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Cassava Sciences, Inc.

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FY2020 Annual Report · Cassava Sciences, Inc.
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UNITED STATES 
SECURITIES AND EXCHANGE COMMISSION 
Washington, D.C. 20549 
_______________ 

Form 10-K 
_______________ 

(Mark One) 

  ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 

For the Fiscal Year Ended December 31, 2020 
or 

 

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 

For the transition period from _____ to _____ 

Commission File Number: 000-29959 

Cassava Sciences, Inc. 

(Exact name of registrant as specified in its charter) 

Delaware  
(State or other jurisdiction of 
incorporation or organization) 

91-1911336  
(I.R.S. Employer 
Identification Number) 

7801 N. Capital of Texas Highway, Suite 260, Austin, TX 78731 
 (512) 501-2444 
(Address, including zip code, of registrant's principal executive offices and 
telephone number, including area code) 

Securities registered pursuant to Section 12(b) of the Act: 

0 

Title of each class 
Common Stock, $0.001 par value 

Trading 
Symbol(s) 
SAVA 

Name of each exchange on which registered 
NASDAQ Capital Market 

Securities registered pursuant to Section 12(g) of the Act:  None 

Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes   No  
Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes   No  
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 
during  the preceding  12  months  (or  for  such  shorter period  that the  registrant  was  required  to  file  such  reports),  and  (2) has been  subject  to such  filing 
requirements for the past 90 days.  Yes   No  

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of 
Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).  
Yes   No . 

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an 
emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” 
in Rule 12b-2 of the Exchange Act.  (Check one):  

Large accelerated filer   
Non-accelerated filer   

Accelerated filer   
Smaller reporting company    
Emerging growth company    

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any 

new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act.  

Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal 
control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 USC. 7262(b)) by the registered public accounting firm that prepared or 
issued its audit report.  

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act).  Yes   No  
The aggregate market value of the voting and non-voting common equity held by non-affiliates was $71,146,906 computed by reference to the last sales 
price of $3.08 as reported on the Nasdaq Capital Market, as of the last business day of the Registrant's most recently completed second fiscal quarter, June 30, 
2020. The number of shares outstanding of the Registrant's common stock on March 18, 2021 was 39,898,325. 
DOCUMENTS INCORPORATED BY REFERENCE 

Portions of the Registrant's Proxy Statement for its 2021 Annual Meeting of Stockholders (the Proxy Statement), to be filed with the U.S. Securities 

and Exchange Commission, are incorporated by reference to Part III of this Form 10-K Report. 

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CASSAVA SCIENCES, INC. 

FORM 10-K 
INDEX 

PART I 

Business  
Risk Factors  
Unresolved Staff Comments  
Properties 
Legal Proceedings 
Mine Safety Disclosures  

PART II 

Market  for  Registrant’s  Common  Equity,  Related  Stockholder  Matters  and  Issuer  Purchases  of 
Equity Securities 
Selected Financial Data  
Management’s Discussion and Analysis of Financial Condition and Results of Operations  
Quantitative and Qualitative Disclosures About Market Risk  
Financial Statements and Supplementary Data  
Changes in and Disagreements with Accountants on Accounting and Financial Disclosure  
Controls and Procedures  
Other Information  

PART III 

Directors and Executive Officers and Corporate Governance  
Executive Compensation  
Security  Ownership  of  Certain  Beneficial  Owners  and  Management  and  Related  Stockholder 
Matters  
Certain Relationships and Related Transactions and Director Independence  
Principal Accountant Fees and Services  

Item 1. 
Item 1A. 
Item 1B. 
Item 2. 
Item 3. 
Item 4. 

Item 5. 

Item 6. 
Item 7. 
Item 7A. 
Item 8. 
Item 9. 
Item 9A. 
Item 9B. 

Item 10. 
Item 11. 
Item 12. 

Item 13. 
Item 14. 

Item 15. 
Item 16. 

Exhibits and Financial Statement Schedules  
Form 10-K Summary 

PART IV 

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PART I 

FORWARD-LOOKING STATEMENTS 

This  Annual  Report  on  Form  10-K  contains  forward-looking  statements  within  the  meaning of  the  Private  Securities 
Reform Act of 1995. All statements other than statements of historical facts contained in this Annual Report are forward-
looking  statements.  We  intend  that  such  statements  be  protected  by  the  safe  harbor  created  thereby.  Forward-looking 
statements  relate  to  expectations,  beliefs,  projections,  future  plans  and  strategies,  anticipated  events  or  trends  and  similar 
expressions concerning matters that are not historical facts. In some cases, you can identify forward-looking statements by 
terms such as “anticipate,” “believe,” “could,” “estimate,” “expect,” “intend,” “may,” “plan,” “potential,” “should,” “will” 
and “would” or the negatives of these terms or other comparable terminology. 

The forward-looking statements are based on our beliefs, assumptions and expectations of our future performance, taking 
into account all information currently available to us. Forward-looking statements involve risks and uncertainties and our 
actual results and the timing of events may differ significantly from the results discussed in the forward-looking statements. 
Such forward-looking statements and our business are subject to numerous risks and uncertainties that you should consider 
before investing in our Company. These risks are described more fully in the section titled “Risk Factors.” Accordingly, you 
should not rely upon forward-looking statements as predictions of future events. Examples of such forward-looking statements 
include, but are not limited to statements about: 

• 

• 

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• 

• 

• 

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• 

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our intention to initiate a pivotal Phase 3 clinical program with simufilam in Alzheimer’s disease, the anticipated 
scope of Phase 3 studies and our estimated timeline for doing so; 
our reliance on third-party contractors to make drug supply on a large-scale for our Phase 3 clinical program, or their 
ability to do so on-time or on-budget; 
our intention to initiate a cognition maintenance study with simufilam in Alzheimer’s disease; 
limitations around the interpretation of cognitive results from a long-term open-label study design, as compared to 
efficacy results from a fully completed, randomized controlled study design; 
the expected rate of cognitive decline over time in untreated Alzheimer’s patients; 
the  ability  of  the  Alzheimer's  Disease  Assessment  Scale-Cognitive  Subscale  (ADAS-cog),  Neuropsychiatric 
Inventory (NPI), CANTAB or other clinical scales to assess cognition or health in our trials of Alzheimer’s disease; 
announcements or plans regarding any future interim analyses of our open-label study of simufilam and our estimated 
timeline for doing so; 
any  significant  changes  we  have  made,  or  anticipate  making,  to  the  design  of  an  on-going  open-label  study  of 
simufilam; 
announcements regarding an End-of-Phase 2 meeting held January 2021 with the U.S. Food and Drug Administration 
(FDA); 
our  ability  to  initiate,  conduct  or  analyze  additional clinical  and  non-clinical  studies  with  our product  candidates 
targeted at Alzheimer’s disease and other neurodegenerative diseases; 
the interpretation of results from our Phase 2 clinical studies; 
our estimated timeline for publishing in a peer-reviewed technical journal clinical results of our Phase 2b study of 
simufilam; 
our  plans  to  initiate  a  validation  study  of  SavaDx,  our  investigational  blood-based diagnostic,  and  our  estimated 
timeline for doing so; 
the safety, efficacy, or potential therapeutic benefits of our product candidates; 
the utility of protection, or the sufficiency, of our intellectual property; 
our potential competitors or competitive products; 
expected future sources of revenue and capital and increasing cash needs; 
our use of Clinical Research Organizations (CROs) to conduct clinical studies of our product candidates; 
expectations  regarding  trade  secrets,  technological  innovations,  licensing  agreements  and  outsourcing  of  certain 
business functions; 
our expenses increasing or fluctuations in our financial or operating results; 
our operating losses and anticipated operating and capital expenditures; 
expectations  regarding  the  issuance  of  shares  of  common  stock  to  employees  pursuant  to  equity  compensation 
awards, net of employment taxes; 

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• 
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• 
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the development and maintenance of our internal information systems and infrastructure; 
our need to hire additional personnel and our ability to attract and retain such personnel; 
existing regulations and regulatory developments in the United States and other jurisdictions; 
our need to expand the size and scope of our physical facilities; 
the sufficiency of our current resources to continue to fund our operations; 
the accuracy of our estimates regarding expenses, capital requirements, and needs for additional financing; 
assumptions and estimates used for our disclosures regarding stock-based compensation; and 
the  long-term  impact  of  COVID-19,  a  novel  coronavirus  first  detected  in  2019,  on  our  operations  and  financial 
condition. 

We cannot assure you that we will realize the results or developments we expect or anticipate or, even if substantially 
realized, that they will result in the consequences or affect us or our operations in the way we expect. The forward-looking 
statements included in this Annual Report on Form 10-K are made only as of the date hereof. We undertake no obligation to 
publicly update or revise any forward-looking statement as a result of new information, future events or otherwise, except as 
required by law. 

In addition, statements that “we believe” and similar statements reflect our beliefs and opinions on the relevant subject. 
These statements are based upon information available to us as of the date of this report, and while we believe such information 
forms a reasonable basis for such statements, such information may be limited or incomplete, and our statements should not 
be  read  to  indicate  that  we  have  conducted  an  exhaustive  inquiry  into,  or  review  of,  all  potentially  available  relevant 
information. These statements are inherently uncertain and you are cautioned not to unduly rely upon these statements. 

Our research programs in neurodegeneration benefit from longstanding scientific and financial support from the National 
Institutes of Health (NIH). The contents of this Annual Report are solely our responsibility and do not necessarily represent 
any official views of NIH. 

Item 1.    Business 

Overview 

Cassava Sciences, Inc. is a clinical-stage biotechnology company. Our mission is to detect and treat neurodegenerative 
diseases, such as Alzheimer’s disease. Our novel science is based on stabilizing – but not removing – a critical protein in the 
brain. 

Over the past 10 years, we have combined state-of-the-art technology with new insights in neurobiology to develop novel 
solutions  for  Alzheimer’s  disease  and  other  neurodegenerative  diseases.  Our  strategy  is  to  leverage  our  unique 
scientific/clinical platform to develop a first-in-class program for treating neurodegenerative diseases, such as Alzheimer’s.  

We currently have two clinical-stage biopharmaceutical assets under development:  

• 
• 

our lead therapeutic product candidate is called simufilam, and it is a novel treatment for Alzheimer’s disease; and  
our lead investigational diagnostic product candidate is called SavaDx, and it is a novel way to detect the presence 
of  Alzheimer’s  disease  from  a  small  sample  of  blood,  possibly  years  before  the  overt  appearance  of  clinical 
symptoms. 

Our scientific approach for the treatment of Alzheimer’s disease seeks to simultaneously improve both neurodegeneration 
and neuroinflammation. We believe our ability to improve multiple vital functions in the brain represents a new, different and 
crucial approach to address Alzheimer’s disease.  

Our  lead  therapeutic  product  candidate,  simufilam,  is  a  proprietary  small  molecule  (oral)  drug.  Simufilam  targets  an 
altered form of a protein called filamin A (FLNA) in the Alzheimer’s brain. Published studies have demonstrated that the 
altered form of FLNA causes neuronal dysfunction, neuronal degeneration and neuroinflammation.   

We believe simufilam improves brain health by reverting altered FLNA back to its native, healthy conformation, thus 
countering  the  downstream  toxic  effects  of  altered  FLNA.  We  have  generated  and  published  experimental  and  clinical 

4 

  
 
 
 
 
 
 
 
 
 
 
 
 
evidence of improved brain health with simufilam.  Importantly, simufilam is not dependent on clearing amyloid from the 
brain.  Since  simufilam  has  a unique  mechanism  of  action, we  believe  its  potential  therapeutic  effects  may  be  additive  or 
synergistic with that of other therapeutic candidates aiming to treat neurodegeneration. 

Simufilam  has  demonstrated  a  multitude  of  beneficial  effects  in  animal  models  of  disease,  including  normalizing 

neurotransmission, decreasing neuroinflammation, suppressing neurodegeneration, and restoring memory and cognition.   

In 2019, we completed a small, first-in-patient, clinical-proof-of-concept, open-label Phase 2a study of simufilam in the 
U.S., with substantial support from the National Institute on Aging (NIA), a division of the NIH. Treatment with simufilam 
for  28  days  significantly  improved  key  biomarkers  of  Alzheimer’s  pathology,  neurodegeneration  and  neuroinflammation 
(p<0.001). Biomarkers effects were seen in all patients in both cerebrospinal fluid (CSF) and plasma. 

In September 2020, we announced final results of a Phase 2b study with simufilam in Alzheimer’s disease. In this clinical 
study funded by the NIH, Alzheimer’s patients treated with 50 mg or 100 mg of simufilam twice-daily for 28 days showed 
statistically  significant  (p<0.05)  improvements  in  CSF  biomarkers  of  disease  pathology,  neurodegeneration  and 
neuroinflammation, versus Alzheimer’s patients who took placebo. In addition, Alzheimer’s patients treated with simufilam 
showed improvements in validated tests of episodic memory and spatial working memory, versus patients on placebo (Effect 
Size 17-46%). Cognitive improvements correlated most strongly (R2=0.5) with decreases in levels of P-tau181. 

In March 2020, we initiated a long-term open-label extension study to evaluate simufilam in patients with Alzheimer’s 
disease. This  open-label,  multi-center,  extension  study is  intended  to  monitor  the  long-term  safety  and  tolerability 
of simufilam 100 mg twice-daily for 12 or more months. The study’s initial target enrollment was approximately 100 patients 
with mild-to-moderate Alzheimer’s disease and, in February 2021, was increased to approximately 150 patients. This study 
uses  the  Alzheimer's  Disease  Assessment  Scale-Cognitive  Subscale  (ADAS-Cog-11)  to  assess  cognitive  symptoms  of 
dementia and the Neuropsychiatric Inventory (NPI) to assess the presence and severity of dementia-related behavior. Both 
scales are widely used clinical tools in trials of Alzheimer’s disease. 

On February 2, 2021, we announced results of the first of two preplanned interim analysis of our open-label study of 
simufilam. The first interim analysis summarizes clinical data at the midway point of enrollment, i.e., the first 50 patients who 
have completed at least 6 months of drug treatment.  Patients’  cognition and behavior scores both improved following six 
months of simufilam treatment, with no safety issues. Six months of simufilam treatment improved cognition scores by 1.6 
points on ADAS-Cog11, a 10% mean improvement from baseline to month 6. In these same patients, simufilam also improved 
dementia-related behavior, such as anxiety, delusions and agitation, by 1.3 points on the Neuropsychiatric Inventory, a 29% 
mean improvement from baseline to month 6.   

Based  on  the  interim  results  and  inbound  demand  from  Alzheimer’s  patients  and  their  caregivers,  we  announced 
significant changes to the open-label program, including an increase in the enrollment target by up to 50 additional patients, 
for a total target of approximately 150 patients. This study had enrolled approximately 80 patients as of February 2021. 

We expect to  announce results of a second planned interim analysis on safety and cognition for our open-label study 
approximately  mid-2021. The  second  interim  analysis  is  intended  to  summarize  clinical data  on  the  first 50 patients  who 
complete at least 12 months of open label drug treatment. 

On February 22, 2021, we announced the successful completion of an End-of-Phase 2 (EOP2) meeting with the FDA for 
simufilam.  Official  EOP2  meeting  minutes  indicate  we  and  the  FDA  agree  on  key  elements  of  a pivotal  Phase  3  clinical 
program in support of a New Drug Application (NDA) filing for simufilam in Alzheimer’s disease.  We believe agreements 
reached during the EOP2 meeting show a clear path forward for advancing simufilam into Phase 3 studies. We expect to 
initiate a pivotal Phase 3 program with simufilam in Alzheimer’s disease in the second half of 2021. 

Our diagnostic effort, called SavaDx, is an early-stage program focused on detecting the presence of Alzheimer’s disease 
from a small sample of blood, possibly years before the overt appearance of clinical symptoms. We are developing SavaDx 
as  a  fast,  accurate  and  quantitative  blood-based  investigational  biomarker/diagnostic  to  detect  and  monitor  Alzheimer's 
disease. The goal is to make the detection of Alzheimer’s disease as simple as getting a blood test.  We expect to initiate a 
validation/disease specificity study of SavaDx in 2021.  

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About Alzheimer’s Disease 

Alzheimer’s disease is a progressive neurodegenerative disorder that affects cognition, function and behavior. There are 
no  disease-modifying drug  therapies  to  treat  the  disease.  As  such,  cognition  will  always  continue  to  decline  over  time  in 
patients with Alzheimer’s. 

As of 2020, there were approximately 50 million people worldwide living with dementia, a figure expected to increase to 
150 million  by  2050  and  the  annual  global  cost  of  dementia  is  now  above  $1  trillion,  according  to  Alzheimer’s  Disease 
International, a charitable organization.    

Our Scientific Approach is Different 

Over the last ten years, we have developed a new and promising scientific approach for the treatment and diagnosis of 
neurodegenerative diseases, such as Alzheimer’s disease. Importantly, we do not seek to clear amyloid out of the brain. Rather, 
we seek to stabilize a critical protein in the brain that has many downstream effects. 

Our scientific approach is to treat neurodegeneration by targeting an altered form of a scaffold protein called FLNA. 
Through years of basic research, we and our academic collaborators identified FLNA as a structurally altered protein in the 
Alzheimer’s brain. We have shown that the altered form of FLNA is pervasive in the Alzheimer’s brain and undetectable in 
healthy control brains. 

Using  scientific  insight  and  advanced  techniques  in  molecular  biochemistry,  bioinformatics  and  imaging,  we  have 
elucidated this protein dysfunction. Through this work, we have produced experimental evidence that altered FLNA plays a 
critical role in Alzheimer’s disease. We engineered a family of high-affinity, small molecules to target this structurally altered 
protein and restore its normal shape and function. This family of small molecules, including our lead therapeutic candidate, 
simufilam, was designed in-house and characterized by our academic collaborators.  

Our lead therapeutic product candidate, simufilam, is a small molecule (oral) drug with a novel mechanism of action. The 
target of simufilam is altered FLNA, the brain protein we seek to stabilize (simufilam does not bind to healthy, normal FLNA). 
Importantly, since simufilam has a unique mechanism of action, we believe its potential therapeutic effects may be additive 
or synergistic with that of other therapeutic candidates aiming to treat neurodegeneration. 

Given the biopharmaceutical industry’s challenging track record in Alzheimer’s research, we believe there is an urgent 
need  to  consider  more  recent  and  innovative  approaches  to  combat  this  disease.  We  believe  our  scientific  approach  may 
broaden the range of possible treatment approaches for this complex disease. 

Our science is based on stabilizing a critical protein in the brain 

Proteins are essential for cell function because they participate in virtually every biological process. If protein function is 
impaired, the health consequences can be devastating. Technological advances in medicine and improvements in lifestyle are 
making our lives longer. But with age, genetic mutations and other factors conspire against healthy cells, resulting in altered 
proteins. Sometimes a cell can rid itself of altered proteins. However, when disease changes the shape and function of critical 
proteins,  multiple  downstream  processes  are  impaired.  There  are  many  clinical  conditions  in  which  proteins  become 
structurally  altered  and  impair  the  normal  function  of  cells,  tissues  and  organs,  leading to  disease.    Conversely,  restoring 
altered proteins back to health –called proteostasis – is a well-accepted therapeutic strategy in clinical medicine. 

For over 100 years, scientists have ascribed various neurodegenerative diseases to proteins that misfold and are rendered 
pathological. In Alzheimer’s disease, certain proteins, such as amyloid and tau, lose their normal shape and function. Such 
misfolded proteins can breakdown or aggregate in clumps and form plaque in the brain. Destruction of neuronal synapses, 
accelerated nerve cell death, and dysfunction of the brain support cells, are all widely believed to be direct consequences of 
misfolded proteins.  

FLNA is a scaffolding protein widely found throughout the body. A healthy scaffolding protein brings multiple proteins 
together,  initiating  their  interaction.  However,  an  altered  form  of  FLNA  protein  is  found  in  the  Alzheimer’s  brain.  Our 
experimental evidence shows that altered FLNA protein contribute to Alzheimer’s disease by disrupting the normal function 
of  neurons,  leading  to  neurodegeneration  and  brain  inflammation.  Our  product  candidate,  simufilam,  aims  to  counter  the 

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altered and toxic form of FLNA in the brain, thus restoring the normal function of this critical protein. Our novel science is 
based on stabilizing – but not removing – a critical protein in the brain. 

One drug, multiple effects  

Our lead therapeutic candidate, simufilam, binds to altered FLNA with very high (femtomolar) affinity. This drug effect 
restores  the  normal  shape  of  FLNA  and  the  normal  function  of  key  brain  receptors,  including:  the  alpha-7  nicotinic 
acetylcholine receptor; the N-methyl-D-aspartate (NMDA) receptor; and the insulin receptor. These receptors have pivotal 
roles in brain cell survival, cognition and memory.   

In animal models, treatment with simufilam resulted in dramatic improvements in brain health, such as reduced amyloid 
and  tau  deposits,  improved  receptor  signaling  and  improved  learning  and  memory.  In  addition,  simufilam  has  another 
beneficial  treatment  effect  of  significantly  reducing  inflammatory  cytokines  in  the  brain.  In  animal  models  of  disease, 
treatment with simufilam greatly reduced levels of IL-6 and suppressed TNF-alpha and IL-1beta levels by 86% and 80%, 
respectively, illustrating a powerful anti-neuroinflammatory effect.   

By restoring function to multiple receptors and exerting powerful anti-inflammatory effects, we believe our approach has 
potential to slow the progression of neurodegeneration in patients. Thus, we have designed simufilam to slow or, potentially, 
even reverse the deterioration of brain cells. 

In  2019,  a  small,  first-in-patient,  clinical  proof-of-concept  Phase  2a  study  funded  by  NIH,  showed  that  open-label 
treatment with simufilam for 28 days significantly improved key biomarkers of Alzheimer’s pathology, neuroinflammation 
and neurodegeneration (p<0.001). On July 15, 2020, we presented additional Phase 2a clinical results at the Biomarkers for 
Alzheimer’s Disease Summit, a virtual scientific conference. In addition to showing that SavaDx could distinguish and stratify 
patients  with  Alzheimer’s  disease,  this  presentation  provided  direct  evidence  for  target engagement  and  for  the  treatment 
effects  of simufilam.  Target  engagement  is  a  crucial  step  in  drug  research  because  it  shows  that  our  small molecule drug 
candidate binds to its intended site of action in cells and confirms that treatment effects are caused by the drug hitting its 
target. 

In  March  2020,  we  completed  a randomized,  placebo-controlled,  double-blind Phase  2b  study  of simufilam in  64 
patients with  mild-to-moderate  Alzheimer’s  disease,  50-85  years  of  age,  with  MMSE  scores  16  to  26.  Study participants 
received simufilam 100 mg, 50 mg or  matching placebo, twice-daily, for 28 continuous days. This study was substantially 
funded by a research grant award from NIH. 

In  September 2020, we reported  positive final study results  for  our  Phase  2b  study. Drug  was  safe  and  well-tolerated. 
Simufilam significantly (P<0.05) improved an entire panel of validated biomarkers of disease in patients with Alzheimer’s 
disease compared  to  a  placebo  group.  In  addition,  Alzheimer’s  patients  treated  with  simufilam  showed  directional 
improvements in validated tests of episodic memory and spatial working memory, versus patients on placebo (Effect Sizes 
46-17%). Cognitive improvements correlated most strongly (R2=0.5) with decreases in levels of  CSF P-tau181. The study 
achieved a 98% response rate, defined as the proportion of study participants taking simufilam who showed improvements in 
biomarkers. Importantly, we believe these data are consistent with prior clinical and preclinical results, the drug’s mechanism 
of action and over 10 years of basic research. 

To our knowledge, no competing drug candidate has demonstrated the ability to reduce an entire panel of biomarkers of 
disease in patients with Alzheimer’s disease. For this reason, CSF biomarker data generated in our Phase 2a  and Phase 2b 
studies may not be directly comparable to clinical results generated by our competitors. 

On February 2, 2021, we announced results of a preplanned interim analysis of our open-label study of simufilam. This 
first interim analysis summarizes clinical data at the midway point of enrollment, i.e., the first 50 patients who have completed 
at least 6 months of drug treatment. Patients’ cognition and behavior scores both improved following six months of simufilam 
treatment, with no safety issues. Six months of simufilam treatment improved cognition scores by 1.6 points on ADAS-Cog11, 
a  10%  mean  improvement  from  baseline  to  month  6.  In  these  same  patients,  simufilam  also  improved  dementia-related 
behavior, such as anxiety, delusions and agitation, by 1.3 points on the Neuropsychiatric Inventory, a 29% mean improvement 
from baseline to month 6.   

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We expect to announce results of a second planned interim analysis on safety and cognition for this study in mid-2021. 

Based on positive clinical results and inbound demand from clinical sites, patients, and their caregivers, we expanded the 
size of the ongoing open-label study of simufilam. In February 2020, we increased the target enrollment by up to 50 additional 
patients with mild-to-moderate Alzheimer’s disease, for a total target enrollment of up to 150 patients. 

We  also  plan  to  initiate  a  6-month,  double-blind,  randomized,  placebo-controlled  study  in  patients  with  Alzheimer’s 
disease who complete at least one year of open-label treatment with simufilam. This is a Cognition Maintenance Study (CMS), 
in  which  patients  who  complete  one  year  of  open-label  treatment  will  subsequently  be  randomized  (1:1)  to  simufilam  or 
placebo  for  six  months.  The CMS  is  designed  to  compare  simufilam’s  effects  on  cognition  and behavior  in  patients who 
continue  with  drug  treatment  versus  those  who  discontinue  drug  treatment.  For  ethical  and  other  reasons,  patients  who 
successfully complete the six-month CMS will have the option to receive open-label simufilam.  

Our science is published in multiple peer-reviewed journals. In addition, our research has been supported by NIH under 
multiple research grant awards. Each grant was awarded following an in-depth, peer-reviewed evaluation of our approach for 
scientific and technical merit by a panel of outside experts in the field. Strong, long-term support from NIH has allowed us to 
advance our two product candidates for neurodegeneration, simufilam and SavaDx, into clinical development. 

Overview of Alzheimer’s disease 

Alzheimer’s disease is a progressive neurodegenerative disorder that affects cognition, function and behavior. There are 
no disease-modifying drug therapies to treat the disease. As of 2020, there were approximately 50 million people worldwide 
living with dementia, a figure expected to increase to 150 million by 2050 and the annual global cost of dementia is now above 
$1 trillion, according to Alzheimer’s Disease International, a charitable organization.   According to the non-profit Alzheimer's 
Association, Alzheimer’s disease is expected to nearly triple in the U.S. between now and 2050. If this occurs, there is potential 
for Alzheimer's disease to cause a major financial drain on the national economy. 

Currently marketed drug therapies for Alzheimer’s disease have limited therapeutic effect 

There are no disease-modifying drug therapies to treat Alzheimer’s disease. The FDA has not approved any new drugs 
for Alzheimer’s disease since 2003. Biogen, Inc., a large biopharmaceutical company, is currently seeking FDA approval for 
an investigational drug, aducanumab, for the treatment of Alzheimer’s disease. 

Currently  marketed  drug  therapies  focus  solely  on  treating  symptoms,  mostly  in  patients  with  mild-to-moderate 
Alzheimer's disease. At the time of diagnosis, patients are initiated on a class of drugs called cholinesterase inhibitors. The 
Alzheimer’s brain has low levels of a neurotransmitter called acetylcholine. Cholinesterase inhibitors prevent an enzyme in 
the brain, called acetylcholinesterase, from breaking down acetylcholine. Currently marketed cholinesterase inhibitors include 
donepezil (marketed by Eisai Co., Ltd. and Pfizer, Inc. as Aricept®), rivastigmine (marketed by Novartis AG as Exelon®) and 
galantamine (marketed by Janssen Pharmaceuticals, Inc. as Razadyne®). Cholinesterase inhibitors may benefit some patients 
for several months, after which the targeted brain receptors are desensitized, and drug efficacy is lost. To our knowledge, no 
drug for Alzheimer’s has shown an ability to stabilize cognition in patients, much less restore loss cognition, beyond a few 
months. 

