Zealand Pharma A/s · OMXCOP:ZEAL
Zealand Pharma A/s — Investor Day (2025)
119 slides from Zealand Pharma A/s's investor day presentation, 2025
Slide 1: Zealand Pharma Capital Markets Day 2025
Zealand Pharma Capital Markets Day 2025
Slide 2: Forward-looking statements
Forward-looking statements This presentation contains “forward-looking statements”, as that term is defined in the Private Securities Litigation Reform Act of 1995 in the United States, as amended, even though no longer listed in the United States this is used as a definition to provide Zealand Phar
Slide 3: Not a faster horse
Not a faster horse
Slide 4: Redefining obesity for a new era
Redefining obesity for a new era Building a generational biotech company in metabolic health. 4
Slide 5: Obesity: requires a civilization-scale health shift
Obesity: requires a civilization-scale health shift >1 billion people living Rising for decades Obesity is not an with obesity today without decisive action individual failure 5
Slide 6: The GLP-1 revolution changed expectations
The GLP-1 revolution changed expectations Double-digit weight loss at scale Obesity proven as drug treatable Expectations reset for patients, systems and markets 6
Slide 7: Petrelintide
Petrelintide A potential foundational therapy Feel full faster Designed for high-quality, durable weight loss Stand-alone and in combo with CT-388 (GLP-1/GIP) Zealand Pharma has a collaboration and license agreement with Roche for petrelintide, including co-development and co-commercialization in th
Slide 8: Biotech speed, pharma strength
Biotech speed, pharma strength • Equal partnership with a shared commitment to redefine obesity care • Unites Zealand Pharma’s • Zealand Pharma to metabolic heritage with build U.S. launchpad for Roche’s manufacturing petrelintide and future and commercial metabolic health infrastructure medicines T
Slide 9: A generational biotech in metabolic health
A generational biotech in metabolic health By ‘generational’ we mean: We will shape Through a With multiple obesity care platform and waves of for decades, exceptional innovation not cycles pipeline, not in metabolic a single product health 9
Slide 10: An engine built on peptides, data and AI
An engine built on peptides, data and AI METABOLIC FRONTIER 2030 Our unfair advantage in By 2030: metabolic health • 5 launches in 5 years Unmatched expertise in peptides and metabolic health • 10+ clinical programs in metabolic health + • Industry-leading cycle times from idea to clinic >25 years o
Slide 11: Clear path to long-term value creation with milestones ahead
Clear path to long-term value creation with transformational milestones ahead NON-EXHAUSTIVE Survodutide Ph3 obesity data (BI) Survodutide Ph3 MASH data (BI) Petrelintide launch in obesity Petrelintide Ph2 data Survodutide launch in obesity (BI) Petrelintide/CT-388 Ph3 initiation Petrelintide Ph3 in
Slide 12: The culture that delivers generational biotech
The culture that delivers generational biotech for Patient-driven patients & science-first: Every decision anchored in metabolic biology & patient impact Small, accountable, Data-native & collaborative: owner mindset: Turning >25 years of data Lean teams, into better solutions clear ownership, with
Slide 13: Move Like a Biotech, Hit Like a Pharma
Move Like Hit Like a a Biotech, Pharma
Slide 14: Today's journey: how the story unfolds
Today’s journey: how the story unfolds 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health Adam Steensberg 1:05-1:25 Carel Le Roux & David pi
Slide 15: Maximize this metabolic moment
Maximize this Obesity will define the next decades metabolic of healthcare moment Catalyst-rich 2026 igniting transformational journey toward 2030 and beyond We will become a generational biotech by building the world’s most valuable metabolic health pipeline The opportunity now: Zealand Pharma on t
Slide 16: The future of weight management
2. The future of weight management Eric Cox – 1:25-1:50 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health Adam Steensberg 1:05-1:25 Carel L
Slide 17: Five launches in the next five years
Five launches in the next five years Obesity and related comorbidities Rare disease Product candidatea Product candidatea Petrelintide Dasiglucagon: Obesity Phase 2 Congenital hyperinsulinism Registration (amylin analog)b SC continuous infusion Petrelintide/CT-388 Phase 2- Glepaglutide Obesity ready
