E
$2,500.0
$22.0
NM
+14%
2027E
$2,275.0
+340%
$20.0
+17%
2026E
$2,040.0
$5.0
NM
+22%
2025E
$1,785.0
$0.0
$15.0
NM
2024E
$1,520.0
$0.0
NM
NM
2023E
$1,245.0
$0.0
$7.5
NM
2022E
$940.0
$0.0
NM
NM
2021E
$555.0
$0.0
$5.1
NM
2020E
$220.0
62.2%
$120.8
35.0%
$224.3
64.4%
$211.9
35.0%
$393.5
67.9%
$295.9
35.0%
$549.5
69.0%
$366.9
35.0%
$681.5
70.6%
$441.0
35.0%
$819.0
71.4%
$510.0
35.0%
$947.2
71.7%
$570.8
35.0%
$1,060.0
72.6%
$635.3
35.0%
$1,179.8
71.5%
$535.6
35.0%
$994.6
72.2%
$315.9
35.0%
$586.6
68.9%
$132.7
35.0%
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$246.4
Capex
($0.1)
($0.3)
($0.5)
($1.0)
($2.0)
($3.0)
($3.0)
($0.5)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
$3.4
$5.0
$2.5
$0.0
($5.0)
($10.0)
($10.5)
($11.0)
($11.6)
($12.2)
($12.8)
($13.4)
($14.1)
($14.8)
($15.5)
($16.3)
($17.1)
($18.0)
($18.9)
($19.8)
($20.8)
($21.8)
($6.3)
($25.8)
($54.0)
($52.0)
($53.0)
($34.0)
$46.0
$209.3
$377.9
$533.4
$664.7
$801.6
$929.1
$974.3
$565.5
$224.4
$62.3
$17.2
$19.4
$18.4
Adjustments:
Terminal
($3.0)
($3.0)
10
www.cowen.com
($3.0)
($3.0)
($3.0)
($3.0)
($3.0)
$1,041.2
($3.0)
$1,160.2
($3.0)
($3.0)
($3.0)
$94.21
This report is intended for world-cowen-morningnotesdistribution@cowen.com. Unauthorized redistribution of this report is prohibited.
Ohr Pharmaceutical
Equity Research
March 2, 2015
OHR-102 Has The Potential To Be The First Topical Eye Drop For Retinal
Disease
Our consultants believe that despite previous
topical failed programs for wet AMD, it will only
be a matter of time before a drop potent enough
is found with the right dosage that reaches the
retina. We believe Ohrs OHR-102 (squalamine)
might be the one.
Our consultants believe that despite previous topical failed programs for wet AMD, it
will only be a matter of time before an eye drop potent enough is found with the right
dosage that reaches the retina. We believe Ohrs OHR-102 (squalamine) might be the
one. OHR-102 is a first-in-class molecule anti-angiogenic compound that inhibits
multiple growth factors: vascular endothelial growth factor (VEGF), platelet-derived
growth factor (PDGF), and basic fibroblast growth factor (bFGF). VEGF is a signaling
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Ohr Pharmaceutical
Equity Research
March 2, 2015
The OHR-102 eye drop formulation 0.2% squalamine lactate has emollient
properties to soothe the ocular surface, which results in increased comfort for
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Ohr Pharmaceutical
Equity Research
March 2, 2015
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patients, particularly in the elderly patient population which is the vast majority of wet
AMD patients. Moreover, OHR-102 has been shown to have improved residence time
on the ocular surface along with minimized uptake into the aqueous humor.
Additionally, OHR-102 has demonstrated trans-scleral permeability into the choroid
with increased retention time in the posterior sclera/choroid. The sclera is known as
the white of the eye and it is the opaque, fibrous, protective outer layer of the eye. Just
inside that is the choroid, which is the vascular layer of the eye, contains connective
tissue, and lies between the retina and the sclera. Hence, OHR-102 has been shown
penetrate the tissue immediate to the retina, which is the primary target of treatment
for wet AMD and other retinal diseases.
Ohr Pharmaceutical
Equity Research
March 2, 2015
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Ohr Pharmaceutical
Equity Research
March 2, 2015
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We acknowledge that despite this data, many are still skeptical on the ability for drops
to get to the back of the eye. We believe this is largely because previous topical wet
AMD eye drop programs including GSKs pazopanib or Votrient have failed.
Additionally, there was an old IV formulation of squalamine that was terminated in wet
AMD, but this was due to its short half-life, which didnt provide adequate coverage
when dosed weekly, and the systemic dosing, which led to subtherapeutic drug levels
in the eye and systemic safety concerns. With that said, the IV formulation did show a
dose response and positive visual and anatomical benefits. Per the data above, OHR102 is clearly not systemic and certainly has an adequate coverage of 24 hours.
Whether or not investors believe eye drops can reach the back of the eye, the clinical
data with OHR-102 should ultimately win out and put this controversy to bed and we
believe that the interim data was a solid start in the right direction.
Ohr Pharmaceutical
Equity Research
March 2, 2015
Upon onset of macular degeneration, many people have trouble adjusting quickly
between bright sunlight or dim light or shadows. This may be especially dangerous
when driving in bright sunlight and then entering the shade or vice versa. Whereas a
normal retina takes 3-5 minutes to adjust from bright light to dim (when entering a
movie theater, for example), a person with macular degeneration may take 8-12
minutes or longer.
Figure 11 The Progression Of Wet AMD
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Etiology Of AMD Not Well Understood, But VEGF Is Clearly An Important Player
There Are Three Categories Of Wet AMD: Occult, Minimally Classic, and Classic
Based on the appearance of the blood vessels at the back of the eye when visualized
using fluorescein angiography, wet AMD can be subdivided into predominantly classic
(25%), minimally classic (35%) and occult (40%). In predominantly classic choroidal
neovascularization (CNV), greater than 50% of the neovascular AMD lesions can be
clearly defined, and this is generally regarded as the most aggressive subtype. In
minimally classic choroidal neovascularization, 1% to 50% of the neovascular AMD
lesions can be clearly defined, and this is generally regarded as the intermediate
subtype in terms of progression. In occult choroidal neovascularization, none of the
neovascular lesions can be clearly defined, and this is generally regarded as being the
least aggressive subtype. It is helpful to think of the AMD lesion as an expanding
vascular membrane which penetrates into an area underneath the retina. Angiography
lights up the blood vessels in this membrane, and physicians use the angiogram to
discern the outline of the membrane. However, leakage of dye from these blood
vessels can obscure a physicians ability to clearly see the membrane, and the extent
to which this visibility is obscured determines its classification. While it is important to
identify lesion subtypes to determine potential eligibility for photodynamic therapy
with Visudyne, the intra-vitreous anti-VEGF therapies have utility across wet AMD
subtypes, making differentiation less critical.
The Wet AMD Treatment Paradigm Has And Is Expected To Continue To Evolve
Rapidly
Current treatment methodologies for wet AMD include three options: anti-VEGF
therapy, photodynamic therapy (PDT), and laser photocoagulation. Retina specialists
are quick to adopt new therapies, often before they have undergone rigorous clinical
testing or have received FDA approval. The wet AMD treatment paradigm therefore
evolves rapidly and sometimes unexpectedly.
The First Wave Of AMD Treatment Used Lasers
Until March 2000, the only primary treatment for neovascular wet AMD was laser
coagulation. This technique involves the use of a strong light source targeted on
extrafoveal and juxtafoveal CNV lesions to coagulate the diseased tissue. The laser
produces a thermal effect within the lesion that causes necrosis of its cellular
components. In the 1980s, the National Eye Institute conducted the Macular
Degeneration Photocoagulation Studies (MPS), and the results demonstrated that
photocoagulation of well-demarcated CNV membranes effectively prevented large
decreases in visual acuity compared with observation for CNV. However, the thermal
effect of the laser can damage viable photoreceptor cells, resulting in retinal scarring
and loss of visual acuity. As such, use of laser coagulation in the current practice
setting is rare, as superior treatment options discussed below have emerged.
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Any number of factors, including genetics, age, race, gender, menopause, nutrition,
smoking, and exposure to sunlight, may cause AMD. Based on the original striking
results from pan-VEGF inhibition therapy with Roches Lucentis, it is clear that VEGF is
an important driver of new blood vessel formation in the retina and conversion from
dry to wet AMD. Research is ongoing to identify additional molecules that drive the
wet AMD process and to better understand the pathophysiologic processes that result
in VEGF overexpression.
Ohr Pharmaceutical
Equity Research
March 2, 2015
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In June 2011, the FDAs Dermatologic and Ophthalmic Drugs Advisory Committee
voted unanimously in favor of approving Eylea for wet AMD at a dose of 2mg Q8W,
following three initial doses given monthly. The panel was benign with no real points
of contention. After a minor hiccup in which the PDUFA date was pushed back due to
clarifying questions from the FDA regarding the CMC section, Eylea was FDA
approved in November 2011. In line with the panels conclusions, Eyleas
recommended dose is 2mg Q8W, following three initial loading doses given monthly.
In turn, the growth of Regenerons Eylea is the most recent example of the rapid
market transformation in this market and has expanded upon advances made by the
earlier agents by offering a less frequent injection schedule (every 8 weeks vs. every 4
weeks). Following the success of anti-VEGF therapies Lucentis, Eylea, and Avastin, the
most effective treatment for wet AMD is acknowledged to be angiogenesis inhibition.
Given its vascular and progressive nature, AMD thrives on new blood vessel growth.
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Visudyne was originally approved in 2000 and was most recently acquired by Valeant
(from QLT) in September 2012 for $125MM suggesting that its use is very limited.
Visudyne is a photosensitizer that attaches to lipoproteins, which tend to accumulate
in rapidly proliferating cells. Visudyne traps energy from light and converts oxygen in
cells to a highly energized state that results in cell death. Visudyne therefore must be
activated at the site of desired effect by light. Photodynamic therapy (PDT) with
Visudyne consists of administering the light-activated drug by intravenous infusion
and then shining a light to the back of the eye to activate Visudyne in the retina.
Clinicians must therefore purchase the machinery to administer the light (up to $40K
in fixed costs), and hire personnel to administer the intravenous infusion. Therapy is
repeated every three months if patients continue to have active lesions, and our
consultants estimate that, on average, patients receive three to four treatments before
the CNV lesion is converted to a quiescent scar. Side effects of Visudyne include
transient skin sensitivity to bright light, acute onset and transient back pain, and
rarely, acute visual deterioration, which may not be reversible. Successful pan-VEGF
therapies Lucentis, Avastin, and Eylea have since significantly eroded Visudynes
commercial presence.
Ohr Pharmaceutical
Equity Research
March 2, 2015
Over the past 1-2 years, surveyed physicians believe that the number of wet AMD
patients in their practice has grown modestly by 5-10% and that approximately 50% of
patients are treated with Roches Avastin. The physician panelists believe that the slow
increase in wet AMD patients is due to the chronic nature of the disease. Additionally,
the amount of Avastin use depends on the size of the practice as larger groups are
more familiar with billing and will therefore use more Avastin (perhaps more than
50%), while smaller private groups may be closer to using Avastin in 25% of patients.
Avastin substitution has and continues to be a barrier to Lucentiss commercial
success in the U.S. Compounding pharmacies reconstitute the significantly cheaper
Avastin ($50 versus just under $2000 a dose) for intraocular injection despite its lack
of FDA approval for AMD. However, the current main competition is from Eylea, which
our Biotech team estimates will reach approximately $2.2B and $2.8B in 2015 and 2019
U.S. sales, respectively. In the U.S., our Pharma team estimates Lucentis sales of $1.7B
in 2015, decreasing to $1.5B in 2019 due to increased competition and as U.S. patents
begin to expire. Our Pharma team estimates ex-U.S. Lucentis sales of $2.5B in 2015,
declining to $1.8B in 2019 as the ex-US patents expire and competition continues to
increase.
