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1 Physician Survey Survey of Healthcare Professionals on Community-Acquired Bacterial Pneumonia We conducted a survey on prescribing habits for community-acquired bacterial pneumonia (CABP) in order to better understand the existing unmet needs in the space, current treatment paradigms, and response to updated FDA guidance on the use of fluoroquinolones. We surveyed 120 healthcare professionals, including 34 emergency medicine specialists (EMR), 28 infectious disease specialists (INF), 26 hospitalists (HOS), 16 primary care providers (PCP), and 16 nurse practitioners (NP). We plan to explore the market opportunity for Paratek s (NasdaqGM: PRTK) omadacycline in the context of our survey results in a follow-up note. Analysts David Sherman, Ph.D. (AC) (212) dsherman@lifescicapital.com Key Results from the Survey. Below are the most important findings from our analysis of the survey data: Need for Oral Drugs Targeting Drug-Resistant Pathogens This was most frequently cited by 43% of physicians as the biggest unmet need in CABP. Most Important Features in Selecting an Antibiotic The physicians cited the importance of an antibiotic being well-tolerated, having an IV-to-oral step-down, and having a low propensity to cause C. difficile infections. Fluoroquinolone Use is Expected to Decrease in CABP 56% of surveyed physicians expected to prescribe fluoroquinolones for CABP less often following the updated FDA guidance earlier this year. Focus on Lowering Treatment Costs Lower cost of therapy and reducing hospital stays, a major driver of treatment cost, were commonly cited as pressing unmet needs in CABP. Empiric Treatment is Standard Practice in CABP The surveyed physicians performed cultures only roughly 40% of the time in CABP patients, highlighting the importance of empiric treatment options. Oral Antibiotics as a Route to Lower Overall Treatment Costs. Many of biggest unmet needs cited by the survey respondents reflect a desire in the healthcare community to reduce the amount of treatment for CABP that must be administered in the hospital setting. Oral antibiotics capable of treating drug-resistant pathogens, cited most frequently as the biggest unmet need in CABP, may allow for a greater percentage of patients to avoid hospital admission when bacterial resistance is suspected. In addition, a bioequivalent IV-to-oral option can permit earlier discharges from the hospital with a seamless transition to oral therapy. Since hospital stays are a major driver of treatment cost, reducing hospital admissions and enabling earlier discharges can have a substantial impact on healthcare expenditure. Each year in the US, CABP leads to over 1 million hospitalizations, resulting in over $17 billion in annual healthcare expenditure. There appears to be a strong need in the market for oral antibiotics that can reduce inpatient treatment for CABP. Opportunity in CABP for Novel Antibiotics with Broad-Spectrum Activity. Fluoroquinolones have been a mainstay in the treatment of many community-acquired infections due to their broad-spectrum coverage of relevant pathogens as a monotherapy. This profile has made fluoroquinolones an attractive option for empiric therapy in CABP, particularly when bacterial resistance is a concern. The expected decrease in fluoroquinolone use in CABP, indicated by our survey results, will likely create an opportunity for novel antibiotics that match the broad-spectrum activity of fluoroquinolones with a cleaner safety profile. Of the drugs in development for CABP, Paratek s (NasdaqGM: PRTK) omadacycline and Nabriva s (NasdaqGS: NBRV) lefamulin are the two antibiotics that could likely fill this niche in the market if approved. Cempra s (NasdaqGS: CEMP) Solithera (solithromycin), which has been plagued by concerns over potential liver injury, and Melinta s (private) Baxdela (delafloxacin), a next-generation fluoroquinolone, are unlikely to satisfy physicians seeking safer alternatives to the fluoroquinolone drug class. Biggest Unmet Needs in CABP. We asked the physicians what they considered to be the biggest unmet needs in CABP, and permitted up to 5 answers. The top responses are shown in Figure 1. The most frequently cited response, by 43% (52/120) of physicians, was a desire for increased availability of oral drugs targeting drug-resistant pathogens. Reducing the duration of hospital stays (31%) and increasing the availability of bioequivalent IV-to-oral options (30%) were also reported as major needs in the space. Among the infectious disease specialists, who likely see many of the most severe cases of CABP, the two most pressing needs were increased availability of oral drugs targeting drug-resistant pathogens (54%) and bioequivalent IV-oral therapies (50%). Hospitalists and emergency medicine specialists also responded that once-daily dosing was a pressing need in the CABP space. Figure 1. Most Frequently Cited as Biggest Unmet Needs in CABP For analyst certification and disclosures please see page 7 Page 1