Simufilam is our Proprietary Drug for the Treatment of Alzheimer’s Disease. 

We  have  generated  and  published  experimental  evidence  of  improved  brain  health  by  restoring  altered  FLNA  with 
simufilam, our lead therapeutic product candidate. Simufilam is a proprietary small molecule drug that represents an entirely 
new  scientific approach to treat neurodegeneration. Published studies have demonstrated that simufilam targets an altered 
form of a protein called FLNA that is pervasive in the Alzheimer’s brain. Altered FLNA causes neuronal dysfunction, neuronal 
degeneration and neuroinflammation. We believe our drug candidate, simufilam, improves brain health by reverting altered 
FLNA  back  to  its  native,  healthy  conformation,  thus  countering  downstream  toxic  effects  of  altered  FLNA.  Importantly, 
simufilam  is  not  dependent  on  clearing  amyloid  from  the brain.  The following  is  a  summary  profile  of  simufilam’s  drug 
development program.   

8 

  
 
 
 
 
 
 
 
 
 
 
 
IND submission to FDA 

Over the past ten years, we successfully conducted basic research, in vitro studies and preclinical studies in support of an 
Investigational New Drug (IND) submission to FDA for simufilam, including requisite studies around safety pharmacology, 
toxicology, genotoxicity and bioanalytical methods. In 2017 we filed an IND with FDA for simufilam. 

Clinical safety of simufilam in a Phase 1 study 

Following  FDA  acceptance  of  our  IND  in  2017,  we  investigated  the  safety,  dosing  and  pharmacokinetic  profile  of 
simufilam in healthy human volunteers. The design of our first-in-human Phase 1 study was based on regulatory feedback, 
clinical and scientific rationale and observations from previously conducted preclinical and in vitro studies.  

In  a  Phase  1  study,  simufilam  was  evaluated  in  24  healthy  human  volunteers  in  a  single  site  in  the  U.S.  for  safety, 
tolerability and pharmacokinetics. Study subjects were administered a single oral dose of 50, 100 or 200 mg of simufilam. 
Drug  was  well-tolerated  in  all  subjects.  Importantly,  simufilam  showed no  treatment-related  adverse  effects  and  no  dose-
limiting safety findings. Pharmacokinetic measurements demonstrated that simufilam, a small molecule, was rapidly absorbed. 
Dose-proportionality was observed over the full dose range of 50 to 200 mg. Results of this Phase 1 study were presented at 
the 10th Annual International Conference on Clinical Studies on Alzheimer's Disease in 2017.  

Given the absence of any observable dose-limiting effects in healthy adults in a Phase 1 study, a strong scientific rationale, 
and multiple peer-reviewed publications and research grant awards, we believe this program demonstrated favorable proof-
of-principle for the development of simufilam in Alzheimer’s disease.  

Mean PTI-125  Plasma  Concentration  Concentratio n (ng/mL) 0 500  100 150 0 0 4 8  12 16 g  200  mg Time ( 

Phase 2 clinical development program for simufilam 

In 2018, we mapped out, in collaboration with outside science advisors and medical experts, a strategic clinical plan to 
advance simufilam into a comprehensive Phase 2 clinical development program. The general objective of our Phase 2 program 
with simufilam was to gain an initial estimate of the safety, tolerability and biological activity of this drug candidate in patients 
with Alzheimer’s disease. We believe meaningful Phase 2 data now enable us to design and conduct a large-scale Phase 3 
efficacy program for simufilam and may also enable us to seek one or more strategic collaborations with pharmaceutical or 
biotechnology companies. 

Phase 2a Clinical Study  

In 2019, we completed a first-in-patient, clinical proof-of-concept study of simufilam in the U.S. Our Phase 2a was an 
open-label,  multi-center,  safety  and  pharmacokinetic  study  of  simufilam.  Thirteen  (13)  patients  with  mild-to-moderate 
Alzheimer’s disease, age 50-85, received 100 mg oral simufilam twice daily for 28 days. A diagnosis of Alzheimer’s disease 
was confirmed with Mini-Mental State Examination (MMSE) ≥ 16 and ≤ 24 and a cerebrospinal fluid (CSF) T-tau/Aβ42 ratio 
≥ 0.30. Safety was assessed  by ECGs, clinical labs, adverse event monitoring and physical examinations.  CSF was drawn 
from patients before dosing started and again after 28 continuous days of dosing with simufilam.  CSF samples were then 
analyzed  for  biomarkers  of  Alzheimer’s  pathology  (T-tau,  P-tau,  Aβ42);  neurodegeneration  (NfL,  neurogranin);  and 
neuroinflammation (YKL-40, IL-6, IL-1β and TNFα). A consulting biostatistician conducted an independent analysis of the 
data set. 

A key objective of our Phase 2a study was to measure levels of CSF biomarkers in the brain. Key results of this study 

include (Figure 1):  

•  Total tau (T-tau) decreased 20% (p<0.001) 
•  Phosphorylated tau (P-tau) decreased 34% (p<0.0001) 
•  Neurofilament light chain (NfL), a marker for neurodegeneration, decreased 22% (p<0.0001) 
•  Neurogranin, a marker for cognitive decline, decreased 32% (p<0.0001) 
•  Neuroinflammatory marker YKL-40, an indicator of microglial activation, decreased 9% (p<0.0001) 
•  Proinflammatory Interleukin 6 (IL-6) decreased 14% (p<0.0001) 
•  Proinflammatory Interleukin 1 beta (IL-1β) decreased 11% (p<0.0001) 
•  Proinflammatory Tumor Necrosis Factor alpha (TNFα) decreased 5% (p<0.001)  

9 

  
 
 
 
 
 
 
 
 
 
 
 
•  The ratio of CSF P-tau to Aβ42, a widely accepted biochemical value of Alzheimer’s disease, improved in all patients 

(p<0.001) 

Figure 1: Simufilam treatment reduces levels of CSF biomarkers in patients with Alzheimer’s in a Phase 2a study. 

Neurogranin*  NfL* 

+

T-tau

P-tau

181

* 

YKL40* 

IL-6* 

IL-1β* 

+

TNFα

Figure 1. Percent change from baseline in CSF biomarkers measured by ELISA. Eight CSF biomarkers of disease in 
Alzheimer’s patients were significantly reduced with simufilam treatment.  *p < 0.0001, +p < 0.001 in paired t test comparing 
Day 28 to pre-dose baseline.  

Neurogranin* NfL* T-tau+ P-tau181 * YKL40* IL-6* IL-1β * TNFα+ -32% -22% -20% -34% -9% -14% -11% -5%  

10 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
In addition, visual line plots,  which are  also known as spaghetti plots, of each individual patient and each individual 
biomarker measurement show that all patients had a biomarker response to treatment with simufilam in our Phase 2a study 
(Figure 2).  

Figure 2. Individual patient response to treatment with simufilam in a Phase 2a study. CSF data are plotted as pg/mL. 

0 200 400  600 80 0 1000  1200 Neurogranin 0  100 20 0 300 4 00 500  600 70 0 800 Neurofila ment Lig ht  Chain 0 2  4 6 8 1 0 12  Phosp ho-tau (T181)  

Figure 2. Each spaghetti plot shows change from baseline to Day 28 for each patient and each biomarker. 

0 100 200  300 40 0 500  Total ta u  Screening Da y 28 0 5 0 100 1 50 200  250 30 0 350 4 00 450 A 42 Screening Day  28 0 1 0 20 30  40 50 6 0 70 80  90 YKL40  Screening Day 28  0 5 10  15 20 2 5 IL-6  Screning Day  28 0 1 0 20 30  40 50 6 0 I L-1 Screening Day 2 8 0 5 10  15 20  25 30 3 5 40 45  TNF  Screening   Day 28 

Consistent with over 10 years of basic research and pre-clinical data, we  believe our Phase 2a  study showed clinical 

evidence of simufilam’s mechanism of action and drug-target engagement, including: 

Improvements in biomarkers of Alzheimer’s disease in CSF, plasma and lymphocytes; 

• 
•  Consistency across biomarker improvements in CSF, plasma, and lymphocytes;  
•  Significant reductions (p<0.01) in both nitrated and phosphorylated forms of tau protein; 
•  Evidence that each individual patient showed biomarker responses to simufilam; 
•  Evidence that simufilam reversed the shape of altered filamin A in lymphocytes; 

11 

  
 
 
 
 
 
 
 
 
•  Evidence that simufilam reduced levels of amyloid bound to alpha 7 nicotinic receptors in lymphocytes; 
•  Early clinical validation of the drug target – altered filamin A – as a facilitator protein between amyloid beta and 

both neuroinflammation and tau pathology.  

In December 2019, we presented data from our Phase 2a study at the 12th International Conference on Clinical Trials on 
Alzheimer’s Disease (CTAD 2019), a conference for the medical and scientific community held in San Diego, CA. Our Phase 
2a presentation was selected as a Late Breaking Oral Communication by CTAD 2019.   

In  February 2020,  our Phase 2a study was published in The Journal of Prevention of Alzheimer’s Disease (JPAD), a 
technical  journal for  the  research  community.  This  peer-reviewed  publication  highlighted  that  biomarkers  of  Alzheimer’s 
disease pathology (P-tau, total tau and Aβ42), neurodegeneration (NfL and neurogranin) and neuroinflammation (YKL-40, IL-
6, IL-1β and TNFα) improved significantly after 28 days of treatment with simufilam. 

On July 15, 2020, we presented additional Phase 2a clinical results at the Biomarkers for Alzheimer’s Disease Summit, a 
virtual  scientific conference. In  addition  to  showing  that  SavaDx,  our  investigational  diagnostic  product  candidate,  could 
distinguish and stratify patients with Alzheimer’s disease, this presentation provided direct evidence for target engagement 
and for the treatment effects of simufilam. Presenting evidence of target engagement is a crucial step in drug research because 
it shows that a drug candidate binds to its intended site of action in cells and confirms that treatment effects are caused by the 
drug hitting its target. 

Cognition and function were not assessed in this small Phase 2a study. However, independent research has shown that 
high levels of CSF biomarkers of P-tau and total tau/Aβ42 ratio correlate with worse performance on a wide range of memory 
and attention tests. Conversely, we believe lowering a panel of CSF biomarkers of disease may benefit patients.  

Phase 2b Clinical Study  

In March 2020, we announced the completion of a double-blind, randomized, placebo-controlled, multi-center clinical 
study of simufilam. Sixty-four patients with mild-to-moderate Alzheimer’s disease, age 50-85, were randomized (1:1:1) to 
100mg or 50 mg oral simufilam or matching placebo. Treatment was administered twice daily for 28 days. Nine U.S. study 
sites enrolled patients. A clinical diagnosis was confirmed with the MMSE ≥16 and ≤26 and a CSF T-tau/Aβ42 ratio ≥0.28. 
Safety was assessed by ECGs, clinical labs, adverse event monitoring and physical examinations. This study was substantially 
funded by a research grant award from NIH. 

In May 2020, we announced that an outside lab with whom we had no prior work experience had generated an initial 
bioanalysis  of  CSF  samples  from  our  Phase  2b  study.  The  data  set  from  the initial  bioanalysis  showed  unnaturally  high 
variability and other problems, such as no correlation among changes in levels of biomarkers over 28 days, even in the placebo 
group, and different biomarkers of disease moving in opposite directions in the same patient. Importantly, we later observed 
no statistical correlation between levels of simufilam in plasma and CSF, further indicating an invalid analysis.  Overall, we 
believe data from the initial bioanalysis can be interpreted as anomalous and highly improbable. With its validity in question, 
the  initial  bioanalysis  serves  no  useful purpose.  Backup  CSF  samples  were  subsequently  sent  to  a  second  outside  lab  for 
bioanalysis. All bioanalyses were conducted under blinded conditions to eliminate any possibility of bias. 

On September 14, 2020, we reported final positive Phase 2b clinical study results. Drug was safe and well-tolerated in 
this  study.  Simufilam  significantly (P<0.05) improved  an  entire  panel  of  validated  biomarkers  of  disease  in  patients  with 
Alzheimer’s disease compared to a placebo group. In addition, Alzheimer’s patients treated with simufilam showed directional 
improvements in validated tests of episodic memory and spatial working memory, versus patients on placebo (Effect Sizes 
46-17%). Cognitive improvements correlated most strongly (R2=0.5) with decreases in levels of P-tau181 in CSF. The study 
achieved a 98% response rate, defined as the proportion of study participants taking simufilam who showed improvements in 
biomarkers. We later observed a direct correlation between levels of simufilam in plasma and CSF, which provides strong 
evidence of a valid analysis. Importantly, we believe these data are consistent with prior clinical and preclinical results, the 
drug’s mechanism of action and over 10 years of basic research. 

Phase 2b results with simufilam were selected for a late-breaking oral presentation by the 13th International Conference 
on Clinical  Trials  on  Alzheimer’s  Disease  (CTAD  2020), which took place  virtually  November 4-7th,  2020.  Members  of 
CTAD 2020’s scientific committee select research abstracts for late-breaking, oral presentation based on medical and scientific 
significance, quality of data and methodology. 

12 

  
 
 
 
 
 
 
 
 
 
The ability to improve multiple biomarkers from distinct biological pathways with one drug has never been shown before 
in patients with Alzheimer’s disease. Phase 2b study results are expected to be published in a peer-reviewed publication at a 
future date. 

The Phase 2b clinical study was designed to evaluate safety, tolerability and drug effects of simufilam on biomarkers of 
Alzheimer’s disease. The primary endpoint was improvement in biomarkers of Alzheimer’s disease from baseline to Day 28. 
CSF was drawn from patients before dosing started and again after 28 continuous days of dosing with simufilam. CSF samples 
were then analyzed for biomarkers of Alzheimer’s pathology (T-tau, P-tau, Aβ42); neurodegeneration (NfL, neurogranin); and 
neuroinflammation  (YKL-40,  IL-6,  sTREM2,  HMGB1)  and  BBB  integrity  (IgG,  albumin).  A  consulting biostatistician 
conducted an independent analysis of the data set. 

A further objective of this study was to measure drug effects on cognition. Patients were tested at baseline and again on 
Day 28. Changes in episodic memory and spatial working memory were assessed on CANTAB, a validated, computer-based 
battery of tests. CANTAB is designed to measure cognitive skills regardless of the subject’s language skills, speed, gender or 
education. 

Key biomarker results include the following (all p-values versus placebo) (Figure 3): 

•  Core markers of Alzheimer’s pathology are total tau (T-tau), phosphorylated tau (P-tau181), and amyloid beta42 (Aβ42). 

In Alzheimer’s, tau and P-tau levels are elevated and Aβ42 is low. 

o  T-tau decreased 15% (p<0.01) for patients in the 50 mg drug group.  
o  T-tau decreased 18% (p<0.01) for patients in the 100 mg drug group. 
o  P-tau decreased 8% (p<0.01) for patients in the 50 mg drug group.  
o  P-tau decreased 11% (p<0.01) for patients in the 100 mg drug group.  
o  Aβ42 increased 17% (p<0.01) for patients in the 50 mg drug group. 
o  Aβ42 increased 14% (p<0.01) for patients in the 100 mg drug group.  

•  Elevated CSF levels of two proteins, Neurogranin (Ng) and Neurofilament Light Chain (NfL) indicate neurodegeneration.  

o  Ng decreased 36% (p<0.01) for patients in the 50 mg drug group.  
o  Ng decreased 43% (p<0.01) for patients in the 100 mg drug group. 
o  NfL decreased 28% (p<0.05) for patients in the 50 mg drug group.  
o  NfL decreased 34% (p<0.01) for patients in the 100 mg drug group. 

•  Proinflammatory IL-6 (Interleukin 6) is produced in response to tissue stress and injury. 

o  IL-6 decreased 10% (p<0.01) for patients in the 50 mg drug group. 
o  IL-6 decreased 11% (p<0.01) for patients in the 100 mg drug group. 

•  Elevated levels of neuroinflammatory marker YKL-40 indicate microglial activation.  

o  YKL-40 decreased 10% (p<0.01) for patients in the 50 mg drug group. 
o  YKL-40 decreased 12% (p<0.01) for patients in the 100 mg drug group. 

•  sTREM2 is a neuroinflammation biomarker that has commanded substantial recent attention from researchers for its role 

in Alzheimer’s disease and frontotemporal dementia. 

o  sTREM2 decreased 43% (p<0.01) for patients in the 50 mg drug group. 
o  sTREM2 decreased 46% (P<0.01) for patients in the 100 mg drug group. 

•  Simufilam Significantly Reduced Levels of HMGB1 in Cerebrospinal Fluid (CSF). 
o  HMGB1 decreased 33% (p<0.001) in patients treated with 50 mg simufilam 
o  HMGB1 decreased 32% (p<0.001) in patients treated with 100 mg simufilam   

•  Simufilam Significantly Improved the Integrity of the Blood-brain Barrier (BBB). 

13 

  
 
 
 
 
  
 
 
 
 
 
 
o  CSF IgG decreased 30% (p<0.05) in patients treated with 50 mg simufilam 
o  CSF IgG decreased 30% (p<0.05) in patients treated with 100 mg simufilam 
o  CSF albumin decreased 15% (p<0.05) in patients treated with 50 mg simufilam 
o  CSF albumin decreased 28% (p<0.05) in patients treated with 100 mg simufilam 

•  Simufilam Improved the Albumin Ratio, a Test of Blood-brain Barrier (BBB) Permeability: 

o  BBB permeability can be clinically evaluated by comparing levels of albumin in CSF and plasma. The albumin 
ratio is a test for BBB permeability because albumin protein is not synthesized in CSF. Hence, albumin in CSF 
necessarily  comes  from  plasma  through  the  BBB.  The  albumin  ratio  is  frequently  elevated  in  patients  with 
dementia and various other disorders. 

o  In the Phase 2b study, the albumin ratio was unchanged for Alzheimer’s patients on placebo. The albumin ratio 
improved by approximately 5 and 7 points for patients treated with simufilam, 50 mg and 100 mg, respectively, 
over 28 days. 

Changes in the Albumin Ratio by Treatment Group 

Treatment 
Placebo 
50 mg simufilam 
100 mg simufilam 

Day 0 
24 
25 
25 

Day 28 
24 
20 
18 

Change-Day 0 to 28 
No change 
- 20% 
- 28% 

Figure 3. Simufilam improved levels of CSF biomarkers in patients with Alzheimer’s in a Phase 2b study. 

% Change  Baseline to Day 28 -55%  -45% -35% -25% -15% -5% 5% 1 5% 25% A42 T- tau P-tau18 1 Nurogranin NfL YKL-40 IL-6  sTRE M2 HMG B1 A lbumin IgG  Placebo 50 mg 100  mg +p < 0.05  p < 0.01, #  p < 0.001,  p < 0.0001  vs. placebo 

14 

  
 
 
 
 
 
 
 
 
 
 
 
Figure 4. Study response rate, defined as the proportion of study participants taking simufilam who showed 
improvements in biomarkers. 

Key cognition results. Only directional trends are observed, due to limitations around study size (N=64). (Figure 5): 

% of Patients  Who Resp onded to  Simufila m on  CSF  Bio markets Tau/p- Tau Biomarkers 98%  Bio markers of Neuroinflammation 98%  Bio markers of Neurodegeneration 98% Biomarkers of BBB In tegrity 9 5% 0% 10% 2 0% 30% 40% 5 0% 60% 70% 8 0% 90% 10 0% 

•  Alzheimer’s patients in both drug groups showed directional improvements on tests of episodic memory and spatial 

memory after 28 days of treatment, versus patients on placebo. Effect Sizes were 46-17% versus placebo. 

•  Episodic memory improved by -5.7 (lower score is better) for Alzheimer’s patients in the 50 mg drug group, versus 

-1.5 for patients on placebo.  

•  Episodic memory improved by -4.3 (lower score is better) for Alzheimer’s patients in the 100 mg drug group, versus 

-1.5 for patients on placebo.  

•  Spatial memory improved by -1.6 (lower score is better) for Alzheimer’s patients in the 50 mg drug group, versus -

0.4 for patients on placebo.  

•  Spatial memory improved by -3.3 (lower score is better) for Alzheimer’s patients in the 100 mg drug group, versus 

• 

-0.4 for patients on placebo.  
Improvements in cognition correlated most strongly (statistical R2=0.5) with decreases in CSF P-tau181, a biomarker 
that, when elevated, leads to tangles in the brain.  Simufilam decreased brain levels of Ptau-181 by 8-11%, versus 
placebo. 

15 

  
 
 
 
 
 
Figure 5. Episodic Memory and Spatial Working Memory Improvements 

Figure 6. Improvements in cognition correlated most strongly (statistical R2=0.5) with decreases in CSF P-tau181. 

Change in Errors  Baseline to Day 2 8 -6.0 -5.0 -4.0  -3.0 -2.0 -1.0  0.0  Placebo -1.5 50  mg -5.7 10 0 mg -4. 5 37% Effect Size 2% Effect Size  -3.5 -3. 0 -2.5 -2.0 -1.5 -1. 0 -0.5 0.0  Placebo -0.41  50 mg  -1.65 100  mg -3.3 3  

Open-label Extension Clinical Study  

Cognition /Biomarker Correlation s (R2) 1 YKL NfL  T-tau Albu min II-6  P-tau181 0.3 0 0.36  0.37 0.3 7 0.41  0.48 

In  March  2020,  we  announced  the  initiation  of  an  open-label  extension  study  to  evaluate  simufilam  in  patients  with 
Alzheimer’s disease. This open-label, multi-center, extension study is designed to monitor the long-term safety and tolerability 
of simufilam at 100 mg twice-daily for 12 months. The study’s target enrollment is approximately 150 patients with mild-to-
moderate Alzheimer’s disease, including patients from a prior study of simufilam.  

ADAS-Cog-11 is being used to assess cognitive symptoms of dementia in patients enrolled in the open-label study. The 

NPI is being used to assess the presence and severity of Alzheimer’s related behavior. 

16 

  
 
 
 
 
 
 
 
 
 
  
On February 2, 2021, we announced results of the first of two preplanned interim analysis from our open-label study of 
simufilam. The first interim analysis summarized clinical data at the midway point of enrollment, i.e., the first 50 patients who 
have completed at least 6 months of drug treatment. Patients’ cognition and behavior scores both improved following six 
months of simufilam treatment, with no safety issues.  In the study, six months of simufilam treatment improved cognition 
scores by 1.6 points on ADAS-Cog11, a 10% mean improvement from baseline to month 6. In these same patients, simufilam 
also  improved dementia-related  behavior,  such  as  anxiety,  delusions  and  agitation, by  1.3  points  on  the  Neuropsychiatric 
Inventory, a 29% mean improvement from baseline to month 6. The safety profile of simufilam in the interim analysis was 
consistent  with  prior  human  studies.  There  were  no  drug-related  serious  adverse  events.  Adverse  events  were  mild  and 
transient. Based on these results and other factors, we announced significant changes to the design of our open-label study, 
including  a  50%  increase  in  the  enrollment  target  and  other  potential  enhancements  to  the  study  design.  This  study has 
approximately 80 patients enrolled as of February 2021. 

On February 8, 2021, we announced additional changes to our open-label program with simufilam in Alzheimer’s disease. 
We plan to initiate a 6-month, double-blind, randomized, placebo-controlled study in patients with Alzheimer’s disease who 
complete at least one year of open-label treatment with simufilam. This is a cognition maintenance study (CMS), in which 
patients who complete one year of open-label treatment will subsequently be randomized (1:1) to simufilam or placebo for 
six months. The CMS is designed to compare simufilam’s effects on cognition and behavior in patients who continue with 
drug treatment versus those who discontinue drug treatment. 

Figure 7. Cognition Maintenance Study Design 

SCREEN Ong oing Open-label  Study simufilam 100  mg  BID (n=up to 1 50) Mon th 12  Cogn itio n stu dy comp leters Rado mization 1 :1  COGNITION MAINTENANCE STUDY  Double-blind, rando mized, placebo-controlled s tudy  simufilam 1 00 mg  BID placebo M onth 6 co gnition s tudy co mpleters Open-la be Treatment simuf ilam 10 0 mg  BID Mo nth 0  Mon th 12  Month  0 Mo nth 6  

We expect to announce results of a second interim analysis on safety and cognition for this study in the mid-2021, after 
approximately 50 patients have completed at least 12 months of drug treatment. To our knowledge, no drug for Alzheimer’s 
has shown an ability to stabilize cognition in patients, much less restore loss cognition, beyond a few months. 

Phase 3 Clinical Strategy 

We  held  an  end-of-phase  2  (EOP2)  meeting  with  FDA  in  January  2021.  An  EOP2  meeting  is  a  critical  regulatory 
milestone to ensure that meaningful data will be generated during a Phase 3 clinical program. Our objectives for the EOP2 
meeting  were  to  gain  agreement  around  proposed  Phase  3  clinical  plans  and  protocols,  and  to  identify  outstanding 
requirements around safety, product development or manufacturing, or any other information needed to support the statutory 
requirements for a 505(b)(1) NDA submission and marketing approval of simufilam for the treatment of mild-to-moderate 
Alzheimer’s disease.  

Official EOP2 meeting minutes were issued by the FDA in February 2021. We believe these indicate FDA and Company 
agreement on key elements of a pivotal Phase 3 clinical program in support of a New Drug Application (NDA) filing for 
simufilam in Alzheimer’s disease. Agreements reached during the EOP2 meeting show a clear path forward for advancing 
simufilam into a pivotal Phase 3 program, which we plan to initiate in the second half of 2021. 

17 

  
 
 
 
 
 
 
 
 
 
Official EOP2 meeting minutes also indicate agreement that the use of separate clinical scales to assess cognition (ADAS-
cog1) and function (ADCS-ADL2) are appropriate co-primary endpoints of efficacy. A clinical scale that combines cognition 
and function, such as iADRS3, is a secondary efficacy endpoint.  

Our pivotal Phase 3 clinical program consists of two double-blind, randomized, placebo-controlled studies, each described 

below. 

Our first Phase 3 study is designed to evaluate disease-modifying effects of simufilam in Alzheimer’s disease. The goal 
is to demonstrate a slower rate of decline in cognition and health function in subjects treated with simufilam compared to 
placebo. 

Details of the first Phase 3 study include: 

➢  Approximately 1,000 subjects with mild-to-moderate Alzheimer’s disease to be enrolled. 
➢  Subjects to be randomized (1:1:1) to simufilam 100 mg, 50 mg, or placebo BID.  
➢  Subjects to be treated for 18 months. 
➢  The co-primary efficacy endpoints are ADAS-Cog, a cognitive scale, and ADCS-ADL, a functional scale; both are 

widely used clinical tools in trials of Alzheimer’s disease.  

➢  A secondary efficacy endpoint is iADRS, a widely used clinical tool in trials of Alzheimer’s disease that combines 

cognitive and functional scores from ADAS-Cog & ADCS-ADL.  

➢  Other secondary endpoints include biomarkers of disease  and NPI4, a clinical tool that assesses the presence and 

severity of dementia-related behavior. 

➢  We plan to initiate the first pivotal Phase 3 study approximately Q3 2021. 

Our  second  Phase  3  study  is  designed  to  evaluate  symptomatic  improvement  in  Alzheimer’s  disease.  The  goal  is  to 

demonstrate improved cognition and health function in subjects treated with simufilam compared to placebo.  

Details of the second Phase 3 study include: 

➢  Approximately 600 subjects with mild-to-moderate Alzheimer’s disease to be enrolled. 
➢  Subjects to be randomized (1:1) to simufilam 100 mg or placebo BID.  
➢  Subjects to be treated for 9 to 12 months. 
➢  The co-primary efficacy endpoints are ADAS-Cog, a cognitive scale, and ADCS-ADL, a functional scale; both are 

widely used clinical tools in trials of Alzheimer’s disease.  

➢  A secondary efficacy endpoint is iADRS, a widely used clinical tool in trials of Alzheimer’s disease that combines 

cognitive and functional scores from ADAS-Cog & ADCS-ADL.  

➢  Other  secondary  endpoints  include  biomarkers  of  disease  and  NPI,  a  clinical  tool  that  assesses  the  presence  and 

severity of dementia-related behavior. 