Slide 18: Obesity: greatest healthcare challenge of our time
Obesity: greatest healthcare challenge of our time The obesity epidemic has surged over the past decades, with 50% of adults globally expected to live with overweight or obesity by 20301 >200 complications and comorbidities associated with obesity2 Today, ~35% of U.S. children and adolescents aged 2
Slide 19: Obesity: unique disease area
Unique disease area 1 The consumer as key decision drivera 2 Unprecedented size and scale Obesity 3 Two key healthcare providers: Primary care and specialty care 4 Heterogeneity and fragmentation 5 Linked to many comorbidities aMedicinal products remain prescription only. Ultimate decision maker rem
Slide 20: Public health challenge: treatment penetration and maintenance
Public health challenge: We must improve treatment penetration and maintenance BMI distribution and GLP-1 usage todaya,1-3 Overweight Obesity High Share of population (%) Treated with GLP-1: ~3% of eligible people in the U.S.2 Have been exposed to GLP-1: ~12% of Americans4 Low 15 20 25 30 35 40 45 5
Slide 21: Scientific progress in weight management
Beyond Weight loss Olympics: key unmet needs First wave of incretins New mechanisms and next-gen incretins Better understanding of gut–brain axis biology Unlocked the development of incretins Acceptability Focus on key unmet medical needs and Scientific progress in weight management weight loss expe
Slide 22: Obesity demands new classes of drugs
Obesity demands new classes of drugs Hypertension Dyslipidemia Type 2 diabetes Obesity • Diuretics • Statins • Metformin • GLP-1RA-based therapies • Beta-blockers • Cholesterol absorption • Sulfonylureas (GLP-1 and GLP-1/GIP) • ACE inhibitors inhibitors • Meglitinides • ARBs • PCSK9 inhibitors • DPP
Slide 23: Two distinct segments, two focus areas
Two distinct segments, two focus areas Prescriber-driven Consumer-driven Specialist-driven prescriptions focusing on benefits of Consumer-driven primary care prescriptions treating comorbidities and health impact of weight loss focusing on desired weight loss and user experience Objectives: Objectiv
Slide 24: Two distinct segments: prescriber-driven
Two distinct segments, two focus areas Prescriber-driven Specialist-driven prescriptions focusing on benefits of treating comorbidities and health impact of weight loss Objectives: 1 Comorbidity risk reduction and health outcomes 2 Relative weight loss 3 Tolerability and user experience (to improve
Slide 25: Obesity impacts several organ systems
Obesity impacts several organ systems NON-EXHAUSTIVE Musculoskeletal and mechanical Cardiovascular Liver and gut Overweight and obesity CNS and mental health Endocrine Renal Source: American Medical Association 2024: https://www.ama-assn.org/topics/obesity. CNS=central nervous system. 25
Slide 26: Urgent need for better treatment options in MASH
Urgent need for better treatment options in MASH Survodutidea holds potential to revolutionize treatment of MASH and establish a strong foothold in the prescriber-driven segment People who are overweight or have “See Obesity, Think Liver” obesity ~15–30%2,3 T2D MASLD ~75%1 ~10–15%4 MASH ~34%1 CVD CK
Slide 27: Primary care leads; specialty still emerging
Primary care leads; specialty still emerging ~90% of GLP-1 prescriptions for weight management are driven by primary care providers 1,a Identified as primary care providers 7% 5% Nurse practitioner/ Physician assistant 11% Primary care physician 40% Osteopathic physician Endocrinologist Other specia
Slide 28: Two distinct segments: consumer-driven
Two distinct segments, two focus areas Consumer-driven Consumer-driven primary care prescriptions focusing on desired weight loss and user experience Objectives: 1 Desired weight loss 2 Tolerability and user experience 3 Health outcomes 4 Convenience of treatment 28
Slide 29: Healthier version of themselves, not healthiest
Healthier version of themselves, not healthiest Decisions driven by more than clinical needs Physical 61% of users in the U.S. self-refer1 Unprecedented willingness to pay out of pocket Social Emotional Highly individualized and cyclical journeys Source: 1Ipsos Obesity and Cardiometabolic Therapy Mo
Slide 30: Desired weight loss contradicts weight loss Olympics
Desired weight loss contradicts Weight loss Olympics >80% of GLP-1 20% want to lose 1–9% users want to lose 2% are unsure Weight loss goals of current up to 20% 3% want to GLP-1 users lose >30% of their body 14% want to 63% want to weight lose 21–30% lose 10–20% Source: LifeSci Capital Survey May 20
