Resmed Inc. · NYSE:RMD
Resmed — Investor Day (September 2015)
33 slides from Resmed's investor day presentation, September 2015
Slide 1: ResMed's Clinical Strategy — 20 million lives by 2020
ResMed’s Clinical Strategy — 20 million lives by 2020 Glenn Richards MD Chief Medical Officer
Slide 2: ResMed's Clinical Strategy — Sleep Apnea and Beyond
ResMed’s Clinical Strategy — Sleep Apnea and Beyond • Clinical Perspective on SDB • Core market - Obstructive Sleep Apnea • Adjacent Markets - Respiratory Failure - Central Sleep Apnea • Serve HF - What do the results mean • Where to from here? © 2015 ResMed I 2
Slide 3: Sleep Disordered Breathing
Sleep Disordered Breathing • 3 very different abnormal patterns of breathing during sleep - Obstructive sleep apnea - Central sleep apnea - Respiratory failure • OSA is easily the most common — affecting approximately 26% of the general adult population • OSA accounts for over 80% of patients • CSA
Slide 4: OSA and Upper Airway Collapse
OSA and Upper Airway Collapse © 2015 ResMed I 4
Slide 5: OSA
Changing lives with every breath ‘
Slide 6: Apnea Hypopnea Index
Apnea Hypopnea Index Flow Thorax Abdomen 100 SaO2 % 70 • Apnea Hypopneas Index is a measure of severity • AHI is the number of events divided by time asleep - AHI less than 5 is considered normal - AHI from 5 to 15 is mild sleep apnea - AHI from 15 to 30 is moderate sleep apnea - AHI above 30 is sev
Slide 7: Obstructive vs. Central Sleep Apnea
Obstructive vs. Central Sleep Apnea OSA Flow Thorax Abdomen 100 SaO2 % 70 CSR Flow Thorax Abdomen 100 SaO2 % 70 CSA Flow Thorax Abdomen 100 SaO2 % 70 © 2015 ResMed I 7
Slide 8: Symptoms
Symptoms • Men present with “typical” OSA symptoms - Snoring - Witnessed apneas - Daytime sleepiness • Women often present with different symptoms, causing misdiagnosis - Insomnia - Restless legs - Fatigue/depression - Headaches and muscle pain OSA reduces quality of life — CPAP improves quality of
Slide 9: Cardiovascular Consequences of Sleep Apnea
Cardiovascular Consequences of Sleep Apnea Negative swings in intra-thoracic pressure Increase in blood pressure Surge in sympathetic nerve activity © 2015 ResMed I 9
Slide 10: Sleep Apnea: Highly prevalent in key chronic diseases
Sleep Apnea: Highly prevalent in key chronic diseases Stroke 63% Depression 45% Drug-Resistant Hypertension 83% Heart Failure 76% Coronary Artery Disease Morbid Obesity 57% 77% Atrial Fibrillation Type 2 Diabetes 49% 72% References: Logan et al. J. Hypertension; O’Keefe and Patterson, Obes Surgery;
Slide 11: Effect of CPAP on Upper Airway
Effect of CPAP on Upper Airway © 2015 ResMed I 11
Slide 12: PAP Patient Interfaces: smaller, quieter, more comfortable
PAP Patient Interfaces: smaller, quieter, more comfortable Over the past 25 years there have been large improvements in the equipment used for treatment © 2015 ResMed I 12
Slide 13: PAP Flow Generators: smaller, quieter, more comfortable
PAP Flow Generators: smaller, quieter, more comfortable © 2015 ResMed I 13
Slide 14: Positive Airway Pressure (PAP) Therapy
Positive Airway Pressure (PAP) Therapy CPAP Pressure 1) CPAP Time VPAP Pressure 2) Bi-level (VPAP) Time 15 3) ASV 9 5 0 © 2015 ResMed I 14
Slide 15: Automatic Positive Airway Pressure (APAP)
Automatic Positive Airway Pressure (APAP) • Used in long term therapy • Monitor flow to predict events or titration - Apnea • Raises pressure to prevent events - Hypopnea and lowers it if no events - Snoring - Flow limitation © 2015 ResMed I 15
Slide 16: Respiratory Failure and Ventilation
Respiratory Failure and Ventilation Ventilation Demand Supply Exercise Weak muscles Illness Distorted chest Sleep Diseased lungs © 2015 ResMed I 16
Slide 17: Respiratory Failure
Respiratory Failure 100 100 Oxygen Saturation 80 Transcutaneous Carbon Dioxide 50 50 20 2344 Time 0540 © 2015 ResMed I 17
Slide 18: Positive Airway Pressure (PAP) Therapy
Positive Airway Pressure (PAP) Therapy CPAP Pressure 1) CPAP Time VPAP Pressure 2) Bi-level (VPAP) Time 15 3) ASV 9 5 0 © 2015 ResMed I 18