Combination Therapy With Anti-PDGFs To Come Next For Retinal Disease
Fovista, an anti-PDGF aptamer, is the PDGF program that is furthest along in clinical
development. It is used in combination with anti-VEGF therapy (rather than in place of
it). OHR-102 due to potentially enter Phase III by the end of H1:2015 upon successful
final Phase II data is the second drug furthest along in clinical development and is
catching up to Fovista quickly. Allergan/Molecular Partners and Regeneron also have
PDGF programs, but they are much earlier-stage than Fovista and OHR-102. AntiVEGFs have revolutionized the treatment of wet AMD, but they produce most of their
improvement in about 4 months and then there is a plateau in efficacy. Moreover,
patients must be continuously dosed with frequent anti-VEGF to maintain the plateau;
data from several large trials were shown to suggest that switching from monthly
dosing to PRN results in a loss of efficacy. The biological explanation for this may be
that anti-VEGFs cause regression of tip cells at the distal end of neovascularization,
but the bulk of the vessel outgrowths are protected from the anti-VEGF by a lining of
pericytes. Anti-PDGF agents, in combination with the anti-VEGFs, denude the
overgrown vessels of pericytes and cause regression of the outgrowth. Current
development of anti-VEGF agents is aimed at extending the duration of treatment
thereby allowing for a fewer number of injections a year, or better compliance as
recent agents have largely failed to meaningfully increase visual acuity in long-term
studies. However, this dogma appears to be changing with advent of anti-PDGF
agents. PDGF agents in the case of Fovista and OHR-102 have demonstrated
significant visual acuity gains on top of anti-VEGF treatments when used in
combination. For wet AMD, a disease where patients ultimately lose their vision,
increased visual acuity is paramount. Ultimately, our consultants suggest that the vast
majority of treated AMD patients (2/3 and up) will want better visual acuity and
therefore go on PDGF treatment. Lastly, our consultants note that as many as 10-20%
of their patients are not adequately managed by the current anti-VEGF options, and
therefore there is also a need for more potent alternatives to help better manage the
disease in refractory patients.
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By blocking the development of new blood vessels, supply of oxygen and nutrients is
cut off and, therefore, the diseases proliferation throughout the back of the eye.
Ohr Pharmaceutical
Equity Research
March 2, 2015
In June 2014, Ohr announced positive interim topline clinical results of a Phase II
study in wet AMD. Prior to the positive data release, few had any expectations for the
program much less an observed visual acuity benefit. However, since the data
which produced significant visual acuity benefits and our consultants believe is very
surprising and intriguing that perception has changed and we now approach the
final Phase II data readout in mid-to-late March with expectations of a visual acuity
benefit. While there is still substantial risk to any wet AMD data readout, OHR-102
appears to have a strong possibility of repeating the interim data. If this occurs, not
only would the perception of the program be strengthened even more, but it would be
significantly de-risked as it heads into Phase III with the same exact clinical endpoint.
Upon potential successful final Phase II data, Ohr has stated that they would be able
to initiate the Phase III program by the end of Q2:2015. We estimate that the time to
topline data could be 2-2.5 years accounting for 12-18 months of enrollment and the 9
month primary endpoint. 2.5 years would put the topline data readout at late 2017.
Since Ohr has Fast Track status, it could begin filing a rolling NDA submission during
the trial and then submit the final topline 9 month primary endpoint data in early 2018.
In essence, Ohr could receive approval even before the final 2-year study time point
just like Eylea. This would allow for a potential approval and launch by early 2019.
Lastly, we would note that this timeline could potentially be conservative by 6 months.
For Europe, Ohr plans to meet with regulators soon to nail down the requirements for
the Phase III program. However, we would note that Ohr will be measuring the primary
endpoint out to 12 months in case they require the standard 12 month endpoint.
Additionally, it will be a global program with clinical sites in the US and EU. It is quite
possible that the EU submission could come shortly after the US submission, but we
conservatively assume a year delay in the European launch.
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The ongoing Phase II IMPACT study has enrolled 142 patients (completed in April
2014) and is designed to measure the impact of twice-daily OHR-102 on visual acuity
in combination with PRN (as needed) Lucentis versus placebo drops plus PRN
Lucentis. Lucentis retreatment is mandated if any of the following present on SD-OCT:
retinal cystic changes, retinal fluid, subretinal fluid, or meaningful RPE elevation. The
primary endpoint was the reduction in frequency of Lucentis injections at 9 months.
Secondary visual acuity endpoints included mean visual acuity and the proportion of
patients gaining >3 lines (>15 letters; >3 line gainers) of vision acuity at 9 months.
The study was randomized, double-masked, and placebo controlled and enrolled
patients at 23 sites across the US. Enrollment criteria allowed for treatment nave wet
AMD patients with all lesion compositions (classic and occult), <12 disc areas in size,
and visual acuity ranging from 20/40 to 20/320. Diabetic patients without retinopathy
were also included. There are a few points worth making with respect to the
enrollment criteria: (1) including all lesions is representative of the overall patient
population and includes patients with both mild and aggressive wet AMD. Ophthotech
Ohrs closest comp enrolled patients with only classic containing CNV lesions.
Essentially, these patients should have more aggressive disease and therefore larger
improvements in visual acuity may be seen with treatment; (2) Ohr enrolled patients
with visual acuity up to 20/40, which also encompasses patients with fairly mild
disease and is where most wet AMD studies start. In contrast, Ophthotech enrolled
patients with more advanced disease up to 20/63 visual acuity; (3) Ophthotech
restricted disc size, while Ohr did not. (1), (2), and (3) would theoretically have
provided a relative ceiling effect of response, which is impressive considering the
interim results discussed in previous sections; and finally, (4) Ophthotech excluded
diabetic patients in their study because Fovista has been shown to almost completely
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Ohr Pharmaceutical
Equity Research
March 2, 2015
The baseline demographics for the IMPACT study were consistent with the enrollment
criteria described above, which called for enrollment of a wide swath of patients with
varying disease severity mild, moderate, and severe patients. Most importantly, the
mean baseline vision of the overall study patient population was 7-10 letters better
than most other wet AMD programs, including the Fovista Phase II program. In
general, this means that Ohr enrolled relatively healthier patients with better vision.
Again, this could have provided a ceiling effect. Similarly, 47% of patients had occult
CNV, which is more moderate disease, while Ophthotechs Phase II studies enrolled
patients with only classic CNV or more aggressive disease. Average lesion size was
also on the larger end of the spectrum for the population and 16% of patients were
diabetic.
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strip pericytes, which can cause serious health consequences. We wonder if Ohrs
topical formulation as opposed to Ophthotechs intravitreal injection may have a
less destructive effect on pericytes and ultimately be safer for diabetic patients. This
could have significant implications for the DME indication for which Ohr has a Phase
II program ongoing and is arguably the largest follow-on indication.
Ohr Pharmaceutical
Equity Research
March 2, 2015
The Reduction Of Lucentis Injection Frequency Endpoint Is Not A Point Of Focus For
Us
Per the study plan, a pre-specified interim analysis was conducted with ~50% of the
planned total patient enrollment completing the study protocol. 62 patients 29 and
33 in the OHR-102 and placebo arms, respectively completed the 9 month treatment
period at interim. Not surprisingly, the primary endpoint, the difference in the
frequency of Lucentis injections, did not meet statistical significance at interim. Given
our knowledge of PRN studies (no difference in year 2 of the VIEW studies with
Eylea/Lucentis) and the fact that no study has shown the ability to reduce Lucentis
injections including Ophthotechs Phase II program we were not surprised by this
result. Furthermore, our panelists at our March 2014 Health Care Conference stated
that a fewer injections endpoint largely isnt clinically relevant. Thus, based on the
data (6.2 Lucentis injections for the OHR-102 arm and 6.4 for the placebo arm), we
find it improbable that this endpoint will meet statistical significance in the final data
set nor do we care. Sure a reduction in injections would be a positive outcome, but
ultimately what matters to clinicians is improving visual acuity. To Ohrs defense, this
primary endpoint was picked almost 4 years ago, where the role of anti-PDGFs in wet
AMD was significantly less defined. This will not be the primary endpoint in Phase III.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Figure 14 Mean Change In Visual Acuity For OHR-102 +Lucentis vs. Placebo + Lucentis
OHR-102 Hit On The Planned Phase III Primary Endpoint In Few Patients
Additionally, 48.3% of OHR-102-treated patients showed BCVA gains of >3 lines (>15
letters) on a standard ETDRS eye chart compared with 21.2% in the placebo arm
(p=0.025) a statistically significant observation. Additionally, the effect was
sustained throughout the end of the study with no saw tooth-like effects that can be
observed with anti-VEGF agent like Lucentis. Overall, our consultants view both the
mean visual acuity and >3 line gain results as impressive particularly if they hold up
when the final data reads out in the second half of March. Since the interim readout,
Ohr has met with the FDA and received confirmation that the Phase III endpoint will
be the proportion of patients with >3 line visual acuity gains, which was the exact
secondary endpoint that hit statistical significance at the interim readout per above in
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Ohr Pharmaceutical
Equity Research
March 2, 2015
As we head towards the final results, it is also important to consider that while 62
patients wasnt enough to hit on the mean visual acuity endpoint, 142 patients with
the observed +4.1 letter increase in visual acuity is just reaching the boundary
where there might be enough powering to reach statistical significance, per our
consultants. Of course, a 300-400 patients study would be ideally powered, but the
potential to hit statistical significance on mean visual acuity in the final dataset is a
source of additional upside and would further help to dispel any skeptics. However, it
is important to keep in mind that even if mean visual acuity doesnt hit which could
be a perceived negative all that matters is that the >3 line gainers Phase III endpoint
hits.
Figure 15 Percentage of > 3 Line VA Gainers For OHR-102 +Lucentis vs. Placebo + Lucentis
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only 62 patients. Moreover, our consultants suggest that this endpoint also has a good
chance of reaching statistical significance when the larger, final 142-patient Phase II
data set reads out by the end of March 2015 as the data in 62 patients gives us a
good feel for OHR-102s efficacy. One consultant remarked that it would be
shocking if the final data showed no visual acuity benefit as the first 62 patients are
very typical looking and he would put the odds of success on the >3 line gainers
endpoint pretty high. If it does, our consultants would also consider the final Phase
III program employing the exact same endpoint and study design to be
significantly de-risked. In fact, they believe that upon a successful readout, OHR-102
would have the same probability of success in Phase III as Ophthotech which per
previous physician surveys has been pegged at around 75%. One consultant
believes that successful Phase II wet AMD results tend to have an 80% chance of
translating to Phase III. At the very least, we believe the early interim results
demonstrate that OHR-102 treats the back of the eye and may cause a significant
increase in visual acuity in wet AMD patients. Overall, our consultants suggest that
the mean change in visual acuity and >3 line gainer results look very much like
Ophthotech and the curves and outcomes look remarkably similar. While some
skepticism will always remain through the final Phase III data, consultants appear to
be looking at the program very differently now following the interim data.
Ohr Pharmaceutical
Equity Research
March 2, 2015
Figure 16 The Percentage Of Patients With >4, 5 Line Visual Acuity Gains
Per the figure below, an interesting trend was observed with OHR-102 combination
therapy. It resulted in patients transitioning to a better vision category with almost 50%
of patients gaining >3 lines (>15 letters per the chart) of visual acuity. Lucentis
performed as expected and most patients gained letters, but <3 lines of visual acuity
gain was observed in most patients (0-14 letters with a mean gain of 6-7 letters).
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Further to the >3 line gainer results above, the Company also analyzed the proportion
of patients with >4 and >5 line visual acuity gains. 28% and 6% of OHR-102 and
placebo patients achieved >4 line visual acuity gains, respectively. This result reached
statistical significance with a p-value of 0.022. For >5 line visual acuity gains, 17% and
3% of OHR-102 and Lucentis patients met the endpoint, respectively (p=0.059).
Ohr Pharmaceutical
Equity Research
March 2, 2015
As discussed previously, there are some significant differences between the patient
population that Ohr enrolled in the IMPACT study and the Ophthotech Phase II
program. Therefore, the Company completed an exercise or a subgroup analysis
looking at patients with classic containing CNV and up to 12 disc areas only a
population similar to the Ophthotech Phase II study. In this patient population, OHR102 performed even better with mean visual acuity gains of +13.8 letters over the +6.7
letters in the placebo arm. With respect to >3 line gainers, 67% of OHR-102 patients
achieved the endpoint, while only 20% of placebo patients did. Our consultants believe
this delta is really big so big that it almost doesnt make sense. Clearly, we have
interpreted these statements positively. With that said, given that the analysis includes
only includes 33 patients, we would not expect either endpoint to be statistically
significant (as they werent), but nonetheless we do find it impressive that OHR-102
once again reached statistical significance on >3 line gainers. Furthermore, the
magnitude of the mean visual acuity results is even more impressive than that
observed in the overall patient population and substantially higher (an estimated +2.5
letter difference when comparing both at 6 months) than that observed with Fovista in
Phase II. With that said, we would be remiss if we did not caveat this comparison by
noting that cross study comparisons using subgroup analyses typically cannot be
relied on too much. Nonetheless, while we dont place any reliance on this analysis,
we do find it interesting.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Positive SD-OCT results were also observed with OHR-102 and presented at the ASRS
2014 meeting. The mean change in central retinal thickness for OHR-102 and the
placebo arms was -139 microns and -117 microns, respectively a meaningful benefit
of 22 microns at 9 months. Our consultants believe that these anatomical results
correlate with and help validate the positive visual acuity results discussed above.
