• The clinical program in Alzheimer's disease is planned to include approximately 3,000 patients in 17 countries
• Lu AE58054 is a selective 5-HT6 receptor antagonist under investigation for the treatment of Alzheimer's disease^*1
• The two companies' focus on the 5-HT6 receptor is a different approach from much of the drug research to date on Alzheimer's disease^*2
• Alzheimer's disease affects more than 26 million people worldwide. The worldwide cost of Alzheimer's disease and related dementias has been reported as USD 600 billion per year^*3,4
• Lu AE58054 is the third project the two companies are developing together globally, following Abilify Maintena^™ (aripiprazole) and brexpiprazole

Valby, Denmark and Tokyo, Japan, 10 October 2013 - H. Lundbeck A/S (Lundbeck) and Otsuka Pharmaceutical Co., Ltd. (Otsuka) announced today the continuation of the development program of Lu AE58054 for the treatment of Alzheimer's disease, initiating the first out of four phase III clinical trials with the compound.

The investigational compound Lu AE58054 is a selective 5-HT6 receptor antagonist with a different proposed mechanism of action than currently available Alzheimer's medications.^*1 Notably, a focus on the 5-HT6 receptor is a different approach from the amyloid and tau hypotheses that have underpinned much of the drug research to date on Alzheimer's disease.^*2

Lundbeck and Otsuka are now initiating the phase III program which is planned to include four trials. Several doses of Lu AE58054 ranging from 10-60 mg will be used in combination with donepezil in order to explore the effect of Lu AE58054 in mild-to-moderate Alzheimer's disease as adjunctive therapy to acetylcholinesterase inhibitors (AChEls). The key endpoints are Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-cog), Activities of Daily Living (ADL), and the Clinical Global Impression of Change Scale (CGIC).

The program will enroll approximately 3,000 patients. The first trial will enroll 930 patients in the U.S., Canada and 15 other countries mainly in Europe, and is expected to last up to three years.

Data from the phase II clinical study were presented at the Alzheimer's Association International Conference (AAIC) in July 2013. This study showed that adjunctive therapy with Lu AE58054 (plus 10 mg/day donepezil) at the selected dose resulted in statistically significant improvement (p=0.004) in cognitive performance, as measured by the ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive sub-scale) over a 24-week treatment period versus placebo (plus 10 mg/day donepezil). Secondary endpoints, including measures of global status and activities of daily living, also showed positive trends with the addition of Lu AE58054 compared with patients who only received donepezil; however the differences were not statistically significant.^*5

"Following consultations with different health agencies we are now ready, together with Otsuka, to start this major program," said: Executive Vice President Anders Gersel Pedersen, Head of Research & Development at Lundbeck, and continued: "There is a strong need for more treatment options for patients with Alzheimer's disease, and we see Lu AE58054 as a potentially promising therapy for this devastating disease."

William H. Carson, M.D., President and Chief Executive Officer, Otsuka Pharmaceutical Development and Commercialization, Inc., said: "Use of the serotonin 5-HT6 antagonism mechanism against the cognitive effects of Alzheimer's is a promising hypothesis that we will seek to validate more fully in these phase III trials."

About Lu AE58054

The 5-HT6 receptor is expressed in brain regions involved in cognition, such as the cortex and the hippocampus, and modulates activity of multiple neurotransmitter systems.^*6
Lu AE58054 is a selective 5-HT6 receptor antagonist.^*5 In pre-clinical models, Lu AE58054 was shown to improve cognition^*1 and enhance the effects of the acetylcholinesterase inhibitor donepezil on hippocampal function.^*7 A number of early trials have demonstrated that a 5-HT6 receptor antagonist could offer potential benefits in the treatment of disorders such as Alzheimer's disease^*1 and Lundbeck recently presented the positive results of a 24-week clinical phase II trial with Lu AE58054 as adjunctive therapy in Alzheimer's disease, as mentioned above.^*5,8

About Alzheimer's disease

Alzheimer's disease is a progressive brain disorder in which the brain gradually degenerates. It most frequently occurs in people above 65 years of age. People with Alzheimer's disease develop distressing changes in memory, thought, function and behaviour, which worsen over time. These changes increasingly impact the person's daily life and reduce their independence until ultimately these patients are entirely dependent on others.^*9

Alzheimer's disease also has an enormous impact on the patient's caregiver. Most caregivers are close relatives who provide care at home - a demanding and exhausting role that represents a significant emotional and physical burden.^*9

Worldwide, it is estimated that about 36 million people have dementia. With the shift towards an increasingly elderly population, it is predicted that the number of people affected by dementia will almost double every 20 years, and by the year 2050, 115 million people will have the condition.^{*4, 10} Alzheimer's disease is the most common cause of dementia, accounting for 60 to 80% of these patients.^*11

The worldwide costs of dementia (USD 604 billion in 2010) amounts to 1% of the global gross domestic product (GDP).^*4

• *1 Arnt J., et al. Lu AE58054, a 5-HT6 antagonist, reverses cognitive impairment induced by subchronic phencyclidine in a novel object recognition test in rats. The International Journal of Neuropsychopharmacology 2010; 13 (8): 1021-1033.
• *2 Mohandas E., et al. Neurobiology of Alzheimer's disease. Indian Journal of Psychiatry 2009; 51(1): 55-61.
• *3 Panza F, et al. γ -Secretase Inhibitors for the Treatment of Alzheimer's Disease: The Current State. CNS Neuroscience & Therapeutics 2010; 16: 272-284
• *4 Alzheimer's Disease International. World Alzheimer's Report 2012. Overcoming the stigma of dementia. Document accessible at:
  www.alz.co.uk/research/world-report-2012.
• *5 Wilkinson J., et al. "A clinical Phase II study of Lu AE58054 added to stable donepezil treatment in patients with moderate Alzheimer's disease." Abstract presented at the Alzheimer's Association International Conference; 2013 July 13-18; Boston, MA.
• *6 Yun H. and Rhim H. The Serotonin-6 Receptor as a Novel Therapeutic Target. Experimental Neurobiology 2011; 20(4):159-168.
• *7 Inge E.M. de Jong, et al. "The 5-HT6 receptor antagonist Lu AE58054 potentiates the effects of the acetylcholinesterase inhibitor donepezil on hippocampal acetylcholine efflux and oscillatory activity."7. Poster P2-397 presented at the Alzheimer's Association International Conference; 2013 July 13-18; Boston, MA.
• *8 ClinicalTrials.gov. Lu AE58054 Added to Donepezil for the Treatment for Moderate Alzheimer's Disease. November 2009. Document accessible at: http://clinicaltrials.gov/show/NCT01019421. NLM Identifier: NCT01019421.
• *9 Georges J, Jansen S, Jackson J, et al. Alzheimer's disease in real life - the dementia career's survey. International Journal Geriatric Psychiatry 2008; 23 (5): 546-551.
• *10 Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005; 366 (9503): 2112-2117.
• *11 Alzheimer's Association. "Alzheimer's changes the whole brain" Brain Tour. 2011. Document accessible at:
  http://www.alz.org/braintour/alzheimers_changes.asp.