Factor XI Deficiency

Abelacimab, a Dual-Acting Factor XI / XIa Inhibitor, Demonstrated an Unprecedented Reduction in Bleeding in the Largest and Longest Head-to-Head Study Comparing a Factor XI Inhibitor to a DOAC Abelacimab is the First and Only Factor XI Inhibitor to Demonstrate a Reduction in Major Bleeding Versus a DOAC Abelacimab 150 mg Dose Provides Near-Complete Inhibition of Factor XI, Recapitulating the Benign Bleeding Pro Genetic Factor XI Deficient Patients Patients in the Rivaroxaban Arm Can Transition to Abelacimab in an Extension Study CAMBRIDGE, Mass.--(BUSINESS WIRE)-- Anthos Therapeutics, Inc., a clinical stage company developing innovative therapies for cardiovascular diseases, founded by Blackstone Life Sciences, announced today that the AZALEA-TIMI 71 Phase 2 study in 1,287 patients with atrial fibrillation at moderate-to-high risk of stroke, met its primary endpoint. The study has been stopped early by the Data Monitoring Committee due to an overwhelming reduction in the composite of major and clinically relevant non-major bleeding in patients taking abelacimab compared with patients taking rivaroxaban, a leading standard-of-care DOAC. In addition, abelacimab is the first and only Factor XI inhibitor to demonstrate an unprecedented reduction in major bleeding compared to a DOAC, which is the most serious type of bleeding. Full results of AZALEA-TIMI 71 will be presented at an upcoming scientific congress. “The AZALEA-TIMI 71 study is the largest and longest head-to-head study of a Factor XI inhibitor to provide definitive evidence of a highly significant reduction in bleeding as compared to the standard-of-care anticoagulant. With a median of 21 months of follow-up, spanning more than 2,000 patient-years, AZALEA-TIMI 71 represents a landmark study confirming the promise of Factor XI inhibition as causing substantially less bleeding than a current standard-of-care,” said Marc S. Sabatine, MD, MPH, the Lewis Dexter, MD, Distinguished Chair in Cardiovascular Medicine, Brigham and Women’s Hospital; Professor, Harvard Medical School; and Chairman of the Thrombolysis in Myocardial Infarction (TIMI) Study Group. Abelacimab is a novel, highly selective, fully human monoclonal antibody with dual inhibitory activity against Factor XI and its active form, Factor XIa. Abelacimab 150 mg maintains ~98% inhibition over the dosing interval, recapitulating the benign bleeding pro patients with genetic Factor XI deficiency. Prior to AZALEA-TIMI 71, abelacimab achieved a ~80% reduction in venous thromboembolism (VTE) versus a standard-of-care comparator in a gold standard proof-of-concept efficacy study that was published in the New England Journal of Medicine.1 “Given AZALEA-TIMI 71’s overwhelming reduction in bleeding, together with an 80% reduction in thrombosis demonstrated in our earlier VTE study,1 abelacimab embodies its promise as a hemostasis-sparing anticoagulant and represents a paradigm shift in the prevention of stroke and other thrombotic conditions,” said Dan Bloomfield, MD, Chief Medical Officer of Anthos Therapeutics. “If approved, more patients with atrial fibrillation could be treated effectively and safely, with a much lower risk of bleeding with abelacimab as compared to a DOAC.” The Center for Disease Control and Prevention (CDC) estimates that 12.1 million people in the United States will have atrial fibrillation by 2030.2 Unfortunately, 40% to 60% of patients with atrial fibrillation are not prescribed anticoagulants today. This underuse of anticoagulants for stroke prevention has been cited as one of the greatest public health issues facing cardiovascular patients.3 In a physician survey, the foremost barrier to patients taking oral anticoagulants was bleed related.4 “Abelacimab has the potential to provide a game-changing treatment option for all those patients who live with the daily fear of bleeding while taking current anticoagulants. We can now imagine a future where these patients are able to resume and enjoy activities that they are currently being forced to give up due to concerns associated with bleeding,” said Leslie Lake, President of the National Blood Clot Alliance. “We are thrilled that AZALEA-TIMI 71 has demonstrated such a positive outcome and excited about the promise that it offers to patients.” Anthos Therapeutics has initiated an extension study to enable patients to transition from rivaroxaban to abelacimab to benefit from the improved bleeding profile. Further, a Fast-Track Designation for abelacimab was previously granted by the U.S. Food and Drug Administration for the prevention of stroke and systemic embolism in patients with atrial fibrillation. About Abelacimab Abelacimab is a novel, highly selective, fully human monoclonal antibody that locks Factor XI in the inactive state, resulting in dual inhibitory activity against both Factor XI and its activated form, Factor XIa. By uncoupling thrombosis from hemostasis, a dual-activity Factor XI inhibitor may provide a path forward for those patients who would benefit from the protection that anticoagulants can provide. In a PK / PD study, abelacimab administered IV provided profound