Figure 19 OHR-102 + Lucentis vs. Placebo + Lucentis SD-OCT Changes
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Figure 18 Subgroup Analysis: Mean Visual Acuity And >3 Line Gainers In Patients With Classic Containing CNV And Up To 12 Disc Areas
Ohr Pharmaceutical
Equity Research
March 2, 2015
Ohr has presented some individual case studies on SHRM reduction in the IMPACT
study via a quantitative analysis of SHRM via OCT. Two independent masked readers
at the Digital Angiography Reading Center (DARC) conducted the analysis by
measuring the greatest width and height observed on all scans. Only patients with
measurable SHRM at baseline were included in the analysis. In the case study below,
when comparing the baseline and end of treatment pictures, a clear reduction in
SHRM (indicated by the red arrow) does appear to be correlated with a 26 letter
increase in visual acuity. In a total of 54 patients (27 per arm) with measurable SHRM
at baseline, average reductions of 75% and 56% were observed in the OHR-102 and
placebo arms, respectively.
Across patients with measurable SHRM at baseline, the proportion of subject with
total SHRM reduction was 59% and 44% in the OHR-102 and placebo arms,
respectively. In classic containing CNV, or more aggressive disease, an even greater
relative SHRM reduction was observed (74% for OHR-102 vs. 43% for placebo; n=31).
The proportion of patients with total SHRM reduction was also enhanced in this
patient population (56% for OHR-102 vs. 31% for placebo). Furthermore, in the overall
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Ohr Pharmaceutical
Equity Research
March 2, 2015
patient population and classic containing CNV patients, a relationship was observed
between increase in visual acuity and SHRM reduction. We believe it is possible that
these observations are related to the data announced by Ophthotech at AAO 2014,
which suggested that Fovista has the potential to reduce the severity of subretinal
fibrosis relative to Lucentis (mean change in severity of SRF at 24 weeks = 0.97 vs. 2.0;
p=0.003). Our consultants have noted that the subretinal fibrosis data appears very
interesting and clinically meaningful and it appears that there is a clear and
compelling anatomical benefit. The scientific rationale is that a decrease in PDGF
decreases fibroblast migration, which then may lead to a decrease in fibrosis.
Figure 21 An Observed Relationship Between SHRM Reduction And Improved Visual Acuity
Interim safety results suggest that OHR-102 eye drops were well tolerated and had a
comparable safety profile both in terms of ocular or systemic AEs to placebo eye
drops. Furthermore, there were no differences in intraocular pressure, no cataract
formation, and no corneal changes.
We Believe The Phase III Program Is Employing A Meaningfully De-Risked Endpoint
The Company will be required to complete the
standard two identical Phase III studies (one
primarily US-based and one EU-based) with 2
years of follow-up for safety. The design will be
almost identical to the Phase II program as it will
compare twice-daily OHR-102 + Lucentis with
placebo drops + Lucentis with 1:1 randomization
and 300-350 patients per arm. Between both
studies, there will be a total of 1,200-1,400
patients. It will be double-masked and placebocontrolled and include 125-150 clinical sites.
As previously discussed, Ohr received guidance from the FDA on September 16, 2014,
which allowed the Company to go ahead and proceed with the global Phase III
program once Phase II wraps up. The Company will be required to complete the
standard two identical Phase III studies (one primarily US-based and one EU-based)
with 2 years of follow-up for safety. The design will be almost identical to the Phase II
program as it will compare twice-daily OHR-102 + Lucentis with placebo drops +
Lucentis with 1:1 randomization and 300-350 patients per arm. Between both studies,
there will be a total of 1,200-1,400 patients. It will be double-masked and placebocontrolled and include 125-150 clinical sites. However, both arms will dose Lucentis
once-monthly as opposed to PRN in Phase II, which resulted from Lucentis injection
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Most importantly and as previously discussed, the primary endpoint that the FDA
agreed to is the proportion of >3 line visual acuity gainers at 9 months, which is
virtually identical to the Phase II endpoint that reached statistical significance at the
interim readout. The study will be 90% powered to detect low double-digit visual
acuity gains, which is a low bar when being compared to the interim data. Therefore,
Ohr ultimately just needs to replicate the final Phase II IMPACT study if successful in
late March. This is also similar, but perhaps more clinically relevant than the outdated
primary endpoint that Eylea and Lucentis used in registration, which was the
proportion of patients losing >3 lines of visual acuity. For perspective, one consultant
expects 90% of patients to not have >3 line vision loss using current standard of care
and treatment techniques. Our consultants note that achieving statistical significance
by actually gaining vision is more meaningful. Moreover, while recent registration
programs in wet AMD have tended to use a 12 month time point, clearly the FDA
doesnt see a meaningful difference and our consultants certainly dont as they note
that the vast majority of visual acuity is gained in the first 9 months and maintained
through 2 years. Furthermore, they note that Lucentis looked at >3 line gainers at 9
months in the historical ANCHOR, HARBOR, MARINA, and CATT studies (discussed
further in the Appendix) and that any visual acuity endpoint beyond 6 months is
adequate for the wet AMD space. Additionally, our consultants note that hitting
statistical significance on a >3 line gainer endpoint is probably somewhat easier to do
and safer than mean visual acuity due to the nature of what the clinical endpoint is
measuring. It measures the amount of patients with a strong, meaningful visual acuity
improvement as opposed to a mean measure, which may include outliers or noise.
For all of these reasons, we and our consultants believe that this choosing this
endpoint was an intelligent decision by Ohr and was an incremental de-risking event
for the Phase III program.
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every 5.5-6 weeks. The Company can change the Lucentis dosing to PRN any time
after the 9 month primary endpoint at its discretion.
Ohr Pharmaceutical
Equity Research
March 2, 2015
As previously stated, we expect anti-PDGF therapy to be the next major class of drugs
for wet AMD. For that reason, several of the large players are exploring their own
proprietary programs. But before we discuss the PDGF competitive landscape, it is
important to note that we do not expect the various anti-PDGF drugs in development
to directly compete with the anti-VEGFs on market or in development. The goal of
anti-PDGFs is to use them in combination and improve total visual acuity. Therefore,
one can assume that the two are in fact complementary. We believe Ophthotech is
clearly in the lead with their PDGF program as the Phase III program is ongoing with
topline data to readout during 2016. If successfully developed, we expect them to
make it to market ~1-1.5 years before OHR-102, which would give Fovista a firstmover advantage. However, there are dramatic differences in the Fovista and OHR-102
product profiles that one should consider.
Due to the fact that Fovista is an injection and a certain volume of drug will be
injected into the intravitreal space following an anti-VEGF injection, 30 minutes will be
required between both injections in order to avoid adverse increases in intraocular
pressure. This is a very meaningful difference per our consultants. Many
ophthalmologists already feel a huge burden as it is to shuffle patients through their
clinic to receive injections. Our consultants say that they and their staff already spend
much of their time giving anti-VEGF injections and would like to be free to perform
other (perhaps more interesting or lucrative) procedures. In fact, some physicians
have dedicated injection days where they just inject patients one after another.
Others note that patient volume continues to increase with sometimes up to 60
patients a day. Many have streamlined the process by ensuring that patients get
imaged immediately after dilating, then prepped for injection immediately, and treated
right away. A second injection would require a second preparation and most likely, a
second waiting room for many doctors. This may ultimately cause an increase in time
of 45-60 minutes per wet AMD patient. Therefore, the Fovista approach does not seem
to jive well with consultants desires for therapeutics that can manage the condition
with fewer injections and/or better potency, but we believe OHR-102 fits this profile.
We expect some physicians may adapt their practice to administer two injections, but
once OHR-102 potentially reaches the market not long after a potential Fovista launch,
our consultants anticipate that a significant portion of doctors would prefer to just
simply write a prescription for OHR-102 topical eye drops and send the patient home
with it after their initial anti-VEGF injection. Therefore, we would expect a significant
amount of Fovista patients to switch over to OHR-102 therapy. One consultant
believes that OHR-102 could completely cannibalize Fovista; although we believe this
is an aggressive assumption and that there is plenty of room for both in the market. In
general, our consultants expect OHR-102s product profile to be viewed more
favorably than Fovista and that many patients will simply opt for the drops.
The other two visible potential competitors in development are Regeneron and
Allergan/Molecular Partners and they are at least an estimated two years behind.
Regeneron plans to enter Phase II in H1:2015 and Allergan/Molecular Partners plans
to enter the clinic this year. Both are developing anti-VEGF/PDGF co-formulations,
which we and our consultants think will ultimately provide stiffer competition for
OHR-102 than Fovista (assuming all are successfully developed and approved) for the
following reasons: (1) they are co-formulated, so they will require a single injection
and wont significantly affect physicians practices; and (2) they would potentially be
launching on the back of successful anti-VEGF franchises in the case of Eylea (and
potentially Allergan/Molecular Partners abicipar pegol) which will give them a
significant advantage in terms of brand loyalty and market uptake.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Opthotechs Fovista Succeeded In Phase IIb; Phase III Under Way With Data By 2016
In June 2012, Opthotech reported top-line Phase IIb data showing statistical
superiority of the combination of Fovista and Lucentis over Lucentis alone. The 449patient trial demonstrated a 10.6-letter vision gain on the combination vs. 6.5 letters on
Lucentis alone at 24 weeks (p = 0.019). Full data were presented at the AAO meeting
in November 2012. Fovistas trial was randomized and blinded, and had three arms,
comparing 1.5 mg Fovista to 0.3 mg Fovista to placebo, all on a background of
Lucentis (n=152, n=149, and n=148, respectively). The full data revealed that there
were no baseline imbalances in randomization. Both drug arms achieved statistical
significance on the primary endpoint of superiority over Lucentis on visual acuity at 6
months (10.76 letters gained for 1.5 mg Fovista+Lucentis and 8.76 letters gained for
0.3mg Fovista+Lucentis vs. 6.52 letters gained for Lucentis alone). There was a clear
dose response across the entire duration of the trial, and the separation between
curves continued to grow through 6 months, suggesting longer-term follow-up could
reveal greater benefit. Unlike anti-VEGF treatment alone, in the drug arms there was
no evidence of plateauing efficacy after four months. There was a consistent, doseresponsive benefit across all subgroups examined, including stratification by baseline
lesion size, baseline vision, baseline fluid level (OCT reading), and proportion of
patients gaining at least 3 lines, 4 lines, and 5 lines. Moreover, there was also a dose
dependent benefit on proportion of patients losing visual acuity (patients losing >5
letters was 8.3% on high drug plus Lucentis vs. 21.5% on Lucentis alone). There were
no imbalances in AEs or SAEs (ocular or systemic) and no difference in intraocular
pressure between arms.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
An interesting wrinkle was that Fovista had no apparent effect on OCT. The presenter
and panelists seemed to agree that this was likely because the anti-VEGF treatment
cleared up the vascular leakage and fluid buildup, while anti-PDGF would affect other
potential biomarkers. Some possible biomarkers were examined in the trial, but
consultants told us they were largely still in the validation stage.
All the consultants we have spoken with are convinced that Fovistas Phase IIb data
reflects genuine additive efficacy over Lucentis alone, the first time this has ever been
seen in a clinical trial prior to the OHR-102 interim results. Consultants expressed
extreme optimism that Fovistas Phase IIb results would lead to success in Phase III,
assuming the Phase IIb trial design is simply replicated (with a one-year efficacy
follow-up). Their optimism was based on: (1) a robust, clinically and statistically
significant, dose-dependent treatment effect that increased with time and was present
in all subgroups; (2) blinded trial design; (3) large patient number in the trial; (4) no
imbalance in baseline randomization; and (5) clean safety. In fact, consultants appear
to estimate the chance of success in the Phase III trial at approximately 75%. Some
consultants were disdainful of any suggestion, based on cross-trial comparisons, that
the Lucentis arm performed unusually poorly, mainly because it is scientifically
unsound to make cross-trial comparisons, but also because 6 letters gained in 6
months actually struck them as about the expected level of efficacy for Lucentis. Also,
the loss of vision in the Lucentis arm of Ophthotechs trial was less than they would
have expected, suggesting to them that if anything these Lucentis patients did better
than usual. However, other consultants are less convinced and come to the conclusion
that the Lucentis arm behaved unusually poorly as the ANCHOR studies, which
enrolled all classic CNV patients similar to Ophthotech, showed a much larger +10
letter visual acuity benefit with Lucentis.