Slide 31: GLP-1 efficacy: real world vs. clinical trials
GLP-1 efficacy: real world vs. clinical trials Real-world use of Wegovy by dose1 Real-world use of Zepbound by dose1 100 100 90 90 80 80 Real-world weight reduction: Real-world weight reduction: 70 70 7.7% at 1 year4 12.4% at 1 year4 Users (%) Users (%) 60 60 50 50 40 40 30 30 20 20 33% 10 17% 20% 1
Slide 32: Poor treatment persistence and frequent restarts
Poor treatment persistence and frequent restarts in the real world 100 Treatment persistencea Restarts Share of GLP-1 users (%) 80 69% 60 50% 40 34% 22% 20 18% 8% 22% 0 Day Month Month Month Month Month Month Month Month Month Month Month Month 0 1 2 3 4 5 6 7 8 9 10 11 12 Enhancing weight loss expe
Slide 33: GI adverse effects primary reason for discontinuation
Gastrointestinal adverse effects primary reason for discontinuation Reasons given by GLP-1 users for negative Top five adverse effects experience with current treatments for obesity1 prompting discontinuation2 49%: Adverse effects • Nausea • Vomiting • Diarrhea 32%: Cost concerns • Fatigue • Headach
Slide 34: Zealand Pharma poised to lead in highest unmet needs
Zealand Pharma poised to lead in highest unmet needs Enhanced weight loss experience to improve treatment Petrelintidea persistence New foundational MoA, redefining the standard of care in Petrelintidea weight management Survodutideb, petrelintidea, Targeted effects on obesity-related comorbidities
Slide 35: Strategic roadmap toward fully-integrated biotech
Strategic roadmap ~2026-2028 Scaling alongside Roche, to build toward becoming a customer-centric commercial and medical affairs footprint fully-integrated biotech company 2024-2025 2029 and beyond • Established core commercial Harness launchpad for capabilities petrelintide as force • Petrelintide
Slide 36: Survodutide: the next frontier in obesity & MASH
3. Survodutide: the next frontier in obesity & MASH (GCG/GLP-1) Carel Le Roux & David Kendall - including Q&A – 1:50-2:25 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & M
Slide 37: Survodutide: the next frontier in obesity & MASH
Survodutide: the next frontier in obesity & MASH (GCG/GLP-1) Carel Le Roux, MBChB, MSC, FRCP, FRCPath, PhD Professor of Experimental Pathology
Slide 38: Treatment of obesity extends far beyond weight loss
Treatment of obesity extends far beyond weight loss Source: Joseph Wright of Derby. The Alchemist Discovering 38 Phosphorus. 1771. Derby Museum and Art Gallery.
Slide 39: Oxyntomodulin is the scientific foundation for survodutide
Oxyntomodulin is the scientific foundation for the investigation of survodutide • Hormone with dual agonism at GCG and GLP-1 receptors that reduces body weight Oxyntomodulin by increasing energy expenditure and regulating appetite1 • Clinical application is limited due to a short half-life2 Survodut
Slide 40: Glucagon/GLP-1 dual agonism regulates energy expenditure and intake
Glucagon/GLP-1 dual agonism offers coordinated regulation of energy expenditure and energy intake GCG/GCGR GLP-1/GLP-1R4 Energy expenditure (metabolic rate) Insulin secretion Food intake Liver Adipose tissue Liver Pancreas GI tract Brain (direct) (indirect) (indirect) Fatty acid oxidation1 Lipolysis
Slide 41: 16-week Phase 2 trial in T2D
In a 16-week Phase 2 trial in T2D, survodutide effectively reduced HbA1c and body weight Change in HbA1c Change in body weight 0 0.0 0 -0.25% -1.20% -0.5 -0.5 -2 Mean (SE) absolute Mean (SE) relative change (%) change (%) -1.0 -1.0 -4 -1.47% -5.40% -1.5 -1.5 -6 -2.0 -2.0 -1.88% -8 -8.95% -2.5 -2.5 -
Slide 42: 46-week Phase 2 obesity trial: up to 18.7% weight reduction
In a 46-week Phase 2 trial in obesity, survodutide dose- dependently reduced body weight by up to 18.7% Randomized, double-blind, placebo-controlled Phase 2 trial of survodutide in people with overweight or obesity Mean relative change at Week 46 (%) 0 -2 Placebo -2.0% (n=76) -4 change in body weigh
Slide 43: Survodutide reduced blood pressure
Survodutide substantially reduced blood pressure, with heart rate effects consistent with GLP-1RAs Absolute change in blood pressure at Week 461 Absolute change in heart rate (bpm)2 Systolic blood pressure 20 Mean change in heart rate from 15 baseline (bpm, ± SD) Adjusted mean (95% CI) absolute chan