Slide 19: Respiratory Failure Treated
Respiratory Failure Treated © 2015 ResMed I 19
Slide 20: Ventilation for Acute COPD Exacerbation
Ventilation for Acute COPD 8 Initial IMV Initial NIPPV Percentage of Admissions 7 for COPD Exacerbation 6 5 4 3 2 1 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year References: Chandra et al, AJRCCM online pub 20 October 2011 © 2015 ResMed I 20
Slide 21: Home NIV for Chronic COPD
Home NIV for Chronic COPD © 2015 ResMed I 21
Slide 22: Our new respiratory care platform
Our new respiratory care platform • Designed to enrich life for patients - Greater freedom - Versatile choices Life Support Ventilation - Saves time, so that clinicians and staff can focus on patients Astral™ © 2015 ResMed I 22
Slide 23: Central Sleep Apnea
Central Sleep Apnea • Abnormal breathing due to • ASV is used to treat all of these problems with respiratory control subgroups - Complex SA accounts for most 1. Complex Sleep Apnea/ Mixed prescriptions Sleep Apnea - Around 25% of scripts are for heart - Associated with OSA (5 to 10% failure of slee
Slide 24: Obstructive vs. Central Sleep Apnea
Obstructive vs. Central Sleep Apnea OSA Flow Thorax Abdomen 100 SaO2 % 70 CSR Flow Thorax Abdomen 100 SaO2 % 70 CSA Flow Thorax Abdomen 100 SaO2 % 70 © 2015 ResMed I 24
Slide 25: Adaptive Servo Ventilation
Adaptive Servo Ventilation Adaptive Servo Ventilation — mechanism of action Flow Effort Pressure support Flow Effort Pressure support © 2015 ResMed I 25
Slide 26: SERVE-HF Study Design
• Primary endpoint • Multi-center, outcome study - Time to first event of all - Comparing control (optimal medical cause mortality or unplanned management) with active treatment hospitalization for worsening (optimal medical treatment plus heart failure ASV) • Secondary endpoints - Sample size:1325
Slide 27: Patient Selection
Patient Selection • Severe heart failure • Systolic heart failure = HFrEF - Symptoms on maximal therapy - Around 50% of HF, men, coronary disease • Moderate and Severe Central Sleep Apnea • Diastolic Heart Failure = HFpEF - AHI>15 - Around 50% of HF, women, elderly, hypertensive, obese - Not studied
Slide 28: Field Safety Notice — issued 13 May 2015
Field Safety Notice — issued 13 May 2015 Numbers of events reached late April and analysis began • Preliminary primary end-point analysis • However, there was a 2.5% absolute showed no significant difference between increased annual risk of cardiovascular patients treated with ASV and those in the m
Slide 29: Field Safety Notice — issued 13 May 2015
Field Safety Notice — issued 13 May 2015 • The increased risk appears to be greater in those with more severe ventricular dysfunction • The majority of excess mortality is due to death occurring out of hospital (likely sudden cardiac death). • The risk does not diminish with time on therapy and is i
Slide 30: PAP Therapy is Safe outside SERVE-HF patient group
PAP Therapy is Safe outside SERVE-HF patient group • SERVE-HF population very Marin et al, Lancet 2005;365:1046-53 different to other PAP users • Untreated OSA is associated with increased CV mortality • No safety signals among several large trials and several demonstrate a lowering of mortality wit
Slide 31: Sleep Apnea: Many clinical targets for ResMed to focus on
Sleep Apnea: Many clinical targets for ResMed to focus on Stroke 63% Depression 45% Drug-Resistant Hypertension 83% Heart Failure 76% Coronary Artery Disease Morbid Obesity 57% 77% Atrial Fibrillation Type 2 Diabetes 49% 72% References: Logan et al. J. Hypertension; O’Keefe and Patterson, Obes Surge
Slide 32: Where are we going next in clinical research?
Where are we going next in clinical research? • Many opportunities exist to increase market size through demonstrating the influence of therapy on chronic diseases. • ResMed remains committed to advancing the field through scientific research. © 2015 ResMed I 32
Slide 33: Thank you
Thank you © 2015 ResMed I 33