2 Source: LifeSci Capital Tolerability and IV-to-Oral Stepdown Are the Most Important Characteristics When Selecting an Antibiotic. We asked the physicians what they considered to be the most important features in choosing to prescribe a certain antibiotic. The feature rated highest by the physicians was that an antibiotic be well-tolerated. Overall, 88% of surveyed physicians rated this feature either as important or very important. The survey results, shown in Figure 2, also indicate that having an IV-to-oral stepdown and a low propensity for C. difficile infections were particularly important features for the surveyed physicians. Coverage of resistant strains of Streptococcus pneumoniae was also a top response. Figure 2. Most Important Characteristics in Selecting an Appropriate Antibiotic Source: LifeSci Capital Current Empiric Treatment of CABP. Combination therapy consisting of a beta-lactam and a macrolide was reported as the most commonly used empiric treatment regimen for CABP patients, with 29% (35/120) of respondents describing this as their preferred empiric regimen and 87% (104/120) reporting at least some use. The surveyed healthcare providers used fluoroquinolones at similar rates. Fluoroquinolones were the preferred empiric therapy for 21% (25/120) of respondents and 83% (100/120) cited at least some use. In the hospital setting, including emergency medicine, ID specialists, and hospitalists, there are nearly twice as many respondents describing a beta-lactam/macrolide combination as their preferred regimen compared to those preferring fluoroquinolone monotherapy. The survey also revealed that healthcare providers do not perform bacterial cultures or susceptibility testing for the majority of their CABP patients. The survey showed that they perform cultures for 43% of their CABP cases and susceptibility testing for 36% of their patients. This highlights the importance of broad spectrum coverage for empiric therapies, since the underlying pathogen and Page 2

3 its specific susceptibility profile are not usually known. The surveyed physicians reported that 17% of their empirically treated CABP patients had to be switched to a new therapy for efficacy or safety/tolerability reasons. Fluoroquinolone Use in CABP Expected to Decrease Following FDA Update. Overall, 56% (67/120) of physicians expected to prescribe fluoroquinolones less often for CABP patients following an update from the FDA recommending against the use of these antibiotics in acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated urinary tract infections (uuti). Fluoroquinolones are associated with a range of serious side effects, including tendon ruptures and neurological sequalae. Although the warning issued by the FDA did not touch on CABP, the survey responses suggest that concerns over the safety of fluoroquinolones may have spilled over into the CABP indication. Of the physicians expecting to prescribe less fluoroquinolones, 90% expected to shift to a beta-lactam and macrolide combination. The physicians also appeared willing to switch to clindamycin, a third-generation cephalosporin, or doxycycline, instead of a fluoroquinolone. We also asked the respondents who did not expect to prescribe less fluoroquinolones for their reasoning. The most cited reason, by 32% of this group, was that the risk-reward profile was acceptable for their patients. Those who expected to continue prescribing at the same rate also reported a preference for monotherapy and broad spectrum coverage of relevant pathogens. 17% of this group expected their fluoroquinolone use to remain unchanged by the FDA warning since their use of this antibiotic was already quite limited. These results suggest that physicians continuing to use fluoroquinolones place a premium on monotherapies with broad spectrum coverage and that there may be an opportunity for novel antibiotics meeting these criteria with a better safety profile to cut into the market for fluoroquinolones. Page 3

4 Survey Results 1. What type of physician are you? Emergency Medicine Specialist 34 Nurse Practitioner 16 Primary Care Physician 16 Infectious Disease Specialist 28 Hospitalist What do you see as the biggest unmet needs in CABP? Lower cost therapies 36 Increased availability of oral drugs targeting drug-resistant pathogens 52 Improved clinical efficacy 29 Improved ability to target gram negative infections 8 Reduction in duration of hospital stays 37 Increased availability of bioequivalent IV-oral therapies 36 Improved safety profile 24 Improved ability to target resistant strains of S. pneumoniae 27 Improved ability to target MRSA infections 20 Increased availability of monotherapy 35 Improved ability to target a broad spectrum of pathogens 17 Increased availability of once-daily dosing 32 Increased coverage of resistant pathogens in first-line therapy 17 Improved compliance 21 Improved drug-drug interactions 13 Improved insurance coverage 36 Improved ability to target atypical infection 14 Ability to treat as a monotherapy for all relevant pathogens (including atypicals, MRSA) How often do you culture CABP patients? 42.9±3.1% 4. How often do you do susceptibility testing for CABP treatment? 36.3±3.4% 5. How important are each of these product characteristics in driving your use of an antibiotic and providing greatest clinical value for CABP patients? Not Important at All (1) Somewhat Important (3) Very Important (5) Well-tolerated Low propensity for C. difficile infection IV-to-oral step-down Coverage of MRSA Coverage of PRSP Gram negative coverage Once-daily dosing Free of boxed warnings Page 4