Fovista Partnered With Novartis; The $1B+ Deal Validates The Anti-PDGF Approach
In May 2014, Ophthotech signed a collaboration agreement with Novartis for Fovistas
ex-U.S. rights. Under the agreement, Ophthotech received a $200MM upfront
payment, and is further entitled to receive up to $130MM in Phase III enrollmentbased milestones, up to $300MM in ex-U.S. approval milestones, and another
$400MM in ex-U.S. sales milestones. In addition, Ophthotech will receive royalties on
ex-U.S. sales. The total deal value is estimated over $1B. We view these terms as very
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Ohr Pharmaceutical
Equity Research
March 2, 2015
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lucrative for Ophthotech, particularly, given the fact that the company was able to
secure up to $330MM in near-term milestones, while retaining full U.S. rights. Under
the agreement, Novartis will also develop a co-formulation of Fovista with its antiVEGF candidates (likely with ESBA-1008). We view this partnership to have strategic
importance for Novartis, who also has exclusive ex-U.S. rights to Lucentis. In light of
this recent collaboration, and keeping in mind Novartis goal to co-formulate Fovista
with an anti-VEGF therapy.
Ohr Pharmaceutical
Equity Research
March 2, 2015
March 2014
October 2014
Source: Cowen and Company March 2014 Health Care And October 2014 Therapeutics Conferences; Vistacom
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Ohr Pharmaceutical
Equity Research
March 2, 2015
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Regeneron entered the clinic with a co-formulation of its own human anti-PDGFR
antibody (REGN2176) and Eylea in Q1:2014 under an agreement with Bayer.
Regeneron will conduct the first proof of concept trial, after which Bayer will have an
opt-in right. Should Bayer opt in, it will gain full ex-U.S. commercialization rights and
share the cost of development (25% of global development costs and 50% of
development costs exclusively for territory outside the U.S.). Regeneron will retain full
rights in the U.S., and be entitled to a 50% profit share ex-U.S. In February 2015,
Regeneron announced that initial data from a Phase I trial of REGN2176-3 showed
that the combination is safe and well-tolerated. Based on Phase I data, REGN has also
identified two doses that it plans to move forward in Phase II studies in H1:15.
Ohr Pharmaceutical
Equity Research
March 2, 2015
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Ohr Pharmaceutical
Equity Research
March 2, 2015
The only data that has been shared for this technology by Ohr is some in vitro data
with the sustained-release protein, SKS1002. The current SKS1002 formulation has
demonstrated sustained-protein release up to 3 months. The ultimate goal is to
achieve duration up to 3-6 months. We would note that this technology appears to be
very similar to Ocular Therapeutix sustained-release programs and hydrogel
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For DME, the Company is running its own Phase II study (005) with final data to
readout in mid-2016. The topline data will include several visual acuity endpoints,
most likely mean visual acuity and >3 line gainers. Based on the interim IMPACT data,
this study has been expanded to 90 patients looking at visual acuity parameters over
24 weeks.
Ohr Pharmaceutical
Equity Research
March 2, 2015
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Ohr Pharmaceutical
Equity Research
March 2, 2015
2013A
2014A
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
U.S. We t A MD
Prevalence of moderate-advanced wet AMD pt.s ('000)
% diagnosed
# diagnosed patients ('000)
% of diagnosed pt.s Tx with anti-VEGFs
# treated patients ('000)
% growth
454
80%
361
95%
343
+6%
476
80%
381
96%
364
+6%
500
80%
400
96%
384
+6%
525
80%
420
96%
403
+5%
552
80%
441
96%
424
+5%
579
80%
463
96%
445
+5%
608
80%
486
96%
467
+5%
632
80%
506
96%
486
+4%
658
80%
526
96%
505
+4%
684
80%
547
96%
525
+4%
711
80%
569
96%
546
+4%
740
80%
592
96%
568
+4%
769
80%
615
96%
591
+4%
Avastin
% Avastin patient penetration
# patients receiving Avastin each year ('000)
Average # vials per patient per year
Avastin price per dose
U.S. A va s tin Sa le s In We t A MD ($MM)
26%
89
5.6
$50
$2 5
33%
120
5.5
$50
$3 5
37%
142
5.5
$50
$4 0
40%
161
5.5
$50
$4 5
40%
169
5.5
$50
$4 5
41%
182
5.5
$50
$5 0
42%
196
5.5
$50
$5 5
42%
204
5.5
$50
$5 5
42%
212
5.5
$50
$6 0
42%
221
5.5
$50
$6 0
42%
229
5.5
$50
$6 5
42%
239
5.5
$50
$6 5
42%
248
5.5
$50
$7 0
+757%
+40%
+14%
+13%
+0%
+11%
+10%
+0%
+9%
+0%
+8%
+0%
+8%
35%
120
5.6
$1,950
$1 ,3 1 0
23%
84
5.5
$1,950
$9 0 0
17%
65
5.5
$1,950
$7 0 0
16%
65
5.5
$1,950
$6 9 0
15%
64
5.5
$1,950
$6 8 0
15%
67
5.5
$1,950
$7 1 5
15%
70
5.5
$1,950
$7 5 0
15%
73
5.5
$1,950
$7 8 0
15%
76
5.5
$1,950
$8 1 5
15%
79
5.5
$1,950
$8 4 5
15%
82
5.5
$1,950
$8 8 0
15%
85
5.5
$1,950
$9 1 5
15%
89
5.5
$1,950
$9 5 0
+4%
-31%
-22%
-1%
-1%
+5%
+5%
+4%
+4%
+4%
+4%
+4%
+4%
39%
53%
134
5.4
$1,850
$1 ,3 3 4
44%
66%
160
5.2
$1,850
$1 ,5 4 0
46%
73%
177
5.2
$1,850
$1 ,7 0 0
45%
74%
182
5.2
$1,850
$1 ,7 4 5
45%
75%
191
5.2
$1,850
$1 ,8 3 5
44%
75%
196
5.2
$1,850
$1 ,8 8 0
43%
72%
201
5.2
$1,850
$1 ,9 3 0
43%
66%
209
5.2
$1,850
$2 ,0 1 0
43%
59%
217
5.2
$1,850
$2 ,0 9 0
43%
53%
226
5.2
$1,850
$2 ,1 7 5
43%
50%
235
5.2
$1,850
$2 ,2 6 0
43%
48%
244
5.2
$1,850
$2 ,3 5 0
43%
46%
254
5.2
$1,850
$2 ,4 4 5
+64%
+15%
+10%
+3%
+5%
+2%
+3%
+4%
+4%
+4%
+4%
+4%
+4%
66%
226
66%
240
66%
254
66%
266
66%
280
66%
294
66%
308
2%
6
11.0
$750
66%
321
8%
24
10.7
$750
66%
333
15%
50
10.5
$750
66%
347
23%
78
10.3
$750
66%
361
28%
99
10.0
$750
66%
375
32%
120
10.0
$750
66%
390
36%
140
10.0
$750
% growth
Lucentis
% Lucentis patient penetration
# patients receiving Lucentis each year ('000)
Average # vials per patient per year
Lucentis price per dose
U.S. Luc e ntis Sa le s In We t A MD ($MM)
% growth
Eylea
% Eylea patient penetration
% penetration of non-Avastin market
# patients receiving Eylea each year ('000)
Average # vials per patient per year
Eylea price per dose
U.S. Ey le a Sa le s In We t A MD ($MM)
% growth
OHR-1 0 2
% treated patients eligible for anti-PDGF treatment
# treated patients eligible for anti-PDGF treatment ('000)
% OHR-102 patient penetration
# patients receiving OHR-102 each year ('000)
Average # bottles per patient per year
OHR-102 price per dose
U.S. OHR-1 0 2 Sa le s In We t A MD ($MM)
$5 0
% gr ow th
$1 9 5
$3 9 5
$6 0 0
$7 4 5
$9 0 0
+2 9 0 %
+1 0 3 %
+5 2 %
+2 4 %
+2 1 %
2 0 2 5 E 5 Y CG R Com m e nts
$1 ,0 5 5
$1,310
$900
$700
$690
$680
$715
$750
$780
$815
$845
$880
$915
$950
% growth
Eylea Sales ($MM)
+4%
$1,334
-31%
$1,540
-22%
$1,700
-1%
$1,745
-1%
$1,835
+5%
$1,880
+5%
$1,930
+4%
$2,010
+4%
$2,090
+4%
$2,175
+4%
$2,260
+4%
$2,350
+4%
$2,445
+64%
+15%
+10%
+3%
+5%
+2%
+3%
$50
+4%
$195
+4%
$395
+4%
$600
+4%
$745
+4%
$900
+4%
$1,055
% growth
T OT A L U.S. WET A MD SA LES ($MM)
% gr ow th
$2 ,6 4 4
$2 ,4 4 0
$2 ,4 0 0
$2 ,4 3 5
$2 ,5 1 5
$2 ,5 9 5
$2 ,7 3 0
+290%
$2 ,9 8 5
+103%
$3 ,3 0 0
+52%
$3 ,6 2 0
+24%
$3 ,8 8 5
+21%
$4 ,1 6 5
+17%
$4 ,4 5 0
+2 7 %
-8 %
-2 %
+1 %
+3 %
+3 %
+5 %
+9 %
+1 1 %
+1 0 %
+7 %
+7 %
+7 %
40
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+2%
+3% - Ma r k e t le a de r
+1 7 %
U.S. We t A MD
Lucentis Sales ($MM)
% growth
OHR-102 Sales ($MM)
+2%
+3%
+78% - Assumes PDGF competition
+ 4%
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Ohr Pharmaceutical
Equity Research
March 2, 2015
2013A
2014E
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
Ex-U.S. We t A MD
Prevalence of moderate-advanced wet AMD pt.s ('000)
% diagnosed
# diagnosed patients ('000)
% of diagnosed pt.s Tx with anti-VEGFs
# treated patients ('000)
% growth
681
80%
541
95%
514
+6%
715
80%
572
96%
546
+6%
750
80%
600
96%
576
+6%
788
80%
630
96%
605
+5%
827
80%
662
96%
635
+5%
869
80%
695
96%
667
+5%
912
80%
730
96%
700
+5%
949
80%
759
96%
728
+4%
986
80%
789
96%
758
+4%
1,026
80%
821
96%
788
+4%
1,067
80%
854
96%
819
+4%
1,110
80%
888
96%
852
+4%
1,154
80%
923
96%
886
+4%
Avastin
% Avastin patient penetration
# patients receiving Avastin each year ('000)
Average # vials per patient per year
Avastin price per dose
Ex-U.S. A va s tin Sa le s In We t A MD ($MM)
55%
282
5.6
$50
$7 9
48%
262
5.5
$50
$7 0
44%
254
5.5
$50
$7 0
43%
260
5.5
$50
$7 0
43%
273
5.5
$50
$7 5
43%
287
5.5
$50
$8 0
43%
301
5.5
$50
$8 5
43%
313
5.5
$50
$8 5
43%
326
5.5
$50
$9 0
43%
339
5.5
$50
$9 5
43%
352
5.5
$50
$9 5
43%
366
5.5
$50
$1 0 0
43%
381
5.5
$50
$1 0 5
-11%
-11%
+0%
+0%
+7%
+7%
+6%
+0%
+6%
+6%
+0%
+5%
+5%
38%
195
5.6
$1,950
$2 ,1 3 3
36%
197
5.5
$1,950
$2 ,1 1 0
34%
196
5.5
$1,950
$2 ,1 0 0
32%
194
5.5
$1,950
$2 ,0 7 5
30%
191
5.5
$1,950
$2 ,0 4 5
29%
193
5.5
$1,950
$2 ,0 7 5
28%
196
5.5
$1,950
$2 ,1 0 5
27%
197
5.5
$1,950
$2 ,1 1 0
26%
197
5.5
$1,950
$2 ,1 1 5
25%
197
5.5
$1,950
$2 ,1 1 5
24%
197
5.5
$1,950
$2 ,1 1 0
23%
196
5.5
$1,950
$2 ,1 0 0
22%
195
5.5
$1,950
$2 ,0 9 0
+10%
-1%
-0%
-1%
-1%
+1%
+1%
+0%
+0%
+0%
-0%
-0%
-0%
7%
16%
37
5.4
$1,850
$3 7 0
16%
31%
87
4.7
$1,850
$7 6 0
22%
39%
127
4.3
$1,850
$1 ,0 1 0
25%
44%
151
4.3
$1,850
$1 ,2 0 5
27%
47%
172
4.3
$1,850
$1 ,3 6 5
28%
49%
187
4.3
$1,850
$1 ,4 8 5
29%
51%
