Eledon Pharmaceuticals FY Conference Summary Company Overview - **Company**: Eledon Pharmaceuticals (NasdaqCM:ELDN) - **Focus**: Development of tegoprubart (Tego) for kidney transplantation and other transplant-related therapies Key Points Industry Context - **Transplantation Market**: Approximately 48,000 transplants are performed annually in the U.S., with 60% being kidney transplants [4][5] - **Kidney Transplant Statistics**: About 25,000 to 27,000 kidney transplants occur each year, while around 100,000 Americans are on the waiting list for transplants [5][6] Product Development and Clinical Trials - **Phase 2 BESTOW Data**: Recent results show that Tego's efficacy is not inferior to tacrolimus, the current standard of care, with a strong safety profile [1][2] - **Patient Involvement**: Over 150 patients have used Tego, with more than 100 post-transplant patients included in the study [2] - **Future Milestones**: Plans to approach the FDA regarding the path to market for kidney transplantation and other transplant types, including islet cell and xenotransplantation [3] Financial Position - **Cash Reserves**: Eledon finished the last quarter with over $93 million in cash and completed a $57.5 million financing round, providing sufficient funds until the second quarter of 2027 [2] Comparative Analysis with Tacrolimus - **Market Size**: Tacrolimus represents a $1.5 billion market, despite being over 30 years old [8] - **Safety Concerns**: Tacrolimus is nephrotoxic and associated with diabetes and hypertension, which are leading causes of kidney issues [9] - **Efficacy Metrics**: Mean eGFR (estimated Glomerular Filtration Rate) at 52 weeks was 69 for Tego compared to 66 for tacrolimus, indicating superior kidney function [12] Adverse Events (AEs) Comparison - **Tego vs. Tacrolimus**: Tego showed lower rates of proteinuria, bacteremia, hyperglycemia, and new-onset diabetes compared to tacrolimus [13][14][15][16] - **Psychological Impact**: Patients on tacrolimus may experience longer post-transplant dialysis, which can be psychologically challenging [17] Regulatory and Future Plans - **Phase 3 Trial**: Eledon plans to initiate a Phase 3 trial in the second half of the year, pending FDA discussions [18] - **Patient Enrollment**: Expected enrollment of 200-300 patients per arm for the Phase 3 trial, focusing on achieving non-inferiority in safety and efficacy [19] Market Opportunity - **Concentration of Transplant Centers**: There are about 250 transplant centers in the U.S., with 40 centers performing half of the transplants, indicating a concentrated market [6] Conclusion Eledon Pharmaceuticals is positioned to make significant advancements in the transplantation market with its product Tego, which has demonstrated promising efficacy and safety compared to the current standard of care, tacrolimus. The company is well-funded and has a clear path forward for regulatory approval and further clinical development.