➢  We plan to initiate the second pivotal Phase 3 study approximately Q4 2021. 

_____________________________ 

1 ADAS-Cog = The Alzheimer’s Disease Assessment Scale – Cognitive Subscale, a measure of cognition  
2 ADCS-ADL = Alzheimer’s Disease Cooperative Study – Activities of Daily Living, a measure of health function 
3 iADRS = integrated Alzheimer’s Disease Rating Scale, a composite measure of cognition and health function 
4 Neuropsychiatric Inventory (NPI) 

18 

  
 
 
 
 
 
 
 
 
 
Figure 8. Phase 3 Program Design 

FDA has provided further flexibility to us by agreeing to review the final version of each protocol for the two Phase 3 
studies, and to conduct a Special Protocol Assessment (SPA) for each Phase 3 study. An SPA is a formal regulatory procedure 
that confirms certain critical details of a Phase 3 study protocol, such as the statistical analyses, meet FDA’s standards of 
approvability. 

SavaDx 

Our diagnostic effort, called SavaDx, is an early-stage program focused on detecting Alzheimer’s disease from a small 
sample of blood, possibly years before the overt appearance of clinical symptoms. The goal of SavaDx, an early-stage product 
candidate, is to make the detection of Alzheimer’s disease as simple as getting a blood test. We are developing SavaDx as a 
fast, accurate and quantitative blood-based biomarker/diagnostic to detect and monitor Alzheimer's disease. If successful, we 
believe SavaDx has potential to make obsolete more invasive approaches for diagnosing Alzheimer’s disease.  

Over  the  past  ten  years,  we  discovered  that  altered  FLNA  is  a  hallmark  feature  of  brain  pathology  in  patients  with 
Alzheimer’s disease. We believe SavaDx, which is a complex and unique detection system for altered filamin A (FLNA), can 
reveal early traces of the disease, potentially even before the overt appearance of disease symptoms, such as memory loss.   

In September 2017, we announced a $1.8 million research grant award from the NIH for SavaDx. The NIH awarded us 
this research grant following a confidential, in-depth evaluation of SavaDx technology for scientific and technical merit. This 
technical milestone-based grant award enables us to work collaboratively with leaders in the field to collect clinical samples 
needed to develop our blood-based diagnostic for Alzheimer’s disease.     

A  diagnostic  test  usually  measures  one  or  more  biomarkers,  which  are  biological  indicators  of  disease.  A  deep 
understanding of the biology of disease is required to identify and develop a diagnostic. A valid diagnostic has certain baseline 
characteristics to be functional and useful for clinical practice. It must detect disease in patients and, conversely, not detect 
disease in healthy subjects; and it is preferably quantitative, giving some indication of severity or stage of disease. Collectively, 
the ability to selectively detect disease indicators can be useful to provide diagnostic information (i.e., detect the disease) or 
prognostic information (i.e., predict the disease or its future course).  

Currently,  the  most  definitive  method  to  diagnose  Alzheimer’s  disease  is  through  autopsy  after  death,  which  is  not 
particularly helpful. Methods to detect Alzheimer’s disease during its course can be expensive, invasive, subjective, risky or 
uncomfortable. Importantly, because of the expense and invasiveness of current tests, most people are not tested until they 
show obvious cognitive decline.  

Current approaches for diagnosing Alzheimer’s disease include measurement of amyloid-β (specifically, Aβ42), total tau 
(T-tau)  or  phosphorylated  tau  (P-tau)  levels  in  CSF;  structural  neuroimaging  techniques,  including  magnetic  resonance 
imaging  (MRI)  or  computerized  tomography  (CT);  positron-emission  tomography  (PET)  imaging  of  brain  amyloid 
(AmyVid®); and batteries of cognitive tests. Usually, a combination of more than one test is necessary to provide a working 
diagnosis. When such tests and techniques are used together, the totality of data can be sensitive and specific for the detection 
of  Alzheimer’s  disease.  In  practice,  however,  such  tests  and  techniques  are  only  used  after  overt  symptoms  of  impaired 
memory.   

19 

Co-PrimaryEndpointsSecondaryEndpointsEnrollment TargetTreatmentLength of TreatmentCognition ScaleFunction ScaleCognition + Function ScaleDementia-related Behavior Scale1stPhase 31,000 Subjects100 mg or 50 mg18 MonthsADAS-CogADCS-ADLiADRSNPI2ndPhase 3600 Subjects100 mg9 –12 MonthsADAS-CogADCS-ADLiADRSNPI  
 
 
 
 
 
 
 
 
 
 
 
 
We  believe  there  is  a  profound  need  for  a  blood-based  diagnostic  test  for  Alzheimer’s  disease.  A  quick,  simple, 
inexpensive  test  may benefit the  medical  community  in  many  ways.  Advantages  may  include  confirming  the presence  of 
Alzheimer’s disease earlier, when lifestyle changes and potential therapeutics may have the most impact, or conversely, to 
rule out Alzheimer’s disease at such early stages. Other potential benefits include discriminating Alzheimer’s disease from 
other causes of dementias; helping to identify stage of Alzheimer’s disease; selection and enrollment of appropriate patients 
into clinical studies of experimental product candidates; and better alignment of a patient’s specific diagnosis with a targeted 
therapeutic.   

It is widely accepted that in  Alzheimer’s disease, pathological changes in the brain occur at least 10-15 years before 
clinical symptoms appear. These “pre-symptomatic” changes include deposits of certain misfolded or impaired proteins in the 
brain.  Our  long-term  goal  with  SavaDx  is  to  identify  people  with  Alzheimer’s  disease,  potentially  long  before  clinical 
symptoms occur. Early detection may be critical for any intervention to cease - or at least slow down - brain damage before it 
is too late. Importantly, a non-invasive screen for latent Alzheimer’s disease prior to overt symptoms could be conducted as a 
general health screen, not just in patients at risk by family history or in patients already showing cognitive impairment. Once 
a disease-modifying treatment is found, early detection is likely to be critically important. Early detection and treatment may 
also be critical in identifying such a disease-modifying treatment, as many believe one reason for clinical study failures in 
Alzheimer’s disease is that treatment has routinely started too late in the course of disease to make any impact. 

Moreover,  with  repeat  measurements  over  time,  SavaDx  may  provide  a  probability  of  cognitive  decline  or  disease 
progression. Even if SavaDx does not provide a precise numerical cutoff value for Alzheimer’s disease, we believe it may be 
important to incorporate data from SavaDx into the overall diagnostic framework for neurodegeneration, and  Alzheimer’s 
disease in particular. As with any diagnosis of disease, some people may embrace a way to detect Alzheimer’s disease long 
before clinical symptoms appear, while others may prefer not to know – at least until a treatment is found. 

Diagnostic development program for SavaDx. 

Diagnostic development differs from drug development in many important ways. As a result, diagnostic development 

requires substantial differences in planning, study design and study execution. 

Some of the ways that diagnostic development differs from drug development include the following: 

•  We may need to choose among a wider range of regulatory pathways for approval of SavaDx, depending on factors 

such as intended use and user, test type and complexity and role in patient-care decisions; 

•  Drug studies usually deal primarily with one office within FDA, but the regulatory pathway for SavaDx may require 

us to consider the policies of multiple federal or state regulatory agencies and offices; 

•  Unlike drug programs, statistical analysis with SavaDx does not focus on efficacy and safety endpoints. Rather, study 
endpoints for SavaDx will focus on sensitivity (true positives), specificity (true negatives), positive predictive value 
(percentage  of  correct  positive  diagnoses  of  known  positive  cases)  and  negative  predictive  value  (percentage  of 
correct negative diagnoses of known negative cases); 

SavaDx is an investigational diagnostic product candidate that has not yet been reviewed by FDA. Clinical testing consists 
of collecting blood samples on a limited scale to validate SavaDx. Our ability to test such samples depends on multiple factors, 
many of which are beyond our control. For example, optimal sample collection depends on risk of sample degradation, storage 
requirements to preserve samples, cost of sample storage and actual vs. predicted time of assay validation.  

Over the past four years, we have conducted four such rounds of early validation tests, with funding from NIH. In three 
blinded studies of test samples, SavaDx detected more than a 10-fold separation between Alzheimer’s patients and normal 
healthy control subjects (N=232 test samples). In these three proof-of-concept studies, SavaDx demonstrated nearly 100% 
accuracy and specificity. The three studies deployed a research grade antibody manufactured by an outside vendor.   

A fourth blinded study of SavaDx failed to generate meaningful diagnostic data. We believe the fourth study deployed a 
faulty  research  antibody  sourced  from  an  outside  vendor.  Commercially  available  research  antibodies  can  present  certain 
technical flaws, such as improper validation, significant batch-to-batch variations or inconsistent storage, any of which can 
jeopardize results of studies and experiments. For these reasons, and in order to increase consistency of quality, reliability and 
availability, we are now developing and validating a proprietary, fit-for-purpose, antibody system for use with SavaDx. NIH 
is funding the development expenses for this project. Such technical activities are on-going. 

20 

  
 
 
 
 
 
 
 
 
 
SavaDx was selected as a keynote presentation at the Biomarkers for Alzheimer’s Disease Summit, a virtual conference, 
on July 15, 2020. The Biomarkers for Alzheimer’s Disease Summit is a scientific forum dedicated to solving the challenges of 
developing clinically validated biomarkers to detect Alzheimer’s disease. 

We  are  prioritizing  the  development  of  simufilam  for  the  treatment  of  Alzheimer’s  disease  over  the  development  of 
SavaDx for the detection of Alzheimer’s disease in light of our assessment of each product candidate’s ability to address 
unmet clinical needs, severity of disease burden, market potential, growth potential, and other factors. We expect to initiate a 
validation/disease specificity study of SavaDx in 2021. 

The legal system for intellectual property around diagnostic methods is highly complex and uncertain. In the U.S., patent 
courts have struggled to define a clear means of patent eligibility for modern age diagnostics. Generally, a simple process 
involving correlations between blood test results and patient health is not eligible for patent claims because such processes 
incorporate “laws of nature”. However, different outcomes from different courts, including Federal Circuit, district court and 
Patent  Trial  and  Appeal  Board  decisions,  have  continued  to  create  a  sometimes vague  or  conflicting  legal  framework  for 
determining the eligibility of patent claims for diagnostic methods. As a result, we cannot be certain how SavaDx fits into the 
current  U.S.  legal  framework  for  obtaining  effective  patent  claims.  Furthermore,  claims  for  diagnostic  methods  can  be 
complicated to enforce. We currently have no patents or patent applications with respect to SavaDx, and is protected in the 
United States by trade secrets, know-how and other proprietary rights technology. 

Expansion of our science to other indications. 

It is well-known that protein misfolds occur in a wide variety of biological processes and diseases. We may leverage our 
scientific insights in neurodegeneration and advanced tools in biochemistry, bioinformatics and imaging to expand our science 
to other diseases. New indications and new drug development approaches may complement our initial focus on Alzheimer’s 
disease.   

Pre-clinical programs are always visionary, sometimes innovative and often of high biomedical potential. However, by 
definition such programs are exploratory and risky. Moreover, most pre-clinical programs fail for scientific or other reasons, 
regardless of the amount of effort or resources that are brought to bear upon such programs. For these reasons, in general we 
do  not  intend  to  disclose  our  pre-clinical  programs  until  such  time  as  they  become  material  to  our  pipeline  of  product 
candidates. 

We own worldwide rights to our neurodegeneration program.  

We own intellectual property, including patents, patent applications, technology, trade secrets and know-how in the U.S. 
and  other  countries.  The protection  of patents,  designs,  trademarks  and  other  proprietary  rights  that  we  own  or  license  is 
critical  to  our  success  and  competitive  position.  We  consider  the  overall  protection  of  our  patents  and  other  intellectual 
property rights to be of material value and act to protect these rights from infringement.  

We seek to protect our technology by, among other methods, filing and prosecuting U.S. and foreign patents and patent 
applications with respect to our technology and products and their uses.  The focus of our patent strategy is to secure and 
maintain intellectual property rights to technology for our program in neurodegeneration. 

Simufilam  and  SavaDx  were  both  discovered  and  designed  in-house  and  were  characterized  by  our  academic 
collaborators during research activities that were conducted from approximately 2008 to date. We own exclusive, worldwide 
rights to these drug assets and related technologies, without royalty obligations to any third party. Our patent protection with 
respect to simufilam and use of simufilam for Alzheimer’s disease and other neurodegenerative disease currently runs through 
2033 and includes six issued patents and related patent filings and applications. In addition,  we have patent protection with 
respect  to  simufilam  for  use  in  treating  certain  cancers  that  runs  through  2034.  We  currently  have  no  patents  or  patent 
applications with respect to SavaDx, and is protected in the United States by trade secrets, know-how and other proprietary 
rights technology. 

21 

  
 
 
 
 
 
 
 
 
 
 
 
Our Development Team  

Our product development team is led by seasoned professionals with a proven track record of innovation in drug discovery 

and development, as well as substantial business expertise.  

Our Founder and Chief Executive Officer, Remi Barbier, has over 25 years of biopharmaceutical industry experience and 
has  led  teams  responsible  for  pioneering  several  pharmaceutical  innovations,  including abuse-deterrent  drugs;  the  clinical 
development of multiple pain drugs; an innovative antibody program in cancer; and other programs in neuroscience and other 
therapeutics areas. Before founding Cassava Sciences (formerly known as Pain Therapeutics, Inc.), he held leadership roles 
and was founder or co-founder of four life science companies, three of which are now publicly traded. 

Our Chief Medical Officer, Nadav Friedmann PhD, MD, has eight prior FDA drug approvals and previously served as 

CEO of Daiichi Pharmaceuticals USA and Head of Johnson & Johnson’s Biotechnology Research Center. 

James  Kupiec,  MD,  has  two  prior  FDA  drug  approvals  and  previously  served  as  VP,  Global  Clinical  Leader  for 
Parkinson’s Disease and Clinical Head of the Neuroscience Research Unit for Pfizer, Inc. and also held leadership roles at 
Sanofi and Ciba-Geigy Pharmaceuticals. 

Lindsay Burns, PhD, SVP, Neuroscience, worked on the development of several product candidates in neuroscience and 

other therapeutics areas while at Neurex (acquired by Elan Pharmaceuticals) and Abgenix (acquired by Amgen). 

Michael Zamloot, SVP of Technology Operations, has four prior FDA drug approvals and has worked in drug operations 
and supply chain management at Boehringer Mannheim (acquired by Roche Diagnostics), Athena Neuroscience (acquired by 
Elan Pharmaceuticals) and Ciba-Geigy (acquired by Novartis). 

George (Ben) Thornton, PhD, SVP of Technology, has led research and development teams at Johnson & Johnson as 

well as translated basic science to the clinical setting at biotechnology start-ups such as GeneMedicine and Apovia. 

Our management team is further supported by scientific advisors that share our commitment to advancing new treatments 

for Alzheimer’s disease. Leading experts in the field who advise us include: 

• 

Jeff  Cummings,  MD,  Director  of  Cleveland  Clinic  Lou  Ruvo  Center  for  Brain  Health  and  Professor  of 
Neurotherapeutics and Drug Development, Cleveland Clinic.   

•  Hoau-Yan  Wang,  PhD,  Tenured  Medical  Professor  at  CUNY  Medical  School;  co-lead  scientist  on  discovery  & 

development of simufilam and SavaDx. 

•  Steven E. Arnold, MD, Translational Neurology Head of the Interdisciplinary Brain Center, Massachusetts General 

Hospital, Harvard Medical School.   

•  Barbara  Sahakian,  FBA,  FMedSci,  Professor  of  Clinical  Neuropsychology  at  the  Department  of  Psychiatry  and 
Medical  Research  Council  /Wellcome  Trust  Behavioral  and  Clinical  Neuroscience  Institute,  University  of 
Cambridge. 

•  Trevor W. Robbins, CBE FRS FMedSci, Professor of Cognitive Neuroscience at the University of Cambridge and 

Past President of the British Neuroscience Association. 

Our Strategy  

Our goal is to develop product candidates to diagnose and treat neurodegeneration, such as Alzheimer’s disease. Key 

elements of our business strategy to achieve this mission include:  

• 

• 

• 

building  a  lean  company  that  is  narrowly  focused  on  developing  innovative  product  candidates  for  Alzheimer’s 
disease and other areas of neurodegeneration; 
validating our unique scientific approach with competitive research grants and publishing our scientific data in peer-
reviewed journals; 
applying our development capabilities to advance our product candidates through clinical proof-of-concept studies 
and beyond; 

22 

  
 
 
 
 
 
 
 
 
 
 
 
 
• 

• 

using  our  expertise  and  experience  to  continue  to  focus  on  discovering  new  indications  and  product  candidates, 
validated by experimental evidence and leading experts in the field; and 
continuing to outsource preclinical studies, clinical studies and formulation development activities in order to allow 
more efficient deployment of our resources 

We also conduct basic research and development in collaboration with academic and other partners. Our research and 
development  expenses  were  $3.1 million  and  $1.6 million  for  the  year  ended  December 31,  2020  and  2019,  respectively. 
These amounts are net of significant reimbursement received from NIH. See “Item 7 Management’s Discussion and Analysis 
of Financial Condition and Results of Operations” for additional details regarding our research and development activities. 

Competition 

The drug discovery and development industry is characterized by rapidly advancing technologies, intense competition 
and  a  strong  emphasis  on  proprietary  products.  We  face  potential  competition  from  many  different  sources,  including 
pharmaceutical  and  biotechnology  companies,  academic  institutions  and  governmental  agencies  and  public  and  private 
research institutions. Any product candidates that we successfully develop and commercialize, such as simufilam or SavaDx, 
may compete with existing therapies and new therapies that may become available in the future. 

Historically, the drug industry has attempted to treat Alzheimer’s disease by developing drugs that block the synthesis of, 
or remove or dis-aggregate, beta amyloid and, more recently another protein in the brain called tau. Essentially, the prevailing 
doctrine says amyloid must be cleared out of the brain. This scientific approach – known as the amyloid hypothesis - has been 
repeatedly  tested  by  our  competitors  in  late  stage  clinical  studies  using  a  variety  of  antibody  backbones,  epitopes,  target 
conformations, biomarkers and in various stages of disease. While this approach may yet work, to date the amyloid hypothesis 
has  failed  to  generate  unambiguous  therapeutic  benefit  in  patients  with  Alzheimer’s  disease.  More  recent  competitors  in 
Alzheimer’s  research  are  focused  on  modulating  proteins in  the  brain  that  have  anti-inflammatory  or other  properties,  an 
approach known as immunotherapy.  

In  contrast,  our  scientific  approach  seeks  to  simultaneously  improve  neurodegeneration  and  neuroinflammation.  We 
believe improving multiple vital functions in the brain represents a new, different and crucial approach to address Alzheimer’s 
disease. 

Regardless of scientific approach, improvements in cognition and function remains a key criterion for FDA approval of 
a new drug in Alzheimer’s disease, a hurdle which, to date, no drug candidate has met with clear and compelling clinical data. 

Our competitors may have significantly greater financial resources, an established presence in the market, expertise in 
research and development, manufacturing, preclinical and clinical testing, obtaining regulatory approvals and reimbursement 
and marketing-approved products. These competitors also compete with us in recruiting and retaining qualified scientific and 
technical personnel, establishing clinical study sites and patient registration for clinical  studies, as well as in acquiring or 
developing technologies complementary to, or necessary for, our programs. Smaller or early-stage companies may also prove 
to be significant competitors, particularly through collaborative arrangements with large and established companies.  

The  key competitive factors affecting the success of simufilam, and any other product candidates that we  develop to 
address neurodegenerative disorders, if approved, are likely to be their efficacy, safety, convenience, price, the level of generic 
competition, patient and physician acceptance and the availability of reimbursement from government and other third-party 
payors. Our commercial opportunity could be reduced or eliminated if our competitors develop and commercialize products 
that are more effective, have fewer or less severe side effects, are more convenient or are less expensive than any products 
that we may develop. 

Our competitors also may obtain FDA approval for their products more rapidly than we may obtain approval for ours. 
For  example,  Biogen,  Inc.,  a  large  biopharmaceutical  company,  is  currently  seeking  regulatory  approval  in  the  U.S.  for 
aducanumab.  Aducanumab  is  a  proprietary  investigational  drug  candidate  (human  monoclonal  antibody)  that  has  been 
intensely studied for the treatment of Alzheimer’s disease. The safety and efficacy data with aducanumab are complex and 
subject to debate. However, aducanumab may become the first therapy since 2003 to receive FDA approval in patients with 
Alzheimer’s disease. 

23 

  
 
 
 
 
 
 
 
 
 
 
In recent years, we have observed ramped-up worldwide efforts aimed at developing blood-based techniques to detect 
and  monitor  Alzheimer’s  disease.  The  key  competitive  factors  affecting  the  success  of  SavaDx,  and  any  other  product 
candidates that we develop to diagnose neurodegeneration, if approved, are likely to be their measure of accuracy, such as 
specificity and sensitivity, as well as their convenience, patient acceptance, price and the availability of reimbursement from 
government  and  other  third-party  payors.  Our  competitors  in  the  diagnostic  area  are  pharmaceutical  and  biotechnology 
companies, academic institutions and governmental agencies and public and private research institutions. Despite increased 
research effort, the field has generally been hampered by lack of reproducibility and an unclear path on how to move academic 
discoveries into clinical utilization.  

In addition to blood-based techniques to detect Alzheimer’s disease, competitors are examining the use of novel tracing 
agents  and  imaging  techniques  to  map  the  course  of  neurodegeneration.  In  2012,  FDA  approved  Amyvid ®  (Eli  Lilly 
Pharmaceuticals),  which  is  a  radioactive  diagnostic  agent  for  brain  imaging  of  amyloid  plaque.  Amyvid  can  rule  out 
Alzheimer’s disease but does not confirm its presence. That is, a negative scan means little or no plaque is present; however, 
a positive scan does not necessarily indicate Alzheimer’s disease. In addition, Amyvid cannot be used to stage Alzheimer’s 
disease because some people take years to show cognitive decline after amyloid plaque develops, while other others rapidly 
develop advanced Alzheimer’s disease within months. Since its approval in 2012, Amyvid has had modest clinical utilization 
due to its high cost, lack of widespread reimbursement and need for specialized training.   

Manufacturing 

We do not own or lease any manufacturing facilities. We outsource formulation, manufacturing and related activities to 
third  parties.  For  the  foreseeable  future,  we  will  continue  to  rely  on  third  parties  to  conduct  certain  quality  control  and 
assurance testing, shipping or storage of our product candidates. 

We currently rely on contract development and manufacturing organizations (CDMOs) for the manufacture of all our 
materials  for  preclinical  and  clinical  studies  and  expect  to  continue  to  do  so,  and  for  commercial  supply  of  any  product 
candidates that we may develop. We currently have established relationships with several CDMOs for the manufacturing of 
our product candidates. 

We believe our manufacturing strategy is on-track to ensure sufficient drug supply for a Phase 3 program, including both 
drug substance (i.e., active ingredient) and drug product (i.e., oral tablets). On March 8, 2021, we entered into an agreement 
with Evonik Corporation to supply large-scale, clinical-grade quantities of drug substance for simufilam. The goal is to ensure 
the integrity of the drug supply chain on a worldwide basis, in compliance with FDA standards. 

We believe raw materials for our drug product are readily available from reliable sources. We have experienced no supply 

chain disruption due to COVID-19. 

Our suppliers must comply with current good manufacturing practices (cGMP) enforced by FDA and other government 
agencies. Our suppliers are subject to unannounced inspection by regulators, including pre-approval inspections by FDA, to 
ensure they are in strict compliance with government regulations and standards. Our suppliers may be forced to stop producing, 
storing, shipping or testing our drug products if they fall out of compliance with government regulations and standards.  

We have no control over our suppliers’ compliance, or lack thereof, with the multitude of regulations and standards that 
affect our drug products. We cannot control decisions by our suppliers that affect their ability or willingness to continue to 
supply us on acceptable terms, or at all.  

Strategic Shift Away from Analgesic Drug Development 

Until approximately 2018, our efforts in neurology drug development had focused on analgesic drugs. In late 2018, we 

announced a strategic shift away from analgesic drugs to focus exclusively on neurodegeneration. 

Government Regulation  

Government authorities in the U.S. at the federal, state and local level and in other countries regulate, among other things, 
the  research,  development,  testing,  manufacture,  quality  control,  approval,  labeling,  packaging,  storage,  record-keeping, 
promotion, advertising, distribution, post-approval monitoring and reporting, marketing and export and import of drug and 

24 

  
 
 
 
 
 
 
 
 
 
 
 
 
diagnostic products. Generally, before a new drug or diagnostic can be marketed, considerable data demonstrating its quality, 
safety  and  efficacy  and/or  specificity  must  be  obtained,  organized  into  a  format  specific  for  each  regulatory  authority, 
submitted for review and approved by the regulatory authority.  

U.S. Drug Development  

In the U.S., FDA regulates drugs under the Food, Drug, and Cosmetic Act (FDCA). Both drugs and diagnostics also are 
subject  to  other  federal,  state  and  local  statutes  and  regulations.  The  process  of  obtaining  regulatory  approvals  and  the 
subsequent compliance with appropriate federal, state, local and foreign statutes and regulations requires the expenditure of 
substantial time and financial resources. Failure to comply with the applicable U.S. requirements at any time during the product 
development process, approval process or post-market may subject an applicant to administrative or judicial sanctions. These 
sanctions could include, among other actions, FDA’s refusal to approve pending applications, withdrawal of an approval, a 
clinical hold, untitled or warning letters, product recalls or market withdrawals, product seizures, total or partial suspension 
of  production  or  distribution,  injunctions,  fines,  refusals  of  government  contracts,  restitution,  disgorgement  and  civil  or 
criminal penalties. Any agency or judicial enforcement action could have a material adverse effect on us. 

Product candidates must be approved by FDA before they may be commercialized in the U.S. The drug approval process 

generally involves the following:  

•  Completion of extensive preclinical studies in accordance with applicable regulations, including studies conducted 

in accordance with good laboratory practice; 

•  Submission to FDA of an IND, which must become effective before human clinical studies may begin; 
•  Approval by an independent institutional review board (IRB) or ethics committee before each study may be initiated; 
•  Performance of adequate and well-controlled human clinical studies in accordance with applicable IND regulations, 
code of good clinical practice (cGCP), requirements and other clinical trial-related regulations to establish the safety 
and efficacy of the investigational product for each proposed indication; 

•  Submission to FDA of an NDA; 
•  A determination by FDA within 60 days of its receipt of an NDA to accept the filing for review; 
•  Satisfactory completion of an FDA pre-approval inspection of the manufacturing facility or facilities where the drug 
will be produced to assess compliance with cGMP, requirements to assure that the facilities, methods and controls 
are adequate to preserve the drug’s identity, strength, quality and purity; 

•  Potential FDA audit of the preclinical study and/or clinical study sites that generated the data in support of the NDA; 
•  FDA review and approval of the NDA, including consideration of the views of any FDA advisory committee, prior 

to any commercial marketing or sale of the drug in the U.S.; and  

•  Compliance  with  any  post-approval  requirements,  including  the  potential  requirement  to  conduct  post-approval 

studies. 

The data required to support an NDA are generated in two distinct developmental stages: preclinical and clinical. The 
preclinical and clinical testing and approval process requires substantial time, effort and financial resources, and we cannot 
be certain that any approvals for any future product candidates will be granted on a timely basis, or at all.  

Preclinical Studies and IND  

The  preclinical  developmental  stage  generally  involves  laboratory  evaluations  of  drug  chemistry,  formulation  and 
stability, as well as studies to evaluate toxicity in animals, which support subsequent clinical testing. As sponsor, we must 
submit the results of the preclinical studies, together with manufacturing information, analytical data, any available clinical 
data or literature and a proposed clinical protocol, to FDA as part of the IND. An IND is a request for authorization from FDA 
to administer an investigational product to humans and must become effective before human clinical studies may begin.  

