Precision Immunotherapy™

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Tcelna Process and Mechanism of Action

Tcelna® (imilecleucel-T)

Tcelna® (formerly known as Tovaxin) is a personalized T-cell immunotherapy in a Phase IIb clinical development program (the Abili-T trial) for the treatment of Secondary Progressive Multiple Sclerosis. Tcelna is specifically tailored to each patient's immune response profile to myelin and is designed to reduce the number and/or functional activity of specific subsets of myelin-reactive T-cells (MRTC) known to attack myelin. Tcelna is manufactured using ImmPath™, Opexa's proprietary method for the production of a patient-specific T-cell immunotherapy, which encompasses the collection of blood from the MS patient, isolation of peripheral blood mononuclear cells, generation of an autologous pool of myelin-reactive T-cells (MRTCs) raised against selected peptides from myelin basic protein (MBP), myelin oligodendrocyte glycoprotein (MOG) and proteolipid protein (PLP), and the return of these expanded, irradiated T-cells back to the patient. These attenuated T-cells are reintroduced into the patient via subcutaneous injection to trigger a therapeutic immune system response.

Fast Track Regulatory Approval

Tcelna® has been granted Fast Track status by the U.S. FDA in Secondary Progressive MS (SP-MS) based on the unmet need of the progressive indication and the potential of Tcelna to benefit this patient population. Opexa has also completed formal End of Phase II meetings with the FDA and has received support to move forward with the design of pivotal Phase III clinical trials in Relapsing Remitting MS (RR-MS). Opexa is currently conducting a Phase IIb clinical trial in SP-MS patients and continues to evaluate its plans in the RR-MS indication.

Tcelna® Differentiation

Tcelna® possesses a unique mechanism of action that combats the demyelination of the nerve fibers in the central nervous system, the underlying cause of MS. Five clinical trials have been completed with Tcelna in 356 patients, many with multiple years of treatment. Opexa believes Tcelna may possess a number of advantages compared to other MS therapies currently available or in development, including:

Personalization - Tcelna® is a personalized autologous immunotherapy that is manufactured for every individual patient, tailored to his or her immunity to myelin. Each patient receives a newly personalized treatment on an annual basis based on their unique epitope profile. Opexa is unique in that it evaluates 109 peptides across the three key myelin proteins to identify each patient's set of dominant epitopes.

Efficacy - Clinical trials conducted to date demonstrate that Tcelna® may result in a reduction in the Annualized Relapse Rate (ARR) for patients with MS, slowing of disease progression and evidence of an improvement in disability in a number of MS patients, which could suggest a neuroprotective benefit.

Safety and Tolerability - It is believed that Tcelna® treatment selectively targets and regulates the pathogenic T-cell population. It is not a general immune suppressant and, accordingly, is not associated with the serious side effects seen by those MS treatments that function by systemically suppressing the immune system. In clinical trials conducted to date, the safety profile of Tcelna has remained superb.

Improved Compliance - Currently, available therapies are administered monthly and, in some cases, daily. The treatment regimen for Tcelna® consists of only five subcutaneous injections per year, which we believe may provide compliance benefits to patients and physicians.

Clinical Development in SP-MS

Patients with Secondary Progressive MS (SP-MS) represent approximately 50% of the total MS population, yet treatment options remain very limited. Currently, there is only one product specifically approved for patients with SP-MS, and that product carries a black box warning due to severe cardiotoxicity. In an effort to meet this significant unmet medical need, Opexa is currently conducting a Phase IIb clinical trial of Tcelna® in SP-MS patients.