Eledon Pharmaceuticals Conference Call Summary Company Overview - **Company**: Eledon Pharmaceuticals (NasdaqCM:ELDN) - **Focus**: Development of tegoprubart, an anti-CD40 ligand antibody aimed at preventing transplant rejection across various organ types including kidney, heart, and liver [3][4] Core Insights and Arguments - **Current Market Context**: Tacrolimus, a long-standing immunosuppressant, has significant side effects including nephrotoxicity, cardiovascular issues, and metabolic toxicities, which Eledon aims to address with tegoprubart [5][6] - **Clinical Trials**: Eledon is conducting multiple clinical trials, with a primary focus on kidney transplants, which account for approximately 25,000 procedures annually in both the U.S. and Europe [9] - **BESTOW Study**: A phase 2 trial designed to compare tegoprubart against tacrolimus, with a primary endpoint focused on kidney function. The study enrolled 120 patients across various countries [13][14] - **Data Results**: The phase 2 study showed promising results, with tegoprubart demonstrating better kidney function compared to tacrolimus in several subgroups, despite missing the primary endpoint by three points [15][16][18] - **Safety Profile**: Tegoprubart exhibited a significantly better safety profile compared to tacrolimus, with lower incidences of diabetes, hypertension, and neurological issues [19][26] Additional Important Points - **Market Reaction**: Despite positive feedback from the medical community, the investment market reacted negatively, possibly due to a misunderstanding of the study's primary endpoint expectations [24][26] - **Future Steps**: Eledon plans to transition to a phase 3 study for kidney transplants, with regulatory discussions ongoing regarding endpoints and study design [22][41] - **Islet Cell and Xenotransplant Programs**: Eledon is also exploring islet cell transplants and xenotransplantation, with ongoing studies showing promising early results [33][36] - **Competitive Landscape**: Eledon is currently the only company focusing on CD40 ligand inhibition for transplant rejection prevention, while competitors are targeting larger autoimmune indications [39] Financial Position - **Cash Reserves**: As of September, Eledon reported approximately $90 million in cash, with plans to extend the runway to Q1 2027 through an ongoing capital raise [40][41]

Core Insights - Eledon Pharmaceuticals, Inc. (NASDAQ:ELDN) stock is experiencing a significant decline following the announcement of Phase 2 trial results for its drug tegoprubart, which is aimed at preventing organ rejection in kidney transplant patients [1][7] Trial Results - The Phase 2 BESTOW trial showed that tegoprubart did not provide significant improvements in estimated glomerular filtration rates (eGFR) compared to the standard immunosuppressant tacrolimus [2][5] - After 12 months, tegoprubart demonstrated an eGFR of 69 mL/min/1.73 m², while tacrolimus had a rate of 66 mL/min/1.73 m² [3] - In living-related donor recipient patients, tegoprubart's eGFR was higher at 72 mL/min/1.73 m², while patients with a high Kidney Donor Profile Index (KDPI > 35) had an eGFR of 62 mL/min/1.73 m² [4] Efficacy and Safety - The composite endpoint of efficacy failure for tegoprubart was non-inferior to tacrolimus, with rates of 22% for tegoprubart compared to 17% for tacrolimus [5] - Delayed graft function was less frequent with tegoprubart, requiring shorter dialysis (14.3% vs. 25.0%; 4.6 days vs. 6.1 days) [6] - Sepsis or bacteremia occurred more frequently in the tacrolimus group (17.2% vs. 4.8%) [6] Future Development - Despite not meeting the primary efficacy endpoint, the company plans to advance tegoprubart into Phase 3 development after discussions with regulators regarding study design and data requirements [6] - Eledon has approximately $93.4 million in cash and short-term investments, which is expected to sustain operations into late 2026 [7]

Eledon Pharmaceuticals Conference Call Summary Company Overview - **Company**: Eledon Pharmaceuticals (NasdaqCM:ELDN) - **Focus**: Development of tegoprubart for transplantation, particularly kidney transplants Key Points and Arguments Industry Context - **Transplantation Landscape**: The success in transplantation has been linked to the development of immunosuppressive drugs to prevent organ rejection. However, existing drugs like tacrolimus have limitations, including toxicity and complexity of use [2][5][6]. Tegoprubart Development - **Tegoprubart's Role**: Eledon aims for tegoprubart to be a cornerstone maintenance chronic immunosuppressive medicine across all transplant types, including kidney, islet cell, and potentially xenotransplantation [3][4]. - **Clinical Trials**: The company is conducting multiple studies, including a phase 2 trial (Bistot study) comparing tegoprubart to tacrolimus, the current standard of care [9][10]. Bistot Study Results - **Study Design**: The Bistot trial compared tacrolimus with tegoprubart in kidney transplant patients, focusing on eGFR (estimated Glomerular Filtration Rate) as a primary endpoint [9][10]. - **Efficacy**: Tegoprubart showed a mean eGFR of 69 mL/min compared to 66 mL/min for tacrolimus, indicating numerical superiority but not statistical significance [11][17]. - **Safety Profile**: Tegoprubart demonstrated a favorable safety profile, with significant reductions in side effects commonly associated with tacrolimus, such as new-onset diabetes, tremors, and hypertension [12][28][33]. Unmet Needs in Transplantation - **Current Limitations**: Tacrolimus, while effective, has a narrow therapeutic index and is associated with various toxicities, leading to complications such as kidney injury and increased cardiovascular risk [6][7][8]. - **Need for New Treatments**: There is a pressing need for new immunosuppressive agents that can reduce toxicity and improve long-term outcomes for kidney transplant patients [8][12]. Future Directions - **Phase 3 Study Plans**: Eledon plans to approach the FDA for a phase 3 study design based on the non-inferiority endpoint, with potential for additional superiority claims based on long-term outcomes [42][43]. - **Financial Position**: The company reported $93.4 million in cash, sufficient to fund operations into late 2026, with several upcoming milestones [35][61]. Additional Insights - **Patient Management**: The ability to maintain patients on tegoprubart during rejection episodes without switching to tacrolimus may lead to better long-term kidney function [50][55]. - **KDPI Scores**: The study revealed unexpected findings regarding the quality of donor kidneys, with higher quality kidneys (KDPI < 35) performing better with tacrolimus, raising questions about the long-term implications of drug choice [62]. Conclusion - **Overall Outlook**: Eledon is optimistic about the potential of tegoprubart to improve kidney transplant outcomes and is preparing for further studies to validate its efficacy and safety [34][36].

Summary of Eledon Pharmaceuticals (ELDN) Conference Call Company Overview - **Company**: Eledon Pharmaceuticals - **Focus**: Development of tegoprubart for kidney transplant rejection prevention Industry Context - **Industry**: Biotech, specifically in transplant medicine - **Current Standard of Care**: Calcineurin inhibitors, primarily tacrolimus, which has been in use since 1994 Key Points and Arguments Unmet Need in Kidney Transplantation - Tacrolimus has significant limitations including nephrotoxicity, hypertension, and beta cell toxicity leading to hyperglycemia and insulin-dependent diabetes [4][5] - The average survival of transplanted kidneys is between 10 to 15 years, with patients often requiring multiple transplants due to organ scarcity [5][6] Tegoprubart Development - Tegoprubart is being evaluated in Phase 1B and Phase 2 trials as an alternative to tacrolimus [3] - The goal is to improve patient quality of life and organ survival by reducing adverse effects associated with tacrolimus [5] Clinical Trial Design and Endpoints - **Phase 1B Study**: Focused on safety and tolerability, with endpoints including rejection rates and kidney function measured by eGFR [14][15] - **Phase 2 Study (BESTOW)**: Designed to demonstrate superiority over tacrolimus, with a primary endpoint of kidney function at 12 months, aiming for an eight-point difference in eGFR [15][34] iBOX Score as a New Endpoint - iBOX is a composite endpoint that includes eGFR, DSA, proteinuria, and time since transplant, which is a better predictor of long-term graft survival than traditional biopsy-proven rejection [7][19] - Eledon reported an iBOX score of negative 4.1 in the on-treatment group, significantly better than the average CNI iBOX score of negative 2.9 [18][22] Rejection Rates and Safety Profile - The rejection rate in the Phase 1B study was reported at 18%, comparable to BALADA sub-studies in the low 20s, while standard care is in the high single digits [23][24] - The safety profile showed no significant adverse events typically associated with tacrolimus, such as graft loss or sepsis [45] Market Opportunity - Approximately 48,000 transplants occur annually in the U.S., with nearly 30,000 being kidney transplants [48] - The U.S. transplant immunosuppressant market is substantial, with tacrolimus generating nearly $1.5 billion in annual revenues [48] Future Expectations - Eledon anticipates presenting data from the Phase 2 study in Q4 and expects to launch Phase 3 trials in the second half of the following year [54][58] - The company is also exploring islet cell transplantation and xenotransplantation, with ongoing studies expected to yield more data [58] Additional Important Insights - The FDA is considering new approval endpoints that may allow for superiority claims based on iBOX scores [11][12] - The concentrated nature of the transplant market, with only 40 centers performing half of the transplants, presents a unique opportunity for Eledon to leverage existing relationships [48][51] This summary encapsulates the critical insights from the conference call, highlighting Eledon's strategic focus on addressing unmet needs in kidney transplantation through innovative therapies and the potential market impact.