Preclinical studies include laboratory evaluation of product chemistry and formulation, as well as in vitro and animal 
studies to assess the potential for adverse events and in some cases to establish a rationale for therapeutic use. The conduct of 
preclinical studies is subject to federal regulations and requirements, including cGCP regulations for safety/toxicology studies. 
An IND sponsor must submit the results of the preclinical tests, together with manufacturing information, analytical data, any 
available clinical data or literature and plans for clinical studies, among other things, to FDA as part of an IND. Some long-
term preclinical testing, such as long-term toxicity tests, animal tests of reproductive adverse events and carcinogenicity, may 

25 

  
 
 
 
  
 
 
 
 
continue after the IND is submitted. An IND automatically becomes effective 30 days after receipt by FDA, unless before that 
time FDA raises  concerns or questions about any aspect of the  program. In such a case, the IND sponsor and FDA must 
resolve any outstanding concerns before the clinical study can begin. 

Clinical Studies  

The  clinical  stage  of  development  involves  the  administration  of  the  investigational  product  to  healthy  volunteers  or 
patients under the supervision of qualified investigators, generally physicians not employed by or under the study sponsor’s 
control,  in  accordance  with  cGCP  requirements,  which  include  the  requirement  that  all  research  subjects  provide  their 
informed consent for their participation in any clinical trial. Clinical studies are conducted under protocols detailing, among 
other things, the objectives of the clinical trial, dosing procedures, subject selection and exclusion criteria and the parameters 
to be used to monitor subject safety and assess efficacy. Each protocol, and any subsequent amendments to the protocol, must 
be submitted to FDA as part of the IND. Furthermore, each clinical study must be reviewed and approved by an IRB for each 
institution at which the clinical study will be  conducted to ensure that the risks to individuals participating in the clinical 
studies are minimized and are reasonable in relation to anticipated benefits. The IRB also approves the informed consent form 
that must be provided to each clinical study subject or his or her legal representative and must monitor the clinical study until 
completed. There also are requirements governing the reporting of ongoing clinical studies and completed clinical study results 
to public registries.  

A sponsor who wishes to conduct a clinical study outside of the U.S. may, but need not, obtain FDA authorization to 
conduct the clinical study under an IND. If a foreign clinical study is not conducted under an IND, the sponsor may submit 
data from the clinical study to FDA in support of an NDA. The FDA may accept a well-designed and well-conducted foreign 
clinical study not conducted under an IND if the study was conducted in accordance with cGCP requirements and FDA is able 
to validate the data through an onsite inspection if deemed necessary. In 2020 we did not conduct any clinical studies outside 
of the U.S. We plan to launch clinical sites in Canada in 2021 and may perform additional clinical studies outside of the U.S. 
in the future. 

Clinical studies in the U.S. generally are conducted in three sequential phases, known as Phase 1, Phase 2 and Phase 3, 

and may overlap.  

•  Phase 1 clinical studies generally involve a small number of healthy volunteers or disease-affected patients who are 
initially exposed to a single dose and then multiple doses of the product candidate. The primary purpose of these 
clinical studies is to assess the metabolism, pharmacologic action, tolerability and safety of a drug candidate. 
•  Phase 2 clinical studies involve studies in disease-affected patients to determine the proper dose required to produce 
the  desired  benefits.  At  the  same  time,  safety  and  further pharmacokinetic  and  pharmacodynamic  information  is 
collected, possible adverse effects and safety risks are identified, and a preliminary evaluation of efficacy may be 
observed. 

•  Phase 3  clinical  studies  generally  involve  many  patients  at  multiple  sites  and  are  designed  to  provide  the  data 
necessary to demonstrate the effectiveness of the product for its intended use, its safety in use and to establish the 
overall benefit/risk relationship of the product and provide an adequate basis for product approval. These studies may 
include comparisons with placebo and/or other comparator treatments. The duration of treatment is often extended 
to mimic the actual use of a product during marketing. 

Post-approval  studies,  sometimes  referred  to  as  Phase 4  clinical  studies,  may  be  conducted  after  initial  marketing 
approval.  These  studies  are  used  to  gain  additional  experience  from  the  treatment  of  patients  in  the  intended  therapeutic 
indication. In certain instances, FDA may mandate the performance of Phase 4 clinical studies as a condition of approval of 
an NDA.  

Progress reports detailing the results of the clinical studies, among other information, must be submitted at least annually 
to  FDA.  Written  safety  reports  and  the  investigators  for  serious  and  unexpected  adverse  events,  or  any  other  findings 
suggesting a significant risk to humans exposed to the drug must be submitted to FDA.  

Phase 1, Phase 2, and Phase 3 clinical studies may not be completed successfully within any specified period, if at all. 
The FDA or the sponsor may suspend or terminate a clinical study at any time on various grounds, including a finding that 
the research subjects or patients are being exposed to an unacceptable health risk. Similarly, an IRB can suspend or terminate 
approval  of  a  clinical  study  at  its  institution  if  the  clinical  study  is  not  being  conducted  in  accordance  with  the  IRB’s 

26 

  
 
 
 
 
  
 
 
 
requirements or if the drug has been associated with unexpected serious harm to patients. Additionally, some clinical studies 
are overseen by an independent group of qualified experts organized by the clinical study sponsor, known as a data safety 
monitoring board or committee. This group provides authorization for whether a study may move forward at designated check-
points based on access to certain data from the trial. Concurrent with clinical studies, companies usually complete additional 
animal studies and must develop additional information about the chemistry and physical characteristics of the drug as well 
as finalize a process for manufacturing the product in commercial quantities in accordance with cGMP requirements. The 
manufacturing process must be  capable of consistently producing quality batches of the  product and, among other things, 
companies  must  develop  methods  for  testing  the  identity,  strength,  quality  and  purity  of  the  final  product.  Additionally, 
appropriate packaging must be selected and tested, and stability studies must be conducted to demonstrate that our product 
candidates do not undergo unacceptable deterioration over their shelf life. 

NDA Review Process 

Following completion of the clinical studies, data is analyzed to assess whether the investigational product is safe and 
effective for the proposed indicated use or uses. The results of preclinical studies and clinical studies are then submitted  to 
FDA as part of an NDA, along with proposed labeling, chemistry and manufacturing information to ensure product quality 
and other relevant data. In short, the NDA is a request for approval to market a drug for one or more specified indication and 
must contain proof of safety and efficacy for a drug’s purity and potency. The application may include both negative and 
ambiguous results of preclinical studies and clinical  studies, as well as positive findings. Data may come from company-
sponsored  clinical  studies  intended  to  test  the  safety  and  efficacy  of  a  product’s  use  or  from  several  alternative  sources, 
including studies initiated by investigators. To support marketing approval, the data submitted must be sufficient in quality 
and quantity to establish the safety and efficacy of the investigational product to the satisfaction of FDA. FDA approval of an 
NDA must be obtained before a drug may be marketed in the U.S.  

Under the Prescription Drug User Fee Act (PDUFA), as amended, each NDA must be accompanied by a user fee. FDA 
adjusts  the  PDUFA  user  fees  on  an  annual  basis.  According  to  FDA’s  fiscal  year  2021  fee  schedule,  effective  through 
September 30, 2021, the user fee for an application requiring clinical data, such as an NDA, is approximately $2.9 million. 
Fee  waivers  or  reductions  are  available  in  certain  circumstances,  including  a  waiver  of  the  application  fee  for  the  first 
application filed by a small business. Additionally, no user fees are assessed on NDAs for products designated as orphan 
drugs, unless the product also includes a non-orphan indication.  

The FDA reviews all submitted NDAs before it accepts them for filing and may request additional information rather 
than accept the NDA for filing. The FDA must decide on accepting an NDA for filing within 60 days of receipt. Once the 
submission is accepted for filing, FDA begins an in-depth review of the NDA. Under the goals and policies agreed to by FDA 
under PDUFA, FDA has 10 months, from the filing date, in which to complete its initial review of a new molecular-entity 
NDA and respond to the applicant, and six months from the filing date of a new molecular-entity NDA designated for priority 
review. The FDA does not always meet its PDUFA goal dates for standard and priority NDAs, and the review process is often 
extended by FDA requests for additional information or clarification.  

Before  approving  an  NDA,  FDA  may  conduct  a  pre-approval  inspection  of  the  manufacturing  facilities  for  the  new 
product  to  determine  whether  they  comply  with  cGMP  requirements.  The  FDA  will  not  approve  the  product  unless  it 
determines that the manufacturing processes and facilities fully comply with cGMP requirements and are adequate to assure 
consistent production of the product within required specifications. The FDA also may audit data  from clinical studies to 
ensure compliance with cGCP requirements. Additionally, FDA may refer applications for novel product candidates which 
present difficult questions of safety or efficacy to an advisory committee, typically a panel that includes clinicians and other 
experts,  for  review,  evaluation  and  a  recommendation  as  to  whether  the  application  should  be  approved  and  under  what 
conditions,  if  any.  The  FDA  is  not  bound  by  recommendations  of  an  advisory  committee,  but  it  considers  such 
recommendations when making decisions on approval. The FDA likely will reanalyze the clinical study data, which could 
result in extensive discussions between FDA and the applicant during the review process. After FDA evaluates an NDA, it 
will issue either an approval letter or a Complete Response Letter (CRL). An approval letter authorizes commercial marketing 
of the drug with specific prescribing information for specific indications. A CRL indicates that FDA’s review of the application 
is complete and the application cannot be approved in its present form. A CRL usually describes the specific deficiencies in 
the NDA identified by FDA. The CRL may require additional clinical data, additional pivotal Phase 3 clinical trial(s) and/or 
other significant and time-consuming requirements related to clinical studies, preclinical studies or manufacturing. If a CRL 
is issued, the applicant may either resubmit the NDA, addressing all the deficiencies identified in the CRL, or withdraw the 
application. Even if such data and information are submitted, FDA may decide that the NDA does not satisfy the criteria for 

27 

  
 
 
 
 
 
approval.  Data  obtained  from  clinical  studies  are  not  always  conclusive  and  FDA  may  interpret  data  differently  than  we 
interpret the same data. 

Advertising and Promotion  

The FDA and other federal regulatory agencies closely regulate the marketing and promotion of drugs through, among 
other  things,  standards  and  regulations  for  direct-to-consumer  advertising,  communications  regarding  unapproved  uses, 
industry-sponsored scientific and educational activities, and promotional activities involving the Internet. None of our product 
candidates can be commercially promoted before receiving FDA approval. After approval, product promotion can include 
only  those  claims  relating  to  safety  and  effectiveness  that  are  consistent  with  the  labeling  approved  by  FDA.  Healthcare 
providers are permitted to prescribe drugs for “off-label” uses — that is, uses not approved by FDA and therefore not described 
in the drug’s labeling — because FDA does not regulate the practice of medicine. However, FDA regulations impose stringent 
restrictions on manufacturers’ communications regarding off-label uses. Failure to comply with applicable FDA requirements 
and restrictions in this area  may subject  us to adverse publicity and enforcement action by FDA, the U.S. Department of 
Justice, or the Office of the Inspector General of Health and Human Services, as well as state authorities. This could subject 
us to a range of penalties that could have a significant commercial impact, including civil and criminal fines and agreements 
that materially restrict the manner in which we promote or distribute our product candidates. 

Post-Approval Requirements 

After a product candidate receives regulatory approval, it is often subject to pervasive and continuing regulation by FDA, 
including,  among  other  things,  requirements  relating  to  drug  listing  and  registration,  recordkeeping,  periodic  reporting, 
product sampling and distribution, adverse event reporting and advertising, marketing and promotion restrictions.  

Adverse event reporting and submission of periodic reports is required following FDA approval of an NDA. The FDA 
also may require post-market testing, known as Phase 4 testing, or FDA may place conditions on an approval that could restrict 
the distribution or use of the product. In addition, quality control, drug manufacture, packaging, and labeling procedures must 
continue to conform to cGMP after approval. Drug manufacturers and certain of their subcontractors are required to register 
their  establishments  with  FDA  and  certain  state  agencies.  Registration  may  result  in  periodic  announced  or  unannounced 
inspections by FDA or these state agencies, during which the agency inspects manufacturing facilities to assess compliance 
with cGMP. Accordingly, manufacturers must continue  to expend time, money, and effort in the areas of production and 
quality control to maintain compliance with cGMP. Regulatory authorities may withdraw product approvals or request product 
recalls if a company fails to comply with regulatory standards, if it encounters problems following initial marketing, or if 
previously unrecognized problems are subsequently discovered. In addition, other regulatory actions may be aken, including, 
among other things, warning letters, the seizure of products, injunctions, consent decrees placing significant restrictions on or 
suspending manufacturing operations, refusal to approve pending applications or supplements to approved applications, civil 
penalties, and criminal prosecution.  

The FDA may require post-approval clinical studies to help assure continued safety or effectiveness of the approved drug. 
The FDA may also require a labeling change if it becomes aware of new safety information that it believes should be included 
in the labeling of a drug.  

The Hatch-Waxman Amendments  

Orange Book Listing  

In seeking approval for our product candidates through an NDA, we will be required to list with FDA each patent whose 
claims cover the drug product. Upon receiving regulatory approval, each of the patents listed in the application for this drug 
is then published in FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations, commonly known as the 
“Orange Book”. Drugs listed in the Orange Book can, in turn, be cited by potential generic competitors in support of approval 
of an abbreviated NDA, or ANDA. An ANDA provides for marketing of a drug product that has the same active ingredient 
in  the  same  strengths  and  dosage  form  as  the  listed  drug  and  has  been  shown  through  bioequivalence  testing  to  be 
therapeutically equivalent to the listed drug. Other than the requirement for bioequivalence testing, ANDA applicants are not 
required to conduct, or submit results of, preclinical or clinical tests to prove the safety or efficacy of their drug product. Drugs 
approved in this way are commonly referred to as “generic equivalents” to the listed drug, and can often be substituted by 
pharmacists under prescriptions written for the original listed drug.  

28 

  
 
 
 
 
 
 
 
 
 
The ANDA applicant is required to make certain certifications to FDA concerning any patents listed for the approved 
product in FDA’s Orange Book. Specifically, the applicant must certify that: (i) the required patent information has not been 
filed; (ii) the listed patent has expired; (iii) the listed patent has not expired but will expire on a particular date and approval 
is sought after patent expiration; or (iv) the listed patent is invalid or will not be infringed by the new product. The ANDA 
applicant may also elect to submit a section viii statement certifying that its proposed ANDA label does not contain (or carves 
out) any language regarding the patented method-of-use rather than make certifications concerning a listed method-of-use 
patent. If the applicant does not challenge the listed patents, the ANDA application will not be approved until all the listed 
patents claiming the referenced product have expired.  

A certification that the new product will not infringe the already approved product’s listed patents, or that such patents 
are invalid, is called a Paragraph IV certification. If the ANDA applicant has provided a Paragraph IV certification to FDA, 
the applicant must also send notice of the Paragraph IV certification to the NDA and patent holders once the ANDA has been 
accepted for filing by FDA. The NDA and patent holders may then initiate a patent infringement lawsuit in response to the 
notice  of  the  Paragraph IV  certification.  The  filing  of  a  patent  infringement  lawsuit  within  45 days  of  the  receipt  of  a 
Paragraph IV certification automatically prevents FDA from approving the ANDA until the earlier of 30 months, expiration 
of the patent, settlement of the lawsuit, or a decision in the infringement case that is favorable to the ANDA applicant. The 
ANDA application also will not be approved until any applicable non-patent exclusivity listed in the Orange Book for the 
referenced product has expired.  

Disclosure of Clinical Study Information  

Sponsors  of  clinical  studies  of  FDA-regulated  products,  including  drugs,  are  required  to  register  and  disclose  certain 
clinical study information. Information related to the product, patient population, phase of investigation, clinical study sites 
and investigators, and other aspects of the clinical study is then made public as part of the registration. Sponsors are also 
obligated to post certain information regarding the results of their clinical studies after completion. Disclosure of the results 
of these studies can be delayed until the new product or new indication being studied has been approved. Competitors may 
use this publicly available information to gain knowledge regarding the progress of development programs.  

Other Regulatory Requirements 

We may be subject to federal, state and local environmental laws and regulations, including the Environmental Protection 
Act and the Clean Air Act. Although we believe that our safety procedures for handling and disposing of controlled materials 
comply with the standards prescribed by state and federal regulations, accidental contamination or injury from these materials 
may occur. In the event of such an occurrence, we could be held liable for any damages that result and any such liability could 
exceed our resources. 

We may also be subject to regulations under other federal, state, and local laws, including the Occupational Safety and 
Health Act, national restrictions on technology transfer, and import, export, and customs regulations. It is possible that any 
portion of the regulatory framework under which we operate may change and that such change could have a negative impact 
on our current and anticipated operations. Failure  to comply with these requirements could result, among other things, in 
suspension of regulatory approval, recalls, injunctions or civil or criminal sanctions. 

Third-Party Payor Coverage and Reimbursement 

The commercial success of our product candidates, if approved, will depend, in part, upon the availability of coverage 
and  adequate  reimbursement  from  third-party  payors  at  the  federal,  state  and  private  levels.  Third-party  payors  include 
governmental programs such as Medicare or Medicaid, private insurance plans and managed care plans. These third-party 
payors may deny coverage or reimbursement for our product candidates in whole or in part if they determine that our product 
candidates are not medically appropriate or necessary. Also, third-party payors attempt to control costs by limiting coverage 
through  the  use  of  formularies  and  other  cost-containment  mechanisms  and  the  amount  of  reimbursement  for  particular 
procedures or drug treatments.  

Some third-party payors also require pre-approval of coverage for new or innovative devices or drug therapies before 
they  will  reimburse  healthcare  providers  who  use  such  therapies.  While  we  cannot  predict  whether  any  proposed 
cost-containment measures will be adopted or otherwise implemented in the future, these requirements or any announcement 

29 

  
 
 
 
 
 
 
 
 
 
 
or adoption of such proposals could have a material adverse effect on our ability to obtain adequate prices for our approved 
product candidates to operate profitably.  

Human Capital 

As of December 31, 2020, we had 11 full-time employees. None of our employees are represented by a labor union or 
covered under a collective bargaining agreement. We also engage numerous consultants to perform services on retainer, per 
diem or an hourly basis. 

We focus on identifying, recruiting, developing and retaining a small team of highly talented and motivated employees. 
The principal purposes of our equity and cash incentive plans are to attract, retain and reward personnel through the granting 
of stock-based and cash-based compensation awards in order to increase stockholder value by motivating such individuals to 
perform to the best of their abilities and achieve our objectives. The success of our business is fundamentally connected to the 
health, safety and well-being of our employees. In an effort to protect the health and safety of our employees, we took proactive 
action from the earliest signs of the COVID-19 outbreak, which included implementing social distancing policies at our office, 
facilitating remote working arrangements and imposing employee travel restrictions. 

Corporate Information 

We were incorporated as a Delaware corporation in May 1998 under the name Pain Therapeutics, Inc. In March 2019, 
we  changed  our  company  name  to  Cassava  Sciences,  Inc.  Our  principal  offices  are  located  at  7801  N.  Capital  of  Texas 
Highway,  Suite  260,  Austin,  TX,  78731.  Our 
is 
www.CassavaSciences.com. 

is  512-501-2444.  Our  website  address 

telephone  number 

We use Cassava Sciences, the Cassava Sciences logo, artwork and other marks as trademarks in the United States and 
other  countries.  Solely  for  convenience,  trademarks  and  trade  names  referred  to  in  this  Annual  Report,  including  logos, 
artwork, and other visual displays, may appear without the ® or TM symbols, but such references are not intended to indicate 
in any way that we will not assert, to the fullest extent under applicable law, our rights, or the rights of the applicable licensor 
to these trademarks and trade names. We do not intend our use or display of other entities’ trade names, trademarks, or service 
marks to imply a relationship with, or endorsement or sponsorship of us by, any other entity. 

We file electronically with the Securities and Exchange Commission, or SEC, our annual reports on Form 10-K, quarterly 
reports on Form 10-Q and current reports on Form 8-K pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 
1934.  The  SEC  maintains  an  Internet  site  that  contains  reports,  proxy  and  information  statements,  and  other  information 
regarding issuers that file electronically with the SEC. The address of the site is http://www.sec.gov. 

You may obtain a free copy of our annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on 
Form  8-K  and  amendments 
the  SEC  on  our  website  at 
http://www.cassavasciences.com,  by  contacting  our  corporate  offices  by  calling  512-501-2450  or  by  sending  an  e-mail 
message to IR@cassavasciences.com. 

the  day  of  filing  with 

reports  on 

those 

to 

30 

  
 
 
 
 
 
 
 
 
 
 
 
Item 1A.     Risk Factors 

RISK FACTORS  

Investing in our common stock involves a high degree of risk. You should carefully consider the risks described below, 
as well as other information contained in this Annual Report on Form 10-K, including our financial statements and the related 
notes  and  the  section  titled  “Management’s  Discussion  and  Analysis  of  Financial  Condition  and  Results  of  Operations,” 
before deciding whether to invest in our common stock. The occurrence of any of the events or developments described below 
could harm our business, financial condition, results of operations, and growth prospects. In such an event, the market price 
of our common stock could decline, and you may lose all or part of your investment.  

Below is a summary of the principal factors that make an investment in our common stock speculative or risky. Additional 
risks  and  uncertainties  not  presently  known  to  us  or  that  we  currently  deem  immaterial  also  may  impair  our  business 
operations and the market price of our common stock. 

Risks Related to the Discovery, Development, and Commercialization of Our Product Candidates  

• 

Since 2017, we have concentrated a substantial portion of our research and development efforts on the treatment 
and detection of Alzheimer’s disease, an area of research that has seen significant failure rates. Further, our product 
candidates are based on new scientific approaches and novel technology, which makes it difficult to predict the time 
and cost of product candidate development and likelihood of success. 

•  We are heavily dependent on the success of simufilam and SavaDx, our product candidates which are still  under 
clinical development. If these product candidates do not receive regulatory approval, we will be unable to generate 
product revenue and our business will be harmed. 

•  We  have  a  limited  operating  history  in  our  business  targeting  Alzheimer’s  disease  and  no  history  of  product 
approvals for commercial sale, which may make it difficult to evaluate our current business and predict our future 
success and viability. 

•  We  cannot  give  any  assurance  that  any  of  our  product  candidates  will  receive  regulatory  approval,  which  is 

necessary before they can be commercialized.  

•  There  can  be  no  assurance  that  results  of  smaller  Phase  1  and  Phase  2  clinical  trials  with  simufilam  will  be 
reproduced in the additional large, well-controlled studies that are required to demonstrate safety and efficacy in 
order to potentially receive regulatory approval. 

•  We may encounter substantial delays in our clinical studies or may not be able to conduct or complete our clinical 

• 

studies on the timelines we expect, if at all. 
If physicians and patients do not accept and use our drugs, we will not achieve sufficient product revenues and our 
business will suffer. 

Risks Related to Government Regulation and Other Legal Compliance Matters 

• 

If we are ultimately unable to obtain regulatory approval for our product candidates, we will be unable to generate 
product revenue and our business will be substantially harmed. 

•  Our ability to market and promote our product candidates will be determined and limited by FDA-approved labeling. 
•  Our employees, independent contractors, consultants, commercial partners, and vendors may engage in misconduct 

• 

or other improper activities, including noncompliance with regulatory standards and requirements. 
If we fail to comply with the complex federal, state, local and foreign laws and regulations that apply to our business, 
we could suffer severe consequences that could materially and adversely affect our operating results and financial 
condition. 

•  Government  agencies  may  establish  and  promulgate  usage  guidelines  that  could  limit  the  use  of  our  product 

candidates. 

Risks Related to Our Intellectual Property  

• 

If  we  are unable  to  obtain and  maintain  sufficient  patent  protection  for  any product  candidates  we  develop,  our 
competitors could develop and commercialize products similar or identical to ours, and our ability to successfully 
commercialize any product candidates we may develop may be adversely affected. 

31 

  
 
 
 
 
 
 
 
 
 
• 

•  U.S. intellectual property rights around diagnostic methods is a complex, evolving area of law and effective patent 
claims may not be available to us for our investigational diagnostic product candidate, SavaDx, in the United States. 
Issued patents covering our product candidates and other technologies could be found invalid or unenforceable if 
challenged in court or before administrative bodies in the U.S. or abroad. 
If  we  do  not  obtain  patent  term  extension  and  data  exclusivity  for  any  product  candidates  we  may  develop,  our 
business may be materially harmed. 
If we are unable to protect the confidentiality of our trade secrets, our business and competitive position would be 
harmed. 

• 

• 

Risks Related to Our Business and Operations  

•  The worldwide outbreak of an infectious disease, called COVID-19, may materially and adversely affect our business 

operations and our ability to conduct clinical studies. 

•  Our reliance on third parties for both the supply and manufacture of materials for our product candidates carries 
the risk that we will not have sufficient quality or quantities of such materials or product candidates, or that such 
supply will not be available to us at an acceptable cost, which could delay, prevent, or impair our development or 
commercialization efforts. 

•  We expect to grow the size and capabilities of our organization, including accessing new physical facilities, and we 

may experience difficulties in effectively managing this growth. 

•  Our internal computer systems, or those used by third-parties on whom we rely, may fail or suffer other breakdowns, 
cyberattacks, or information security breaches that could compromise the confidentiality, integrity, and availability 
of such systems and data, result in material disruptions of our development programs and business operations, risk 
disclosure of confidential, financial, or proprietary information, and affect our reputation. 

•  Our business involves environmental risks that may result in liability for us. 
•  Business disruptions and lack of appropriate levels of commercial insurance could seriously harm our future revenue 

and financial condition and increase our costs and expenses. 
Social media platforms present risks and challenges. 

• 

Risks Related to Financial Condition and Capital Requirements  

•  We have incurred significant net losses in each period since our inception and anticipate that we will continue to 

incur net losses for the foreseeable future. 

•  We have broad discretion in the use of the net proceeds from any of our financing transactions and may not use them 

effectively. 

Risks Related to the Ownership of Our Common Stock  

•  We do not know whether a sufficient market will continue to develop for our common stock or what the market price 
of our common stock will be, and, as a result, it may be difficult for investors to sell shares of our common stock. 
•  The market price of our common stock has historically been highly volatile and we expect it to continue to be volatile, 

• 

which could result in substantial losses for investors who purchase our shares. 
If we are unable to maintain effective internal controls, our business, financial position, and results of operations 
could be adversely affected. 

•  Anti-takeover provisions in our charter documents and Delaware law may prevent or delay removal of incumbent 

management or a change of control. 

•  Changes in our ownership could limit our ability to utilize net operating loss carryforwards. 

Risks Related to the Discovery, Development, and Commercialization of Our Product Candidates  

Since 2017, we have concentrated a substantial portion of our research and development efforts on the  treatment  and 
detection  of  Alzheimer’s  disease,  an  area  of  research  that  has  seen  significant  failure  rates.  Further,  our  product 
candidates are based on new scientific approaches and novel technology, which makes it difficult to predict the time and 
cost of product candidate development and likelihood of success. 

32 

  
 
 
 
 
 
 
 
 
 
Since 2017, we have concentrated a substantial portion of our research and development efforts on experimental methods 
for  the  treatment  and  detection  of  Alzheimer’s  disease.  Prior  efforts  by  biopharmaceutical  companies  to  develop  new 
treatments  for  Alzheimer’s  disease  have  seen  very  limited  clinical  success.  No  new  treatments  have  been  approved  for 
Alzheimer’s disease since 2003, and since that time, while many large clinical studies have been completed, no drug candidate 
has shown clear evidence of clinical efficacy in large, Phase 3 clinical studies. FDA-approved drugs for Alzheimer’s disease 
only  address  symptoms,  and  there  are  no  FDA-approved  disease  modifying  therapeutics  available  for  patients  with 
Alzheimer’s disease. Notwithstanding these substantial challenges to date, we seek to improve brain health by addressing the 
neurodegeneration  and  neuroinflammation  components  of  Alzheimer’s  disease.  Our  lead  drug  candidate  for  Alzheimer’s 
disease is based on a new approach of stabilizing – but not removing – a critical protein in the brain. We cannot be certain 
that  our  novel  technologies  will  lead  to  an  approvable  or  marketable  product.  In  addition,  because  FDA  has  limited 
comparators to evaluate our lead drug candidate, we could experience a longer than expected regulatory review process and 
increased development costs. 