Slide 44: No unexpected safety findings in Phase 2 obesity trial
Treatment with survodutide in the Phase 2 obesity trial showed no unexpected safety findings Survodutide Survodutide Placebo TEAE, n (%)a 3.6 mg (n=77) 4.8 mg (n=77) (n=77) GI TEAE Nauseab 48 (62.3) 49 (63.6) 15 (19.5) As expected, GI AEs were the most frequent TEAEs Vomitingb 26 (33.8) 27 (35.1) 4
Slide 45: MASH: urgent need for better treatments
MASH is among the most serious obesity-related comorbidities with urgent need for better treatments Need for more and better treatment options for Normal people with overweight/obesity and MASH liver One of the most prevalent obesity-related comorbidities (75% of people with overweight and obesity h
Slide 46: Best-in-disease potential in Phase 2 MASH trial
Survodutide demonstrated best-in-disease potential in the 48-week Phase 2 trial in people with MASHa MASH resolution with no worsening in fibrosis Improvement in liver fibrosis with no worsening of MASH Paired biopsy results (F2/F3) Paired biopsy results (F2/F3) 100 p<0.001 100 p<0.01 90 p<0.001 90
Slide 47: Two therapies approved in the U.S. for MASH
There are currently two therapies approved in the U.S. for the treatment of MASH with liver fibrosis Phase 3 trial (MAESTRO-NASH) with Phase 3 (ESSENCE) trial with Phase 2 trial with resmetirom in people with MASH semaglutide in people with MASH survodutide in people with MASH (F1B-F3)1,a (F2/F3)2,b
Slide 48: Glucagon/GLP-1: potential next frontier in obesity and MASH
Glucagon/GLP-1: Holistic approach to metabolic health and potential next frontier in obesity and MASH Key takeaways Coordinated regulation of energy intake (GLP-1) and energy expenditure (glucagon) Robust clinical data with survodutide across comprehensive Phase 2 program with separate trials in typ
Slide 49: Survodutide in Phase 3 for obesity and MASH
Survodutide in Phase 3 for obesity and MASH David Kendall Chief Medical Officer
Slide 50: SYNCHRONIZE-1 topline expected H1 2026
We expect topline results from the Phase 3 SYNCHRONIZETM-1 trial with survodutide in H1 2026 Randomized, double-blind, placebo-controlled Phase 3 trial in people with overweight or obesity without T2D1 Dose escalation Safety Primary endpoint: (every 4 weeks) follow-up • Percentage change in body wei
Slide 51: SYNCHRONIZE program may pave way for submissions in 2026
Results from the Phase 3 SYNCHRONIZETM program may pave the way for regulatory submissions in 2026 Large, global Phase 3 program in obesity • SYNCHRONIZETM-11: Overweight/obesity w/o T2D (N=~720) • SYNCHRONIZETM-22: Overweight/obesity with T2D (N=~750) • SYNCHRONIZETM-CVOT3: Long-term CV safety in p
Slide 52: Largest Phase 3 program in MASH initiated October 2024
Largest ever Phase 3 program in MASH with an incretin-based therapy was initiated in October 2024 Inclusion criteria Study design Primary endpoint LIVERAGE1 Efficacy and safety in • Diagnosis of MASHa and • N=1,800 Part 1: 52 weeks participants with MASH biopsy-proven fibrosis • 6.0 mg or placebo •
Slide 53: Survodutide potential as leading therapy in obesity and MASH
Survodutide holds potential as a leading therapy for people with overweight/obesity and MASH MoA – Dual agonism leveraging GCGR and GLP-1R to achieve Registrational effective body weight reduction and direct liver effects trials Obesity – potential for competitive weight loss and SYNCHRONIZETM impro
Slide 54: Q&A Survodutide
Q&A Survodutide Adam Steensberg David Kendall Carel Le Roux
Slide 55: Amylin: an emerging therapeutic class
4. Amylin: an emerging therapeutic class Jonathan D. Roth & Louis J. Aronne – 2:25-3:05 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health A
Slide 56: Amylin: an emerging class for weight management
Amylin: an emerging class for weight management Jonathan D. Roth, PhD Metabolic researcher Louis J. Aronne, MD, FACP, DABOM Weill Professor of Medical Research at Weill Cornell Medicine
Slide 57: Amylin biology and mechanism of action
Amylin biology and mechanism of action Jonathan D. Roth, PhD Metabolic researcher
Slide 58: The discovery and development of amylin
The discovery and development of amylin Amylin (IAPP) FDA approves Pramlintide Cagrilintide, a long-acting Petrelintide demonstrates identified as a 37- pramlintide (Symlin) demonstrates amylin analog, demonstrates significant weight loss amino-acid peptide as an adjunct to sustained weight signific
Slide 59: What is amylin?
