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bristol myerd squibb American Diabetes Association (ADA) Highlights
1. *
ADA 2008 Highlights
Investor Teleconference
June 11, 2008
Fred Fiedorek, MD
Vice President, Global Clinical Research
Roland Chen, MD
Group Director, Global Clinical Research
*American Diabetes Association
June 6 – June 10, 2008 Not For Promotional Use 1
2. Comments will be about the Company’s future plans and
prospects that may be forward-looking statements under
the Private Securities Litigation Reform Act of 1995.
We caution that actual results may differ materially from
those indicated by these forward-looking statements as
a result of various important factors, including those
discussed in the Company’s most recent annual report on
Form 10-K, periodic reports on Form 10-Q and current
reports on Form 8-K. These documents are available from
the SEC, the Bristol-Myers Squibb web site or from
Bristol-Myers Squibb Investor Relations. While we may elect
to update forward-looking statements at some point in the
future, we specifically disclaim any obligation to do so,
even if our estimates change.
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3. Diabetes: A Growing, Global Problem
Type 2 Diabetes prevalence expected to grow
from 190 million to 330 million by 2030
50-70% of patients are not controlled
Europe prevalence is
Diabetes growing rapidly lower (~4.6%), but
in U.S. – current increasing, especially in
prevalence rate 6.7% the southern countries
Mexico – highest India and China will make up
prevalence rates in nearly 50% of the total
the world: 12.4% number of patients with
diabetes in 2030
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Source: WHO NOT FOR PROMOTIONAL USE 3
3
4. Majority of Patients Are Not Optimally
Controlled
Lack of involvement / motivation / compliance / knowledge leads to
progression of disease, with nearly 2/3 of patients not controlled
Percentage of patients not controlled,
by market (relative to HbA1c target of 7.0%)
100
60% of
80
US diabetic 69
64
patients 62
Patients (%)
58 57
60
do not know 51
their A1c or
40
FPG values
20
0
UK FR GER ITL SPN
US
Source: Adelphi, 2006 Disease Specific
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Programmes, NHWS 2006
4
5. The Progressive Nature of Type 2 Diabetes
Ultimately Overwhelms Medications
Glycemic Control in an Illustrative Patient
Potential =
Slope 5
treatment
p er
0.75%
change
yrs.
First
5yr s
Agent
Goal*
HbA1c
A1c=<7
Goal**
A1c=<6.5
Normal***
A1c=5%
~30 Years
Sources: ADOPT, UKPDS
(*) According to the ADA; (**) according to the AACE/ACE; (***) according to the NIH
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6. Pharmacologic Intervention in Diabetes
Several different classes of oral antidiabetic agents are
available
Most agents fail after 3-5 years; the current paradigm is
one of adding a new treatment to an existing regimen
Some patients do not even reach the 3-5 year time to fail
point because of adverse events or poor tolerance
The market is and continues to be an add-on market
New classes have an important place in overall
management
There remains a need for new therapies
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7. Site of Action of Oral Antidiabetic Agents
Carbohydrate
Skeletal
Load
Muscle
Pancreas
Reduced glucose uptake
Impaired Insulin Secretion
and utilization
Sulfonylureas Metformin
Hyperglycemia
DPP-4 inhibitors Thiazolidinediones
Increased glucose Glucose
production reabsorption Kidney
Liver
Metformin
Thiazolidinediones
SGLT2 inhibitors
DPP-4 inhibitors
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8. Unmet Medical Needs Still Remain
Optimal glycemic control on treatment
Sustainable A1c reduction/glycemic
efficacy
Concurrent weight management
Delaying or halting disease progression
Improving patient compliance
Finding additional therapies that are
efficacious, well tolerated and safe
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9. ADA Highlights: Bristol-Myers Squibb
Key data presented for two-late stage pipeline
compounds in collaboration with AstraZeneca:
Saxagliptin Phase 3 monotherapy study:
Produced significant reductions in HbA1c, FPG,
PPG
Dapagliflozin Phase 2B study: Reductions in all
measures of glycemic control with addition of
weight loss
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10. Saxagliptin Overview
Highly potent and selective DPP-4 inhibitor
Completed Phase 3 registrational program
Well tolerated
Produced significant reductions in all key
measures of glucose control
On track for mid-year submission
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11. Patient Exposures Throughout
Saxagliptin Program
Phase 1 and 2
~110 subjects exposed to saxagliptin at 20-80x the
5 mg dose for up to 6 weeks
~670 subjects exposed to saxagliptin at 2-10x the
5 mg dose for up to 12 weeks
Phase 3
~1000 patients treated at 10 mg dose for up to 2 years
>3000 patients treated at any dose in Phase 3
Clinical correlates to the skin lesions in monkeys have
not been identified in human clinical trials of saxagliptin
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12. Previously Disclosed Saxagliptin Data
Pharmacokinetics and safety
2.5 to 400 mg
No identified clinically meaningful drug interactions
No dose adjustment required with hepatic impairment
May be administered without regard to age or gender
Phase 2 data recently published
Diabetes Obesity Metabolism 2008; 10: 376-386
Phase 3 add-on to metformin study presented at
ADA 2007
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13. Saxagliptin Add-On to Metformin:
Significant HbA1c Reductions From Baseline
Adjusted Change From Baseline
Difference in Adjusted Change From
Baseline vs Placebo + MET
0.4
0.2
0
-0.2 -0.83 -0.72
-0.73
%
-0.4
-0.6
-0.8
* *
*
-1
PBO + MET SAXA 2.5 mg SAXA 5 mg SAXA 10 mg
(N = 175) + MET + MET + MET
(N = 186) (N = 186) (N = 180)
Bars indicate 95% two-sided confidence interval.