We are heavily dependent on the success of simufilam and SavaDx, our product candidates which are still under clinical 
development. If these product candidates do not receive regulatory approval, we will be unable to generate product revenue 
and our business may be harmed.  

Since inception, we have not succeeded in getting regulatory approval for our product candidates and we may never do 
so. In recent years we have invested a significant portion of our efforts and financial resources in the development of simufilam 
and SavaDx for the treatment and detection of Alzheimer’s disease, respectively. Our future success is substantially dependent 
on our ability to successfully complete clinical development and obtain regulatory approval for our product candidates, which 
may never occur. We expect that a substantial portion of our efforts and expenditures over the next few years will be devoted 
to  simufilam  and  SavaDx.  This  will  require  additional  clinical  development,  management  of  clinical  and  manufacturing 
activities, regulatory approval in one or more national jurisdictions and obtaining commercial-scale manufacturing supply. 
Substantial investment and significant efforts will be required before we can generate any revenues from any commercial 
sales. We cannot be certain that we will be able to successfully complete any of these activities.  

We have a limited operating history in our business targeting Alzheimer’s disease and no history of product approvals for 
commercial sale, which may make it difficult to evaluate our current business and predict our future success and viability.  

We  are  an  early  clinical-stage  biopharmaceutical  company  with  a  limited  operating  history  in  our  business  targeting 
Alzheimer’s disease. Since we commenced operations in 1998, we have had no product candidates approved for commercial 
sale and have not generated any revenue from product sales. Drug development is a highly uncertain undertaking and involves 
a substantial degree of risk. To date, we have not initiated or completed a pivotal clinical study involving Alzheimer’s disease, 
obtained marketing approval for any product candidates, or conducted sales and marketing activities necessary for successful 
product commercialization. Our long operating history as a company without product revenue makes any assessment of our 
future success and viability subject to significant uncertainty. 

We will continue to encounter risks and difficulties frequently experienced by early-stage biopharmaceutical companies 
in rapidly evolving fields. We have not yet demonstrated an ability to successfully overcome such risks and difficulties. If we 
do not successfully address these risks and difficulties, our business, results of operations and financial condition will suffer 
materially.  

We cannot give any assurance that any of our product candidates will receive regulatory approval, which is necessary 
before they can be commercialized.  

We are at the early stages of development of our product candidates. To date, we have invested substantial effort and 
financial resources to identify, procure intellectual property for, and develop our programs in neurodegeneration, including 
conducting  preclinical  studies  and  early-stage  clinical  studies  for  our  product  candidates,  simufilam  and  SavaDx,  and 
providing  general  and  administrative  support  for  these  operations.  Our  future  success  is  dependent  on  our  ability  to 
successfully develop, obtain regulatory approval for, and then successfully commercialize our product candidates, and we 
may fail to do so for many reasons, including the following:   

• 

our product candidates may not successfully complete preclinical studies or clinical studies; 

33 

  
 
 
 
 
 
 
 
 
 
• 

• 

• 

• 

• 

• 

• 

• 

a product candidate may, on further study, be shown to have harmful side effects or other characteristics that 
indicate it is unlikely to be effective or otherwise does not meet applicable regulatory criteria; 

our competitors may develop products that render our product candidates obsolete or less attractive; 

the product candidates that we develop may not be sufficiently covered by intellectual property; 

the product candidates that we develop may be challenged by third parties’ patents or other intellectual property or 
exclusive rights; 

the market for our product candidates may change so that the continued development of a product candidate is no 
longer reasonable or commercially attractive; 

our product candidate may not be capable of being produced in commercial quantities at an acceptable cost, or at 
all; 

if a product candidate obtains regulatory approval, we may be unable to establish sales and marketing capabilities, 
or successfully market such approved product candidate, to gain market acceptance; and 

 a product candidate may not be accepted as safe, effective or useful by patients, the medical community or third-
party payors, if applicable. 

If any of these events occur, we may be forced to abandon our development efforts for a program or programs, which 

would have a material adverse effect on our business and could potentially cause us to cease operations.  

We may not be successful in our efforts to further develop our current product candidates. We are not permitted to market 
or promote any of our product candidates before we receive regulatory approval from FDA or comparable foreign regulatory 
authorities,  and  we  may  never  receive  such  regulatory  approval  for  any  of  our  product  candidates.  Each  of  our  product 
candidates is in the early stages of development and will require significant additional clinical development, management of 
preclinical,  clinical,  and  manufacturing  activities,  regulatory  approval,  adequate  manufacturing  supply,  a  commercial 
organization, and significant marketing efforts before we generate any revenue from product sales, if at all.  

We  have  never  completed  a  product  development  program  in  neurodegeneration.  None  of  our  product  candidates  in 
neurodegeneration have advanced into late-stage development and we may not be able to initiate such program on anticipated 
timelines, if at all. Further, we cannot be certain that any of our product candidates will be successful in clinical studies. We 
may in the future advance product candidates into clinical studies and terminate such studies prior to their completion.  

If any of our product candidates successfully complete clinical studies, we may seek regulatory approval to market our 
product candidates in the U.S., the European Union, and in additional foreign countries where we believe there is a viable 
commercial opportunity. We may never receive regulatory approval to market any product candidates even if such product 
candidates successfully complete clinical studies, which would adversely affect our viability. To obtain regulatory approval 
in countries outside the U.S., we would need to comply with numerous and varying regulatory requirements of such other 
countries regarding safety, efficacy, manufacturing and controls, clinical studies, commercial sales, pricing, and distribution 
of our product candidates. Even if we are successful in obtaining approval in one jurisdiction, we cannot ensure that we will 
obtain  approval  in  any  other  jurisdictions.  If  we  are  unable  to  obtain  approval  for  our  product  candidates  in  multiple 
jurisdictions, our business, financial condition, results of operations, and our growth prospects could be negatively affected.  

Even if we receive regulatory approval to market any of our product candidates, whether for the treatment or diagnosis 
of  neurodegenerative  diseases  or  other  diseases,  we  cannot  provide  assurance  that  any  such  product  candidate  will  be 
successfully  commercialized,  widely  accepted  in  the  marketplace  or  more  effective  than  other  commercially  available 
alternatives.  

Investment in biopharmaceutical product development involves significant risk that any product candidate will fail to 
demonstrate adequate efficacy or an acceptable safety profile, gain regulatory approval, and become commercially viable. We 

34 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
cannot  provide  any  assurance  that  we  will  be  able  to  successfully  advance  any  of  our  product  candidates  through  the 
development process or, if approved, successfully commercialize any of our product candidates.  

There can be no assurance that results of smaller Phase 1 and Phase 2 clinical trials with simufilam will be reproduced 
in the additional large, well-controlled studies that are required to demonstrate safety and efficacy in order to potentially 
receive regulatory approval. 

Results of our Phase 1, Phase 2 and open-label safety studies with simufilam may not be predictive of the results of later-
stage clinical trials. Simufilam may fail to show the desired safety and efficacy in later clinical trials despite having progressed 
through  preclinical  studies  and  initial  clinical  trials.  Many  companies  in  the  biopharmaceutical  industry  have  suffered 
significant setbacks in advanced clinical trials due to lack of efficacy or adverse safety profiles, notwithstanding promising 
results in earlier trials. In addition, conclusions based on data from analyses of Phase 1 and Phase 2 clinical studies and open-
label results may not be reproduced when implemented in large, well-controlled, randomized clinical trials. Even if our clinical 
trials  for  simufilam  are  completed  as  planned,  we  cannot be  certain  that  their  results  will  support  the  safety  and  efficacy 
sufficient to obtain regulatory approval. 

We may encounter substantial delays in our clinical studies or may not be able to conduct or complete our clinical studies 
on the timelines we expect, if at all.  

Clinical testing is expensive, time consuming, and subject to uncertainty. We cannot guarantee that any clinical studies 
will be conducted as planned or completed on schedule, if at all. We cannot be sure that submission of an IND or a clinical 
study application (CTA) will result in FDA or European Medicines Agency (EMA), as applicable, allowing clinical studies 
to begin in a timely manner, if at all. Moreover, even if these studies begin, safety or other issues may arise that could suspend 
or terminate such clinical studies. A failure of one or more clinical studies can occur at any stage of testing, and our future 
clinical studies may not be successful. Events that may prevent successful or timely initiation or completion of clinical studies 
include:  

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

inability to generate sufficient preclinical, toxicology, or other in vivo or in vitro data to support the initiation or 
continuation of clinical studies; 

delays in confirming target engagement, patient selection, or other relevant biomarkers to be utilized in preclinical 
and clinical product candidate development; 

delays in reaching a consensus with regulatory agencies on study design; 

delays in reaching an agreement on acceptable terms with prospective contract research organizations (CROs) and 
clinical study sites, the terms of which can be subject to extensive negotiation and may vary significantly among 
different CROs and clinical study sites; 

delays in identifying, recruiting, and training suitable clinical investigators; 

delays in obtaining required IRB approval for each clinical study site; 

 imposition of a temporary or permanent clinical hold by regulatory agencies for a number of reasons, including: 

 after review of an IND or amendment, CTA or amendment, or equivalent application or amendment; 

 as a result of a new safety finding that presents unreasonable risk to clinical study participants; 

 a negative finding from an inspection of our clinical study operations or study sites; or 

the finding that the investigational protocol or plan is clearly deficient to meet its stated objectives; 

delays in identifying, recruiting, and enrolling suitable patients to participate in our clinical studies, and delays 
caused by patients withdrawing from clinical studies, or failing to return for post-treatment follow-up; 

35 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

delays caused by disease epidemics or pandemics, such as COVID-19; 

difficulty collaborating with patient groups and investigators; 

failure by our CROs, other third parties, or us to adhere to clinical study requirements; 

failure to perform in accordance with FDA’s or any other regulatory authority’s Code of Good Clinical Practice 
(GCPs) requirements, or applicable EMA or other regulatory guidelines in other countries; 

occurrence of adverse events associated with the product candidate that are viewed to outweigh its potential 
benefits; 

changes in regulatory requirements and guidance that require amending or submitting new clinical protocols; 

changes in the standard of care on which a clinical development plan was based, which may require new or 
additional studies; 

the cost of clinical studies of our product candidates being greater than we anticipate; 

clinical studies of our product candidates producing negative or inconclusive results, which may result in our 
deciding, or regulators requiring us, to conduct additional clinical studies or abandon product development 
programs; and 

delays in manufacturing, testing, releasing, validating, or importing/exporting sufficient stable quantities of our 
product candidates for use in clinical studies or the inability to do any of the foregoing. 

Any inability to successfully initiate or complete clinical studies could result in additional costs to us or impair our ability 
to generate revenue. In addition, if we make manufacturing or formulation changes to our product candidates, we may be 
required  to,  or  we  may  elect,  to  conduct  additional  studies  to  bridge  our  modified  product  candidates  to  earlier  versions. 
Clinical study delays could also shorten any periods during which our products have patent protection and may allow our 
competitors  to  bring  products  to  market  before  we  do,  which  could  impair  our  ability  to  successfully  commercialize  our 
product candidates and may harm our business and results of operations.  

We may in the future advance product candidates into clinical studies and terminate such studies prior to their completion, 

which could adversely affect our business.  

Delays in the completion of any clinical study of our product candidates will increase our costs, slow down our product 
candidate development and approval process and delay, or potentially jeopardize our ability to commence product sales and 
generate revenue. In addition, many of the factors that cause, or lead to, a delay in the commencement or completion of clinical 
studies may also ultimately lead to the denial of regulatory approval of our product candidates.  

If physicians and patients do not accept and use our drugs, we will not achieve sufficient product revenues and our business 
will suffer. 

Even if FDA approves our drugs, physicians and patients may not accept and use them. Acceptance and use of our drugs 

will depend on a number of factors including:  

•  when the drug is launched into the market and related competition; 

• 

• 

approved label claims; 

perceptions by members of the healthcare community, including physicians, about the safety and effectiveness of 
our drugs;  

36 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• 

• 

• 

• 

perceptions by physicians regarding the cost-benefit of our product candidates;  

published studies demonstrating the cost effectiveness of our drugs relative to competing products;  

availability of reimbursement for our products from government or healthcare payers;  

effectiveness of marketing and distribution efforts by us and other licensees and distributors.  

Because we expect to rely on sales generated by our current lead product candidates for substantially all of our revenues 
for the foreseeable future, the failure of any of these drugs to find market acceptance would harm our business and could 
require us to seek additional financing.  

We may not be successful in developing our product candidates in neurodegeneration.  

Our product candidates in neurodegeneration are still in the early stages of development and will take several more years 
to develop and must undergo extensive clinical and scientific validations. Even if we are successful in developing any of our 
product candidates through clinical and scientific validation, we may not be able to develop a drug or a diagnostic that: 

•  meets applicable regulatory standards, in a timely manner or at all; 
• 
• 
• 
• 
• 

successfully competes with other technologies and tests;  
avoids infringing the proprietary rights of others;  
are adequately reimbursed by third-party payors;  
can be performed at commercial levels or at reasonable cost; or 
can be successfully marketed. 

To  the  extent  we  are  not  successful  in  developing  our  new  product  candidates  in  neurodegeneration,  our  results  of 

operations and business will be materially adversely affected.  

We currently have no in-house capabilities to manufacture or commercialize our product candidates and we rely on third-
party commercial drug manufacturers for clinical drug  supplies. If  we are  unable to develop our own manufacturing, 
sales, marketing and distribution capabilities, or if we are not successful in contracting with third parties for these services 
on favorable terms, or at all, our product revenues could be adversely impacted.  

We rely on various third parties to manufacture, fill, label, store, test and ship our product candidates. We plan to continue 
to outsource formulation, manufacturing and related activities. These suppliers must comply with cGMP regulations enforced 
by FDA and other government agencies, and are subject to ongoing periodic unannounced inspection, including preapproval 
inspections by FDA and corresponding state and foreign government agencies to ensure strict compliance with cGMP and 
other standards. These manufacturers may subsequently be stopped from producing, manufacturing, filling, labeling, storing, 
testing and shipping our product candidates due to their non-compliance with federal, state or local regulations. We do not 
have control over our suppliers’ compliance with these regulations and standards and we cannot control decisions by our 
suppliers that affect their ability or willingness to continue to supply us on acceptable terms, or at all. 

Disputes  in  the  past  have  arisen  with  some  of  these  third  parties  with  respect  to  fulfilling  certain  conditions  and 
obligations. There can be no guarantee that such disputes will not arise again in the future, which may lead to termination of 
an agreement. If an agreement is terminated, we would not be able to commercialize our product candidates until another 
manufacturer is identified and we have entered into a manufacturing agreement with such manufacturer. We may not be able 
to replace a commercial supplier on commercially reasonable terms, or at all. Replacing any of our commercial  suppliers 
would be expensive and time consuming. Failure by any of our suppliers to perform as expected could delay or prevent the 
commercialization  or  potential  regulatory  approval  of  our  product  candidates  for  an  extended  period  of  time,  result  in 
shortages, cost overruns or other problems and would materially harm our business. 

We  currently  have  no  sales,  marketing  or  distribution  capabilities.  We  have  not  established  commercial  strategies 
regarding any of our product candidates. In order to commercialize our products, if any are approved by FDA, we will either 
have to develop such capabilities internally or collaborate with third parties who can perform these services for us.  

37 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
If we decide to commercialize any of our drugs ourselves, we may not be able to  

• 
• 

• 
• 

hire and retain the necessary experienced personnel;  
build  sales,  marketing  and  distribution  operations  in  a  cost-effective  manner  which  are  capable  of  successfully 
launching new drugs; 
obtain access to adequate numbers of physicians to prescribe our products; or 
generate sufficient product revenues.  

In addition, establishing such operations on our own will take time and involve significant expense. If our commercial 
operations lack complementary products, we may not be able to compete in a cost-effective manner with competitors with 
more products to sell. If we engage third-party collaborators to perform any commercial operations, our future revenues may 
depend significantly upon the performance of those collaborators. 

If we decide to enter into new co-promotion or other licensing arrangements with third parties, we may be unable to locate 
acceptable collaborators because the number of potential collaborators is limited and because of competition from others for 
similar alliances. Even if we are able to identify one or more acceptable new collaborators, we may not be able to enter into 
any collaborative arrangements on favorable terms, or at all. 

In  addition,  due  to  the  nature  of  the  market  for  our  product  candidates,  it  may  be  necessary  for  us  to  license  all  or 
substantially all of our product candidates to a single collaborator, thereby eliminating our opportunity to commercialize these 
other products independently. If we enter into any such new collaborative arrangements, our revenues are likely to be lower 
than if we marketed and sold our products ourselves.  

In addition, any revenues we receive would depend upon our collaborators’ efforts which may not be adequate due to 
lack of attention or resource commitments, management turnover, change of strategic focus, business combinations or other 
factors  outside  of  our  control.  Depending  upon  the  terms  of  our  collaboration,  the  remedies  we  have  against  an  under-
performing collaborator may be limited. If we were to terminate the relationship, it may be difficult or impossible to find a 
replacement collaborator on acceptable terms, or at all.  

Alzheimer’s disease has failed every attempt at drug approval. 

Despite billions of dollars invested by the biopharmaceutical industry in research programs to develop novel therapeutics 
for Alzheimer’s disease, no FDA approved treatments have been developed in the past 15 years. In that span of time, many 
new types and classes of drugs have been developed and tested in Alzheimer’s disease, including monoclonal antibodies, g-
secretase  modulators  and  inhibitors,  β-site  amyloid  precursor  protein  cleaving  enzyme  (BACE)  inhibitors,  receptor  for 
advanced glycation end-products (RAGE) inhibitors, nicotinic agonists, serotonin subtype receptor (5HT6) antagonists, and 
others. Virtually all of these scientific programs have failed in clinical testing.  

We may not be successful in our efforts to expand our technology or product candidates in other indications.  

Our drug development strategy is to clinically test and seek regulatory approval for our product candidates in Alzheimer’s 
disease, our primary indication. We may expand our research efforts outside of this primary indication and into other areas of 
clinical medicine based on genetic, biological or mechanistic overlap with the primary indication. Conducting clinical studies 
for additional indications for our product candidates will require substantial technical, financial and human resources and is 
prone to the inherent risks of failure in drug development. We cannot provide you any assurance that we will be successful in 
our effort to expand our technology or our product candidates in additional indications, even if we obtain approval for our 
product candidate in Alzheimer’s disease.  

If we fail to successfully identify and develop additional product candidates, our commercial opportunity will be limited to 
Alzheimer’s disease or other neurodegenerations.  

Identifying,  developing,  obtaining  regulatory  approval,  and  commercializing  additional  product  candidates  requires 
substantial expertise and funding and is prone to the risks of failure inherent in drug development. We cannot provide any 
assurance that we will be able to successfully identify or acquire additional product candidates, advance any additional product 
candidates  through  the  development  process,  or  assemble  sufficient  resources  to  identify,  acquire,  or  develop  additional 

38 

  
 
 
 
 
 
 
 
 
 
 
 
product  candidates.  If  we  are  unable  to  successfully  identify,  acquire,  develop,  and  commercialize  additional  product 
candidates, our commercial opportunity may be limited. 

Early indications of safety, tolerability or biomarker results from our small clinical studies with simufilam may not predict 
the results of later studies. 

Results of a Phase 1 clinical study with simufilam demonstrated safety, tolerability and pharmacokinetics in 24 healthy 
subjects exposed to 50-200 mg in a single ascending dose study. However, this was a small, “first-in-human” Phase 1 study 
designed to assess the initial safety characteristics of simufilam in healthy subjects and this study was not designed to, and did 
not, evaluate safety, tolerability and efficacy of simufilam in patients. Additional large, well-controlled, multi-dose studies 
will be required to evaluate the safety, tolerability and efficacy of simufilam to treat patients with any indication, including 
Alzheimer’s disease. There can be no assurance that such future studies will demonstrate the safety, tolerability or efficacy of 
simufilam.  

Results of Phase 2 clinical studies with simufilam demonstrated a reduction in biomarkers of disease. However, these 
were  small,  clinical-proof-of-concept  Phase  2  studies  designed  to  assess  the  initial  safety  characteristics  of  simufilam  in 
patients. Our Phase 2 program was not designed to, and did not,  evaluate  large-scale or long-term safety, tolerability and 
efficacy of simufilam in patients. Additional large, well-controlled, multi-dose studies will be required to evaluate the safety, 
tolerability and efficacy of simufilam to treat patients with any indication, including Alzheimer’s disease. There can be no 
assurance that such future studies will demonstrate the safety, tolerability or efficacy of simufilam. The failure of simufilam 
to show safety, tolerability or efficacy in any future clinical studies would significantly harm our business. 

We have never obtained FDA approval for a diagnostic test and we may not be able to secure such approval in a timely 
manner or at all.  

We  are  developing  a  blood-based  diagnostic  test  for  Alzheimer’s  disease,  called  SavaDx,  which  will  require  FDA 
approval  prior  to  commercialization.  Our  diagnostic  product  candidate,  marketing,  sales  and  development  activities  and 
manufacturing  processes  are  subject  to  extensive  and  rigorous  regulation  by  FDA  pursuant  to  the  FDCA,  by  comparable 
agencies in foreign countries, and by other regulatory agencies and governing bodies. Under the FDCA, a diagnostic must 
receive FDA clearance or approval before it can be commercially marketed in the U.S. The process of obtaining marketing 
approval or clearance from FDA or by comparable agencies in foreign countries for new products could: 

• 
• 
• 
• 
• 

take a significant period of time; 
require the expenditure of substantial resources; 
 involve rigorous pre-clinical testing, as well as increased post-market surveillance;  
require changes to products; and  
result in limitations on the indicated uses of products. 

If we do not compete effectively with scientific and commercial competitors, we may not be able to successfully develop our 
diagnostic test for Alzheimer’s disease. 

The field of clinical laboratory testing is highly competitive. Diagnostic tests that are developed are characterized by rapid 
technological  change. Our competitors in the U.S.  and abroad are numerous and include, among others, major diagnostic 
companies,  reference  laboratories,  molecular  diagnostic  firms,  universities  and  other  research  institutions.  Most  of  our 
potential competitors have considerably greater financial, technical, marketing and other resources than we do, which may 
allow these competitors to discover important biological markers and determine their function before we do. We could be 
adversely  affected  if  we  do  not  discover  proteins  or  biomarkers  and  characterize  their  function,  develop  diagnostic  and 
pharmaceutical and clinical services based on these discoveries, obtain required regulatory and other approvals and launch 
these tests and their related services before our competitors. We also expect to encounter significant competition with respect 
to any diagnostic tests that we may develop or commercialize. Those companies that bring to market new diagnostic tests 
before we do may achieve a significant competitive advantage in marketing and commercializing their tests. We may not be 
able to develop additional diagnostic tests successfully and we may not obtain or enforce patents, if any, covering these tests 
that provide protection against our competitors. Moreover, our competitors may succeed in developing diagnostic tests that 
circumvent our technologies or tests. Furthermore, our competitors may succeed in developing technologies or tests that are 
more effective or less costly than those developed by us or that would render our technologies or tests less competitive or 
obsolete. We expect competition to intensify in the fields in which we are involved as technical advances in these fields occur 

39 

  
 
 
 
 
 
 
 
 
and become more widely known and changes in intellectual property laws generate challenges to our intellectual property 
position. 

We will need to develop our own proprietary antibodies to advance our SavaDx and our diagnostic program. 

SavaDx currently relies on the use of commercially available antibodies, which are complex molecules that can recognize 
and  bind  to  an  intended  protein.  Commercially  available  antibodies  present  certain  technical  flaws,  such  as  improper 
validation,  significant  batch-to-batch  variations  or  inconsistent  storage,  any  of  which  can  jeopardize  our  studies  and 
experiments. Because antibody underperformance can be a significant drain on time and resources, we are developing and 
validating our own, fit-for-purpose antibody for use with SavaDx and such technical activities are on-going. The complexity 
of developing our own antibody gives rise to many technical issues that are challenging to solve, and we cannot be certain 
that we will be able to successfully complete any of these activities, in which case our program may be harmed.  

We have concentrated a substantial portion of our research and development efforts on the treatment and detection of 
Alzheimer’s disease, an area of research that has seen significant failure rates. Further, our product candidates are based 
on  new  scientific  approaches  and  novel  technology,  which  makes  it  difficult  to  predict  the  time  and  cost  of  product 
candidate development.  

We focus substantially all of our research and development efforts on addressing neurodegenerations, such as Alzheimer’s 
disease.  Collectively,  efforts  by  biopharmaceutical  companies  in  the  field  of  neurodegenerative  diseases  have  seen  many 
failures  and  limited  success  in  drug  development.  For  example,  there  are  no  therapeutic  options  available  to  reverse 
Alzheimer’s disease, or even to halt its progress. Our future success is highly dependent on the successful development of our 
product candidates for treating Alzheimer’s disease. Developing and, if approved, commercializing our product candidates 
for treatment of Alzheimer’s disease subjects us to many challenges, including obtaining regulatory approval from FDA and 
other regulatory authorities who have only a limited set of precedents to rely on. We cannot be sure that our approach will 
yield satisfactory therapeutic products that are safe and effective, scalable, or profitable. 

Our Phase 2 clinical studies with simufilam in patients with Alzheimer’s disease are not designed to show a statistically 
meaningful difference between those patients who receive placebo and those who receive drug. 

Clinical research data is often analyzed with statistical probability (p-value) to address the question of whether a clinical 
observation  is  related  to  a  treatment  effect,  a  random  effect  or  something  else.  This,  in  turn,  requires  a  clinical  study  to 
incorporate a sufficiently large sample patient population to infer the appropriate statistical analysis. By design, our Phase 2 
clinical program with simufilam does not include a sufficiently large patient population to generate statistical probability on 
clinical observations. This feature may make it difficult for investors to properly interpret whether clinical observations in our 
Phase  2  studies  with  simufilam  are  important  or  meaningful.  Conversely,  our  clinical  studies  may  generate  statistically 
meaningful data (i.e., p<0.05) with regard to biomarkers, or other endpoints, that have unknown or no clinical importance. In 
general, the distinction between statistical significance and clinical significance is a complex area of research that continues 
to evolve and may be subject to differences of opinion among scientists, clinicians and other professionals.  

We  may  encounter  difficulties  enrolling  patients  in  our  clinical  studies,  and  our  clinical  development  activities  could 
thereby be delayed or otherwise adversely affected.  

The timely completion of clinical studies in accordance with their protocols depends, among other things, on our ability 
to enroll enough patients who remain in the study until its conclusion. We may experience difficulties in patient enrollment 
in our clinical studies for a variety of reasons, including:  

• 
• 

• 
• 
• 

the size and severity of disease in the patient population; 
the patient eligibility criteria defined in the protocol, including biomarker-driven identification and/or certain highly-
specific  criteria  related  to  stage  of  disease  progression,  which  may  limit  the  patient  populations  eligible  for  our 
clinical studies to a greater extent than competing clinical studies for the same indication that do not have biomarker-
driven patient eligibility criteria; 
the size of the study population required for analysis of the trial’s primary endpoints; 
the design of our study protocol; 
our ability to recruit clinical study investigators with the appropriate competencies and experience; 

40 

  
 
 
 
 
 
 
 
 
  
• 
• 

• 
• 
• 
• 

competing clinical studies for similar therapies or targeting patient populations meeting our patient eligibility criteria; 
clinicians’ and patients’ perceptions as to the potential advantages and side effects of the product candidate being 
studied in relation to other available therapies and product candidates; 
our ability to obtain and maintain patient consents; 
physicians’ patient referral practices that are out of our control; 
our ability to adequately monitor patients and their caregivers during and after treatment; and 
the risk that patients enrolled in clinical studies will not complete such studies, for any reason. 

Our  clinical  studies  may  fail  to  demonstrate  substantial  evidence  of  the  safety  and  efficacy  of  our  product  candidates, 
which would prevent, delay, or limit the scope of regulatory approval and commercialization.  