What is amylin? Amylin is a 37-amino acid neuroendocrine peptide hormone1,2 Co-secreted with insulin by pancreatic β-cells Native amylin has strong fibrillating properties3 in response to ingested food2 The t1/2 of native amylin is approximately Amylin has a disulfide bridge at the N-terminal, 12 mi
Slide 60: Amylin receptor biology is complex
Amylin receptor biology is complex Amylin receptors are members of the calcitonin receptor family1 Amylin receptors are heterodimeric – RAMPs alter CTR pharmacology from calcitonin-preferring to amylin-preferring receptors2 Different calcitonin family receptor subtypes – according to the RAMP combin
Slide 61: Amylin exerts beneficial metabolic effects on multiple organ systems
Amylin exerts beneficial metabolic effects on multiple organ systems Physiological and pharmacological effects of amylin receptor activation1-5 CNS Pancreas (indirect)b Leptin sensitivity2 Insulin secretion (improving glucose metabolism)3 Satiety3 Glucagon secretion3 Energy expenditure3 Bone Body we
Slide 62: Leptin as long-term signal of adiposity
Leptin acts as a long-term signal of adiposity and energy balance to the brain Multi-hormonal control of body weight: long-term adiposity signals, short-term satiety signals Hypothalamus GI tract Ghrelin Vagal afferents Hindbrain Leptin LEAP2 PYY3-36 Insulin Amylin GLP-1 Glucagon GIP Liver Pancreati
Slide 63: Circulating leptin levels and leptin sensitivity
Circulating leptin levels differentially influence metabolism and leptin sensitivity Low leptin1 Normal leptin1 Leptin resistance1,2 Brain acts Brain acts on signal on signal Brain only receives part of signal Reduced leptin Normal leptin signal signal Reduced Normal Excess fat mass fat mass fat mas
Slide 64: Pre-clinical studies: amylin as leptin sensitizer
Pre-clinical mechanistic studies in DIO rats suggested that amylin could be a leptin sensitizer Similar weight loss in amylin-treated DIO rats Amylin maintains leptin levels and energy and their pair-fed controls expenditure while promoting fat loss and satiety 114 Drop in leptin 10 Greater fat loss
Slide 65: Amylin and leptin induce synergistic weight loss
Amylin and leptin induce synergistic weight loss that is not explained by the anorexigenic effect of amylin Food intake Body weight 250 2 0 % change in body weight Cumulative food intake 200 -2 (vehicle-corrected) 150 -4 (grams) -6 100 -8 -10 50 * -12 * 0 -14 0 3 6 9 12 0 3 6 9 12 Time (days) Time (
Slide 66: Amylin agonism restores leptin responsiveness
Amylin agonism restores leptin responsiveness in DIO rats… and in humans DIO rats1 Overweight and obese humans2 0 0 Mean (SE) % change -5 (vehicle corrected) D Body weight (%) in body weight -5 -10 -10 -15 -20 -15 0 1 2 3 4 5 6 -4 0 4 8 12 16 20 Time (week) Time (week) Vehicle Amylin (100 µg/kg/d) L
Slide 67: Amylin and GLP-1 exert distinct effects
Amylin and GLP-1 exert distinct physiological and potentially distinct pharmacological effects Amylin GLP-1 Increases satiety1,2 Reduces appetite7 Effect on food intake Smaller meals, prolonged fullness6 Fewer meals, less food-seeking7 Leptin sensitivity Restores leptin responsiveness1,2 Minimal or
Slide 68: Key takeaways
Key takeaways 1. Amylin is a pancreatic hormone that helps regulate meal size and promote fullness 1. Its receptor system is complex but enables broad and coordinated physiological effects 1. Amylin can help restore sensitivity to leptin, a key satiety pathway, supporting the potential for healthier
Slide 69: Clinical evidence of amylin analogs for weight management
Clinical evidence of amylin analogs for weight management Louis J. Aronne, MD, FACP, DABOM Weill Professor of Medical Research at Weill Cornell Medicine
Slide 70: Pramlintide showed weight loss potential in obesity
Short-acting amylin analog pramlintide showed weight loss potential in people with obesity Phase 2b trial with pramlintide in people with obesity Double-blind study Single-blind extension ITT-LOCF Placebo (n=36) 1 0 -1 Pramlintide 120 µg TID (n=38) -2 in body weight (kg) Mean (SE) change -3 Pramlint
Slide 71: Cagrilintide 11.8% weight loss in REDEFINE-1
Long-acting amylin analog cagrilintide showed 11.8% weight loss in the Phase 3 REDEFINE-1 trial Effects of cagrilintide and semaglutide on body weight in REDEFINE-1 trial 0 • This study used a flexible -2.3 Placebo dosing regimen with a maximum dose of 2.4 mg for -5 each drug1 Percent change (%) • T
Slide 72: Cagrilintide gastrointestinal tolerability in REDEFINE-1
Cagrilintide showed excellent gastrointestinal tolerability in the Phase 3 REDEFINE-1 trial Proportion of participants experiencing adverse events Nausea Vomiting 100 100 Participants (%) Participants (%) 50 43.7 50 23.8 23.2 12.6 4.1 7 0 0 Diarrhea Constipation 100 100 Participants (%) Participants
Slide 73: GI AEs with cagrilintide less frequent and less severe
Gastrointestinal AEs with cagrilintide were not only less frequent but also considerably less severe Placebo Cagrilintide Semaglutide Mild 20 20 20 Moderate 10 10 10 Nausea Severe 0 0 0 0 8 20 36 52 68 0 8 20 36 52 68 0 8 20 36 52 68 Participants with events (%) 3 3 3 2 2 2 Vomiting 1 1 1 0 0 0 0 8