203
4.3
$1,850
$1 ,6 1 5
30%
52%
219
4.3
$1,850
$1 ,7 4 0
31%
49%
235
4.3
$1,850
$1 ,8 7 0
32%
46%
252
4.3
$1,850
$2 ,0 0 5
33%
44%
270
4.3
$1,850
$2 ,1 5 0
34%
43%
290
4.3
$1,850
$2 ,3 0 5
35%
43%
310
4.3
$1,850
$2 ,4 7 0
+1847%
+105%
+33%
+19%
+13%
+9%
+9%
+8%
+7%
+7%
+7%
+7%
+7%
66%
339
66%
360
66%
380
66%
399
66%
419
66%
440
66%
462
66%
481
1%
5
11.0
$500
$2 5
66%
500
6%
30
10.8
$500
$1 6 0
66%
520
13%
65
10.5
$500
$3 4 0
66%
541
18%
97
10.3
$500
$5 0 0
66%
562
22%
124
10.0
$500
$6 2 0
66%
585
25%
146
10.0
$500
$7 3 0
+5 4 0 %
+1 1 3 %
+4 7 %
+2 4 %
+1 8 %
% growth
Lucentis
% Lucentis patient penetration
# patients receiving Lucentis each year ('000)
Average # vials per patient per year
Lucentis price per dose
Ex-U.S. Luc e ntis Sa le s In We t A MD ($MM)
% growth
Eylea
% Eylea patient penetration
% penetration of non-Avastin market
# patients receiving Eylea each year ('000)
Average # vials per patient per year
Eylea price per dose
Ex-U.S. Ey le a Sa le s In We t A MD ($MM)
% growth
OHR-1 0 2
% treated patients eligible for anti-PDGF treatment
# treated patients eligible for anti-PDGF treatment ('000)
% OHR-102 patient penetration
# patients receiving OHR-102 each year ('000)
Average # bottles per patient per year
OHR-102 price per dose
Ex-U.S.OHR-1 0 2 Sa le s In We t A MD ($MM)
% gr ow th
Ex-U.S. We t A MD
Lucentis Sales ($MM)
% growth
Eylea Sales ($MM)
% growth
OHR-102 Sales ($MM)
% growth
T OT A L Ex-U.S. WET A MD SA LES ($MM)
% gr ow th
2 0 2 5 E 5 Y CG R Com m e nts
+ 0% - Ma r k e t le a de r
+ 11%
$2,110
$2,100
$2,075
$2,045
$2,075
$2,105
$2,110
$2,115
$2,115
$2,110
$2,100
$2,090
+0%
+10%
$370
-1%
$760
-0%
$1,010
-1%
$1,205
-1%
$1,365
+1%
$1,485
+1%
$1,615
+0%
$1,740
+0%
$1,870
+0%
$2,005
-0%
$2,150
-0%
$2,305
-0%
$2,470
+11%
+1847%
+105%
+33%
+19%
+13%
+9%
+9%
+8%
$25
$2 ,5 0 3
$2 ,8 7 0
$3 ,1 1 0
$3 ,2 8 0
$3 ,4 1 0
$3 ,5 6 0
$3 ,7 2 0
$3 ,8 7 5
+7%
$160
+7%
$340
+7%
$500
+7%
$620
+7%
$730
+540%
$4 ,1 4 5
+113%
$4 ,4 6 0
+47%
$4 ,7 6 0
+24%
$5 ,0 2 5
+18%
$5 ,2 9 0
+15%
+8%
+5%
+4%
+4%
+4%
+4%
+7%
+8%
+7%
+6%
+5%
W.W. We t A MD
Lucentis Sales ($MM)
$3,443
$3,010
$2,800
$2,765
$2,725
$2,790
$2,855
$2,890
$2,930
$2,960
$2,990
$3,015
$3,040
% growth
Eylea Sales ($MM)
+7%
$1,704
-13%
$2,300
-7%
$2,710
-1%
$2,950
-1%
$3,200
+2%
$3,365
+2%
$3,545
+1%
$3,750
+1%
$3,960
+1%
$4,180
+1%
$4,410
+1%
$4,655
+1%
$4,915
% growth
OHR-102 Sales ($MM)
+105%
+35%
+18%
+9%
+8%
+5%
+5%
$50
+6%
$220
+6%
$555
+6%
$940
+6%
$1,245
+6%
$1,520
+6%
$1,785
+340%
$6 ,8 6 0
+152%
$7 ,4 4 5
+69%
$8 ,0 8 0
+32%
$8 ,6 4 5
+22%
$9 ,1 9 0
+17%
$9 ,7 4 0
+6%
+9%
+9%
+7%
+6%
+6%
% gr ow th
$2,133
+27%
% growth
T OT A L W.W. WET A MD SA LES ($MM)
$5 ,1 4 7
+27%
$5 ,3 1 0
+3%
$5 ,5 1 0
+4%
$5 ,7 1 5
+4%
$5 ,9 2 5
+4%
$6 ,1 5 5
+4%
$6 ,4 5 0
+5%
+1%
+7%
+98% - Assumes PDGF competition
+ 4%
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Ohr Pharmaceutical
Equity Research
March 2, 2015
2014
2015E
2016E
2017E
2018E
2019E
2020E
2021E
2022E
2023E
2024E
2025E
$50.0
$195.0
$395.0
$600.0
$745.0
$900.0
$1,055.0
+290%
+103%
+52%
+24%
+21%
+17%
$25.0
$160.0
$340.0
$500.0
$620.0
$730.0
$ 220. 0
$ 555. 0
5YR C GR C om m ent s
O HR- 102
U.S. Wet AMD Sales ($MM)
% Growth
Ex-U.S. Wet AMD Sales ($MM)
% Growth
Tot al O hr Rev enues
+540%
NM
NM
NM
NM
NM
+ 340%
+ 152%
+ 69%
+ 32%
+ 22%
+ 17%
$0.0
$0.0
$0.0
$0.0
$5.0
$22.0
$50.0
$84.6
$99.6
$121.6
$125.0
Gross Profit
$0.0
$0.0
$0.0
$0.0
$0.0
$45.0
$198.0
$505.1
$855.4
$1,145.4
$1,398.4
$1,660.1
NM
NM
NM
NM
NM
90.0%
90.0%
91.0%
91.0%
92.0%
92.0%
93.0%
$5.1
$7.5
$15.0
$20.0
$25.0
$50.0
$90.0
$150.0
$240.0
$290.0
$340.0
$390.0
% of Revs
% of Revs
$ 940. 0
$ 1, 245. 0
$ 1, 520. 0
$ 1, 785. 0
NM
NM
NM
NM
NM
100.0%
40.9%
27.0%
25.5%
23.3%
22.4%
21.8%
$4.0
$20.0
$40.0
$30.0
$20.0
$15.0
$15.0
$10.0
$10.0
$10.0
$10.0
$10.0
NM
NM
NM
NM
NM
30.0%
6.8%
1.8%
1.1%
0.8%
0.7%
0.6%
$9.1
$27.5
$55.0
$50.0
$45.0
$65.0
$105.0
$160.0
$250.0
$300.0
$350.0
$400.0
NM
NM
NM
NM
NM
130.0%
47.7%
28.8%
26.6%
24.1%
23.0%
22.4%
($9.1)
($27.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
NM
NM
NM
NM
NM
NM
42.3%
62.2%
64.4%
67.9%
69.0%
70.6%
Interest Income
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
Interest Expense
(0.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Other Income
(0.0)
(2.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Non-Operating Income
($0.0)
($2.0)
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
Pretax Income
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
NM
NM
NM
NM
NM
NM
42.3%
62.2%
64.4%
67.9%
69.0%
70.6%
$32.6
$120.8
$211.9
$295.9
$366.9
$441.0
35.0%
35.0%
35.0%
35.0%
35.0%
35.0%
Operating Expenses
% of Revs
Operating Income
% Operating Margin
+18%
$0.0
R&D
$ 50. 0
+24%
C ost of Goods
SG&A
$ 0. 0
+47%
$ 0. 0
Gross Margin
$ 0. 0
+113%
$ 0. 0
% Grow t h
$ 0. 0
- Final Phase II data by end of March; Potential Q2:2015 Phase III start
+ 98% - Rapid upt ake ex pect ed; assum es P DGF com pet it ion
+31%
NM
Non-Operating Income
% of Revs
Income Taxes
Income Tax Rate
Net Income - Operations
% Net Margin
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$224.3
$393.5
$549.5
$681.5
$819.0
NM
NM
NM
NM
NM
NM
27.5%
40.4%
41.9%
44.1%
44.8%
45.9%
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$224.3
$393.5
$549.5
$681.5
$819.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
$0.0
($ 0. 41)
($ 1. 00)
($ 1. 85)
($ 1. 60)
($ 1. 40)
($ 0. 60)
$ 1. 80
$ 6. 40
$ 10. 95
$ 14. 85
$ 17. 95
$ 21. 00
NM
NM
NM
NM
NM
NM
NM
+256%
NM
NM - Assumes no NOLs
- Standard U.S. corporate tax rate
NM
Extraordinary Items
Adjusted Net Income
Interest Add-Back
E P S (N on- GAAP ) - B ef ore E x . It em s
% Growth
EPS - Extraordinary Items
EPS - Adjusted
Shares Outstanding (MM)
36%
21%
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
($1.00)
($1.85)
($1.60)
($1.40)
($0.60)
$1.80
$6.40
$10.95
$14.85
$17.95
$21.00
22.1
29.0
30.0
31.0
32.0
33.0
34.0
35.0
36.0
37.0
38.0
39.0
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17%
($0.41)
42
+71%
NM
NM
+3% - Aassuming some onward dilution from options
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Assumptions:
Output:
Increase in WC
Discount Rate
$829.1
19.5% E s t. Sha r e Pr i ce
$2 5 .0
33.5 Debt
$0.0
Cash
$35.0
Enterprise Value
Notes:
Netted $26-27MM from Feb 11 offering
Burned ~$2.8MM Q1; expected to be higher in Q2
$794.1
Total Revenues
% Change
Cost of Goods
Gross Profit
Gross Margin - Total
SG&A
% of Revs
R&D
% of Revs
Operating Expenses
2014
2015E
2016E
2017E
2018E
2019E
$0.0
$0.0
$0.0
$0.0
$0.0
$50.0
NM
-50%
+0%
$125.0
$142.8
$159.3
$175.0
$149.8
$87.5
$38.5
$14.0
$7.0
$7.0
$7.0
$0.0
$0.0
$0.0
$0.0
$0.0
$45.0
$198.0
$505.1
$855.4
$1,145.4
$1,398.4
$1,660.1
$1,897.2
$2,115.8
$2,325.0
$1,990.2
$1,162.5
$511.5
$186.0
$93.0
$93.0
$93.0
93.0%
93.0%
93.0%
93.0%
$50.0
$25.0
$20.0
$20.0
NM
$4.0
NM
$9.1
NM
$20.0
NM
$27.5
NM
$40.0
NM
$55.0
NM
$30.0
NM
$50.0
NM
$20.0
NM
$45.0
90.0%
$50.0
$90.0
100.0%
40.9%
27.0%
25.5%
23.3%
22.4%
21.8%
21.1%
20.9%
20.0%
21.0%
20.0%
22.7%
25.0%
25.0%
20.0%
20.0%
$15.0
$15.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$10.0
$7.5
$5.0
$5.0
$5.0
$5.0
1.4%
2.5%
5.0%
5.0%
30.0%
$65.0
6.8%
$105.0
NM
NM
NM
NM
NM
130.0%
47.7%
($9.1)
($27.5)
($55.0)
($50.0)
($45.0)
($20.0)
$93.0
NM
NM
NM
NM
NM
NM
(0.0)
(2.0)
0.0
0.0
0.0
0.0
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
NM
NM
NM
NM
NM
NM
Adjusted EBIT
% of Revs
42.3%
1.8%
$160.0
28.8%
$345.1
62.2%
$240.0
1.1%
$250.0
26.6%
$605.4
64.4%
$290.0
0.8%
$300.0
24.1%
$845.4
67.9%
$340.0
0.7%
$350.0
23.0%
$1,048.4
69.0%
$390.0
0.6%
$400.0
22.4%
$1,260.1
70.6%
93.0%
$430.0
0.5%
$440.0
21.6%
$1,457.2
71.4%
93.0%
$475.0
0.4%
$485.0
21.3%
$1,630.8
71.7%
93.0%
$500.0
0.4%
$510.0
20.4%
$1,815.0
72.6%
93.0%
$450.0
0.5%
$460.0
21.5%
$1,530.2
71.5%
93.0%
$250.0
0.8%
$260.0
20.8%
$902.5
72.2%
93.0%
$125.0
$132.5
24.1%
$379.0
68.9%
5.0%
$55.0
$30.0
$25.0
$25.0
27.5%
30.0%
25.0%
25.0%
$63.0
$68.0
$68.0
63.0%
68.0%
68.0%
$131.0
65.5%
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
$93.0
$345.1
$605.4
$845.4
$1,048.4
$1,260.1
$1,457.2
$1,630.8
$1,815.0
$1,530.2
$902.5
$379.0
$131.0
$63.0
$68.0
$68.0
65.5%
63.0%
68.0%
68.0%
$45.9
$22.1
$23.8
$23.8
35.0%
35.0%
35.0%
35.0%
$85.2
$41.0
$44.2
$44.2
($3.0)
($3.0)
($3.0)
($3.0)
42.3%
Taxes
$32.6
35.0%
NOPAT
$150.0
93.0%
+0%
90.0%
% of Revenues
Other Income
2035E
$100.0
$121.6
Operating Income
% Operating Margin
2034E
$100.0
$99.6
92.0%
-64%
2033E
$100.0
+32%
92.0%
-56%
2032E
$200.0
$84.6
91.0%
-42%
2031E
$550.0
+69%
91.0%
-14%
2030E
$1,250.0
$50.0
NM
+10%
2029E
$2,140.0
+152%
$25.0
+12%
2028E
$2,500.0
$22.0
NM
+14%
2027E
$2,275.0
+340%
$20.0
+17%
2026E
$2,040.0
$5.0
NM
+22%
2025E
$1,785.0
$0.0
$15.0
NM
2024E
$1,520.0
$0.0
NM
NM
2023E
$1,245.0
$0.0
$7.5
NM
2022E
$940.0
$0.0
NM
NM
2021E
$555.0
$0.0
$5.1
NM
2020E
$220.0
62.2%
$120.8
35.0%
$224.3
64.4%
$211.9
35.0%
$393.5
67.9%
$295.9
35.0%
$549.5
69.0%
$366.9
35.0%
$681.5
70.6%
$441.0
35.0%
$819.0
71.4%
$510.0
35.0%
$947.2
71.7%
$570.8
35.0%
$1,060.0
72.6%
$635.3
35.0%
$1,179.8
71.5%
$535.6
35.0%
$994.6
72.2%
$315.9
35.0%
$586.6
68.9%
$132.7
35.0%
($9.1)
($29.5)
($55.0)
($50.0)
($45.0)
($20.0)
$60.5
$246.4
Capex
($0.1)
($0.3)
($0.5)
($1.0)
($2.0)
($3.0)
($3.0)