Core Insights - Biogen has initiated dosing in a global, late-stage study of felzartamab for treating adult patients with primary membranous nephropathy (PMN), with top-line data expected in 2029 [1][4] - Felzartamab is an anti-CD38 antibody with a unique mechanism of action, and currently, there are no approved therapies for PMN, which typically relies on immunosuppressants or chemotherapy [1][6] - The PROMINENT study will evaluate the efficacy and safety of felzartamab compared to tacrolimus in moderate-to-high-risk PMN patients [3][5] Company Developments - Felzartamab was added to Biogen's pipeline through the acquisition of Human Immunology Biosciences last year, originally developed by MorphoSys AG [2] - The PROMINENT study will enroll approximately 180 PMN patients, with the primary endpoint being the percentage of patients achieving complete remissions at week 104 [5] - Biogen has also initiated dosing patients with felzartamab in two other phase III studies for late antibody-mediated rejection in kidney transplant recipients and IgA nephropathy [7] Clinical Study Details - The PROMINENT study will compare felzartamab to tacrolimus in 180 moderate-to-high-risk PMN patients, including newly diagnosed and relapsed cases [4][5] - Secondary endpoints will evaluate the effect of felzartamab on serum aPLA2R antibodies and patient-reported outcomes [5] - Previous phase II studies showed that felzartamab led to significant reductions in aPLA2R antibody levels and improvements in kidney markers [10] Market Context - PMN affects about 36,000 people in the United States and represents a serious unmet medical need, as current treatment options fail in about one-third of patients [6] - Year to date, Biogen's shares have declined by 17.9%, compared to the industry's decline of 3.6% [3]

Core Viewpoint - Biogen has initiated a Phase 3 clinical study, PROMINENT, to evaluate the efficacy and safety of felzartamab in treating primary membranous nephropathy (PMN), a severe kidney disease with no approved treatments [1][4]. Company Overview - Biogen is a leading biotechnology company founded in 1978, focused on innovative science to develop new medicines and create value for shareholders and communities [10]. - The company has a commitment to advancing treatment options for patients with kidney diseases, as evidenced by the launch of multiple Phase 3 trials for felzartamab in 2025 [3][5]. Drug Information - Felzartamab is an investigational anti-CD38 monoclonal antibody that selectively depletes CD38+ plasma cells, which are implicated in various immune-mediated diseases [2][6]. - The drug targets patients with PMN, where up to 80% have autoantibodies against PLA2R, and aims to provide a novel treatment option in a field lacking approved therapies [2][9]. Clinical Study Details - The PROMINENT study will enroll approximately 180 adults with PMN and is expected to read out in 2029 [1]. - The trial is designed as a 104-week, randomized, open-label study comparing felzartamab to tacrolimus, with the primary endpoint being the percentage of participants achieving complete remission of proteinuria at week 104 [3][4]. - Key secondary endpoints include the impact on serum anti-PLA2R antibodies and patient-reported outcomes [3]. Previous Research - Felzartamab has shown promising results in earlier Phase 2 studies, with significant reductions in aPLA2R titers and improvements in proteinuria and serum albumin levels observed [4][6]. - The majority of treatment-emergent adverse events reported were mild to moderate, primarily infusion-related reactions [4]. Market Context - PMN is a rare immune-mediated kidney disease with an estimated prevalence of approximately 36,000 patients in the U.S., highlighting the unmet medical need in this area [6][9].