LUNGFIT-SLI: Fighting the Most Aggressive Form of NTM

High concentration NO delivery has a demonstrated safety record in people and animals with Beyond Air’s LungFit technology. In addition to being a bronchodilator, NO also has been shown to have anti-inflammatory effects and eliminate some viruses. Beyond Air have embarked on a program to address the needs of patients with severe lung infections using LungFit, starting with acute viral pneumonia (including COVID-19) and Nontuberculous Mycobacteria (NTM)

Acute Viral Pneumonia

In adults, viruses have been identified as the causative agents in approximately 100 million cases of community-acquired pneumonia per year. While viral pneumonia in adults is most commonly caused by rhinovirus, respiratory syncytial virus (RSV) and influenza virus, newly emerging viruses (including SARS-CoV-1, SARS-CoV-2, avian influenza A, and H1N1 viruses) have been identified as pathogens contributing to the overall burden of adult viral pneumonia. Patients aged 65 years or older are at particular risk for death from the disease, as are patients with other underlying health conditions or weakened immune systems. There is no consensus regarding the use of antiviral drugs to treat viral pneumonia, and specific preventative measures are currently limited to the influenza vaccine. Given that current treatment recommendations are largely limited to supportive care, there is an unmet medical need for effective treatment options. NO may prove to be a treatment as the impact on the lung should result in bronchodilation, reduction in inflammation and inhibition of the viral replication process^1,2,3.

^{[1] Tripathi et al, FEMS Immunology and Medical Microbiology, December 2017}
^{[2] Saura, M., et al., An antiviral mechanism of nitric oxide: inhibition of a viral protease. Immunity, 1999. 10(1): p. 21-8.}
^{[3] Akerström S et al. Nitric oxide inhibits the replication cycle of severe acute respiratory syndrome coronavirus. J Virol. 2005; 79(3):1966-9.}

Acute Viral Pneumonia (including COVID-19) Clinical Program

LungFit™ PRO will be used in a multi-center, open-label, randomized clinical trial with approximately 90 adult patients. The enrolled patients will be randomized in a 1:1 ratio to receive inhalations of 150 ppm NO given intermittently for 40 minutes four times per day for up to seven days in addition to standard supportive treatment (NO+SST); or standard supportive treatment alone (SST). Endpoints related to safety, oxygen saturation, fever and ICU admission, among others, will be assessed.

<em>Nontuberculous Mycobacteria</em> (NTM)

Nontuberculous Mycobacteria (NTM)

Nontuberculous Mycobacteria (NTM) comprise of more than 160 species of bacteria that are found naturally in the environment. The most common species causing disease is called Mycobacterium avium complex (MAC). The next most common are Mycobacterium abscessus and Mycobacterium kansasii. Everyone inhales NTM into the lungs but people with existing lung diseases such as bronchiectasis, COPD, CF, alpha-1 antitrypsin deficiency or with primary or secondary immunodeficiencies are at higher risk of developing pulmonary NTM disease. Treatment of NTM infections usually requires long term use of a combination of two to three antibiotics and is limited by the potential toxicity of multiple side-effects.

Nontuberculous Mycobacterium abscessus (Mabs) lung infection is a rare but serious pulmonary disease associated with increased morbidity and mortality. This is the most aggressive and difficult to treat form of NTM. Beyond Air proprietary in-vitro data shows a promising potential synergic effect between antibiotics given for treatment of NTM and high-dose intermittent NO. Longer exposure to NO could be required for bacterial killing in a subset of Mabs strains. Beyond Air’s proprietary nitric oxide formulation yielded positive clinical results in humans in its single-arm pilot NTM study.

Product Status and Market Potential

Beyond Air Pipeline & Market Size

Product	Indication	Development Status	Key Dates^*	US Sales Potential^**	Worldwide Sales Potential^**
LungFit PRO	Acute viral pneumonia (including COVID-19)	Pilot studies in progress	Pilot study data 2H20	N/A	N/A
LungFit GO	Nontuberculous mycobacteria (NTM) lung infection	Pilot phase	Pilot study start 4Q20 Self-administration at home	>$1B	>$2.5B
LungFit GO	Severe exacerbations due to lung infections in COPD patients	Pre-clinical	Pilot study start 2H21	>$2.5B	>$6B

Nitri*All dates are based on projections and appropriate financing, anticipated first launch on global basis pending appropriate regulatory approvals

**All figures are Company estimates for peak year sales: Global Sales Potential includes US Sales Potential

New Care for an Underserved Market

NTM is an FDA disease area of focus with limited options. Beyond Air is initially targeting NTM abscessus (MABSC), the most aggressive and difficult to treat form of NTM.

There are a limited number of companies undertaking human studies for the treatment of NTM. Beyond Air expects to seek approval in NTM MAC (mycobacterium avium complex) following MABSC approval.

180,000+

estimated NTM cases in the U.S. in 2014¹

$1.7 billion

estimated NTM costs, with MABSC costs greater than 2x MAC costs¹

37%

of NTM confirmed cystic fibrosis patients in the U.S. are MABSC²

20% - 25%

of all NTM cases in a South Korean database are MABSC³

13 years

median survival for MAC⁴

4.6 years

median survival for non-MAC NTM⁴

Resources to Learn More

Pilot NTM At-Home Study

Beyond Air is planning a pilot NTM at-home study in Australia to start in Q2 2020. The study will include 20 CF and non-CF patients with refractory MAC and M abs infections. In addition to their standard treatment, the patients will receive intermittent inhalations with NO 4 times a day for the first 14 days and 2 times a day for the next 10 weeks. Patients will receive NO of up to 250 ppm depending of tolerability. The study aims to obtain preliminary data on the safety and efficacy of intermittent NO given in doses of up to 250 ppm.

Severe Lung Infections