Slide 74: Cardiovascular risk factors improved with cagrilintide
All risk factors for cardiovascular disease were improved with cagrilintide Changes in blood pressure over 68 weeks Changes in pulse over 68 weeks diastolic blood pressure (mmHg) Mean pulse at baseline: systolic blood pressure (mmHg) Mean systolic blood pressure Mean diastolic blood pressure 73.2 be
Slide 75: Eloralintide Phase 2 data
Eloralintide Phase 2 data reinforced the potential of amylin as stand-alone therapy for weight management Eloralintide 1 mg Eloralintide 3 mg Eloralintide 6 mg Eloralintide 9 mg Eloralintide 6/9 mg Eloralintide 3/6/9 mg Placebo N=15 N=20 N=20 N=46 N=18 N=42 Weight loss after 48 weeks N=34 Female=75%
Slide 76: Amylin weight loss in type 2 diabetes
Amylin has potential to deliver comparable weight loss in people with type 2 diabetes Phase 2 trial in people with type 2 diabetes 0 Mean relative change at Week 32 -2 in body weight (%) Mean (SE) change -4 -5.1% Semaglutide 2.4 mg (n=31) -6 -8 Cagrilintide 2.4 mg (n=30) -8.1% -10 -12 -14 0 4 8 12 2
Slide 77: Amylin added to GLP-1 in type 2 diabetes
Amylin has potential to enhance weight loss in people with type 2 diabetes when added to GLP-1 Weight loss with semaglutide in STEP-21 Weight loss with CagriSema in REDEFINE-22 Semaglutide 1.0 mg (n=403) Placebo (n=403) Placebo (n=302) CagriSema (n=904) Semaglutide 2.4 mg (n=404) Mean body weight at
Slide 78: Amylin holds transformative potential for chronic weight management
Amylin holds transformative potential for chronic weight management We need a toolbox to address one of the greatest healthcare challenges of our time, not just a hammer 1. Amylin represents a distinct new modality that can expand the chronic weight management toolbox 1. Potential to deliver the wei
Slide 79: Break
Break The meeting commences at 3:45 pm GMT 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health Adam Steensberg 1:05-1:25 Carel Le Roux & Davi
Slide 80: Zealand Pharma leadership team
Utpal Singh Christina S. Bredal Chief Scientific Chief People Officer David Kendall Officer Ivan Møller Chief Medical Chief Operating Officer Officer Steven Johnson Eric Cox Chief Development Officer Henriette Wennicke Adam Steensberg Chief Commercial Officer Chief Financial Officer Chief Executive
Slide 81: Petrelintide: building the leading amylin franchise
5. Petrelintide: building the leading amylin franchise David Kendall - including Q&A – 3:45-4:20 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic
Slide 82: Petrelintide: Lead, Deliver, Win
Petrelintide LEAD DELIVER WIN in amylin-based therapies on efficacy and improved in establishing a new experience foundational therapy for weight management 82
Slide 83: Petrelintide is a long-acting, potential best-in-class amylin analog
Petrelintide is a long-acting, potential best-in-class amylin analog Petrelintide is a 36-amino-acid acylated peptide, based on the peptide sequence of human amylin1 Human amylin backbone (intentionally avoiding sCT due to potential safety and tolerability concerns)1 Potent balanced agonistic effect
Slide 84: Early data support favorable balance of weight loss and GI AEs
Early clinical data support a favorable balance between weight loss and GI AEs with petrelintide Indirect comparison of SAD trials: Placebo-adjusted weight loss one week after a single dose1-5 Petrelintide Eloralintide Met-233i ABBV-295 0.7 mg 1.4 mg 2.4 mg 1.2 mg 4 mg 12 mg 0.6 mg 1.2 mg 2.4 mg 3.5
Slide 85: Totality and consistency of clinical data to date
Totality and consistency of clinical data to date reinforce the best-in-class potential of petrelintide MAD trial Part 1 MAD trial Part 2 SAD trial1 (6-week study)2 (16-week study)3 % change in body weight % change in body weight % change in body weight from baseline at Day 7 from baseline at week 6
Slide 86: Females in Phase 1b trial lost more weight than males
Females in the petrelintide 16-week Phase 1b trial generally lost more weight than the males Weight loss from baseline after 16 weeks by gender % 21% of trial participants in the trial 5 Placebo Petrelintide 2.4 mg Petrelintide 4.8 mg Petrelintide 9.0 mg were female 4 3 2 1 0 -1 -2 -3 A greater trea
Slide 87: Petrelintide potential ~15–20% weight loss with benign tolerability
Petrelintide holds potential to deliver ~15–20% weight loss with a benign tolerability profile Indirect comparison: Placebo-adjusted weight loss at Week 16 by efficacy estimand1-4 Phase 1 trial with ~20% female participants Phase 2/3 trials with up to 80% female participants and baseline BMI <30 kg/
Slide 88: ZUPREME-1 Phase 2 topline expected Q1 2026
We expect to report topline results from the ZUPREME-1 Phase 2 trial in Q1 2026 ZUPREME-1 features a balanced gender distribution and a higher BMI at baseline compared to Phase 1 ZUPREME-1: Overweight/obesity without T2D1 ZUPREME-12,a 16-week Phase 1b3 N=494 N=48 Initiated in December 2024 Enrollmen
Slide 89: Petrelintide monotherapy program towards Phase 3 in H2 2026