($0.5)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
($1.0)
$3.4
$5.0
$2.5
$0.0
($5.0)
($10.0)
($10.5)
($11.0)
($11.6)
($12.2)
($12.8)
($13.4)
($14.1)
($14.8)
($15.5)
($16.3)
($17.1)
($18.0)
($18.9)
($19.8)
($20.8)
($21.8)
($6.3)
($25.8)
($54.0)
($52.0)
($53.0)
($34.0)
$46.0
$209.3
$377.9
$533.4
$664.7
$801.6
$929.1
$974.3
$565.5
$224.4
$62.3
$17.2
$19.4
$18.4
Adjustments:
Terminal
($3.0)
($3.0)
($3.0)
($3.0)
($3.0)
($3.0)
($3.0)
$1,041.2
($3.0)
$1,160.2
($3.0)
($3.0)
($3.0)
$94.21
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Ohr Pharmaceutical
Equity Research
March 2, 2015
About 10-15% of people who start out with the dry form progress to the wet form of
AMD. As dry AMD worsens, new, fragile blood vessels grow from the outer part of the
eye towards the center of the retina, known as the macula. The formation of new
blood vessels (choroidal neovascularization or CNV) is characteristic of wet AMD and
these vessels often leak blood and fluid, causing rapid damage to the macula and
quickly leading to a loss of central vision. Wet AMD typically presents with acuteonset visual deterioration super-imposed on a background of more gradual visual
deterioration characteristic of dry AMD.
AMD Progression
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The Conversion From Dry To Wet AMD Can Result In Abrupt Deterioration
Ohr Pharmaceutical
Equity Research
March 2, 2015
Regenerons Eylea Has Had A Great Launch In Wet AMD, And Is Now The
Market-Leading Branded Anti-VEGF Therapy
Eylea (aflibercept) is a potent VEGF/PlGF inhibitor that is FDA approved in Macular
Degeneration (AMD) and Diabetic Macular Edema (DME) where it is having a
successful launch, competing with Roches/Novartiss Lucentis and Avastin by virtue
of a less frequent injection schedule. Eylea is now the market leader in the branded
anti-VEGF market and appears to be on track to be a $5B+ product worldwide. Eylea
was initially approved for wet AMD by the FDA in November 2011, in the EU in
November 2012, in Japan in September 2012, and in other countries including Brazil,
Colombia, and Australia in 2012. Since then, its label has been expanded to include
DME, RVO (CRVO/BRVO), and CNV indications, with approvals in other indications
including diabetic retinopathy in patients with DME expected globally throughout
2015 (several of these opportunities are discussed later in the chapter). With
Roches/Novartiss standard-of-care Lucentis having achieved 2014 global sales
greater than $4B, the market opportunity for branded wet AMD treatments is sizable
(we estimate likely in the $7B+ area). Regenerons foray into this market was based
on the hope that a more convenient dosing profile (less frequent injections than
Lucentis) would provide Eylea with a competitive commercial advantage. That hope
was born out as Eyleas initial uptake was rapid, well ahead of expectations.
Regeneron reported Q4:11 U.S. Eylea net sales of $25MM, several multiples ahead of
Street expectations, followed by Q1:12 sales of $124MM, again well ahead of then
consensus of about $60MM, Q2:12 sales of $194MM, besting consensus of $143MM,
then $244MM in Q3:12, yet again beating consensus of $225MM. Though Eyleas
launch is maturing somewhat in its initial indication, growth has continued to be quite
robust. Eylea recorded U.S. sales of $838MM in 2012, $1.4B in 2013 (+68% Y/Y), and
$1.7B in 2014 (+23% Y/Y). In fact, in February 2015, Regeneron said that Eylea is now
the market-leading branded anti-VEGF therapy for retinal diseases in the U.S., with
53% dollar share. The company estimates that branded anti-VEGF therapies hold
~56% share of the overall wet AMD market.
In February 2015, Regeneron issued 2015 Eylea guidance of 25-30% growth, implying
revenue of $2.1B-2.3B. This was just below the period consensus estimate of $2.315B
(+33%). On its Q4 call, Regeneron said that it expects "very gradual" uptake in DME,
but did note a few elements that could further augment Eylea growth in 2015: (1)
Protocol T data could favorably impact uptake in DME, (2) an approval in diabetic
retinopathy in patients with DME will provide access to new patient base (PDUFA in
March), and (3) continued growth in macular edema following RVO.
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(directly into the eye), intravenous, or latero-bulbar injections, exposing the patient to
pain and potential side effects. Thus, the mere location of AMD and other back-ofthe-eye diseases makes it difficult for pharmaceutical/device companies to target with
therapies.
Ohr Pharmaceutical
Equity Research
March 2, 2015
$600
$518
$500
$445
$415
$402
$400
$363
$314
$300
$359
$330
$276
$244
$194
$200
$124
$100
$25
$Q4:11A
Q1:12A
Q2:12A
Q3:12A
Q4:12A
Q1:13A
Q2:13A
Q3:13A
Q4:13A
Q1:14A
Q2:14A
Q3:14A
Q4:14A
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Ohr Pharmaceutical
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March 2, 2015
1 Year Endpoint
VIEW-1 (U.S.)
(n=1,217)
VEGFT 2mg Q4W
VEGFT 2mg Q8W
n=
n=
n=
n=
~12
~12
~8
~12
95.9%
95.1%
95.1%
94.4%
6.9
10.9
7.9
8.1
1 Year Endpoint
VIEW-2 (ex-U.S.)
(n=1,240)
VEGFT 2mg Q4W
VEGFT 2mg Q8W
n=
n=
n=
n=
~12
~12
~8
~12
96.3%
95.6%
95.6%
94.4%
9.7
7.6
8.9
9.4
8.3
9.3
8.4
8.8
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Ohr Pharmaceutical
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1. Is Eylea More Efficacious Than Lucentis? Although the VIEW-1 study demonstrated
a statistically superior VA change for monthly VEGFT (2mg) vs. Lucentis (10.9 vs. 8.1
letters), VIEW-2 trended lower in this regard (7.6 vs. 9.4 letters; no statistically
significant difference). Aggregate results appear modestly better for Eylea, though
the margin of difference (~0.5 letters) appears too small to be deemed clinically
meaningful. Therefore when dosed monthly, the efficacy of these two agents
appears to be relatively similar.
2. Can Eylea Produce Similar VA Benefits To Lucentis At A Lower Injection Frequency?
Aggregate results suggest similar results for Lucentis (dosed 12x in year 1) and
Eylea (dosed 8x in year 1), with 8.8 vs. 8.4 letters VA change, respectively. When the
two Eylea arms are compared (monthly vs. Q8W), monthly dosing appears to
provide a modest numerical improvement in VA (~1 letter). One key clinically
relevant secondary endpoint was the rate of so-called 3-line gainers. Consistent
with the VA data, bi-monthly Eylea looked comparable to Lucentis on this endpoint
at week 52 (31% vs. 31% in VIEW-1; 31% vs. 34% in VIEW-2). Nonetheless, since
neither Lucentis nor Eylea were dosed as needed (PRN) during the first year of
the study, and the number of injections patients received was mandated by the
protocol, Eyleas true advantage in dosing frequency was not definitively answered.
3. How Does Eyleas Safety Compare To Lucentis? Eylea looked very clean relative to
Lucentis on both ocular and non-ocular AEs. Ocular SAEs occurred at a rate of
1.6% vs. 3.0% (VIEW-1) and 2.3% vs. 3.1% (VIEW-2) for all Eylea arms vs. Lucentis.
Rates of death (1.3% vs. 1.6%, and 0.8% vs. 0.7%) and thromboembolic (APTC)
events (1.6% vs. 1.6%, and 1.9% vs. 1.7%) were also well balanced, suggesting Eylea
is not associated with any increased risk of systemic VEGF-related side effects.
Perhaps the one fly in the ointment for Eylea related to OCT readings for bi-monthly
Eylea. In the studies in which OCTs were conducted monthly (VIEW-2 and the Phase II
DME study), bi-monthly Eylea was associated with a saw-tooth pattern on OCT, with
retinal thickness increasing at the end of Eylea off-months. The amplitude of these
changes (17 microns maximum) was relatively small, the pattern declined over the
course of treatment, and it was not associated with any changes in visual acuity.
However the issue was a source of some debate as the pattern was not seen in
monthly Eylea or Lucentis arms. With VA changes generally thought to lag OCT
findings, one physician on the VIEW review panel also suggested this pattern could
have significant negative implications for patients who miss one (bi-monthly)
physician visit.
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Dose Group
Lucentis Q4W -> PRN
Eylea 2.0mg Q4W -> PRN
Eylea 0.5mg Q4wk -> PRN
Eylea 2.0mg Q8W ->PRN
% Maintaining VA
92%
92%
91%
92%
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Ohr Pharmaceutical
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How big a discount Eyleas price actually is in practice depends on dosing frequency.
Eyleas label implies that patients will receive on average 7.5 doses during their first
year of treatment, and therefore they will go to their physicians office an average of
7.5 times. Assuming each dose of Eylea is $1,850, and each visit costs $250 (in
addition to the cost of Eylea), which translates into an annual cost of $15,750. Our
consultants suggest that on average they evaluate Lucentis patients every 5-6 weeks
or 8.5-10 times per year. Moreover they suggest that Lucentis patients get an average
of 7-9 doses per year. Taking the midpoint of these ranges, on average Lucentis costs
$17,912 per year, suggesting that Eylea could actually cost about 12% less than
Lucentis. This is less dramatic than the 45% discount suggested by Regeneron.
