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BIOSENSORS-CLINICAL UPDATE “LEADERS AND BEYOND”

BIOSENSORS-CLINICAL UPDATE “LEADERS AND BEYOND”. John E Shulze, CTO BIOSENSORS INTERNATIONAL GROUP Jan 29, 2010. MY CONFLICTS OF INTEREST ARE: EMPLOYEE AND SHAREHOLDER OF BIOSENSORS INTERNATIONAL. Biosensors Research:.

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BIOSENSORS-CLINICAL UPDATE “LEADERS AND BEYOND”

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  1. BIOSENSORS-CLINICAL UPDATE“LEADERS AND BEYOND” John E Shulze, CTO BIOSENSORS INTERNATIONAL GROUP Jan 29, 2010

  2. MY CONFLICTS OF INTEREST ARE: EMPLOYEE AND SHAREHOLDER OF BIOSENSORS INTERNATIONAL

  3. Biosensors Research: • There is an unmet market need for DES that have a high effectiveness for suppression on NH combined with a low incidence of late stent thrombosis upon cessation of antiplatelet therapies. • Development of Acute & SubAcute Thrombosis in stents is multifactorial and we should expect that higher risk patients/procedures will result in more early thrombosis and perhaps greater needs for antiplatelet therapy. • However, Rapid healing, leading to complete endotheliazation and return of normal endothelial function inside the stent we believe to be the most important factors in reducing risk of VLST and maybe LST. • Both PLA biodegradable coating technology and “polymer free” coating technologies developed by Biosensors are intended to provide faster healing of the stent, 6-9 months in the case of BioMatrix and similar to a bare stent in the case of the Biofreedom Stent.

  4. BioMatrix™ The abluminalbiodegradablepolymer DES PLA biodegradation and BA9™ elution Abluminal biodegradable coating absorbed after 6-9 months* * Data on file - molecular weight<10kDa

  5. Stent Biodegradable Polymer and Primer Coating BioMatrix BioMatrix Flex BioMatrix II FUTURE 1 and 2 STEALTH FIM BEACON Registry STEALTH PK LEADERS Stent Stent Primer: Parylene Primer: Parylene No Primer Matrix: Polylactic Acid Matrix: Polylactic Acid Matrix: Polylactic Acid Source: S. Windecker, PCR 2008

  6. 10717-000 – Rev.01

  7. Trial Design Stable and ACS Patients Undergoing PCI Assessor-blind 1:1 Randomisation N=1700 Patients BES BioMatrix Flex N=850 SES Cypher Select N=850 1:3 Randomisation Clinical F/U N=640 Angio F/U N=210 Clinical F/U N=640 Angio F/U N=210 1o endpoint: CV death, MI, clinically-indicated TVR (9 month) 2o endpoints: Death, CV death, MI, TLR, TVR Stent thrombosis according to ARC Angiographic study: In-stent % diameter stenosis Late loss, binary restenosis DAPT recommended for 12 month

  8. Primary EndpointCardiac Death, MI and TVR @ 9 Months2 15 Pnon-inferiority = 0.003 SES 10.5% -12% 10 Cumulative Incidence (%) MACE % BES 9.2% 5 0 0 1 2 3 4 5 6 7 8 9 Months of Follow-up BES reached its primary endpoint 2Windecker S. et al., The Lancet 2008; 372 No. 9644: 1163-1173

  9. MACE 2-year HR 0.84 [0.65 to 1.08] P = 0.18* 15.4% Δ 2.4% 13.0% 1-year HR 0.88 [0.66 to 1.17] P = 0.37* 20 BES SES 15 12.1% Δ 1.4% % 10 10.7% 5 0 0 3 6 9 12 15 18 21 24 Months MACE = Cardiac Death, MI, or Clinically-Indicated TVR * P values for superiority

  10. Cardiac Death or MI 1-year HR 1.01 [0.70 to 1.45] P = 0.95* 2-year HR 0.92 [0.66 to 1.27] P = 0.59* 10 9.1% BES Δ0.8% SES 8 8.3% 6.9% Δ0% 6.9% 6 % 4 2 0 0 3 6 9 12 15 18 21 24 Months *P values for superiority

  11. Superior Strut Coverage and Stent Apposition3 Lesions with at least 5% uncovered struts Lesions with at least 5% malapposed struts p = 0.005 p = 0.04 20 x 10 x % % N strut = 4592 N strut = 6476 N strut = 4592 N strut = 6476 BES with an abluminal biodegradable polymer achieved a 10 x better strut coverage and a 20 x better stent apposition vs. SES with a symmetric durable polymer at 9 months 3Di Mario C., TCT 2008

  12. Very Late Stent Thrombosis Signs of Safety Benefits Beyond One Year

  13. Definite ST through 2 years 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0 3 6 9 12 15 18 21 24 Zoom at 1% scale 2.5% +0.5% BES SES 2.2% 2.0% +0.2% % 2.0%

  14. Advantage in Complex Patients

  15. Complex Patients – STEMI12 Month MACE p=0.02 p=0.07 -57% -77% p= 0.22 p=0.04 MACE % Superior clinical outcomes for the BES vs. SES up to 12 months Buszman, P., PCR 2009

  16. BIOSENSORS PRODUCT PIPELINE BioFreedom: complete elimination of polymer, Use of Surface texturing, yields more rapid drug clearance to enhance healing: • Changes to stent platform, stent delivery catheter, coating methods, and connector design, for the Biomatrix Flex design….. BioMatrix BioMatrix Flex • Enhance flexibility • Increase stent retention

  17. 4 Month Late Lumen Loss P< 0.0001 P= 0.002 P= 0.09 Late Loss mm (median) In-segment P = 0.09 P = 0.77 P = 0.71 P = 0.32 P = 0.35 P = 0.89 P = 0.99 P = 0.19 P = 0.37

  18. Conclusions • The biodegradable PLA polymer with complete release of drug and polymer within 6-9 months differentiates the Biolimus eluting stents from other DES with limus drugs eluted from durable polymers • The abluminal surface coating manufacturing technology reduces the polymer exposure compared with symmetric coatings

  19. Conclusions • The clinical trial program demonstrates that Biolimus A9 released from a biodegradable PLA coating is a safe antiproliferative combination for use in DES. The clinical studies in both simple and complex lesions have consistently achieved or exceeded clinical endpoints compared to BMS and other approved DES with: -low MACE at various clinical endpoints up to and including 4 years -low %DS & late loss -no very late Thrombosis • Clinical Trial data is currently available in the Biolimus program in over 4000 patients , and during 2010, additional >5000 patients (e-BioMatrix). • Ongoing and planned clinical trials in an additional >5000 patients will evaluate the durability of the BioMatrix results in large populations and in a wide range of more complex patients and lesion subsets incl AMI.

  20. Rue de Lausanne 29 – 1110 MORGES – Switzerland Tel. (41) 0 21 804 80 00 – Fax (41) 0 21 804 80 01 customer@biosensors.com

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