The petrelintide monotherapy program is progressing rapidly towards Phase 3 initiation in H2 2026 Robust Phase 2 program ZUPREME-1 (obesity w/o T2D)1 42-week topline data expected in Q1 2026 ZUPREME-2 (obesity w. T2D)2 28-week topline data expected in H2 2026 Comprehensive Phase 3 program Phase 3a:
Slide 90: Phase 2 trial with petrelintide/CT-388 planned H1 2026
Phase 2 trial with petrelintide/CT-388 planned for initiation in H1 2026 Zealand Pharma and Roche aim to maximize the dose of petrelintidea and optimize the dose of CT-388 Petrelintide as the foundationa Strategic objectives of the Phase 2 trial Identify the doses that maximize weight loss efficacy
Slide 91: Petrelintide as future foundational therapy
Petrelintide holds potential as a future foundational therapy for weight management 1. Weight loss – Potential for ~15–20% reduction in body weight as monotherapy1-3 1. Safety and tolerability – Potential for better tolerability compared to incretins, including less frequent and less severe GI AEs,
Slide 92: Q&A Petrelintide
Q&A Petrelintide Adam Steensberg David Kendall Louis J. Aronne
Slide 93: Our engine: world's most valuable metabolic health pipeline
6. Our engine: world’s most valuable metabolic health pipeline Utpal Singh – 4:20-4:50 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health Ad
Slide 94: Zealand is built to lead in metabolic health
Zealand is built to lead Idea Insights modulating in metabolic multi-hormonal circuits health Utpal Singh David Kendall Discovery Chief Scientific Officer Chief Medical Officer >25 years of data to build ML models Medical Steven Johnson Steven Smith Led by experts and pioneers Chief Development Seni
Slide 95: Defined by firsts in complex peptide engineering
Defined by firsts in complex peptide engineering 25+ years of expertise in peptide R&D Strong track record in stabilizing and developing the most challenging peptides Petrelintide Lixisenatide Survodutide First long-acting ZP9830 First SIP-tail First glucagon/GLP-1 human amylin-derived Potential fir
Slide 96: Metabolic health: hidden epidemic beyond obesity
Metabolic health: Hidden epidemic beyond obesity >1 billion people worldwide with metabolic imbalance NON-EXHAUSTIVE The Visible Epidemic Consequences of metabolic imbalance >120 million people in the U.S. Cardiovascular disease are living with obesity1,2 T2D and beta cell failure The Hidden Epidemi
Slide 97: Designing to treat root causes and enhance experience
Designing to treat root causes and enhance experience Weight loss Olympics (2005-2025) Quality & Durability Era (Now → Future) Weight loss through appetite suppression (gut–brain axis) Systemic rebalancing across brain–gut–periphery Liraglutide Semaglutide Tirzepatide Survodutide Petrelintide Tuned
Slide 98: Tune cross axis signaling to rebalance the system
Tune cross axis signaling to rebalance the system Adipose tissue GI tract Hypothalamus Ghrelin Vagal afferents Hindbrain Leptin LEAP2 PYY3-36 Insulin Amylin GLP-1 Glucagon GIP Liver Pancreatic islets Leveraging human physiology with multi-hormone combinations to dial in efficacy and dial out adverse
Slide 99: Targeting the brain to restore hypothalamic sensitivity
Targeting the brain to restore hypothalamic sensitivity The past: metabolic thrifty physiology Today: hypothalamic insulin-leptin resistance (High hypothalamic sensitivity to the brain) (Chronic energy surplus: impaired central sensing) Leptin Leptin Optimized for Dysregulated by scarcity abundance
Slide 100: Increase peripheral metabolic capacity and flexibility
Increase peripheral metabolic capacity and flexibility The future: metabolic fitness Skeletal muscle Build / preserve functional muscle Adipose tissue Enable adipose remodeling Weight-independent insulin and flexibility sensitization will drive metabolic flexibility required Beta cell Protect, rest,
Slide 101: Delivering outcomes that will increase human health span
Delivering outcomes that will increase human health span Weight loss with higher acceptability to shatter Convenience and Improved bone and adherence ceiling durability muscle health Quality & Durability Era Leptin sensitivity to Improved beta-cell restore brain’s function for T2D and regulatory bas
Slide 102: GLP-1 story shows persistence and innovation
GLP-1 story shows that persistence and innovation redefine what’s possible Stability & Half-life extension Oral peptide Signaling DPP-4 resistance technologies delivery engineering First BID First QW First oral QD First QW GLP-1 GLP-1RA for T2D4,5 GLP-1RA for T2D3 GLP-1RA for T2D8 GLP-1R/GIPR dual a
Slide 103: Amylin renaissance through peptide design
Amylin renaissance through peptide design Studies demonstrate amylin's Key challenges for pramlintide physiological roles in satiety2,3 • Amyloidogenic instability5 • Inconvenient dosing and injection burden due to short half-life6,7 Potential approval FDA approves pramlintide • Limited market uptak
Slide 104: Prioritizing and accelerating early-stage programs