Before obtaining regulatory approvals for any of our product candidates, we must demonstrate through lengthy, complex, 
and expensive preclinical experiments and clinical studies that our product candidates are both safe and effective for use in an 
intended population. Each product candidate must demonstrate an adequate risk versus benefit profile in its intended patient 
population and for its intended use.  

Clinical testing is expensive and can take many years to complete, and its outcome is inherently uncertain. Failure can 
occur at any time during the clinical study process. The results of preclinical studies of our product candidates may not be 
predictive  of  the  results  of  early-stage  or  later-stage  clinical  studies,  and  results  of  early  clinical  studies  of  our  product 
candidates may not be predictive of the results of later-stage clinical studies. The results of clinical studies in one set of patients 
or disease indications may not be predictive of those obtained in another. In some instances, there can be significant variability 
in safety or efficacy results between different clinical studies of the same product candidate due to numerous factors, including 
changes in study procedures set forth in protocols, differences in the size and type of the patient populations, changes in and 
adherence to the dosing regimen, and other clinical study protocols and the rate of dropout among clinical study participants. 
Open-label extension studies may also extend the timing and cost of a clinical study substantially. Product candidates in later 
stages of clinical studies may fail to show the desired safety and efficacy profile despite having progressed through preclinical 
studies and initial clinical studies. Many companies in the biopharmaceutical industry have suffered significant setbacks in 
advanced clinical studies due to lack of efficacy or unacceptable safety issues, notwithstanding promising results in earlier 
studies. This is particularly true in neurodegenerative diseases, where failure rates historically have been higher than in many 
other  disease  areas.  Most  product  candidates  that  begin  clinical  studies  are  never  approved  by  regulatory  authorities  for 
commercialization.  

We have limited experience in designing clinical studies in neurodegeneration and may be unable to design and execute 
a clinical study to support marketing approval. We cannot be certain that our current clinical studies or any other future clinical 
studies  will  be  successful.  Additionally,  any  safety  concerns  observed  in  any  one  of  our  clinical  studies  in  our  targeted 
indications could limit the prospects for regulatory approval of our product candidates in those and other indications, which 
could have a material adverse effect on our business, financial condition, and results of operations.  

In addition, even if such clinical studies are successfully completed, we cannot guarantee that FDA or foreign regulatory 
authorities will interpret the results as we do, and more studies could be required before we submit our product candidates for 
approval. To the extent that the results of the studies are not satisfactory to FDA or foreign regulatory authorities for support 
of a marketing application, we may be required to expend significant resources, which may not be available to us, to conduct 
additional studies in support of potential approval of our product candidates. Even if regulatory approval is secured for any of 
our product candidates, the terms of such approval may limit the scope and use of our product candidates, which may also 
limit its commercial potential. 

If our drug candidate causes or contribute to a death or a serious injury before or after approval, we will be subject to 
medical reporting regulations, which can result in voluntary corrective actions or agency enforcement actions. 

Our drug candidate in Alzheimer’s disease is aimed at a frail, elderly patient population that is in a state of perpetual 
cognitive decline. Under FDA medical reporting regulations, we are required to report to the FDA information that our drug 
candidate has or may have caused or contributed to a death or serious injury. Any such serious adverse event involving our 
drug could result in future FDA action, such as an inspection, enforcement action or warning, or in more serious cases, a 
complete shutdown of our clinical program. In the context of our ongoing clinical trial, we report adverse events to the FDA 
in accordance with applicable national and local regulations. Any corrective action, whether voluntary or involuntary, and 

41 

  
 
 
 
 
 
 
  
either pre- or post-market, needed to address any serious adverse events will require the dedication of our time and capital, 
distract management from operating our business, and may harm our reputation and financial results. 

The market opportunities for simufilam and SavaDx, if approved, may be smaller than we anticipate. 

If  our  clinical  development  programs  succeed,  we  expect  to  seek  regulatory  approval  of  simufilam  and  SavaDx  for 
patients with Alzheimer’s disease. Our projections of the number of patients with Alzheimer’s disease is based on our beliefs 
and estimates. These estimates have been derived from a variety of sources, including scientific literature, patient foundations 
and market research, and may prove to be incorrect. The actual number of patients may turn out to be lower than expected. 
Additionally, the potential patient population for our current programs or future product candidates may be limited. Even if 
we obtain significant market share for any product candidate, if approved, if the potential target populations are smaller than 
anticipated, we may never achieve profitability without obtaining marketing approval for additional indications.  

We face significant competition in an environment of rapid technological and scientific change, and there is a possibility 
that our competitors may achieve regulatory approval before us or develop therapies that are safer, more advanced, or 
more effective than ours, any of which may harm our business operations.  

The  development  and  commercialization  of  new  product  candidates  is  highly  competitive.  Moreover,  the 
neurodegenerative field is characterized by intense and increasing competition, and a strong emphasis on intellectual property. 
We may face competition with respect to any of our product candidates that we seek to develop or commercialize in the future 
from  major  pharmaceutical  companies,  specialty  pharmaceutical  companies,  and  biotechnology  companies  worldwide. 
Potential  competitors  also  include  academic  institutions,  government  agencies,  and  other  public  and  private  research 
organizations  that  conduct  research,  seek  patent  protection,  and  establish  collaborative  arrangements  for  research, 
development, manufacturing, and commercialization.  

Several large pharmaceutical and biotechnology companies are currently pursuing the development of products for the 
treatment of neurodegenerative diseases, including Alzheimer’s disease. Many of these current or potential competitors, either 
alone or with their strategic partners, have significantly greater financial resources and expertise in research and development, 
manufacturing,  preclinical  testing,  conducting  clinical  studies,  obtaining  regulatory  approvals,  and  marketing  approved 
products than we do.  

Our commercial opportunity could be reduced or eliminated if our competitors develop and commercialize products that 
are safer, more effective, have fewer or less severe side effects, are more convenient, or are less expensive than any products 
that  we  may  develop.  Furthermore,  currently  approved products  could  be  discovered  to have  application  for  treatment  of 
neurodegenerative  disease  indications,  which  could  give  such  products  significant  advantages  over  any  of  our  product 
candidates. Our competitors also may obtain FDA, EMA, or other regulatory approval for their products more rapidly than 
we may obtain approval for ours, which could result in our competitors establishing a strong market position before we are 
able to enter the market. Additionally, products or technologies developed by our competitors may render our potential product 
candidates uneconomical or obsolete, and we may not be successful in marketing any product candidates we may develop 
against competitors.  

In  addition,  we  could  face  litigation  or  other  proceedings  with  respect  to  the  scope,  ownership,  validity,  and/or 
enforceability of our patents relating to our competitors’ products and our competitors may allege that our products infringe, 
misappropriate, or otherwise violate their intellectual property. The availability of our competitors’ products could limit the 
demand, and the price we are able to charge, for any products that we may develop and commercialize.  

Risks Related to Government Regulation and Other Legal Compliance Matters 

If we are ultimately unable to obtain regulatory approval for our product candidates, we will be unable to generate product 
revenue and our business will be substantially harmed. 

The  time  required  to  obtain  approval  by  FDA,  EMA,  and comparable  foreign  regulatory  authorities  is  unpredictable, 
typically takes many years following the commencement of clinical studies, and depends upon numerous factors, including 
the type, complexity, and novelty of the product candidates involved. In addition, approval policies, regulations, or the type 
and  amount  of  clinical  data  necessary  to  gain  approval  may  change  during  the  course  of  a  product  candidate’s  clinical 
development and may vary among jurisdictions, which may cause delays in  the approval or the decision not to approve an 

42 

  
 
 
 
 
 
 
 
 
 
 
application. Regulatory authorities have substantial discretion in the approval process and may refuse to accept any application 
or may decide that our data are insufficient for approval and require additional preclinical, clinical, or other studies. The FDA 
has not approved a new drug for Alzheimer’s disease since 2003. We have not obtained regulatory approval for any product 
candidate, including our product candidates aimed at Alzheimer’s disease, and it is possible that none of our existing product 
candidates or any product candidates we may seek to develop in the future will ever obtain regulatory approval.  

Applications for our product candidates could fail to receive regulatory approval in an initial or subsequent indication for 

many reasons, including but not limited to the following:  

•  FDA, EMA, or comparable foreign regulatory authorities may disagree with the design, implementation, or results 

of our clinical studies; 

•  FDA, EMA, or comparable foreign regulatory authorities may determine that our product candidates are not safe and 
effective, only moderately effective or have undesirable or unintended side effects, toxicities, or other characteristics 
that preclude our obtaining marketing approval or prevent or limit commercial use; 
the population studied in the clinical program may not be sufficiently broad or representative to assure efficacy and 
safety in the full population for which we seek approval; 

• 

•  we  may  be  unable  to  demonstrate  to  FDA,  EMA  or  comparable  foreign  regulatory  authorities  that  a  product 

candidate’s risk-benefit ratio when compared to the standard of care is acceptable; 

•  FDA,  EMA,  or  comparable  foreign  regulatory  authorities  may  disagree  with  our  interpretation  of  data  from 

• 

preclinical studies or clinical studies; 
the data collected from clinical studies of our product candidates may not be sufficient to support the submission of 
a new drug application (NDA), or other submission or to obtain regulatory approval in the United States or elsewhere; 
•  FDA,  EMA,  or  comparable  foreign  regulatory  authorities  may  fail  to  approve  the  manufacturing  processes,  test 
procedures,  and  specifications,  or  facilities  of  third-party  manufacturers  with  which  we  contract  for  clinical  and 
commercial supplies; and 
the approval policies or regulations of FDA, EMA, or comparable foreign regulatory authorities may significantly 
change in a manner rendering our clinical data insufficient for approval. 

• 

This lengthy approval process, as well as the unpredictability of the results of clinical studies, may result in our failing to 
obtain regulatory approval to market any of our product candidates, which would significantly harm our business, results of 
operations, and growth prospects.  

Our ability to market and promote our product candidates will be determined and limited by FDA-approved labeling.  

The  commercial  success  of  our  product  candidates  will  depend  upon  our  ability  to  obtain  FDA-approved  labeling 
describing their features. Our failure to achieve FDA approval of product labeling containing such information will prevent 
us from advertising and promoting the key features of our product candidates in order to differentiate them from other similar 
products. This would make our products less competitive in the market. 

Our employees, independent contractors, consultants, commercial partners, and vendors may engage in misconduct or 
other improper activities, including noncompliance with regulatory standards and requirements.  

We  are exposed to the risk of  fraud, misconduct, or other illegal activity by our employees, independent contractors, 
consultants, commercial partners, and vendors. Misconduct by these parties could include intentional, reckless, and negligent 
conduct that fails to:  

• 
• 
• 
• 
• 

comply with the laws of FDA, EMA, and other comparable foreign regulatory authorities;  
provide true, complete, and accurate information to FDA, EMA, and other comparable foreign regulatory authorities; 
comply with manufacturing standards we have established; 
comply with healthcare fraud and abuse laws in the U.S. and similar foreign fraudulent misconduct laws; or 
report financial information or data accurately or to disclose unauthorized activities to us. 

Activities subject to laws also involve the improper use of information obtained in the course of patient recruitment for 
clinical studies, which could result in regulatory sanctions and cause serious harm to our reputation. Further, it is not always 
possible to identify and deter misconduct by employees and third parties, and the precautions we take to detect and prevent 

43 

  
 
 
 
 
 
 
 
 
 
this activity may not be effective in controlling unknown or unmanaged risks or losses or in protecting us from governmental 
investigations or other actions or lawsuits stemming from a failure to be in compliance with such laws. If any such actions are 
instituted  against  us,  and  we  are  not  successful  in defending  ourselves  or  asserting  our rights,  those  actions  could  have  a 
significant impact on our business, including the imposition of significant fines or other sanctions. 

If we fail to comply with the complex federal, state, local and foreign laws and regulations that apply to our business, we 
could suffer severe consequences that could materially and adversely affect our operating results and financial condition.  

Our operations are subject to extensive federal, state, local and foreign laws and regulations, all of which are subject to 

change. These laws and regulations currently include, among other things: 

•  The  Clinical  Laboratory  Improvement  Amendments  (CLIA)  of  1988,  which  are  United  States  federal  regulatory 
standards  that  apply  to  all  clinical  laboratory  testing  performed  on  humans  in  the  United  States,  requires  that 
laboratories obtain certification from the federal government, and state licensure laws; 

• 

• 

•  FDA laws and regulations; 
•  The Health Insurance Portability and Accountability Act (HIPAA), which imposes comprehensive federal standards 
with  respect  to  the  privacy  and  security  of  protected  health  information  and  requirements  for  the  use  of  certain 
standardized electronic transactions, including penalties for violators, enforcement authority to state attorneys general 
and requirements for breach notification; 
state laws regulating testing and protecting the privacy of test results, as well as state laws protecting the privacy and 
security of health information and personal data and mandating reporting of breaches to affected individuals and state 
regulators; 
the  federal  anti-kickback  law,  or  the  Anti-Kickback  Statute,  which  prohibits  knowingly  and  willfully  offering, 
paying, soliciting, receiving, or providing remuneration, directly or indirectly, in exchange for or to induce either the 
referral of an individual, or the furnishing, arranging for, or recommending of an item or service that is reimbursable, 
in whole or in part, by a federal health care program; 
the  federal  False  Claims  Act  (FCA),  which  imposes  liability  on  any  person  or  entity  that,  among  other  things, 
knowingly presents, or causes to be presented, a false or fraudulent claim for payment to the federal government; 
the  federal  Civil  Monetary  Penalties  Law,  which  prohibits,  among  other  things,  the  offering  or  transfer  of 
remuneration to a Medicare or state health care program beneficiary if the person knows or should know it is likely 
to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of services reimbursable by 
Medicare or a state health care program, unless an exception applies; 
other federal and state fraud and abuse laws, such as anti-kickback laws, prohibitions on self-referral, and false claims 
acts, which may extend to services reimbursable by any third-party payor, including private insurers; 
the  federal  Physician  Payments  Sunshine  Act,  which  requires  manufacturers  to  track  and  report  to  the  federal 
government certain payments and other transfers of value made to physicians and teaching hospitals and ownership 
or investment interests held by physicians and their immediate family members;  

• 

• 

• 

• 

•  Section  216  of  the  federal  Protecting  Access  to  Medicare  Act  of  2014  (PAMA),  which  requires  applicable 
laboratories  to  report  private  payer  data  in  a  timely  and  accurate  manner  every  three  years  (and  in  some  cases 
annually); 
state laws that impose reporting and other compliance-related requirements; and  
similar foreign laws and regulations that will apply to us in foreign countries in which we may choose to operate in 
the future.  

• 
• 

Government agencies may establish and promulgate usage guidelines that could limit the use of our product candidates.  

Government agencies, professional and medical societies, and other groups may establish usage guidelines that apply to 
our product candidates. These guidelines could address such matters as usage and dose, among other factors. Application of 
such guidelines could limit the clinical use or commercial appeal of our product candidates.  

44 

  
 
 
 
 
 
 
Our  product  candidates  may  cause  undesirable  side  effects  or  have  other  properties  that  could  halt  their  clinical 
development,  prevent  their  regulatory  approval,  limit  their  commercial  potential,  or  result  in  significant  negative 
consequences.  

We have not yet completed long-term safety studies with simufilam to determine if this product candidate is safe for 
humans. Adverse events or other undesirable side effects caused by simufilam could cause us or regulatory authorities to 
interrupt, delay, or halt clinical studies and could result in a more restrictive label or the delay or denial of regulatory approval 
by FDA, EMA, or other comparable foreign regulatory authorities.  

Drug-related side effects could affect patient recruitment, the ability of enrolled patients to complete the study, and/or 
result in potential product liability claims. We are required to maintain product liability insurance pursuant to certain of  our 
development and commercialization agreements. We may not be able to maintain insurance coverage at a reasonable cost or 
in sufficient amounts to protect us against losses due to liability. A successful product liability claim or series of claims brought 
against us could adversely affect our results of operations, business, and reputation. In addition, regardless of merit or eventual 
outcome,  product  liability  claims  may  result  in  impairment  of  our  business  reputation,  withdrawal  of  clinical  study 
participants,  costs  due  to related  litigation, distraction  of management’s  attention from  our  primary business,  initiation  of 
investigations by regulators, substantial monetary awards to patients or other claimants, the inability to commercialize our 
product candidates, and decreased demand for our product candidates, if approved for commercial sale. 

If our product candidates receive regulatory approval, we and our collaborators will be subject to ongoing FDA obligations 
and continued regulatory review, such as continued safety reporting requirements, and we and our collaborators may also 
be subject to additional FDA post-marketing obligations or new regulations, all of which may result in significant expense 
and limit our and our collaborators’ ability to commercialize our potential drugs.  

Any regulatory approvals that our product candidates receive may also be subject to limitations on the indicated uses for 
which the drug may be marketed or contain requirements for potentially costly post-marketing follow-up studies. In addition, 
if  FDA  approves  any  of  our  product  candidates,  the  labeling,  packaging,  adverse  event  reporting,  storage,  advertising, 
promotion and record keeping for the drug will be subject to extensive regulatory requirements. The subsequent discovery of 
previously  unknown  problems  with  the  drug,  including  but  not  limited  to  adverse  events  of  unanticipated  severity  or 
frequency,  or  the  discovery  that  adverse  events  previously  observed  in  preclinical  research  or  clinical  studies  that  were 
believed to be minor actually constitute much more serious problems, may result in restrictions on the marketing of the drug, 
and could include withdrawal of the drug from the market.  

The  FDA’s  policies  may  change,  and  additional  government  regulations  may  be  enacted  that  could  prevent  or  delay 
regulatory  approval  of  our  product  candidates.  We  cannot  predict  the  likelihood,  nature  or  extent  of  adverse  government 
regulation that may arise from future legislation or administrative action, either in the U.S. or abroad. If we are not able  to 
maintain regulatory compliance, we may be subject to fines, suspension or withdrawal of regulatory approvals, product recalls, 
seizure of products, operating restrictions and criminal prosecution. Any of these events could prevent us from marketing our 
products and our business could suffer.  

Enacted and future legislation may increase the difficulty and cost for us to commercialize our product candidates and 
may reduce the prices we are able to obtain for our product candidates.  

Legislative and regulatory changes and future changes regarding the healthcare system could prevent or delay marketing 
approval  of  our  product  candidates,  restrict  or  regulate  post-approval  activities  or  affect  our  ability  to  profitably  sell  any 
product candidates for which we obtain marketing approval.  

In the U.S., the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the Medicare Modernization 
Act) established the Medicare Part D program and provided authority for limiting the number of drugs that will be covered in 
any therapeutic class thereunder. The Medicare Modernization Act, including its cost reduction initiatives, could limit the 
coverage  and  reimbursement rate  that  we  receive  for  any of  our  approved products.  Private  payors  may  follow  Medicare 
coverage policies and payment limitations in setting their own reimbursement rates resulting in similar limits in payments 
from private payors.  

The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, or 
collectively, the Affordable Care Act, among other things, imposes a significant annual fee on companies that manufacture or 

45 

  
 
 
 
 
 
 
 
 
 
import  branded  prescription  product  candidates.  It  also  contains  substantial  provisions  intended  to,  among  other  things, 
broaden  access  to  health  insurance,  reduce  or  constrain  the  growth  of  health  care  spending,  enhance  remedies  against 
healthcare fraud and abuse, add new transparency requirements for the healthcare and health insurance industries, and impose 
additional health policy reforms, any of which could have a material adverse effect on our business. A significant number of 
provisions are not yet, or have only recently become, effective, but the Affordable Care Act may result in downward pressure 
on  pharmaceutical  pricing,  especially  under  the  Medicare  program,  and  may  also  increase  our  regulatory  burdens  and 
operating costs.  

The Affordable Care Act, as well as other healthcare reform measures that have been and may be adopted in the future, 
may  result  in  more  rigorous  coverage  criteria  and  in  additional  downward  pressure  on  the  price  that  we  receive  for  any 
approved product, and could seriously harm our future revenues. Any reduction in reimbursement from Medicare or other 
government  programs  may  result  in  a  similar  reduction  in  payments  from  private  payors.  The  implementation  of  cost 
containment measures or other healthcare  reforms may compromise our ability to generate  revenue, attain profitability or 
commercialize our products.  

The  Affordable  Care  Act  is  a  highly  complex  piece  of  legislation  that  continues  to  evolve.  We  do  not  and  cannot 
understand or anticipate the full impact and potential implications of the Affordable Care Act on our business or on our drugs. 

Our relationships with customers and payors will be subject to applicable anti-kickback, fraud and abuse, transparency, 
and other healthcare laws and regulations, which could expose us to criminal sanctions, civil penalties, exclusion from 
government healthcare programs, contractual damages, reputational harm, administrative burdens, and diminished profits 
and future earnings.  

Healthcare providers, physicians and payors play a primary role in the recommendation and prescription of any product 
candidates for which we may obtain marketing approval. Our future arrangements with payors and customers may expose us 
to broadly applicable fraud and abuse and other healthcare laws and regulations that may constrain the business or financial 
arrangements and relationships through which we market, sell and distribute any product candidates for which we may obtain 
marketing approval. Even though we do not and will not control referrals of healthcare services or bill directly to Medicare, 
Medicaid  or  other  third-party  payors,  federal  and  state  healthcare  laws  and  regulations  pertaining  to fraud  and  abuse  and 
patients' rights are and will be applicable to our business. Restrictions under applicable federal, state and foreign healthcare 
laws and regulations may affect our ability to operate and expose us to areas of risk, including:  

• 

• 

the federal Anti-Kickback Statute, which prohibits, among other things, knowingly and willfully soliciting, offering, 
receiving or providing remuneration, directly or indirectly, in cash or in kind, to induce or reward either the referral 
of an individual for, or the purchase, order or recommendation of, any good or service, for which payment may be 
made under federal and state healthcare programs such as Medicare and Medicaid. A person or entity does not need 
to have actual knowledge of the statute or specific intent to violate it in order to have committed a violation;  
the  FCA,  which  imposes  criminal  and  civil  penalties,  including  through  civil  whistleblower  or  qui  tam  actions, 
against individuals or entities for knowingly presenting, or causing to be presented, to the federal government, claims 
for payment that are false or fraudulent or making a false statement to avoid, decrease or conceal an obligation to 
pay  money  to  the  federal  government.  In  addition,  the  government  may  assert  that  a  claim  including  items  and 
services resulting from a violation of the federal Anti-Kickback Statute constitutes a false or fraudulent claim for 
purposes of the FCA;  

•  HIPAA, which imposes criminal and civil liability for executing a scheme to defraud any healthcare benefit program 
or making false statements relating to healthcare matters. Similar to the federal Anti-Kickback Statute, a person or 
entity does not need to have actual knowledge of the statute to defraud any healthcare benefit program or specific 
intent to violate it in order to have committed a violation;  

•  HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009 and its 
implementing  regulations,  which  also  imposes  obligations  on  certain  covered  entity  healthcare  providers,  health 
plans, and healthcare clearinghouses as well as their business associates that perform certain services involving the 
use or disclosure of individually identifiable health information, including mandatory contractual terms, with respect 
to safeguarding the privacy, security and transmission of individually identifiable health information;  
federal laws requiring drug manufacturers to report information related to payments and other transfers of value made 
to physicians and other healthcare providers, as well as ownership or investment interests held by physicians and 
their  immediate family  members,  including  under  the  federal  Open  Payments  program,  commonly  known  as  the 
Sunshine Act, as well as other state and foreign laws regulating marketing activities; and  

• 

46 

  
 
 
 
 
 
• 

state and foreign equivalents of each of the above laws, including state anti-kickback and false claims laws, which 
may apply to sales or marketing arrangements and claims involving healthcare items or services reimbursed by non-
governmental payors, including private insurers; state laws which require pharmaceutical companies to comply with 
the pharmaceutical industry's voluntary compliance guidelines and the relevant compliance guidance promulgated 
by the federal government or otherwise restricting payments that may be made to healthcare providers; and state and 
foreign laws governing the privacy and security of health information in certain circumstances, many of which differ 
from each other in significant ways and often are not preempted by HIPAA, thus complicating compliance efforts.  

Efforts  to  ensure  that  our  business  arrangements  with  third  parties  will  comply  with  applicable  healthcare  laws  and 
regulations  will  involve  substantial  costs.  Nonetheless,  it  is  possible  that  governmental  authorities  will  conclude  that  our 
business practices may not comply with current or future statutes, regulations or case law involving applicable fraud and abuse 
or  other  healthcare  laws  and regulations.  If  our  operations  are  found  to  be  in violation of  any  of  these  laws  or  any other 
governmental regulations that may apply to us, we may be subject to significant civil, criminal and administrative penalties, 
damages, fines, imprisonment, exclusion from participation in government funded healthcare programs, such as Medicare and 
Medicaid, and the curtailment or restructuring of our operations. 

Any future litigation against us could be costly and time-consuming to defend.  

Innovative drug development is highly litigious, and we may become subject, from time to time, to legal proceedings, 
claims and allegations that arise in the ordinary course of business or pursuant to governmental or regulatory enforcement 
activity. Regardless of merit, any lawsuits against us, individually or in the aggregate, may have a material adverse effect on 
our business, financial condition, results of operations or cash flows. In addition, any litigation to which we subsequently 
become a party might result in substantial costs and divert management's attention, time and resources, which might seriously 
harm our business, financial condition, results of operations and cash flows. Our insurance policies might not cover such 
claims, might not provide sufficient payments to cover all of the costs to resolve one or more such claims, and might not 
continue to be available on terms acceptable to us. In particular, any claim could result in potential liability for us if the claim 
is outside the scope of the indemnification agreement we have with our third-party partners, or our third-party partners do not 
abide by the indemnification agreement as required, or the liability exceeds the amount of any applicable indemnification 
limits  or  available  insurance  coverage.  A  claim  brought  against  us  that  is  uninsured  or  underinsured  could  result  in 
unanticipated costs and could have a material adverse effect on our financial condition, results of operations, cash flows or 
reputation. 

A recent federal court ruling may mandate significant new disclosure requirements for clinical data dating back over a 
decade which may lead to costly or burdensome disclosures. 

A recent federal court ruling may require all clinical study sponsors to report a decade’s worth of previously exempted 
clinical study data to the federal government for publication on ClinicalTrials.gov. In February 2020, the U.S. District Court 
for the Southern District of New York invalidated a prior interpretation of NIH regulations that had exempted many clinical 
studies  conducted  between  2007  and  2017  from  reporting  requirements  mandated  by  the  Food  and  Drug  Administration 
Amendments Act. If this court ruling takes effect without appeal, or if it is upheld on appeal, it could require us to submit an 
onerous amount of old clinical data to the federal government. In many cases, we were the responsible party for generating 
such clinical data, but such prior data may be difficult or not feasible for us to access as a result of our strategic shift  away 
from analgesic drug development in 2019.  We may no longer have control over, or access to, prior clinical data that we may 
legally be required to report to NIH in the future.  Furthermore, it is unclear whether such new disclosure requirements apply 
to inactive, failed or abandoned drug development programs. As a result of these uncertainties, the government’s recent ruling 
may leave us in a conflicted position or out of compliance with new disclosure requirements.  We currently do not and cannot 
understand or anticipate the full impact and potential implications of this court ruling on our business. 

Risks Related to Our Intellectual Property  

If we are unable to obtain and maintain sufficient patent protection for any product candidates we develop, our competitors 
could develop and commercialize products similar or identical to ours, and our ability to successfully commercialize any 
product candidates we may develop may be adversely affected.  

47 

  
 
 
 
 
 
 
 
 
Our success depends in large part on our ability to obtain and maintain patent protection in the U.S. and other countries 
with respect to our proprietary product candidates and other technologies we may develop. We seek to protect our proprietary 
position by filing patent applications in the U.S. and abroad relating to our core programs and product candidates, as well as 
other technologies that are important to  our business. Given that the development of our product candidates is at an early 
stage, our intellectual property portfolio with respect to certain aspects of our product candidates is also at an early stage. For 
example, we have filed or intend to file patent applications on aspects of our technology and core product candidates; however, 
there can be no assurance that any such patent applications will issue as granted patents. Furthermore, in some cases, we have 
only  filed  provisional  patent  applications  on  certain  aspects  of  our  technology  and  product  candidates  and  each  of  these 
provisional patent applications is not eligible to become an issued patent until, among other things, we file a non-provisional 
patent application within 12 months of the filing date of the applicable provisional patent application. Any failure to file a 
non-provisional patent application within this timeline could cause us to lose the ability to obtain patent protection for the 
inventions disclosed in the associated provisional patent applications.  

