Spruce Biosciences, Inc. · NASDAQ:SPRB
Spruce Biosciences — Investor Presentation (August 2026)
22 slides from Spruce Biosciences's investor presentation, Aug 12, 2026
Slide 1: Corporate Presentation
Corporate Presentation August 12, 2026
Slide 2: Forward Looking Statements
Forward Looking Statements This presentation contains forward-looking statements about Spruce Biosciences, Inc. (“we,” or the “Company”). All statements other than statements of historical facts contained in this presentation are forward-looking statements within the meaning of the “safe harbor” pro
Slide 3: Our Commitment to Patients
Our Commitment to Patients We are inspired by Liv, living with Sanfilippo Syndrome Type B (MPS IIIB). Her courage in facing a relentlessly-progressive condition challenges us to move faster and think bolder — because for patients like Liv, time is everything! 3
Slide 4: Spruce Bio: Global Neuroendocrine Biopharma Company
Spruce Bio: Global Neuroendocrine Biopharma Company Advancing a Differentiated Pipeline of Potentially First-to-Market and Best-in-Class Programs Tralesinidase Alfa Enzyme Replacement Therapy (TA-ERT) for Sanfilippo Syndrome Type B (MPS IIIB), granted Breakthrough Therapy Designation by U.S. FDA ▪ T
Slide 5: Estimated More Than 3,000 MPS IIIB Patients in Key Commercial Territories
Estimated More Than 3,000 MPS IIIB Patients in Key Commercial Territories Incidence varies across regions (0.5 to 4 per 100k live births)1,2,3 ~90% of all incident cases are non- North America: Europe-ME: attenuated (severe and rapidly- ~450 ~500 Asia-Pacific: progressing)4,5 ~1,800 Non-attenuated S
Slide 6: Ultra Rare Disease Products Command Premium Pricing with Limited Restrictions
Ultra Rare Disease Products Command Premium Pricing with Limited Restrictions ▪ Premium Pricing & Reimbursement: High unmet need and measurable clinical benefit support favorable payer coverage and sustainable pricing models ▪ Small patient numbers results in low overall payer burden: Multiple appro
Slide 7: Mucopolysaccharidosis IIIB (MPS IIIB): Progressive Fatal Neurodegenerative Pediatric Disorder
Mucopolysaccharidosis IIIB (MPS IIIB): Progressive Fatal Neurodegenerative Pediatric Disorder • Autosomal recessive disorder affecting 1 in 200,000 newborns 1,2 • A deficiency in alpha-N- acetylglucosaminidase (NAGLU) leads to lysosomal accumulation of Heparan Sulfate (HS)3 • HS buildup impairs neur
Slide 8: MOA: TA-ERT as Enzyme Replacement Therapy
MOA: TA-ERT as Enzyme Replacement Therapy TA-ERT is a recombinant human NAGLU fusion protein (rhNAGLU) delivered directly to the CNS to reduce the accumulation of HS in lysosomes and stabilize progressive neurodegeneration. Heparan Sulfate accumulation is the underlying pathophysiology of MPS IIIB •
Slide 9: Anticipated Development Roadmap
TA-ERT Anticipated Development Roadmap No further clinical or non-clinical studies are expected to be required for BLA submission in Q4 2026 COMPLETED STUDIES SUPPORTING AN ACCELERATED APPROVAL (AA3) PLANNED STUDY FOR FULL APPROVAL Natural History Study Concurrent Natural History Study 1-10 years of
Slide 10: Baseline Demographics and Characteristics in Untreated and Treated Participants
Baseline Demographics and Characteristics in Untreated (Study 902) and Treated (Study 201 + EXT) Participants No DQ Inclusion Criterion DQ>50 Inclusion Criterion Study 902 (NH) Study 201+EXT N=32a N=22 Age (years) Mean (SD) 5.81 (2.20) 4.96 (2.03) Median 6.08 5.08 Sex n (%) Male 17 (53.1) 13 (59.1)
Slide 11: Rapidly and Durably Normalized CSF HS Over Five Years
TA-ERT Rapidly and Durably Normalized CSF HS Over Five Years 450 LS Mean ± SE of CSF HS (ng/mL) 400 350 300 250 200 150 100 50 0 Baseline 1 Month 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Post Treatment (Years) n 22 22 22 21 19 18 16 15 16 13 12 11 LS Mean 381.5 101.1 122.9 113.9 107.1 167.4 121.8 113