5 6. Please consider the patients you treat empirically for CABP. How do you currently treat these patients? Never Use (1) (2) Use Sometimes (3) (4) Preferred Regimen (5) Beta-lactam + macrolide combination therapy Fluoroquinolone monotherapy Cephalosporin monotherapy Fluoroquinolone + macrolide combination therapy Macrolide monotherapy Other regimens What percentage (%) of patients are switched from one empiric therapy to another due to efficacy or safety/tolerability issues in CABP patients? 17.4±1.0% 8. [For PCPs and NPs] If the 1st CABP treatment is not deemed efficacious, how often do you: a. Write a new Rx for another antibiotic? (switch or add-on): 61.7±3.1% b. Refer the patient immediately to a hospital/emergency/urgent care: 16.8±1.2% 9. Are you aware of the black box warning for fluoroquinolones? Yes 107 No Have you had inquiries from patients on the use of fluoroquinolones? Yes 49 No In light of the recent Black Box Warning from the FDA on fluoroquinolones, how will your prescribing habits change for CABP cases? Stop Using Use Less Frequently Use the Same If you expect to use fluoroquinolones less for CABP following the FDA announcement, what will you prescribe in its place? (87 respondents) Beta lactam + macrolide 78 Carbapenem 2 Tigecycline 0 Clindamycin 8 Awaiting newer agents in the pipeline (solithromycin, omadacycline, etc.) 5 Other If you don t expect to prescribe fluoroquinolones less for CABP, why? (34 respondents) No suitable alternatives 3 Broad coverage of all relevant pathogens 9 Risk-reward profile is acceptable for my patients 11 Prefer monotherapy 6 Other How frequently do patients pushback on fluoroquinolones due to safety concerns? Never Rarely Sometimes Frequently Always Page 5

6 15. Do you expect the frequency of patient inquiries on fluoroquinolone safety to change over time? Cease Decrease a Little Unchanged Increase a Little Decrease a Lot Page 6

7 Analyst Certification The research analyst denoted by an AC on the cover of this report certifies (or, where multiple research analysts are primarily responsible for this report, the research analyst denoted by an AC on the cover or within the document individually certifies), with respect to each security or subject company that the research analyst covers in this research, that: (1) all of the views expressed in this report accurately reflect his or her personal views about any and all of the subject securities or subject companies, and (2) no part of any of the research analyst's compensation was, is, or will be directly or indirectly related to the specific recommendations or views expressed by the research analyst(s) in this report. DISCLOSURES This research contains the views, opinions and recommendations of LifeSci Capital, LLC ( LSC ) research analysts. LSC (or an affiliate) has received compensation from the subject company for producing this research report. Additionally, LSC expects to receive or intends to seek compensation for investment banking services from the subject company in the next three months. LSC (or an affiliate) has also provided non-investment banking securities-related services, non-securities services, and other products or services other than investment banking services to the subject company and received compensation for such services within the past 12 months. LSC does not make a market in the securities of the subject company. Neither the research analyst(s), a member of the research analyst s household, nor any individual directly involved in the preparation of this report, has a financial interest in the securities of the subject company. Neither LSC nor any of its affiliates beneficially own 1% or more of any class of common equity securities of the subject company. LSC is a member of FINRA and SIPC. Information has been obtained from sources believed to be reliable but LSC or its affiliates (LifeSci Advisors, LLC) do not warrant its completeness or accuracy except with respect to any disclosures relative to LSC and/or its affiliates and the analyst's involvement with the company that is the subject of the research. Any pricing is as of the close of market for the securities discussed, unless otherwise stated. Opinions and estimates constitute LSC s judgment as of the date of this report and are subject to change without notice. Past performance is not indicative of future results. This material is not intended as an offer or solicitation for the purchase or sale of any financial instrument. The opinions and recommendations herein do not take into account individual client circumstances, objectives, or needs and are not intended as recommendations of particular securities, companies, financial instruments or strategies to particular clients. The recipient of this report must make his/her/its own independent decisions regarding any securities or financial instruments mentioned herein. Periodic updates may be provided on companies/industries based on company specific developments or announcements, market conditions or any other publicly available information. Additional information is available upon request. No part of this report may be reproduced in any form without the express written permission of LSC. Copyright Page 7