Furthermore,  in  some  cases,  we  may  not  be  able  to  obtain  issued  claims  covering  compositions  relating  to  our  core 
programs and product candidates, as well as other technologies that are important to our business, and instead may need  to 
rely on filing patent applications with claims covering a method of use and/or method of manufacture for protection of such 
core programs, product candidates, and other technologies. There can be no assurance that any such patent applications will 
issue as granted patents, and even if they do issue, such patent claims may be insufficient to prevent third parties, such as our 
competitors,  from  utilizing  our  technology.  Any  failure  to  obtain  or  maintain  patent  protection  with  respect  to  our  core 
programs  and  product  candidates  could  have  a  material  adverse  effect  on  our  business,  financial  condition,  results  of 
operations, and growth prospects.  

U.S. intellectual property rights around diagnostic methods is a complex, evolving area of law and effective patent claims 
may not be available to us for our investigational diagnostic product candidate, SavaDx, in the United States. 

The legal system for intellectual property around diagnostic methods is highly complex, remains uncertain and continues 
to evolve. In the U.S., patent courts have struggled to define a clear means of patent eligibility for modern age diagnostics. 
Case law interpretations from the U.S. Supreme Court has left certain important scientific advances in the area of diagnostics 
without effective patent claims. In 2012, the Supreme Court held that a simple process involving correlations between blood 
test results and patient health is not eligible for patent claims because such processes incorporate “laws of nature”. Since then, 
different outcomes from different courts, including Federal Circuit, district court and Patent Trial and Appeal Board decisions, 
have continued to create a sometimes vague or conflicting legal framework for determining the eligibility of patent claims for 
diagnostic methods. As a result, we cannot be certain how SavaDx fits into the current U.S. legal framework for obtaining 
effective  patent  claims.  We  currently  have  no  U.S.  patents  or  patent  applications  with  respect  to  SavaDx,  and  it  is  only 
protected in the United States by trade secrets, know-how and other proprietary rights technology. Furthermore, claims for 
diagnostic methods can be complicated to enforce. For patent infringement to occur with a protected diagnostic, the patented 
method must generally either be performed by one person in its entirety or performed by multiple parties all under the control 
or  direction  of  a  single  party.  Accordingly,  even  if  effective  patent  claims  are  issued  for  SavaDx,  it  may  be  impractical, 
impossible or even undesirable to enforce potential infringement claims. 

48 

  
 
 
 
 
Issued  patents  covering  our  product  candidates  and  other  technologies  could  be  found  invalid  or  unenforceable  if 
challenged in court or before administrative bodies in the U.S. or abroad.  

If  we  initiated  legal  proceedings  against  a  third  party  to  enforce  a  patent  covering  our  product  candidates  or  other 
technologies, the defendant could counterclaim that such patent is invalid or unenforceable. In patent litigation in the U.S., 
defendant counterclaims alleging invalidity or unenforceability are commonplace. Grounds for a validity challenge could be 
an alleged failure to meet any of several statutory requirements, including lack of novelty, obviousness, or non-enablement. 
Grounds  for  an  unenforceability  assertion  could  be  an  allegation  that  someone  connected  with  prosecution  of  the  patent 
withheld relevant information from the USPTO, or made a misleading statement, during prosecution. Third parties may raise 
claims challenging the validity or enforceability of our patents before administrative bodies in the U.S. or abroad, even outside 
the  context  of  litigation.  Such  mechanisms  include  re-examination,  post-grant  review,  inter  partes  review,  interference 
proceedings, derivation proceedings, and equivalent proceedings in foreign jurisdictions (e.g., opposition proceedings). Such 
proceedings could result in the revocation of, cancellation of, or amendment to our patents in such a way that they no longer 
cover our product candidates or other technologies. The outcome following legal assertions of invalidity and unenforceability 
is unpredictable. With respect to the validity question, for example, we cannot be certain that there is no invalidating prior art, 
of which we or our licensing partners and the patent examiner were unaware during prosecution. If a third party were to prevail 
on a legal assertion of invalidity or unenforceability, we would lose at least part, and perhaps all, of the patent protection on 
our product candidates or other technologies. Such a loss of patent protection would have a material adverse impact on our 
business, financial condition, results of operations, and growth prospects.  

If we do not obtain patent term extension and data exclusivity for any product candidates we may develop, our business 
may be materially harmed.  

Depending upon the timing, duration, and specifics of any FDA marketing approval of any product candidates we may 
develop, one or more of our U.S. patents may be eligible for limited patent term extension under the Drug Price Competition 
and Patent Term Restoration Act of 1984 (Hatch-Waxman Act). The Hatch-Waxman Act permits a patent term extension of 
up to five years as compensation for patent term lost during FDA regulatory review process. A patent term extension cannot 
extend the remaining term of a patent beyond a total of 14 years from the date of product approval, only one patent may be 
extended and only those claims covering the approved drug, a method for using it, or a method for manufacturing it may be 
extended. Similar extensions as compensation for patent term lost during regulatory review processes are also available in 
certain foreign countries and territories, such as in Europe under a Supplementary Patent Certificate. However, we may not 
be granted an extension in the U.S. and/or foreign countries and territories because of, for example, failing to exercise due 
diligence during the testing phase or regulatory review process, failing to apply within applicable deadlines, failing to apply 
prior to expiration of relevant patents, or otherwise failing to satisfy applicable requirements. Moreover, the applicable time 
period  or  the  scope  of patent  protection  afforded  could be  less  than  we  request.  If  we  are  unable  to  obtain  a  patent term 
extension or the term of any such extension is shorter than what we request, our competitors may obtain approval of competing 
products following our patent expiration, and our business, financial condition, results of operations, and growth prospects 
could be materially harmed.  

If we are unable to protect the confidentiality of our trade secrets, our business and competitive position would be harmed.  

In  addition  to  seeking  patents  for  our  product  candidates  and  other  technologies,  we  also  rely  on  trade  secrets  and 
confidentiality agreements to protect our unpatented know-how, technology, and other proprietary information and to maintain 
our competitive position. We consider trade secrets and know-how to be one of our primary sources of intellectual property. 
Trade  secrets  and  know-how  can  be  difficult  to  protect.  We  expect  our  trade  secrets  and  know-how  to  over  time  be 
disseminated  within  the  industry  through  independent  development,  the  publication  of  journal  articles  describing  the 
methodology, and the movement of personnel from academic to industry scientific positions.  

We  seek  to  protect  these  trade  secrets  and  other  proprietary  technology,  in  part,  by  entering  into  non-disclosure  and 
confidentiality agreements with parties who have access to them, such as our employees, corporate  collaborators, outside 
scientific collaborators, CROs, CDMOs, consultants, advisors, and other third parties. We also enter into confidentiality and 
invention or patent assignment agreements with our employees and consultants as well as train our employees not to bring or 
use proprietary information or technology from former employers to us or in their work, and remind former employees when 
they  leave  their  employment  of  their  confidentiality  obligations.  We  cannot  guarantee  that  we  have  entered  into  such 
agreements with each party that may have or have had access to our trade secrets or proprietary technology and processes. 
Despite our efforts, any of these parties may breach the agreements and disclose our proprietary information, including our 

49 

  
 
 
 
 
 
 
trade secrets, and we may not be able to obtain adequate remedies for such breaches. Enforcing a claim that a party illegally 
disclosed or misappropriated a trade secret is difficult, expensive, and time-consuming, and the outcome is unpredictable. In 
addition, some courts inside and outside the U.S. are less willing or unwilling to protect trade secrets. If any of our trade 
secrets were to be lawfully obtained or independently developed by a competitor or other third party, we would have no right 
to prevent them from using that technology or information to compete with us. If any of our trade secrets were to be disclosed 
to or independently developed by a competitor or other third party, our competitive position would be materially and adversely 
harmed.  

If any of our patent applications do not issue as patents in any jurisdiction, we may not be able to compete effectively.  

Changes in either the patent laws or their interpretation in the U.S. and other countries may diminish our ability to protect 
our inventions, obtain, maintain, and enforce our intellectual property rights and, more generally, could affect the value of our 
intellectual property or narrow the scope of our patents with respect to our product candidates. With respect to our intellectual 
property related to our product candidates, we cannot predict whether the patent applications we are currently pursuing will 
issue as patents in any particular jurisdiction or whether the claims of any issued patents will provide sufficient protection 
from competitors or other third parties.  

The patent prosecution process is expensive, time-consuming, and complex, and we may not be able to file, prosecute, 
maintain, or enforce all necessary or desirable patent applications at a reasonable cost or in a timely manner. It is also possible 
that we will fail to identify patentable aspects of our research and development output in time to obtain patent protection. 
Although  we  enter  into  nondisclosure  and  confidentiality  agreements  with  parties  who  have  access  to  confidential  or 
patentable aspects of our research and development output, such as our employees, outside scientific collaborators, CROs, 
CDMOs,  consultants,  advisors,  and other  third  parties,  any  of  these  parties  may breach the  agreements  and  disclose  such 
output before a patent application is filed, thereby jeopardizing our ability to seek patent protection. In addition, our ability to 
obtain and maintain valid and enforceable patents depends on whether the differences between our inventions and the prior 
art allow our inventions to be patentable. Furthermore, publications of discoveries in the scientific literature often lag behind 
the actual discoveries, and patent applications in the U.S. and other jurisdictions are typically not published until 18 months 
after filing, or in some cases not at all. Therefore, we cannot be certain that we were the first to make the inventions claimed 
in any of our patents or pending patent applications, or that we were the first to file for patent protection of such inventions.  

If the scope of any patent protection we obtain is not sufficiently broad, or if we lose any of our patent protection, our 
ability to prevent our competitors from commercializing similar or identical technology and product candidates would be 
adversely affected.  

The patent position of biotechnology and pharmaceutical companies generally is highly uncertain, involves complex legal 
and factual questions, and has been the subject of much litigation in recent years. As a result, the issuance, scope, validity, 
enforceability, and commercial value of our patent rights are highly uncertain. Our pending and future patent applications may 
not result in patents being issued which protect our product candidates or other technologies or which effectively prevent 
others from commercializing competitive technologies and product candidates.  

Moreover, the coverage claimed in a patent application can be significantly reduced before the patent is issued, and its 
scope can be reinterpreted after issuance. Even if patent applications we own currently or in the future issue as patents, they 
may not issue in a form that will provide us with any meaningful protection, prevent competitors or other third parties from 
competing with us, or otherwise provide us with any competitive advantage. Any patents to which we have rights may be 
challenged,  narrowed,  circumvented,  or  invalidated  by  third  parties.  Consequently,  we  do  not  know  whether  product 
candidates or other technologies will be protectable or remain protected by valid and enforceable patents. Our competitors or 
other third parties may be able to circumvent our patents by developing similar or alternative technologies or products in a 
non-infringing manner which could materially adversely affect our business, financial condition, results of operations and 
growth prospects.  

The issuance of a patent is not conclusive as to its inventorship, scope, validity, or enforceability, and our patents may be 
challenged in the courts or patent offices in the U.S. and abroad. We may be subject to a third-party pre-issuance submission 
of  prior  art  to  the  United  States  Patent  and  Trademark  Office  (USPTO)  or  become  involved  in  opposition,  derivation, 
revocation,  reexamination,  post-grant  and  inter  partes  review,  or  interference  proceedings  or  other  similar  proceedings 
challenging our patent rights. An adverse determination in any such submission, proceeding, or litigation could reduce the 
scope of, or invalidate or render unenforceable, such patent rights, allow third parties to commercialize our product candidates 

50 

  
 
 
 
 
 
 
 
or  other  technologies  and  compete  directly  with  us,  without  payment  to  us,  or  result  in  our  inability  to  manufacture  or 
commercialize products without infringing third-party patent rights. Moreover, we may have  to participate  in interference 
proceedings  declared  by  the  USPTO  to  determine  priority  of  invention  or  in  post-grant  challenge  proceedings,  such  as 
oppositions in a foreign patent office, that challenge our priority of invention or other features of patentability with respect to 
our patents and patent applications. Such challenges may result in loss of patent rights, loss of exclusivity, or in patent claims 
being narrowed, invalidated, or held unenforceable, which could limit our ability to stop others from using or commercializing 
similar or identical technology and products, or limit the duration of the patent protection of our product candidates and other 
technologies.  Such  proceedings  also  may  result  in  substantial  cost  and  require  significant  time  from  our  scientists  and 
management, even if the eventual outcome is favorable to us. If we are unsuccessful in any such proceeding or other priority 
or inventorship dispute, we may be required to obtain and maintain licenses from third parties, including parties involved in 
any  such  interference  proceedings  or  other  priority  or  inventorship  disputes.  Such  licenses  may  not  be  available  on 
commercially reasonable terms or at all or may be non-exclusive. If we are unable to obtain and maintain such licenses, we 
may need to cease the development, manufacture, and commercialization of one or more of the product candidates we may 
develop. The loss of exclusivity or the narrowing of our owned and licensed patent claims could limit our ability to stop others 
from using or commercializing similar or identical technology and products.  

In  addition,  given  the  amount  of  time  required  for  the  development,  testing,  and  regulatory  review  of  new  product 
candidates,  patents  protecting  such  product  candidates  might  expire  before  or  shortly  after  such  product  candidates  are 
commercialized.  As  a  result,  our  intellectual  property  may  not  provide  us  with  sufficient  rights  to  exclude  others  from 
commercializing products similar or identical to ours.  

We may not be able to protect our intellectual property and proprietary rights throughout the world.  

Filing, prosecuting, and defending patents on our product candidates and other technologies in all countries throughout 
the world would be prohibitively expensive, and the laws of foreign countries may not protect our rights to the same extent as 
the laws of the U.S.  

Consequently, we may not be able to prevent third parties from practicing our inventions in all countries outside the U.S., 
or from selling or importing products made using our inventions in and into the U.S. or other jurisdictions. Competitors may 
use our technologies in jurisdictions where we have not obtained patent protection to develop their own products, and, further, 
may export otherwise infringing products to territories where we have patent protection, but enforcement is not as strong as 
that in the U.S. These products may compete with our products, and our patents or other intellectual property rights may not 
be effective or sufficient to prevent them from competing.  

Many companies have encountered significant problems in protecting and defending intellectual property rights in foreign 
jurisdictions. The legal systems of certain countries, particularly certain developing countries, do not favor the enforcement 
of patents, trade secrets, and other intellectual property protection, particularly those relating to biotechnology products, which 
could make it difficult for us to stop the infringement of our patents or marketing of competing products in violation of our 
intellectual property and proprietary rights generally. Proceedings to enforce our intellectual property and proprietary rights 
in foreign jurisdictions could result in substantial costs and divert our efforts and attention from other aspects of our business, 
could put  our patents  at  risk of  being  invalidated or  interpreted  narrowly,  could  put  our  patent  applications  at  risk  of  not 
issuing, and could provoke third parties to assert claims against us. We may not prevail in any lawsuits that we initiate, and 
the damages or other remedies awarded, if any, may not be commercially meaningful. Accordingly, our efforts to enforce our 
intellectual property and proprietary rights around the world may be inadequate to obtain a significant commercial advantage 
from the intellectual property that we develop or license.  

Obtaining and maintaining our patent protection depends on compliance with various procedural, document submission, 
fee payment, and other requirements imposed by government patent agencies, and our patent protection could be reduced 
or eliminated for non-compliance with these requirements.  

Periodic maintenance fees, renewal fees, annuity fees, and various other government fees on patents and applications will 
be due to be paid to the USPTO and various government patent agencies outside of the U.S. over the lifetime of our owned or 
licensed patents and applications. The USPTO and various non-U.S. government agencies require compliance with several 
procedural, documentary, fee payment, and other similar provisions during the patent application process. In some cases, an 
inadvertent lapse can be cured by payment of a late fee or by other means in accordance with the applicable rules. There are 
situations, however, in which non-compliance can result in abandonment or lapse of the patent or patent application, resulting 

51 

  
 
 
 
 
 
 
 
in a partial or complete loss of patent rights in the relevant jurisdiction. In such an event, potential competitors might be able 
to enter the market with similar or identical products or technology, which could have a material adverse effect on our business, 
financial condition, results of operations, and growth prospects. 

Changes in U.S. patent law could diminish the value of patents in general, thereby impairing our ability to protect our 
products.  

Changes in either the patent laws or interpretation of the patent laws in the U.S. could increase the uncertainties and costs 
surrounding the prosecution of patent applications and the enforcement or defense of issued patents. Assuming that other 
requirements for patentability are met, prior to March 2013, in the U.S., the first to invent the claimed invention was entitled 
to the patent, while outside the U.S., the first to file a patent application was entitled to the patent. After March 2013, under 
the Leahy-Smith America Invents Act (the America Invents Act) enacted in September 2011, the U.S. transitioned to a first 
inventor to file system in which, assuming that other requirements for patentability are met, the first inventor to file a patent 
application will be entitled to the patent on an invention regardless of whether a third party was the first to invent the claimed 
invention.  A  third  party  that  files  a  patent  application  in  the  USPTO  after  March  2013,  but  before  us  could  therefore  be 
awarded a patent covering an invention of ours even if we had made the invention before it was made by such third party. 
This will require us to be cognizant going forward of the time from invention to filing of a patent application. Since patent 
applications in the U.S. and most other countries are confidential for a period of time after filing or until issuance, we cannot 
be certain that we were the first to either (i) file any patent application related to our product candidates or other technologies 
or (ii) invent any of the inventions claimed in our patents or patent applications.  

The America Invents Act also includes a number of significant changes that affect the way patent applications will be 
prosecuted and also may affect patent litigation. These include allowing third party submission of prior art to the USPTO 
during  patent  prosecution  and  additional  procedures  to  attack  the  validity  of  a  patent  by  USPTO  administered  post-grant 
proceedings, including post-grant review, inter partes review, and derivation proceedings. Because of a lower evidentiary 
standard in USPTO proceedings as compared to the evidentiary standard in U.S. federal courts necessary to invalidate a patent 
claim, a third party could potentially provide evidence in a USPTO proceeding sufficient for the USPTO  to hold a claim 
invalid even though the same evidence would be insufficient to invalidate the claim if first presented in a district court action. 
Accordingly, a third party may attempt to use the USPTO procedures to invalidate our patent claims that would not have been 
invalidated if first challenged by the third party as a defendant in a district court action. Therefore, the America Invents  Act 
and its implementation could increase the uncertainties and costs surrounding the prosecution of our patent applications and 
the enforcement or defense of our issued patents, all of which could have a material adverse effect on our business, financial 
condition, results of operations, and growth prospects.  

In  addition,  the  patent  positions  of  companies  in  the  development  and  commercialization  of  pharmaceuticals  are 
particularly uncertain. Recent U.S. Supreme Court rulings have narrowed the scope of patent protection available in certain 
circumstances  and  weakened  the  rights  of  patent  owners  in  certain  situations.  This  combination  of  events  has  created 
uncertainty with respect to the validity and enforceability of patents, once obtained. Depending on future actions by the U.S. 
Congress, the federal courts, and the USPTO, the laws and regulations governing patents could change in unpredictable ways 
that could have a material adverse effect on our existing patent portfolio and our ability to protect and enforce our intellectual 
property in the future.  

We may be subject to claims challenging the inventorship of our patents and other intellectual property.  

We may be subject to claims that former employees, scientific collaborators or other third parties have an interest in our 
patents, trade secrets, or other intellectual property as an inventor or co-inventor. For example, we may have inventorship 
disputes arise from conflicting obligations of employees, consultants, or others who are involved in developing our product 
candidates  or  other  technologies.  Litigation  may  be  necessary  to  defend  against  these  and  other  claims  challenging 
inventorship or ownership of our patents, trade secrets, or other intellectual property. If the defense of any such claims fails, 
in addition to paying monetary damages, we may lose valuable intellectual property rights, such as exclusive ownership of, 
or  right  to  use,  intellectual  property  that  is  important  to  our  product  candidates  and  other  technologies.  Even  if  we  are 
successful in defending against such claims, litigation could result in substantial costs and be a distraction to management and 
other employees. Any of the foregoing could have a material adverse effect on our business, financial condition, results of 
operations, and growth prospects.  

We may not be successful in obtaining necessary rights to our product candidates or other technologies.  

52 

  
 
 
 
 
 
 
 
Many pharmaceutical companies, biotechnology companies, and academic institutions that compete with us in the field 
of  neurodegeneration  therapy  may  have  patents  filed  and  are  likely  filing  patent  applications  potentially  relevant  to  our 
business. In order to avoid infringing these third-party patents, we may find it necessary or prudent to obtain licenses to such 
patents  from  such  third-party  intellectual  property  holders.  We  may  also  require  licenses  from  third  parties  for  certain 
technologies for use with future product candidates. In addition, with respect to any patents we co-own with third parties, we 
may wish to obtain licenses to such co-owner’s interest to such patents. However, we may be unable to secure such licenses 
or otherwise acquire any compositions, methods of use, processes, or other intellectual property rights from third parties that 
we identify as necessary for our future product candidates. The licensing or acquisition of third-party intellectual property 
rights is a competitive area, and several more established companies may pursue strategies to license or acquire third-party 
intellectual property rights that we may consider attractive or necessary. These established companies may have a competitive 
advantage over us due to their size, capital resources, and greater clinical development and commercialization capabilities. In 
addition, companies that perceive us to be a competitor may be unwilling to assign or license rights to us. We also may be 
unable to license or acquire third-party intellectual property rights on terms that would allow us to make an appropriate return 
on our investment or at all. If we are unable to successfully obtain rights to required third party intellectual property rights or 
maintain the existing intellectual property rights we have, we may have to abandon development of the relevant program or 
product candidate, which could have a material adverse effect on our business, financial condition, results of operations, and 
growth prospects.  

We may be subject to claims that our employees, consultants, or advisors have wrongfully used or disclosed alleged trade 
secrets  of  their  current  or  former  employers  or  claims  asserting  ownership  of  what  we  regard  as  our  own  intellectual 
property which may prevent or delay the development of our product candidates.  

The field of developing innovations for neurodegenerative diseases is highly competitive and dynamic. Due to the focused 
research and development that is taking place by several companies, including us and our competitors, the intellectual property 
landscape in this field is in flux, and it may remain uncertain in the future. Additionally, no products utilizing our underlying 
science and technology have yet reached the market. As such, there may be significant intellectual property related litigation 
and proceedings relating to our, and other third party, intellectual property and proprietary rights in the future.  

Many of our employees, consultants, and advisors are currently or were previously employed at universities or other 
biotechnology or pharmaceutical companies, including our competitors and potential competitors. Although we try to ensure 
that our employees, consultants, and advisors do not use the proprietary information or know-how of others in their work for 
us, we  may be subject to claims that we  or these individuals have used or disclosed intellectual property, including trade 
secrets or other proprietary information, of any such individual’s current or former employer. Litigation may be necessary to 
defend against these claims. If we fail in defending any such claims, in addition to paying monetary damages, we may lose 
valuable intellectual property rights or personnel. Even if we are successful in defending against such claims, litigation could 
result in substantial costs and be a distraction to management.  

In addition, while it is our policy to require our employees and contractors who may be involved in the conception or 
development of intellectual property to execute agreements assigning such intellectual property to us, we may be unsuccessful 
in executing such an agreement with each party who, in fact, conceives or develops intellectual property that we regard as our 
own. The assignment of intellectual property rights may not be self-executing, or the assignment agreements may be breached, 
and we may be forced to bring claims against third parties, or defend claims that they may bring against us, to determine the 
ownership of what we regard as our intellectual property. Such claims could have a material adverse effect on our business, 
financial condition, results of operations, and growth prospects.  

Our commercial success depends in part on our ability to develop, manufacture, market, and sell any product candidates 
that we  develop and to use our proprietary technologies without infringing, misappropriating, and otherwise violating the 
patents and other intellectual property rights of third parties. There is a substantial amount of complex litigation involving 
patents and other intellectual property rights in the biotechnology and pharmaceutical industries, as well as administrative 
proceedings for challenging patents, including interference, derivation, and reexamination proceedings before the USPTO or 
oppositions and other comparable proceedings in foreign jurisdictions. We may become party to, or threatened with, such 
actions in the future, regardless of their merit. As discussed above, recently, due to changes in U.S. law referred to as patent 
reform, new procedures including inter partes review and  post-grant review have been implemented. As stated above, this 
reform adds uncertainty to the possibility of challenge to our patents in the future.  

53 

  
 
 
 
 
 
 
 
Numerous U.S. and foreign issued patents and pending patent applications owned by third parties exist in  the fields in 
which we are developing our product candidates. As the biotechnology and pharmaceutical industries expand and more patents 
are issued, the risk increases that our product candidates and other technologies may give rise to claims of infringement of the 
patent rights of others. Although we believe that we do not infringe on any third parties’ patents or other intellectual property, 
we  cannot assure you that our product candidates and other technologies that we  have developed, are developing or may 
develop in the future will not infringe existing or future patents owned by third parties. We may not be aware of patents that 
have already been issued to a third party, such as a competitor in the fields in which we are developing product candidates, 
who  might  assert  infringement  of  patents  it  may  hold  by  our  current  or  future  product  candidates  or  other  technologies, 
including claims to compositions, formulations, methods of manufacture or methods of use or treatment that cover our product 
candidates or other technologies. It is also possible that patents owned by third parties of which we are aware, but which we 
do not believe are relevant to our product candidates or other technologies, could be found to be infringed by our product 
candidates or other technologies. In addition, because patent applications can take many years to issue, there may be currently 
pending  patent  applications  that  may  later  result  in  issued  patents  that  our  product  candidates  or  other  technologies  may 
infringe.  

Engaging  in  litigation  to  defend  against  third  parties  alleging  that  we  have  infringed,  misappropriated,  or  otherwise 
violated their patents or other intellectual property rights is very expensive, particularly for a company of our size, and time-
consuming.  Some  of  our  competitors  may  be  able  to  sustain  the  costs  of  litigation  or  administrative  proceedings  more 
effectively  than  we  can  because  of  greater  financial  resources.  Patent  litigation  and  other  proceedings  may  also  absorb 
significant  management  time.  Uncertainties  resulting  from  the  initiation  and  continuation  of  patent  litigation  or  other 
proceedings against us could impair our ability to compete in the marketplace. The occurrence of any of the foregoing could 
have a material adverse effect on our business, financial condition, results of operations, and growth prospects.  

We may become involved in lawsuits to protect or enforce our patents and other intellectual property rights, which could 
be expensive, time consuming, and unsuccessful.  

Competitors may infringe on our patents or the patents of our licensing partners, or we may be required to defend against 
claims  of  infringement.  In  addition,  our  patents  or  the  patents  of  our  licensing  partners  also  may  become  involved  in 
inventorship, priority, or validity disputes. To counter or defend against such claims can be expensive and time consuming. 
In an infringement proceeding, a court may decide that a patent in which we have an interest is invalid or unenforceable, the 
other party’s use of our patented technology falls under the safe harbor to patent infringement, or may refuse to stop the other 
party from using the technology at issue on the grounds that our patents do not cover the technology in question. An adverse 
result in any litigation proceeding could put one or more of our patents at risk of being invalidated or interpreted narrowly. 
Furthermore, because of the substantial amount of discovery required in connection with intellectual property litigation, there 
is a risk that some of our confidential information could be compromised by disclosure during this type of litigation.  

Even if resolved in our favor, litigation or other legal proceedings relating to intellectual property claims may cause us to 
incur significant expenses and could distract our personnel from their normal responsibilities. In addition, there could be public 
announcements of the results of hearings, motions, or other interim proceedings or developments, and if securities analysts or 
investors perceive these results to be negative, it could have a substantial adverse effect on the price of our common stock. 
Such  litigation  or  proceedings  could  substantially  increase  our  operating  losses  and  reduce  the  resources  available  for 
development activities or any future sales, marketing, or distribution activities. We may not have sufficient financial or other 
resources to conduct such litigation or proceedings adequately. Some of our competitors may be able to sustain the costs of 
such litigation or proceedings more effectively than we can because of their greater financial resources and more mature and 
developed intellectual property portfolios. Uncertainties resulting from the initiation and continuation of patent litigation or 
other proceedings could have a material adverse effect on our ability to compete in the marketplace. 