Slide 12: Rapidly and Durably Normalized CSF HS-NRE Over Five Years
TA-ERT Rapidly and Durably Normalized CSF HS-NRE Over Five Years LS Mean ± SE of CSF HS-NRE (ng/mL) 130 110 90 70 50 30 10 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 Post Treatment (Years) n 22 20 21 17 17 15 15 14 10 9 4 LS Mean 103.3 13.5 10.5 11.7 19.9 13.8 10.2 9.4 11.5 7.1 11.6 Dashed line repre
Slide 13: Stabilized Cognition Based on BSID-C
TA-ERT Stabilized Cognition Based on BSID-C 100 TA Therapy (Studies 201+202+401) LS Mean ± 95% CI of Bayley-III 80 Natural History Cognitive Raw Score (Studies 901+902) 60 40 20 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (Years) Natural History 3 5 5 5 10 14 13 16 20 13 17 12 15 14 18 1 1 14 12 10
Slide 14: Stabilized Receptive Communication Skills Based on VABS-II
TA-ERT Stabilized Receptive Communication Skills Based on VABS-II 100 Mean ± SE of Communication-Receptive TA Therapy 90 (Studies 201+202+401) 80 Natural History 70 (Studies 901+902) 60 Raw Score 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (Years) 901+902 3 5 5 6 9 13 14 18 21 16 19 1
Slide 15: Stabilized Expressive Communication Skills Based on VABS-II
TA-ERT Stabilized Expressive Communication Skills Based on VABS-II 240 Mean ± SE of Communication-Expressive 220 TA Therapy (Studies 201+202+401) 200 180 Natural History 160 (Studies 901+902) 140 Raw Score 120 100 80 60 40 20 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (Years) 901+902 3 5 5 6 9 13 1
Slide 16: Stabilized Gross Motor Skills Based on VABS-II
TA-ERT Stabilized Gross Motor Skills Based on VABS-II Mean ± SE of Motor Skills – Gross Raw Score 250 TA Therapy (Studies 201+202+401) 200 Natural History (Studies 901+902) 150 100 50 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (Years) 901+902 3 5 5 6 8 13 14 18 21 16 19 13 16 18 19 18 18 14 11 8 8
Slide 17: Stabilized Fine Motor Skills Based on VABS-II
TA-ERT Stabilized Fine Motor Skills Based on VABS-II Mean ± SE of Motor Skills – Fine Raw Score 150 140 TA Therapy 130 (Studies 201+202+401) 120 110 Natural History 100 (Studies 901+902) 90 80 70 60 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Age (Years) 901+902 3 5 5 6 9 13 14 18 21 15 1
Slide 18: Stabilized Cortical Grey Matter Volume (CGMV)
TA-ERT Stabilized Cortical Grey Matter Volume (CGMV) 100 Study 901 Study 201 Study 202 Change from Baseline of Each Study 0 -100 -200 Week 48 Week 24 Week 48 Week 48 Week 96 Week 144 Week 192 Week 240 N 15 21 20 16 9 12 13 8 Mean (SD) -33.6 (31.6) -59.0 (43.6) -57.6 (45.7) -54.7 (57.1) -55.0 (55.0)
Slide 19: Normalized Liver and Spleen Volume
TA-ERT Normalized Liver and Spleen Volume Liver (A), spleen (B) were measured by magnetic resonance imaging at Week 1 (Baseline) and Weeks 24 and 48. Liver and spleen volumes were adjusted for body surface area. BSA=body surface area. Boxes represent the 5th to 95th percentiles with the median; dots
Slide 20: Safety Profile and Immunogenicity
TA-ERT Safety Profile and Immunogenicity • 22 patients enrolled with follow up lasting up to 6 years with ~6,000 TA doses administered • 4 discontinuations occurred (3 due to hydrocephalus and 1 following infection) • Most common Treatment-Emergent Adverse Events were vomiting, pyrexia, and upper re
Slide 21: Financial Snapshot
Financial Snapshot Capital Structure and Financials as of June 30, 2026 Capital Structure Shares Cash and Debt 000’s Common Shares Outstanding1 2,874,013 Cash & Cash Equivalents5 $96,295 Restricted Stock Units 127,084 Debt6 $16,600 Common Stock Options2 49,174 Common Stock Warrants3 233,147 Fully Di
Slide 22: SPrucesiOoscliENCES
—— SPrucesiOoscliENCES
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