Physicians Expect Eylea To Maintain Majority Share Of Branded Market
We conducted a survey of ophthalmologists in conjunction with our October 2014
Annual Therapeutics Conference to assess the future use of Eylea. Surveyed
physicians (n=39) believe that the portion of branded wet AMD patients treated with
Eylea is currently somewhere in between 50-75%, but close to 75%, while the
remaining patients are being treated with Lucentis. In three years time, surveyed
physicians expect Eylea to peak at around 75% branded share with Lucentis
remaining at around 25% most likely due to switching between the therapies as some
patients become refractory. Eylea continues to have a modestly longer dosing interval
than Lucentis in clinical practice. Lucentis treatment is observed to be effective up to
9 weeks, while Eylea has a +1-2 week benefit. While established patients represent a
mix of Avastin, Lucentis, and Eylea, our consultants note that most new wet AMD
patients are being started on Eylea.
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Perhaps the biggest controversy heading into Eyleas PDUFA date was Regenerons
pricing strategy, and whether the company would choose to price at a premium to, on
par with, or at a discount to, Roches Lucentis. Regeneron chose to price Eylea at a
small discount. Eylea is priced at $1,850/dose, while Lucentiss WAC is $1,950/dose,
implying a 5% discount per dose. Interestingly, these prices have remained since
Eyleas launch. Regeneron management has suggested that the annual cost of Eylea
will be approximately $16K/patient, compared to an annual cost of Lucentis of
$29K/patient. Regenerons calculations assume that Eylea is dosed Q8W following the
three loading doses, while Lucentis is dosed Q4W, in line with its label. Moreover,
Regenerons calculations also assume that physicians monitor Lucentis patients
monthly, while Eylea patients are monitored bimonthly after the loading doses.
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March 2, 2015
100%
75%
50%
25%
0%
March
May
August
These survey results are more or less in line with our expert consultants commentary
regarding their clinical experience with Eylea. The physicians perception of Eylea has
improved with clinical experience. Ahead of our October 2011 Therapeutics
Conference, held approximately a month before Eyleas approval, the majority of our
surveyed physicians (60%) said they believed Eyleas clinical profile was not
differentiated from that of Lucentis. At the October 2012 conference, physicians firsthand experience had evidently improved their view of the drug, with the majority
(57%) of surveyed doctors saying Eylea is a modest, incremental advance over
Lucentis. Interestingly, our consultants believe Eylea is differentiated from Lucentis not
so much by dosing frequency, where they agree it confers an approximate 1-week
advantage vs. Lucentis, but rather by efficacy. The consultants indicate that in about
5-15% of their patients, Eylea has shown better efficacy than Lucentis. Of course, they
admit that there is some selection bias inherent in this observation, in that only
patients who are not doing well on Lucentis would generally be switched. The
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To gain insight into the reasons that the patients already on therapy were switched to
Eylea, we asked the physicians to estimate the percent of patients who were switched
because (1) the patient had had an inadequate response to the prior agent, or (2) the
physician hoped to reduce the frequency of dosing. The physicians indicated that a
mean 20% of new Eylea patients were switched in order to reduce dosing frequency,
while 33% were switched due to inadequate efficacy of a prior agent. (The remaining
47% of Eylea patients were switched for another reason or were treatment nave).
Ohr Pharmaceutical
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March 2, 2015
Indeed, we have heard numerous anecdotal reports from our retinal specialist
consultants that a subset of their patients who have had an inadequate response to
Lucentis or Avastin may be well-controlled if switched to Eylea. However, it has been
unclear to us to what degree this represents a genuine superiority in efficacy for Eylea
in these Lucentis/Avastin-refractory patients, as opposed to a simple selection bias
resulting from patients being switched from the older agents to the newer but not
(yet) vice versa. We had a conversation with a retinal specialist at the November 2012
AAO meeting that raises our confidence that Eylea may have a genuine efficacy
benefit in some patients. This specialist was an investigator on Eyleas Phase II trial,
and so he has performed the experiment of switching patients doing well on Eylea to
Lucentis/Avastin (when the Phase II trial ended) and saw many of them do much
worse on Lucentis/Avastin. While ideally one would like to know whether there have
been examples of patients doing poorly on Eylea who then improved upon switching
to Lucentis, it appears to be still too early for much of this type of experience to have
accumulated. Nevertheless, our consultants experience moderately increases our
confidence that there may be a legitimate efficacy benefit for Eylea in some patients.
In our view, this bolsters Eyleas prospects for capturing substantial share from
Lucentis in the near term, as well as some from Avastin. In fact, our consultant said his
28,000-injection per year practice has now completely stopped ordering Lucentis and
that he would put all his patients on Eylea if only their insurance covered it.
Regeneron Settled With Roche On Patents For U.S. Ophthalmic Use
In January 2012, Regeneron announced a partial settlement with Genentech in their
intellectual property dispute over patents relating to VEGF receptor proteins and U.S.
ophthalmic sales of Eylea. Under the terms of the agreement, litigation relating to U.S.
ophthalmic sales of Eylea will end and Regeneron will make payments to Genentech
based on U.S. Eylea sales through May 7, 2016. Regeneron paid a $60MM sales
milestone to Roche when cumulative U.S. Eylea sales reached $400MM, and will also
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consultants views were consistent with physicians we surveyed ahead of our Health
Care conference in March 2013. 70% of surveyed physicians said Eylea had a
modestly better dose interval than Lucentis and 80% said Eylea had modestly better
efficacy. Most consultants say they would put all their new wet AMD patients on Eylea
if they could, though some patients still receive Avastin or Lucentis due to insurance
considerations.
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Equity Research
March 2, 2015
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pay a royalty of 4.75% on cumulative U.S. sales of Eylea between $400MM and $3B,
and a 5.5% royalty on cumulative sales over $3B. In May 2013, the settlement was
updated to include a royalty obligation on ex-U.S. revenues under the same terms,
though this portion of the obligation will be shared by Bayer. All of Regeneron's royalty
obligations end on May 7, 2016.
Ohr Pharmaceutical
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March 2, 2015
Sham
Study
MARINA
No. patients
Lesion size (DA)
Occult
Minimally Classic
Predominantly Classic
238
4.41
63.4%
36.6%
0%
Lucentis
0.3 mg
Lucentis
0.5 mg
Macugen
0.3 mg
MARINA MARINA
VISION
Baseline Demographics
238
240
298
4.26
4.47
4.2
63.5%
61.7%
40%
36.1%
37.9%
34%
0.40%
0.40%
26%
# of injections/total possible
Received PDT
10.8/12
10.50%
11.5/12
0.40%
Treatment
11.3/12
0%
62.20%
4.6%
(10.5)
94.50%
24.8%
6.5
Results
94.60%
33.8%
7.2
0%
0%
0%
0%
9.7%
0.4%
0.4%
0%
0.4%
0.4%
0.8%
8.4%
0.4%
0.4%
Culture-positive endophthalmitis
Culture-negative endophthalmitis
Total endophthalmitis
Uveitis
Hypertension
Myocardial infarction
Cerebrovascular event
Sham
Adverse Events
0%
0.8%
0.8%
0.4%
8.4%
0.4%
1.3%
VISION
295
3.7
38%
38%
24%
8.5/9
13%-30%
N/A
11%-22%
55%
2%
(15.0)
70%
6%
(7.0)
N/A
N/A
0%
N/A
5%
1%
1%
N/A
N/A
2%
N/A
7%
1%
<1%
Outcome
Visudyne (n =
143)
Lucentis 0.5 mg
(n=140)
Difference
64%
96%
33%
6%
40%
35%
-9.5
11.3
21.1
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Ohr Pharmaceutical
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No. patients
Lesion size (DA)
Sham
56
2.56
67.9%
5.4%
(8.2)
90.5%
23.8%
4.9
3.4
1.3
0%
0%
0%
0%
7.1%
3.6%
0.0%
1.0%
3.8%
4.8%
8.6%
12.4%
0.0%
3.8%
Lucentis 0.5 mg
106
2.51
p-value
p=0.0003
p=0.0033
While there was an increase in inflammatory adverse ocular events seen with PDT plus
Lucentis, our consultants do not believe this represents a significant concern. The
presenting investigator noted that the risk of ocular inflammation was likely related to
the Lucentis formulation used in the trial (lyophilized powder, switched to pre-mixed
formulation for the Phase II/III studies) and to the timing of Lucentis and PDT
administration (which prompted a change in the study protocol to avoid administering
both drugs simultaneously). Furthermore, visual outcomes even in the group of
patients who had inflammatory ocular complications were better than seen in the
PDT-alone arm. Additionally, there was a trend of increased hypertension and
cerebrovascular events seen with Lucentis plus PDT, although this was offset by a
trend of increased cardiovascular events seen with PDT alone. These findings seem to
have had little impact on Lucentiss adoption.
PIER, PrONTO Provide Clarity On Lucentis Dosing Requirements
In June 2006, results of the Phase IIIb PIER study, which evaluated a less frequent
dosing regimen for Lucentis, were presented at the Retinal Physician Symposium in
the Bahamas. While the MARINA and ANCHOR trials evaluated monthly intravitreous
administration through the course of therapy, the PIER study treated patients with
monthly injections for the first three months after which injections were administered
every three months. After three months of therapy, patients receiving 0.3 mg Lucentis
gained 2.9 letters of visual acuity and patients receiving 0.5 mg Lucentis gained 4.3
letters of visual acuity, while patients receiving sham injections lost 8.7 letters of visual
acuity. However, vision gains were not sustained, and by month 12, patients treated
with Lucentis had returned to baseline while those receiving sham injections
deteriorated further.
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One-year data from the ongoing Phase I/II FOCUS study were also presented at ASRS
in July 2006. The FOCUS trial was a single-masked study that randomized patients
with predominantly classic wet AMD lesions to receive either PDT alone or PDT plus
Lucentis (0.5 mg). The addition of Lucentis to PDT resulted in substantial efficacy
benefit and greatly reduced the need for subsequent PDT administrations. Benefit was
seen regardless of prior PDT therapy. Data from this study are presented in the table
below.
Ohr Pharmaceutical
Equity Research
March 2, 2015
Lucentis 0.3 mg (n
= 60)
Outcome
Lucentis 0.5 mg
(n=61)
83%
90%
49%
12%
13%
0%
-1.6
-0.2
-16.3
Roche/Genentech reported that in the first year of Lucentis therapy, the average
patient had 3-4 Lucentis injections in the first four months of treatment, followed by
an average of 3 injections in the remaining 8 months. The second year is 4-5 doses
per year.
CATT Data Played Out According To Physicians Expectations And Did Not Change
Clinical Practice
CATT (Comparison of Wet AMD Treatments Trial) was an NIH-sponsored trial that
tested four different treatment strategies as outlined in the table below. The trials
primary endpoint was mean visual acuity change at 12-months, on which the study
was is 90% powered to demonstrate non-inferiority of monthly Lucentis to monthly
Avastin (non-inferiority margin of 5-letters on ETDRS). 12-month data from CATT were
presented at the ARVO meeting in May 2011, followed by two-year data at ARVO
2012.
Lucentis vs. Avastin CATT Study Design
Arm
Schedule
Endpoints
Primary Endpoint
A
(n=300)
Lucentis Q4W
(re-randomize at 1 year: Q4W or variable dosing)
B
(n=300)
Avastin Q4W
(re-randomize at 1 year: Q4W or variable dosing)
C
(n=300)
Lucentis PRN
(prn after 1 initial treatment)
D
(n=300)
Avastin PRN
(prn after 1 initial treatment)
Secondary Endpoints
1)
2)
3)
4)
5)
6)
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Comment
Lucentis remains the more proven and thoroughly-tested drug, and has a larger and better-established safety
database. All else equal, most patients would naturally opt for Lucentis vs. Avastin given that Avastin has not
been thoroughly evaluated by the FDA in wet AMD. Academic centers have tended to migrate toward Lucentis
on this basis.
Financial incentives
At a cost of roughly $2K/injection (vs. $50 for Avastin), ASP+6% economics allow high volume private practices
to prosper significantly from dosing Lucentis. This is in addition to other financial perks (e.g. credit card
rewards) physicians might receive.
Compounding pharmacies separate single vials of Avastin (intended for cancer treatment) into multiple singledose syringes. Occasional lapses in sterility have resulted in sporadic cases of infection and vision loss.
Comment
As anecdotal experience has built, physicians increasingly view Avastin and Lucentis as indistinguishable in
terms of efficacy and safety. As a result, other factors (financial risk/patient co-pay) have tended to drive
treatment decisions for many patients.
Because lower-volume practices are not set up to track ultra expensive drugs, even one or two lost vials can tip
Lucentis economics from modestly profitable to negative. Many practices must devote additional resources
(clerical time) to prevent this from happening.
Patient co-pay
Depending on the level of insurance/Medicare coverage, many patients are required to pay Lucentis co-pays
(often 20% of the drug cost), driving the decision to use Avastin. To qualify for Genentechs co-pay
reimbursement, patients income must be less than $75K.
