Figure 128 Pooled LGS % Seizure Reduction: 10mg/kg Epidiolex vs
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COWEN
COLLABORATIVE INSIGHTS
92
February 25, 2019
Figure 128 Pooled LGS % Seizure Reduction: 10mg/kg Epidiolex vs.
Figure 129 Pooled LGS % Seizure Reduction: 20mg/kg Epidiolex vs.
Placebo Placebo
100, our 100, oe 100 oars =79] (30% on VPA 100 pa =83] (38% on CLB
Placebo [n=37] (32% on VPA) Placebo [n=30] (40% on CLB) i 5 sper aoc el a Peereta i 88) Bae on CEA)
= 804 65 5.10 mg/kg/d [n=37] (19% on VPA) ao 4 re 40 mg/kg/d [n=27] (28% on CLB) = 80 a2 ee Bi] Cae a VP AD 30 64 920 mg/kg/d [n=64] (34% on CLB)
g 60} 51 46 60} 47 aA 2 60 St Ee 60 46 47
2 404 ao © 40 ji 40 28
2 | 19 ; J | zn ; 19 2 29 é | 20 i ‘ |
0 0
o + : + 0 225 28D 275 225 >50 275
25 250 275 225 250 275 y
OR 197 408 473 OR 199 732 668 OR: 3.02 436 9.60 OR: 2.17 7.1 8.06
100 Off CLB 100 Off VPA
100 Off CLB 100 Off VPA SS 'Placebo [n=82] (48% on VPA) Placebo [n=98] (55% on CLB)
- Placebo [n=39] (46% on VPA) s Placebo [n=46] (54% on CLB) = 80 120 mg/kgid [n=84] (50% on VPA) 80 62 #20 mg/kg/day [n=97] (57% on CLB)
@ 80 10 ma/kgid [n=36] (58% on VPA on 65 10 morkaid In=48] (65% on CLB) Py 51
= 64 atkald n=36] ( ) 60 60] 4g i
@ 60 60 5 [i 35
E 38 us 37 _ 40 ie B 23
5 40 33 40 i. 2 oa “a 6 20 i .
& 20 8 ri 14 20 ‘4 13 ji oo | |
0 fi} 225 250 275 225 =50 275
225 250 275 225 250 275 OR: 148 3.34 2.38 OR: 1.88 2.62 3.88
OR: 2.63 OR: 2.48
Bi 5.68
Reduction in drop seizure frequency from baseline (%)
al
Reduction in drop seizure frequency from baseline (%)
Reduction in drop seizure frequency from baseline (%)
Reduetion in drop seizure frequency from baseline (96)
Source: GW Pharma, AES 2017
Source: GW Pharma, AES 2017
GW has also studied CBD in psychiatric indications. Results from an exploratory study of
CBD (GWP42003) in schizophrenia were released in September 2015. The trial was a
Phase lla 6 week, placebo-controlled exploratory trial in 88 patients with schizophrenia
refractory to first line anti-psychotic medications. To be enrolled, patients must have
been treated for a minimum of four weeks on a first line anti-psychotic medication and
still have a PANSS total score in excess of 60. CBD was administered as adjunct therapy
ona background of antipsychotic medication. The trial did not have a primary endpoint,
but rather a number of exploratory endpoints.
CBD consistently demonstrated superiority to placebo, suggesting that CBD may have
substantial anti-psychotic effects. CBD produced statistically significant benefits
compared to placebo on the PANSS positive sub-scale (p=0.018), the Clinical Global
Impression of Severity (p=0.04) and Clinical Global Impression of Improvement (p=0.02).
The proportion of responders (improvement in PANSS Total score > 20%) was higher on
CBD than placebo (p=0.07), with an Odds Ratio of 2.65. Moreover, CBD trended superior
to placebo (p=0.07) on sub-domains of the PANSS that were particularly relevant to
cognition in people with schizophrenia. The Scale for Assessment of Negative Symptoms
showed a trend in favor of CBD, and reached statistical significance in patients taking
CBD together with a leading first line anti-psychotic medication. The rest of the
exploratory endpoints, many of which were other scales measuring functionality and
cognition in schizophrenia patients, also trended in favor of CBD.
Even in the context of schizophrenia, CBD produced a clean safety profile, with no
serious adverse events and a balanced incidence of adverse events compared to
placebo. The most common adverse events were diarrhea (9.3% CBD vs. 4.4% placebo),
nausea (7% CBD vs. 0% placebo), headache (7% CBD vs. 8.9% placebo) and somnolence
(0% CBD vs. 6.7% placebo). There were two withdrawals from the study due to
treatment-related adverse events, one each for CBD and placebo.
CBD's activity in schizophrenia is supported by pre-clinical data in animal models, as well
as by a recent study published in The Journal of Clinical investigations (2012) which
suggested CBD may be useful as either monotherapy or in combination with first line
anti-psychotic agents. Nonetheless, while the p-values suggest that CBD has activity, its
potency is difficult to judge without knowing the effect sizes. Therefore, additional data
from this and subsequent studies will be necessary to fully understand the potential of
CBD in schizophrenia. GW Pharma has indicated that it intends to pursue CBD's future
development in pediatric orphan neuropsychiatric indications.
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