*P values vs placebo + MET: P<0.0001.
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Phase 3 Study -014, ADA June 2007 13
14. Saxagliptin Monotherapy Study Design:
ADA 2008
2 Week 24 Weeks 42 Months
PBO
Metformin 500 mg QD* (PBO if enter LT via rescue)
PBO*
Lead In
Superiority
N = 401
2.5 mg Saxa QD*
2.5 mg Saxa QD*
Treatment-
Naïve T2DM
Superiority
A1c
5 mg Saxa QD*
5 mg Saxa QD*
7.0-10.0%
to Enroll Superiority
10 mg Saxa QD*
10 mg Saxa QD*
N = 66
Treatment-
Naïve
T2DM 10 mg Saxa QD*
10 mg Saxa QD*
A1c
10.0-12.0%
*If rescue criteria met in ST, add Metformin 500-2000 mg total daily dose, enter LT phase; Metformin rescue also
available in LT extension (42 weeks)
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Phase 3 Study -011, ADA June 2008 14
15. Significant Reductions in HbA1c, FPG, PPG
From Baseline at Week 24
A1c Fasting Plasma Glucose Postprandial Glucose
2000
0.6 20.0
(%) (mg/dL) (mg min/dL)
15.0
0.4 0
0.19 10.0 -646.6
0.2 6.06 -2000
5.0
0.0
-4000
0.0
-0.2
-5.0 -6000
-0.4
-10.0 -6896
-8.67 -6868
-0.43 -0.46 -8000
-0.6 -0.54 -8084
-15.0
-14.53
-16.75 -10000
-0.8 -20.0
-1.0 -25.0 -12000
Saxagliptin + Met
2.5 mg 5 mg 10 mg PBO + Met
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Phase 3 Study -011, ADA June 2008 15
16. Most Common (≥5%) Adverse Events
Reported In The Main Cohort
Saxagliptin
Open-Label
PBO Saxagliptin
Cohort
Main Cohort Main Cohort
N=66
N=95 N=306
Total patients with AEs (%) 68 (71.6) 231 (75.5) 40 (60.6)
Upper respiratory tract 11 (11.6) 27 (8.8) 6 (9.1)
infection
Headache 7 (7.4) 25 (8.2) 5 (7.6)
Urinary tract infection 4 (4.2) 21 (6.9) 3 (4.5)
Nasopharyngitis 6 (6.3) 18 (5.9) 3 (4.5)
Sinusitis 3 (3.2) 17 (5.6) 1 (1.5)
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Phase 3 Study -011, ADA June 2008 16
17. Saxagliptin: What’s Next?
NDA submission by mid-year
Additional Phase 3 data planned for disclosure
at EASD in September
– Combination studies with SU, TZD
– Initial combination therapy with metformin
Life cycle program underway
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18. Dapagliflozin Overview
First in a new class that inhibits renal glucose
reabsorption
Stable C-glucoside molecule that allows
once-daily dosing
In Phase 3 development
– Monotherapy
– Combination
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19. Effects of SGLT2 Inhibition on Renal
Glucose Reabsorption
Intestine Kidney
SGLT1
Plasma Urine
Diet Glucose Glucose Glucose Glucose
Glucose
SGLT1
SGLT2
Dapagliflozin
Potential benefits of selective SGLT2 inhibition:
Insulin-independent glucose lowering
Loss of calories in urine, with potential for weight
control
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20. ADA 2008: Dapagliflozin
At the ADA, data on dapagliflozin was presented from the
largest and longest (12 weeks) trial of an SGLT2 Renal
Glucose Reabsorption Inhibitor to date. Results
demonstrated that dapagliflozin:
Induced controlled glucosuria
Improved glycemic control
- Reduced fasting glucose
- Reduced postprandial glucose
- Reduced HbA1c
Lowered weight
Showed little propensity to cause hypoglycemia
Demonstrated no clear adverse safety or tolerability signals
over 12 weeks
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21. Dapagliflozin Registrational Program
Patient Population Treatment Types
Treatment-Naïve Monotherapy vs. Initial combination
placebo with metformin
Treatment- Add-on Therapy
Experienced
(previous treatment Versus placebo: Active control:
failure) • Metformin • Sulfonylurea
Sulfonylurea Others under
• •
consideration
TZD
•
Insulin
•
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22. *
ADA 2008 Highlights
Investor Teleconference
June 11, 2008
Fred Fiedorek, MD
Vice President, Global Clinical Research
Roland Chen, MD
Group Director, Global Clinical Research
*American Diabetes Association
June 6 – June 10, 2008 Not For Promotional Use 22