Several policies enacted by Roche/Genentech since Lucentis launch (many since reversed) have led to a
degree of anti-Genentech sentiment within the retina community. Examples include reduced drug payment
timelines and restriction of purchases to drug wholesalers only (i.e. detracting from +6% economics). CMSs
2009 decision to dramatically cut Avastin reimbursement in AMD (reversed in 2010) also fueled discontent.
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developing Lucentis (a Fab fragment of Avastin that has 140x the VEGF-binding
affinity) had been based on preclinical data suggesting that a 149 kD antibody
(Avastin) could not penetrate the retina. Genentech has consistently pointed to several
differences between the two drugs that render Avastin unsuitable for intravitreal use
(e.g., lack of preclinical tox data, longer intravitreal half-life, lower VEGF binding
affinity, potential for full length antibodies to cause ocular inflammation, differing
manufacturing standards for ocular and systemic drugs).
Ohr Pharmaceutical
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March 2, 2015
One-year data from the CATT study were published in the New England Journal of
Medicine in April 2011.
Key points from the data are as follows:
Monthly treatment: Avastin and Lucentis looked similar in terms of efficacy in the
monthly arms at one year, with 8.0 and 8.5 letters gained at 12 months, respectively.
The mean decrease in central retinal thickness was greater in the Lucentis-monthly
group (196 m) than in the other groups (152 to 168 m, P=0.03).
PRN treatment: Avastin administered as needed was equivalent to Lucentis as
needed, with 5.9 and 6.8 letters gained, respectively. Lucentis PRN was equivalent to
monthly Lucentis, although the comparison between Avastin PRN and monthly
Avastin was inconclusive. At the ARVO presentation, Dr. Daniel Martin (the studys
Principal Investigator) expressed positive surprise at the performance of the PRN
dosing arms, indicating the strong results could likely be attributed to 1) a greater
number of injections given vs. previous studies (7 injections per year for Lucentis
PRN arm), 2) a much lower threshold of disease activity for re-treatment, and 3)
PRN injections that were more evenly distributed over the course of the year relative
to other PRN trials (which typically include three upfront monthly doses).
Safety: Rates of death, MI, and stroke were similar for patients receiving either
Avastin or Lucentis (P>0.20). At the ARVO meeting, updated data on deaths and
arteriothrombotic events through 2 years were presented, with similar rates between
Lucentis and Avastin at this time (4.3% vs. 5.5% deaths, respectively; 4.3% vs. 4.1%
arteriothrombotic events, respectively).The proportion of patients with systemic
SAEs (primarily hospitalizations) was higher with Avastin than with Lucentis (24.1%
vs. 19.0%; risk ratio, 1.29; 95CI: 1.01-1.66). Dr. Daniel Martin, the studys principal
investigator described the higher rate of SAEs for Avastin was viewed as intriguing
and worthy of follow-up, but not concerning at present. This reflects: 1) differences
in SAEs that were in areas not previously associated with Avastin in cancer trials
(e.g. sepsis, pneumonia, surgical procedures), with a broad distribution across
organ groups; 2) a higher rate of SAEs in PRN groups; and 3) higher baseline age,
hypertension, diabetes, smoking MI history, arrhythmia and emphysema in Avastintreated patients.
CATT Has Had Little Effect On Thought Leaders Use Of Lucentis/Avastin In Wet AMD
We checked in with several thought leaders at our Therapeutics conference in
October 2011 to get their thoughts on the impact of the CATT data on clinical practice.
Our panelists believed that the CATT results support the view that Lucentis and
Avastin are essentially identical in efficacy and safety. According to the panelists,
CATTs results provide the first evidence from a controlled trial that PRN Avastin or
Lucentis are as effective as the monthly protocol. Since they have been using both
agents PRN since 2005 anyway, CATT has had no impact on their prescribing
practices. Our surveyed specialists were in agreement, with almost all indicating they
would not change their practices as a result of CATT.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Second-Year CATT Data Also Expected To Have Little Effect On Relative Share of
Avastin or Lucentis...
In April 2012, the journal Ophthalmology published the two-year results of the CATT
trial. We believe there are three key findings in the two-year results: (1) Mean visual
acuity gain was similar for Avastin and Lucentis through year two (Avastin-Lucentis
difference of -1.4 letters, p=0.21); (2) The mean gain was greater for monthly
treatment than for as-needed treatment (difference -2.4 letters, p=0.046), although the
magnitude of the difference at 2.4 letters was less than what our consultants have in
the past said was borderline clinical significance; (3) The proportion of patients who
had SAEs was again higher for Avastin than Lucentis (39.9% vs 31.7%, p=0.009),
although similar to the one year data, the excess events have not been associated
previously with systemic anti-VEGF therapy. Moreover, while the cumulative incidence
of SAEs on Avastin compared to Lucentis increased, the annualized frequency
difference actually decreased in year 2 compared to year 1.
We did not expect the results of CATT Year 2 to have a dramatic effect on practice
patterns and it appears that has been the case. In general, it appears experts can all
find some aspect of the data that supports their particular preferred practice. For
example, two consultants we checked in with regarding the CATT data had
diametrically opposed views of the impact of CATT on Lucentis and Avastin. The
physician who predominantly uses Lucentis today thinks the data strongly support
Lucentis dosed monthly, while the physician who uses Avastin as-needed in the
majority of his practice thinks the same about Avastin PRN. The Lucentis user thinks
the 3.8 mean letter improvement of Lucentis monthly compared to Avastin PRN is a
substantial, meaningful difference in visual acuity. He is worried by the increase in
systemic serious adverse events in Avastin-treated patients compared to Lucentistreated patients. He believes therefore the totality of the data recommend monthly
Lucentis of the regimens tested as it produced the best efficacy with the fewest
serious adverse events. This physician is skeptical that the increase in geographic
atrophy seen with monthly Lucentis is a real finding, as in his experience this is a
much less frequent event than suggested by the data. Meanwhile, the Avastin user
thinks the data support the use of PRN Avastin. While he acknowledges the difference
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Responses from surveyed physicians regarding CATT Year 2 are consistent with the
mixed feedback from consultants. Specifically, we asked which of the four treatment
regimens tested in CATT is the best. There was little agreement on the interpretation
of CATT. About a third (32%) of the physicians said none of the tested regimens could
be said to be best, while another 16% were unfamiliar with the CATT data. The
remaining 52% of physicians were comprised of 24% who said Lucentis monthly is the
best regimen, 12% in favor of Avastin monthly, 12% in favor of Avastin PRN, and 4% in
favor of Lucentis PRN.
Roches HARBOR Study Failed To Demonstrate A Benefit To High-Dose Lucentis
Efficacy data from Roche's Phase III HARBOR trial in wet AMD failed to make the case
for conducting further investigations to use a higher 2mg dose of Lucentis. The
HARBOR studies evaluated once-monthly and as-needed dosing regimens of the
higher dose and the approved 0.5 mg dose, which is indicated for once-monthly use.
As the pivotal MARINA and ANCHOR trials both demonstrated a dose-response curve
favoring 0.5mg Lucentis over 0.3mg dosing, HARBOR was designed to test whether a
higher Lucentis dose could provide better clinical benefits (improved VA, or less
frequent dosing).
Avastin Remains Part Of The Treatment Paradigm; Compounding Quality Act Passed
In November 2013, Not Materially Affecting Use
A couple years ago, the deadly outbreak of meningitis associated with steroid
injections from unregulated compounding pharmacies may have led to some
physicians foregoing the use of compounded Avastin. Since then, these compounded
pharmacies have been under increased scrutiny from federal authorities and
lawmakers. In November 2013, a new law was passed (The Drug Quality And Security
Act) that codified FDAs authority over compounding pharmacies, which had been a
source of debate previously because states oversee pharmacies as well. The law
created a class of compounding pharmacies called outsourcing facilities, referring to
those that compound in bulk and ship across state lines, which will need to be
inspected and certified by the FDA. Outsourcing facilities are exempt from obtaining
FDA approval for their products and from labeling them fully, but must comply with
cGMP practices. Regeneron believes that, according to FDA regulations, all bulk
biologics compounding is in fact illegal, including Avastin for off-label ophthalmic use
(meaning Avastin can only be compounded in response to a prescription for a specific
patient). While FDA now has the clear authority to enforce that interpretation and
block compounded Avastin from being bulk produced, it remains to be seen if in fact
this will come to pass. Our physician consultants have not found access to Eylea any
more difficult following the passage of the bill, and have also not noted any changes
in the behavior of the compounding pharmacies thus far.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Over the past several months, there have been rumblings of payors increasing
pressure on the use of Avastin. Interestingly, when the panelists were queried, they
did admit that it might be possible that they get more step-throughs for Avastin in the
future, but this largely remains to be seen. They do already see this for secondary
insurance though. Additionally, the concerns over the past 2 years of the deadly
outbreak of meningitis associated with steroid injections from unregulated
compounding pharmacies appear to have subsided and certainly do not have any
effect on physicians foregoing the use of compounded Avastin at the moment. Our
panelists noted that these concerns were probably overdone in the first place. Our
panelists believe that the only practices affected were those directly impacted by the
outbreak or connected to the compounders in some way.
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Avastin Remains Part Of The Treatment Paradigm; Payor Pressure Might Increase, But
Its Still Too Early To Tell
Ohr Pharmaceutical
Equity Research
March 2, 2015
Valuation Methodology
Pharmaceuticals/Specialty
For our valuation methodology, we arrive at fair value utilizing a discounted cash flow
(DCF) approach to derive our 12-month price target.
Investment Risks
Pharmaceuticals/Specialty
Risks include: (1) growing competitive dynamics in the specialty pharmaceuticals
space; (2) the ability of management to execute on external growth by successfully
acquiring new strategic, accretive products; (3) the ability to grow organically and
keep the product pipeline robust; (4) potential regulatory delays, rejections, or failures
of pipeline products; (5) economic sensitivity of any self-pay products or weakening
consumer demand; (6) domestic or international pricing pressures for marketed
products; and (7) failure to execute on new product launches.
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Ohr Pharmaceutical
Equity Research
March 2, 2015
Company Name
OHRP
Ohr Pharmaceutical
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COWEN AND COMPANY RATING DEFINITIONS
Cowen and Company Rating System effective May 25, 2013
Outperform (1): The stock is expected to achieve a total positive return of at least 15% over the next 12 months
Market Perform (2): The stock is expected to have a total return that falls between the parameters of an Outperform and Underperform over the next 12 months
Underperform (3): Stock is expected to achieve a total negative return of at least 10% over the next 12 months
Assumption: The expected total return calculation includes anticipated dividend yield
Cowen and Company Rating System until May 25, 2013
Outperform (1): Stock expected to outperform the S&P 500
Neutral (2): Stock expected to perform in line with the S&P 500
Underperform (3): Stock expected to underperform the S&P 500
Assumptions: Time horizon is 12 months; S&P 500 is flat over forecast period
Cowen Securities, formerly known as Dahlman Rose & Company, Rating System until May 25, 2013
Buy The fundamentals/valuations of the subject company are improving and the investment return is expected to be 5 to 15 percentage points higher than the general market
return
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Addendum
Ohr Pharmaceutical
Equity Research
March 2, 2015
Hold The fundamentals/valuations of the subject company are neither improving nor deteriorating and the investment return is expected to be in line with the general market
return
Count
Ratings Distribution
Count
IB Services/Past 12 Months
Buy (a)
461
60.50%
109
23.64%
Hold (b)
288
37.80%
14
4.86%
Sell (c)
13
1.71%
0.00%
(a) Corresponds to "Outperform" rated stocks as defined in Cowen and Company, LLC's rating definitions. (b) Corresponds to "Market Perform" as defined in Cowen and Company,
LLC's ratings definitions. (c) Corresponds to "Underperform" as defined in Cowen and Company, LLC's ratings definitions.
Note: "Buy", "Hold" and "Sell" are not terms that Cowen and Company, LLC uses in its ratings system and should not be construed as investment options. Rather, these ratings
terms are used illustratively to comply with FINRA and NYSE regulations.
20
15
10
5
0
Apr 2012
Jul 2012
Oct 2012
Jan 2013
Apr 2013
Jul 2013
Closing Price
Oct 2013
Jan 2014
Apr 2014
Jul 2014
Oct 2014
Jan 2015
Target Price
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Sell The fundamentals/valuations of the subject company are deteriorating and the investment return is expected to be 5 to 15 percentage points lower than the general market
return
Ohr Pharmaceutical
Equity Research
March 2, 2015
Analyst Profiles
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