suppression of Factor XI within one hour after the start of therapy and maintained near maximal inhibition for up to 30 days.5 In a Phase 2 study published in the New England Journal of Medicine in 2021, a single intravenous dose of abelacimab after knee surgery reduced the rate of venous thromboembolism by 80%, measured 10 days after surgery, compared to enoxaparin.1 Factor XI inhibition offers the promise of hemostasis-sparing anticoagulation for the prevention and treatment of arterial and venous thromboembolic events.6 Abelacimab is an investigational agent and is not approved for any indication in any country. About the AZALEA-TIMI 71 Phase 2 Study The AZALEA-TIMI 71 study is an event-driven, randomized, active-controlled, blinded endpoint, parallel-group study with a primary endpoint that evaluates the effect of two blinded doses of abelacimab relative to open-label rivaroxaban in patients with atrial fibrillation (AF) who are at moderate-to-high risk of stroke. The primary endpoint of the AZALEA-TIMI 71 study is the composite of the rate of major or clinically relevant non-major bleeding events. A secondary endpoint is major bleeding on its own. Patients were randomized 1:1:1 and administered subcutaneous (SC) abelacimab 150 mg once-monthly, abelacimab 90 mg once-monthly or rivaroxaban 20 mg daily. This event-driven study completed enrollment in December 2021, with 1,287 patients across 95 global study sites including the U.S. and Canada, Europe and Asia. About the LILAC-TIMI 76 Phase 3 Study The LILAC-TIMI 76 study is an event-driven, randomized, placebo-controlled, double-blind, parallel-group study to evaluate the efficacy and safety of abelacimab relative to placebo on the rate of ischemic stroke or systemic embolism in patients with atrial fibrillation (AF) who have been deemed to be unsuitable for currently available anticoagulation therapy. Patients in the study will be randomized to receive abelacimab 150 mg SC or matching placebo once monthly. The study is targeting to enroll approximately 1,900 patients from more than 400 sites in North America, Europe, Latin America, the Middle East and Asia. About Anthos Therapeutics Anthos Therapeutics was launched by Blackstone Life Sciences in 2019 and obtained from Novartis Pharma the exclusive global rights to develop, manufacture, and commercialize abelacimab. Anthos Therapeutics is a clinical-stage biopharmaceutical company focused on the development and commercialization of genetically and pharmacologically validated innovative therapies to advance care for high-risk cardiovascular patients. For more information, visit the company’s website and follow on Twitter and LinkedIn. Forward-Looking Statements This press release contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995 that involve substantial risks and uncertainties, including statements regarding the initiation, and timing, of future clinical trials and its research and development. All statements, other than statements of historical facts, contained in this press release, including statements regarding the company’s strategy, future operations, future financial position, prospects, plans and objectives of management, are forward-looking statements. The words “anticipate,” “become,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “potential,” “predict,” “project,” “should,” “target,” “will,” “would” and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Any forward-looking statements are based on management’s current expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in, or implied by, such forward-looking statements. In addition, the forward-looking statements included in this press release represent the company’s views as of the date hereof and should not be relied upon as representing the company’s views as of any date subsequent to the date hereof. The company anticipates that subsequent events and developments will cause the company’s views to change. However, while the company may elect to update these forward-looking statements at some point in the future, the company specifically disclaims any obligation to do so. 1 Verhamme P et al. New Engl J Med July 2021 ( ) 2 Center for Disease Control and Prevention website; Atrial Fibrillation page ( ) 3 Pokorney et al, American Heart Journal, April 2019 ( ) 4 Yao C et al PEC Innov 2022;1:100062. ( ) 5 Yi BA et al. J Thromb Haemost. Oct. 2021 ( ) 6 Hsu et al. J Am Coll Cardiol. Aug. 2021 ( ) View source version on businesswire.com: Contacts Media Caren Begun TellMed Strategies 201-396-8551 caren.begun@tmstrat.com Source: Anthos Therapeutics View this news release online at:

Additional Pharmacodynamic Data on Abelacimab Released at the 2022 Congress of the International Society on Thrombosis and Haemostasis (ISTH) CAMBRIDGE, Mass., July 13, 2022 /PRNewswire/ -- Anthos Therapeutics, a clinical-stage biotechnology company developing innovative therapies for cardiovascular and metabolic diseases, announced that four new research updates were presented on abelacimab during the Venous Thromboembolism poster session at the ongoing International Society on Thrombosis and Haemostasis 2022 Congress in London, UK. "Coagulation is a complex multilayered process and the potential benefits of inhibiting Factor XI are becoming increasingly clear. These preclinical studies add important information characterizing the pharmacodynamic effects of abelacimab and further extend our understanding of the biological effects of Factor XI inhibition," said Dan Bloomfield, Chief Medical Officer at Anthos Therapeutics. "With a growing body of evidence from ongoing studies both in the clinic and the lab, and a recent FDA Fast Track designation granted for abelacimab in thrombosis associated with cancer, we are becoming increasingly confident about the potential of our novel dual-acting Factor XI/XIa inhibitor may offer in the future as a treatment advance." The details of each poster presentation are provided below: PB0927 - Abelacimab does not influence the effects of two commonly used antiplatelet agents in vitro This study investigated the effects of clinically relevant doses of abelacimab on the inhibition of platelet aggregation by commonly used antiplatelet agents, aspirin and ticagrelor, in vitro. It demonstrated that abelacimab did not affect the level of antiplatelet inhibition achieved either by aspirin or ticagrelor confirming that abelacimab will not interfere with the benefits of these antiplatelet agents. PB0925 - Abelacimab has no effect on platelet aggregation induced by TRAP-6 and collagen FXI has been identified as a ligand to platelet receptors ApoER2 and GPIbα on the surface of stimulated platelets. This study demonstrated that abelacimab did not interfere with normal platelet aggregation following stimulation with collagen or thrombin receptor activating peptide-6 (TRAP-6) and compared with vehicle and active control (abciximab, anti-GP2b3a) suggesting that the binding of FXI to the platelet surface has no effect on primary hemostasis. PB0548 - Abelacimab, a Factor XI/XIa Antibody Inhibits Clotting in Hemodialysis Circuits Ex Vivo This study compared the effect of a combination of abelacimab and enoxaparin with enoxaparin alone, in an ex vivo model of hemodialysis that is aggressive due to the frequent re-circulation of blood and a lack of endothelial cells. Inhibition of FXI/FXIa by abelacimab combined with enoxaparin (but not enoxaparin alone) reduced and prevented device malfunction. This provides support for testing abelacimab in patients on hemodialysis. PB0926 - Low concentrations of rFVIIa bypass changes in ROTEM coagulation parameters induced by abelacimab in vitro. While patients with severe factor XI (FXI) deficiency rarely have spontaneous bleeding, low doses of recombinant activated factor VII (rFVIIa) have been used and are effective in managing bleeding should it occur. This study was designed to evaluate whether low concentrations of rFVIIa could revert the changes in abelacimab-induced coagulation parameters as measured by rotational thromboelastometry (ROTEM) in whole blood in vitro assays from healthy individuals. As expected and similar to what has been observed in patients with Factor XI deficiency, these data suggest that low doses of rFVIIa can be used to manage bleeding in Factor XI inhibited patients being treated with abelacimab. About Anthos Therapeutics Anthos Therapeutics is a clinical-stage biopharmaceutical company focused on the development and commercialization of genetically and pharmacologically validated innovative therapies to advance care for people living with cardiovascular and metabolic (CVM) diseases. Anthos Therapeutics aims to combine the agility of a biotech with the rigor of a large pharmaceutical company. Anthos Therapeutics was launched by Blackstone Life Sciences in 2019. For more information visit the website at , Twitter at , and LinkedIn at . About Abelacimab Abelacimab is a novel, highly selective, fully human monoclonal antibody designed to induce effective hemostasis-sparing anticoagulation through Factor XI inhibition. Abelacimab targets the active domain of Factor XI, demonstrating dual inhibitory activity against both Factor XI and its activated form, Factor XIa. Abelacimab can be administered intravenously (IV) to achieve rapid inhibition of Factor XI activity and then used subcutaneously (SC) monthly to maintain nearly complete inhibition in a chronic setting. In a PK/PD study, abelacimab administered IV provided profound suppression of Factor XI within one hour after the start of therapy and maintained near maximal inhibition for up to 30 days. 1,2 In a Phase 2 study whose results were published in the New England Journal of Medicine in 2021, a single intravenous dose of abelacimab after knee surgery reduced the rate of venous thromboembolism by 80%, measured 10 days after surgery, compared to enoxaparin.1 Factor XI inhibition offers the promise of hemostasis-sparing anticoagulation for the prevention and treatment of arterial and venous thromboembolic events.3 Abelacimab is an investigational agent and has not been approved for any indication. Verhamme P et al. New Engl J Med July 2021 () Yi BA et al. J Thromb Haemost. Oct. 2021 () Hsu et al. J Am Coll Cardiol. Aug. 2021 () Forward Looking Statements This press release contains "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995 that involve substantial risks and uncertainties, including statements regarding the initiation, and timing, of future clinical trials and its research and development. All statements, other than statements of historical facts, contained in this press release, including statements regarding the company's strategy, future operations, future financial position, prospects, plans and objectives of management, are forward-looking statements. The words "anticipate," "become", "believe," "continue," "could," "estimate," "expect," "intend," "may," "plan," "potential," "predict," "project," "should," "target," "will," "would" and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Any forward-looking statements are based on management's current expectations of future events and are subject to a number of risks and uncertainties that could cause actual results to differ materially and adversely from those set forth in, or implied by, such forward-looking statements. In addition, the forward-looking statements included in this press release represent the company's views as of the date hereof and should not be relied upon as representing the company's views as of any date subsequent to the date hereof. The company anticipates that subsequent events and developments will cause the company's views to change. However, while the company may elect to update these forward-looking statements at some point in the future, the company specifically disclaims any obligation to do so. Media Contacts: Russo Partners LLC Tony Russo, PhD (212) 845-4251 / [email protected] Olipriya Das, PhD (646) 942-5588 / [email protected] SOURCE Anthos Therapeutics

Bristol Myers Squibb and J&J joined forces three years ago with a vision: They wanted to create a blood thinner with the efficacy of their current drugs Eliquis and Xarelto, but without the heightened risk of bleeding. On Monday, they announced they’re well on their way with a Factor XIa inhibitor called milvexian. Milvexian, also known as BMS-986177, significantly lowered patients’ rate of venous thromboembolism (VTE) after knee surgery compared to the commonly used anticoagulant enoxaparin in a Phase II study, the partners said at this year’s American Heart Association conference — and without increasing risk of bleeding. “Current DOACs — direct acting oral anticoagulants — either are underutilized or are not indicated because of concerns for bleeding,” James List, global therapeutic head of Janssen’s cardiovascular, metabolism, and retina departments, told Endpoints News. List said blood clots can be broken down into two basic, interrelated categories: hematosis, which is stopping bleeding, and thrombosis, which is forming a clot. There’s a growing body of evidence that suggests the blood protein Factor XI is very important for the propagation and enlargement of thrombin, but not so important to initial hemostasis, he said. There are also data that show people with Factor XI deficiencies have less of a tendency to bleed. Factor Xa inhibitors — like Eliquis and Xarelto — are approved to treat and prevent VTE, a disorder that includes deep vein thrombosis and pulmonary embolism. But they come with a risk of serious or fatal bleeding. “Our scientists were looking to try to advance beyond factor Xa inhibition as a target,” Roland Chen, head of BMS’ cardiovascular department, said. “What has come forward is data, both preclinical and clinically now, including what is being presented here at AHA, to show the promise of Factor XIa inhibition in preventing major thrombotic conditions, without an increase in bleeding.” At daily doses of at least 100 mg, those treated with milvexian in the Phase II AXIOMATIC-TKR study saw significantly lower rates of VTE compared to enoxaparin (p≤0.014). A group of patients receiving the highest once-daily dose (200mg) of milvexian saw a 7% VTE rate, compared to a 21% rate for the group of patients who took 40 mg of enoxaparin, according to BMS. While the study tested both single and twice-daily doses of milvexian, Chen said the companies will wait to see the results from another Phase II trial in secondary stroke before they decide on a regimen. That readout is expected in the first half of 2022. There were no major bleeds in the milvexian arm of the AXIOMATIC-TKR study, compared to one in the enoxaparin arm, the companies reported. The rates of major plus clinically relevant non-major bleeds (CRNM) were 0.8% and 1.4% in the milvexian and enoxaparin arms, respectively. “The consistently low rates of bleeding across a 16-fold range of milvexian doses suggest that it has a wide therapeutic window, which opens the opportunity to explore milvexian across a broad range of patients including those for whom factor Xa inhibitors are underutilized or not indicated,” Thrombosis and Atherosclerosis Research Institute executive director Jeffrey Weitz said in a statement. List said the companies are shooting to enter Phase III sometime next year. Although they’re keeping the financial terms of their collaboration under wraps for now, they’ve agreed to share all development costs and commercial profits.