Prioritizing and accelerating early-stage programs ZP9830: Highly potent ZP6590: Progressing GIP and specific Kv1.3 inhibitor analog to clinical testing Kv1.3 overexpression in memory T cells Improve tolerability and adipose insulin drives chronic inflammation and sensitivity, reducing ectopic fat a
Slide 105: Expanding platform reach through partnerships
Expanding platform reach through partnerships to reimagine medicine creation Expand toolbox Build multi-asset amylin franchise and expand toolbox to enable tissue-selective targeting Strengthen platform Access technologies (AI/ML) to develop predictive models leveraging our legacy data and expertise
Slide 106: Building a multi-asset amylin franchise
Building a multi-asset amylin franchise to expand treatment options Oral small-molecule amylin True once-monthly injectable amylin ✓ Broader accessibility ✓ Specifically designed for less frequent dosing ✓ Maintain favorable tolerability profile ✓ Greater flexibility in treatment options Force-fitti
Slide 107: Investing in advanced computational methods
Investing in Structural dynamics and legacy data will enable precise molecule design and pivot from empirical sequence screening advanced Static model Dynamic model computational Static views constrain design: Molecular dynamics can reveal novel design: methods for medicine 3D structure: MD simulati
Slide 108: Integrating two biotech powerhouses in metabolic health
Integrating two biotech powerhouses in metabolic health Expand the reach of our platform Copenhagen: Boston: Build on our heritage Accelerate • Peptide engineering medicine creation • Structural biology • AI-ML driven peptide discovery with legacy data • Deep preclinical MoA studies • Automation to
Slide 109: We will build the world's most valuable metabolic health pipeline
We will build the world’s most valuable metabolic health pipeline Partner to evolve Deliver valued medicines our platform Focus on our expertise #1 +10 idea → clinic clinical cycle times programs by 2030 Accelerate our research engine 109
Slide 110: How we fund and scale this
7. How we fund and scale this Henriette Wennicke – 4:50-5:00 1. 3. Break 6. 8. 3:05-3:45 The opportunity Survodutide: the next Our engine: world’s Q&A and & our ambition frontier in obesity most valuable closing remarks Adam Steensberg & MASH (GCG/GLP-1) metabolic health Adam Steensberg 1:05-1:25 Ca
Slide 111: Capital allocation strategy
Uniquely positioned to maximize the value of petrelintide and build a leading metabolic Capital Allocation Strategy health pipeline Establish leading multi-asset 1 amylin-based franchise Accelerate and strengthen 2 research engine Inorganic investments to enhance 3 R&D capabilities and pipeline 111
Slide 112: Allocating resources to lead in obesity and metabolic health
Allocating resources to lead in obesity and metabolic health ILLUSTRATIVEa 2022 2025 2028 2030s R&D S&M Obesity & inflammation Rare diseases Research Commercial aThe anticipated 2028 and 2030 resource allocation is subject to the “Forward-Looking Statements” disclaimer and should not be relied upon
Slide 113: The route to becoming a generational biotech
The route to becoming a generational biotech ILLUSTRATIVEa Obesity & Inflammation • Petrelintide development costs peaked late 2020s • New programs drive development expenses Research • Step change in absolute investments 2030s • From DKK 1 billion past 5 years to DKK ~5 billion in the coming 5 year
Slide 114: Strong financial terms and commitments
Strong financial terms and commitments Petrelintide and petrelintide/CT-388 Survodutide 50% profit share in U.S. and Europe Solely responsible for development Tiered double-digit % royalties on net sales in RoW and commercialization globally ranging up to high-teens Up to USD 1.2bna in outstanding d
Slide 115: Financial muscle for accelerated growth
Financial muscle for accelerated growth ILLUSTRATIVE Robust capital position more than sufficient to deliver on key strategic priorities Mid-term profitability drivers Significant 16.2 petrelintide Potential partnerships across pipeline assets economics: 50/50 Cash position (DKK billion)a profit sha
Slide 116: Building a pharma pipeline with biotech financial discipline
And that’s how we will build a pharma pipeline with biotech financial discipline
Slide 117: Today's speakers from Zealand Pharma Q&A
Today’s speakers Q&A from Zealand Pharma Adam Steensberg Henriette Wennicke David Kendall Eric Cox Utpal Singh Chief Executive Officer Chief Financial Officer Chief Medical Officer Chief Commercial Officer Chief Scientific Officer
Slide 118: What today's journey adds up to
What today’s journey adds up to 1. Opportunity & ambition: 5. Petrelintide – Foundational Zealand Pharma a therapy, anchoring a best-in- generational biotech. class franchise. 2. Weight management must 6. Our engine and unfair shift to long-term advantage: Powering the treatments. world’s most valua
Slide 119: Maximize this metabolic moment
Maximize this metabolic moment Join the disciplined outsider in metabolic health – and be part of the moment that changes the game for patients and healthcare providers.