Intellectual property rights do not necessarily address all potential threats.  

The degree of future protection afforded by our intellectual property rights is uncertain because intellectual property rights 
have limitations and may not adequately protect our business or permit us to maintain our competitive advantage. For example:  

• 

others may be able to make products that are similar to our product candidates or utilize similar technology but that 
are not covered by the claims of the patents that we may own; 

•  we might not have been the first to make the inventions covered by the issued patent or pending patent application 

that we own now or in the future; 

54 

  
 
 
 
 
 
 
 
•  we might not have been the first to file patent applications covering certain of our inventions; 
• 

others may independently develop similar or alternative technologies or duplicate any of our technologies without 
infringing our owned intellectual property rights; 
it is possible that our current or future pending patent applications will not lead to issued patents; 
issued patents that we hold rights to may be held invalid or unenforceable, including as a result of legal challenges 
by our competitors or other third parties; 
our competitors or other third parties might conduct research and development activities in countries where we do 
not have patent rights and then use the information learned from such activities to develop competitive products for 
sale in our major commercial markets; 

• 
• 

• 

•  we may not develop additional proprietary technologies that are patentable; 
• 
•  we may choose not to file a patent in order to maintain certain trade secrets or know-how, and a third party may 

the patents of others may harm our business; and 

subsequently file a patent covering such intellectual property. 

Should any of these events occur, they could have a material adverse effect on our business, financial condition, results 

of operations, and growth prospects.  

Risks Related to Our Business and Operations  

The  worldwide  outbreak  of  an  infectious  disease,  called  COVID-19,  may  materially  and  adversely  affect  our  business 
operations and our ability to conduct clinical studies. 

A widespread outbreak of a novel infectious disease called Coronavirus Disease 2019, or COVID-19, has been declared 
by the World Health Organization to be a “public health emergency of international concern”; a national emergency by the 
President of the U.S; and a major disaster by several states in which we operate. This unprecedented spread of disease may 
affect our operations by causing a period of business disruption, including the potential interruption or halt of our clinical 
study activities and delays or disruptions in the supply of our products and product candidates, or the inability of our employees 
to continue their normal course of work due to disease, quarantine or leave requirements, or the possibility of legal claims and 
actions against us for claims of loss arising out of COVID-19. As a small company that operates with a limited number of 
employees, the impact of disease may disproportionately hurt our operations. Further, our business insurance may not provide 
coverage against economic loss or claims specifically tied to COVID-19 or any other disease.  

COVID-19 presents many challenges that are without precedent. As such, we cannot presently assess or predict all current 
and  potential  uncertainties  around  the  scope  and  severity  of  COVID-19  on  our  business  operations  with  any  meaningful 
precision. There is no assurance that COVID-19 will not have a material adverse impact on our future results. For example, 
the continued spread of COVID-19 could adversely impact our clinical study operations, including our ability to recruit and 
retain  patients  and  principal  investigators  and  site  staff  who,  as  healthcare  providers,  may  have  heightened  exposure  to 
COVID-19 if an outbreak occurs in their geography. COVID-19 could also negatively affect our manufacturing operations, 
which  could  result  in  delays  or  disruptions  in  the  supply  of  our  product  candidates. A  greater  number  of  our  employees 
working remotely during this outbreak of disease may expose us to greater risks related to cybersecurity and cyber-liability. 
Our study participants, vendors, employees, suppliers or others may allege they became sick due to our negligence. In addition, 
there could be a potential effect of a slowdown at FDA, which could result in delays of regulatory correspondence that are 
necessary  for  us  to  maintain or  advance  our product  candidates  in  clinical  studies.  Further,  the  COVID-19  outbreak may 
adversely impact our ability to file on a routine and timely basis our obligations under federal securities laws, present new 
data at annual scientific meetings and professional conferences, reach out to institutional investors through in-person meetings, 
advance simufilam in a Phase 3 efficacy program, add an international component to our clinical studies, obtain additional 
financing as needed, engage in partnering discussions or conduct other activities necessary to the success of our business. 

If we or any of the third parties with whom we engage were to experience shutdowns or other business disruptions related 
to COVID-19, our ability to conduct our business in the manner and on the timelines presently planned could be materially 
and  negatively  impacted,  which  could  have  a  material  adverse  effect  on  our  business,  results  of  operations  and  financial 
condition.   

Our reliance on third parties for both the supply and manufacture of materials for our product candidates carries the risk 
that we will not have sufficient quality or quantities of such materials or product candidates, or that such supply will not 

55 

  
 
 
 
 
be  available  to  us  at  an  acceptable  cost,  which  could  delay,  prevent,  or  impair  our  development  or  commercialization 
efforts. 

We do not have any manufacturing facilities. We currently rely on CDMOs for all of the manufacture of our materials 
for preclinical studies and clinical  studies and expect to continue to do so for preclinical studies, clinical studies, and for 
commercial supply of any product candidates that we may develop. We currently have established relationships with several 
CDMOs for the manufacturing of our product candidates. We may be unable to establish any further agreements with CDMOs 
or  to  do  so  on  acceptable  terms.  Even  if  we  are  able  to  establish  agreements  with  third-party  manufacturers,  reliance  on 
CDMOs entails additional risks, including:  

• 
• 

• 

• 

the possible breach of the manufacturing agreement by the third party; 
the possible termination or nonrenewal of the agreement by the third party at a time that is costly or inconvenient for 
us; 
reliance on the third party for regulatory compliance, quality assurance, safety, and pharmacovigilance and related 
reporting; and 
the inability to produce required volume in a timely manner and to quality standards. 

Third-party manufacturers may not be able to comply with cGMP regulations or similar regulatory requirements outside 
the U.S. Our failure, or the failure of our CDMOs, to comply with applicable regulations could result in clinical holds on our 
studies,  sanctions  being  imposed  on  us,  including  fines,  injunctions,  civil  penalties,  delays,  suspension  or  withdrawal  of 
approvals, seizures, or recalls of product candidates or product candidates, operating restrictions, and criminal prosecutions, 
any of which could significantly and adversely affect supplies of our product candidates and harm our business, financial 
condition, results of operations, and growth prospects.  

Any  product  candidates  that we  may  develop  may  compete  with  other product  candidates  and products  for  access  to 
manufacturing facilities. There are a limited number of manufacturers that operate under cGMP regulations and that might be 
capable of manufacturing for us.  

Any performance failure on the part of our existing or future third-party manufacturers could delay clinical development 
or marketing approval. If any one of our current contract manufacturers cannot perform as agreed, we may be required to 
replace  that  manufacturer  and  may  incur  added  costs  and  delays  in  identifying  and  qualifying  any  such  replacement. 
Furthermore, securing and reserving production capacity with contract manufacturers may result in significant costs.  

We also rely on third-parties for the supply of the raw materials required for the production of our product candidates, 
and we expect to continue to rely on third party manufacturers for the commercial supply of any of our product candidates for 
which we obtain marketing approval. Our current and anticipated future dependence upon others for the manufacture of any 
product  candidates  we  may  develop  may  adversely  affect  our  future  profit  margins  and  our  ability  to  commercialize  any 
medicines that receive marketing approval on a timely and competitive basis. 

We expect to grow the size and capabilities of our organization, including accessing new physical facilities, and we may 
experience difficulties in effectively managing this growth.  

As  our  development  plans  and  strategies  develop,  we  expect  to  add  a  significant  number  of  additional  managerial, 
operational,  financial,  and  other  personnel.  Future  growth  will  impose  significant  added  responsibilities  on  members  of 
management, including:  

identifying, recruiting, integrating, retaining, and motivating additional employees; 
leasing or purchasing additional physical facilities to accommodate our increasing employee headcount; 

• 
• 
•  managing our internal development efforts effectively, including the clinical and FDA review process for our current 
and future product candidates, while complying with our contractual obligations to contractors and other third parties; 
expanding our operational, financial and management controls, reporting systems, and procedures; and  

• 
•  managing increasing operational and managerial complexity. 

56 

  
 
 
 
 
 
 
 
 
 
 
Our future  financial performance and our ability to continue  to develop and, if approved, commercialize our product 
candidates will depend, in part, on our ability to effectively manage any future growth. Our management may also have to 
divert a disproportionate amount of its attention away from day-to-day activities in order to manage these growth activities.  

We  currently  rely,  and  for  the  foreseeable  future  will  continue  to  rely,  in  substantial  part  on  certain  independent 
organizations,  advisors,  and  consultants  to  provide  certain  services.  There  can  be  no  assurance  that  the  services  of  these 
independent organizations, advisors, and consultants will continue to be available to us on a timely basis when needed, or that 
we  can find qualified replacements.  In addition, if we are unable to effectively manage our outsourced activities or if the 
quality  or  accuracy  of  the  services  provided  by  consultants  is  compromised  for  any  reason,  our  clinical  studies  may  be 
extended, delayed, or terminated, and we may not be able to obtain regulatory approval of our product candidates or otherwise 
advance  our  business.  There  can  be  no  assurance  that  we  will  be  able  to  manage  our  existing  consultants  or  find  other 
competent outside contractors and consultants on economically reasonable terms, if at all.  

If  we  are  not  able  to  effectively  expand  our  organization  by  hiring  new  employees  and  expanding  our  groups  of 
consultants and contractors, we may not be able to successfully implement the tasks necessary to further develop our product 
candidates and, accordingly, may not achieve our research, development, and commercialization goals.  

Our  internal  computer  systems,  or  those  used  by  third  parties  on  whom  we  rely,  may  fail  or  suffer  other  breakdowns, 
cyberattacks, or information security breaches that could compromise the confidentiality, integrity, and availability of such 
systems and data, result in material disruptions of our development programs and business operations, risk disclosure of 
confidential, financial, or proprietary information, and affect our reputation.  

In  the  ordinary  course  of  our  business,  we  collect  and  store  sensitive  data,  including  legally  protected  patient  health 
information,  personally  identifiable  information  about  our  employees,  intellectual  property,  and  proprietary  business 
information.  We  manage  and  maintain  our  applications  and  data  utilizing  on-site  systems.  These  applications  and  data 
encompass  a  wide  variety  of  business-critical  information  including  research  and  development  information,  commercial 
information and business and financial information. Despite the implementation of security measures, our internal computer 
systems and those of our current or future Clinical Research Organizations (CROs) and other contractors and consultants may 
be vulnerable to damage from computer viruses and unauthorized access. As the cyber-threat landscape evolves, these attacks 
are growing in frequency, sophistication, and intensity, and are becoming increasingly difficult to detect. Such attacks could 
include the use of key loggers or other harmful and virulent malware, including ransomware or other denials of service, and 
can be deployed through malicious websites, the use of social engineering, and/or other means. If a breakdown, cyberattack, 
or  other  information  security  breach  were  to  occur  and  cause  interruptions  in  our  operations,  it  could  result  in  a 
misappropriation  of  confidential  information,  including  our  intellectual  property  or  financial  information,  and  a  material 
disruption  of  our  development  programs  and  our  business  operations.  For  example,  the  loss  of  clinical  study  data  from 
completed, ongoing, or future clinical studies could result in delays in our regulatory approval efforts and significantly increase 
our costs to recover or reproduce the data. Likewise, we rely on our third-party research institution collaborators for research 
and development of our product candidates and other third parties for the manufacture of our product candidates and to conduct 
clinical studies, and similar events relating to their computer systems could also have a material adverse effect on our business. 
To  the  extent  that  any  disruption  or  security  breach  were  to  result  in  a  loss  of,  or  damage  to,  our  data  or  systems,  or 
inappropriate disclosure of confidential, financial, or proprietary information, including data related to our personnel, we could 
incur  liability  or  risk  disclosure  of  confidential,  financial,  or  proprietary  information,  and  the  further  development  and 
commercialization  of  our  product  candidates  could  be  delayed.  There  can  be  no  assurance  that  we  and  our  business 
counterparties will be successful in efforts to detect, prevent, or fully recover systems or data from all breakdowns, service 
interruptions, attacks, or breaches of systems that could adversely affect our business and operations and/or result in the loss 
of critical or sensitive data, which could result in financial, legal, business, or reputational harm to us. 

Our business involves environmental risks that may result in liability for us. 

In connection with our research and development activities, we, and our collaborators and vendors, are subject to federal, 
state and local laws, rules, regulations and policies governing the use, generation, manufacture, storage, air emission, effluent 
discharge, handling and disposal of certain materials, biological specimens, chemicals and wastes. Although we believe that 
we comply with such applicable laws, regulations and policies in all material respects and have not been required to correct 
any material noncompliance, we may incur significant costs to comply with environmental and health and safety regulations 
in the future. Although we believe that our safety procedures for handling and disposing of controlled materials comply with 
the standards prescribed by state and federal regulations, accidental contamination or injury from these materials may occur. 

57 

  
 
 
 
 
 
 
In the event of such an occurrence, we could be held liable for any damages that result and any such liability could exceed our 
resources. 

Business disruptions and lack of appropriate levels of commercial insurance could seriously harm our future revenue and 
financial condition and increase our costs and expenses.  

Our  operations,  and  those  of  our  third-party  research  institution  collaborators,  CROs,  CDMOs,  suppliers,  and  other 
contractors and consultants, could be subject to earthquakes, power shortages, telecommunications failures, water shortages, 
floods, hurricanes, typhoons, fires, extreme weather conditions, disease epidemics or pandemics, such as COVID-19, a novel 
coronavirus first detected in 2019, and other natural or man-made disasters or business interruptions, for which we are partly 
or entirely uninsured. In addition, we rely on our third-party research institution collaborators for conducting research and 
development  of  our  product  candidates,  and  they  may  be  affected  by  government  shutdowns  or  withdrawn  funding.  The 
occurrence of any of these business disruptions could seriously harm our operations and financial condition and increase our 
costs and expenses. We rely on third party manufacturers to produce and process our product candidates. Our ability to obtain 
clinical supplies of our product candidates could be disrupted if the operations of these suppliers are affected by a man-made 
or natural disaster or other business interruption.  

Our  day-to-day  operations  are  located  in  a  single  office  facility  in  Austin,  Texas.  Damage  or  extended  periods  of 
interruption to our corporate, development, or research facilities could cause us to cease or delay development of some or all 
our product candidates. Our insurance might not cover losses under such circumstances and our business may be seriously 
harmed by such delays and interruption.  

Social media platforms present risks and challenges. 

As social media continues to expand, it also presents us with new challenges. The inappropriate or unauthorized use of 
our confidential information on media platforms could cause brand damage or information leakage, which would cause legal 
or regulatory problems for us. In addition, negative, inappropriate or inaccurate posts or comments about us or our product 
candidates on social media internet sites could quickly and irreversible damage our reputation, brand image and goodwill. 
Further, the accidental or intentional disclosure of non-public sensitive information by our workforce or others through media 
channels could lead to information loss or could lead to legal or regulatory problems for us.  

We expect to rely on third parties to conduct our studies and some aspects of our research, and such third parties may not 
perform satisfactorily, which could delay or harm our studies, research, and testing.  

We  substantially  rely  and  expect  to  continue  to  rely  on  third  parties,  such  as  CROs,  clinical  data  management 
organizations, medical institutions, and clinical investigators, to conduct some aspects of our research and preclinical testing 
and  our  clinical  studies.  Any  of  these  third  parties  may  terminate  their  engagements  with  us  or  be  unable  to  fulfill  their 
contractual obligations. If we need to enter into alternative arrangements, it will delay our product development activities.  

Our reliance on these third parties for research and development activities reduces our control over these activities but 
does not relieve us of our responsibilities. For example, we remain responsible for ensuring that all of our clinical studies are 
conducted in accordance with the general investigational plan and protocols for the trial. Moreover, FDA requires us to comply 
with the norms of Good Clinical Practice (GCPs) for conducting, recording, and reporting the results of clinical studies to 
assure that data and reported results are credible, reproducible, and accurate and that the rights, integrity, and confidentiality 
of study participants are protected. We also are required to register ongoing clinical studies and post the results of completed 
clinical studies on a government-sponsored database within certain timeframes. Failure to do so can result in fines, adverse 
publicity, and civil and criminal sanctions.  

If  our  third-party  vendors  do not  successfully  carry  out  their  contractual  duties,  meet  expected  deadlines,  or  conduct 
studies in accordance with regulatory requirements or our stated protocols, we will not be able to obtain, or may be delayed 
in obtaining, marketing approvals for any product candidates we may develop and will not be able to, or may be delayed in 
our efforts to, successfully commercialize our product candidates. For example, one of our vendors failed to fully comply with 
certain Good Laboratory Practice (GLP) norms in its research facility, which required us to repeat a lab study at a different 
research site. 

58 

  
 
 
 
 
 
 
 
 
 
 
We also rely on other third parties to label, store and distribute drug supplies for our clinical studies. Any performance 
failure on the part of our distributors, including with the shipment of any drug supplies, could delay clinical development or 
marketing approval of any product candidates we may develop or commercialization of our product candidates, producing 
additional losses and depriving us of potential product revenue.  

We do not own any manufacturing facilities and we rely on third-party commercial drug manufacturers for clinical drug 
supply.  

We do not own any manufacturing facilities. We plan to continue to outsource formulation, manufacturing and related 
activities. We rely on a limited number of third-party suppliers to formulate, manufacture, fill, label, ship or store all of our 
product candidates. These suppliers must comply with  current cGMP regulations enforced by FDA and other government 
agencies,  and  are  subject  to  ongoing  periodic  unannounced  inspection,  including  preapproval  inspections  by  FDA  and 
corresponding  state  and  foreign  government  agencies  to  ensure  strict  compliance  with  cGMP  and  other  government 
regulations and corresponding foreign standards. These manufacturers may subsequently be stopped from producing, storing, 
shipping or testing our drug products due to their non-compliance with federal, state or local regulations. We do not have 
control over our suppliers’ compliance with these regulations and standards. We cannot control decisions by our suppliers that 
affect their ability or willingness to continue to supply us on acceptable terms, or at all. We may not be able to replace a 
commercial  supplier  on  commercially  reasonable  terms,  or  at  all.  Replacing  any  of  our  commercial  suppliers  would  be 
expensive  and  time  consuming.  Failure  by  any  of  our  suppliers  to  perform  as  expected  could  delay  or  prevent 
commercialization of our product candidates or result in shortages, cost overruns, or other problems and would materially 
harm our business. 

We are a small company with a limited number of employees. We are highly dependent on our key personnel, and if we 
are not successful in attracting, motivating, and retaining highly qualified personnel, we may not be able to successfully 
implement our business strategy.  

Our ability to compete in the highly competitive biotechnology and pharmaceutical industries depends upon our ability 
to attract, motivate, and retain highly qualified managerial, scientific, and medical personnel. We are highly dependent on our 
management, particularly our Chief Executive Officer, Remi Barbier, and our scientific and technical personnel. The loss of 
the services provided by any of our executive officers, other key employees, and other scientific and medical advisors, and 
our inability to find suitable replacements, could result in delays in the development of our product candidates and harm our 
business.  

Competition for skilled personnel is intense and the turnover rate can be high, which may limit our ability to hire and 
retain highly qualified personnel on acceptable terms or at all. We expect that we may need to recruit talent from outside of 
our region in Austin, Texas, and doing so may be costly and difficult.  

To induce valuable employees to remain at our company, in addition to salary and cash incentives, we have provided 
equity option grants that vest over time. The value to employees of these equity grants that vest over time may be significantly 
affected by movements in our stock price that are beyond our control and may at any time be insufficient to counteract more 
lucrative offers from other companies. Although we have employment agreements with our key employees, these employment 
agreements provide for at-will employment, which means that any of our employees could leave our employment at any time, 
with or without notice. If we are unable to attract and incentivize quality personnel on acceptable terms, or at all, it may cause 
our business and operating results to suffer.  

We may need to cease our operations if we are unable to attract and retain key personnel. 

We  are engaged in developing early-stage  technologies and will continue  to do so for the  foreseeable future.  Unlike 
larger organizations, we rely on a very small number of highly skilled, and highly sought after, employees to continue the 
advancement of our development stage technologies. The knowledge and skills contributed by our key employees may be 
irreplaceable and the loss of a key employee may cause substantial negative financial, operational and scientific consequences 
for our business.  As an example, our research grant awards from NIH depend in part on the continued participation of certain 
key employees, known as a Principal Investigator. The loss of a Principal Investigator may result in the loss of one or more 
research grant awards from NIH, which would have significant adverse effects on our ability to continue to conduct, conclude 
or  fund  our  research  programs  in  Alzheimer’s  disease.  Likewise,  the  intellectual  property  that  is  intended  to  protect  our 
development stage technologies is still evolving and its evolution remains highly dependent on a small number of employees 

59 

  
 
 
 
 
 
 
 
 
with specific expertise. The loss of a key employee may jeopardize our existing or pending intellectual property or may prevent 
us  from  accessing  the  technical  information  and  knowledge  necessary  to  extend  our  portfolio  of  intellectual  property. 
Furthermore, we believe the adverse effects that may result from losing a key employee’s participation cannot be compensated 
with any specific insurance policies, such as “key person” or “business life” insurance. If we are not successful in retaining 
key employees, our business and financial condition will suffer, and we may need to cease our operations. 

If our current research collaborators or scientific advisors terminate their relationships with us or develop relationships 
with a competitor, our ability to continue our business operations could be adversely affected. 

We have relationships with research collaborators at academic and other institutions who conduct research at our request. 
These research collaborators are not our employees. As a result, we have limited control over their activities and, except as 
otherwise required by our collaboration agreements, can expect only limited amounts of their time to be dedicated to our 
activities. Our ability to discover drugs and biomarkers involved in human disease and validate and commercialize diagnostic 
tests will depend in part on the continuation of these collaborations. If any of these collaborations are terminated, we may not 
be  able  to  enter  into  other  acceptable  collaborations.  In  addition,  our  existing  collaborations  may  not  be  successful.  Our 
research collaborators and scientific advisors may have relationships with other commercial entities, some of which could 
compete with us. Our research collaborators and scientific advisors sign agreements which provide for the confidentiality of 
our proprietary information and the results of studies conducted at our request. We may not, however, be able to maintain the 
confidentiality of our technology and other confidential information related to all collaborations. The dissemination of our 
confidential information could have a material adverse effect on our business. 

Risks Related to Financial Condition and Capital Requirements  

We have incurred significant net losses in each period since our inception and anticipate that we will continue to incur net 
losses for the foreseeable future.  

We have incurred net losses in each reporting period since our inception, including a net loss of $6.3 million for the year 

ended December 31, 2020. As of December 31, 2020, we had an accumulated deficit of $174.9 million.  

We have invested significant financial resources in research and development activities for product candidates. We do 
not expect to generate revenue from product sales for several years, if at all. The amount of our future net losses will depend, 
in part, on the level of our future expenditures and revenue. Moreover, our net losses may fluctuate significantly from quarter 
to quarter and year to year, such that a period-to-period comparison of our results of operations may not be a good indicator 
of our future performance.  

We expect to continue to incur significant expenses and higher operating losses for the foreseeable future. We anticipate 

that our expenses will increase substantially as we:   

continue our research and discovery activities; 
advance our current and any future product candidates through preclinical and clinical development; 
initiate and conduct additional preclinical, clinical, or other studies for our product candidates; 

• 
• 
• 
•  work with our CDMO’s to scale up the manufacturing processes for our product candidates; 
• 
• 
• 
• 

seek regulatory approvals and marketing authorizations for our product candidates; 
obtain, maintain, protect, defend and enforce our intellectual property portfolio; 
attract, hire, and retain qualified personnel; 
provide  additional  internal  infrastructure  to  support  our  continued  research  and  development  operations  and  any 
planned commercialization efforts in the future; 
experience any delays or encounter other issues related to our operations; and 

• 
•  meet the requirements and demands of being a public company. 

Our prior losses and expected future losses have had and will continue to have an adverse effect on our stockholders’ 
equity and working capital.  In any quarter, our operating results could be below the expectations of securities analysts or 
investors, which could cause our stock price to decline. 

60 

  
 
 
 
 
 
 
 
 
 
 
We have broad discretion in the use of the net proceeds from any of our financing transactions and may not use them 
effectively.  

We have broad discretion in the application of the net proceeds from our financing transactions, and investors will not 
have the opportunity to assess whether the net proceeds are being used appropriately. We could spend the net proceeds from 
offerings in ways that vary substantially from their intended use, do not improve our results of operations or enhance the value 
of our common stock. Our failure to apply these funds effectively could result in financial losses that could have a material 
adverse effect on our business, cause the price of our common stock to decline and delay the development of our product 
candidates.  Pending  their use,  we  may  invest  the  net  proceeds  from  our  financing  transactions  in  a  manner  that  does  not 
produce income or that loses value. 

We have no product revenues and may never achieve revenues or profitability based on product revenues.  

We have no products approved for commercial sale. To obtain revenues from the sales of our product candidates that are 
significant or large enough to achieve profitability, we must succeed, either alone or with third parties, in developing, obtaining 
regulatory  approval  for,  manufacturing,  and  marketing  product  candidates  with  significant  commercial  value.  This  is  a 
significant  endeavor  that  few  early-stage  biopharmaceutical  companies  can  successfully  achieve.  Our  ability  to  generate 
revenue and achieve profitability depends on many factors, including:  

• 
• 

• 

completing research and preclinical and clinical development of our product candidates; 
obtaining  regulatory  approvals  and  marketing  authorizations  for  product  candidates  for  which  we  successfully 
complete clinical development; 
developing a sustainable and scalable manufacturing process for our product candidates, as well as establishing and 
maintaining  commercially  viable  supply  relationships  with  third  parties  that  can  provide  adequate  products  and 
services to support clinical activities and commercial demand for our product candidates; 
identifying, assessing, acquiring, and/or developing new product candidates; 
negotiating favorable terms in any collaboration, licensing, or other arrangements into which we may enter; 
addressing any competing technological and market developments; 

• 
• 
• 
•  maintaining,  protecting,  expanding,  and  enforcing  our  portfolio  of  intellectual  property  rights,  including  patents, 

trade secrets, and know-how; and  
attracting, hiring, and retaining qualified personnel. 

• 

Because of the numerous risks and uncertainties associated with drug development, we are unable to predict the timing 
or amount of our expenses, or when we will be able to generate any meaningful revenue or achieve or maintain profitability, 
if  ever.  In  addition,  our  expenses  could  increase  beyond  our  current  expectations  if  we  are  required  by  FDA  or  foreign 
regulatory agencies to perform studies in addition to those that we currently anticipate, or if there are any delays in any of our 
clinical studies or the development of any of our product candidates.  

We may require additional capital to fund our operations and to complete the development of our product candidates. A 
failure to obtain this necessary capital on acceptable terms, or at all, could force us to delay, limit, reduce, or terminate 
our commercialization efforts, product development, or other operations.  

Our  operations  have  required  substantial  amounts  of  cash  since  inception,  and  we  expect  our  expenses  to  increase 
significantly in the foreseeable future. To date, we have financed our operations primarily through the sale of equity securities, 
research  grants  and  payments  received  from  prior  third-party  collaborations.  Developing  our  product  candidates  and 
conducting  clinical  studies  for  the  treatment  of  neurodegenerative  diseases,  including  Alzheimer’s  disease,  will  require 
substantial amounts of capital. We will also require a significant amount of capital to commercialize any approved products.  

As of December 31, 2020, we had cash and cash equivalents of $93.5 million. Subsequent to December 31, 2020, we 
completed a registered direct offering of our common stock for net proceeds of approximately $189.7 million. Based on our 
current operating plan, we believe that our existing cash and cash equivalents will be sufficient to fund our projected operations 
for at least the next 12 months. Our estimate as to how long we expect our existing cash and cash equivalents to be available 
to fund our operations is based on assumptions that may prove inaccurate, and we could use our available capital resources 
sooner than we currently expect. In addition, changing circumstances may cause us to increase our spending significantly 
faster than we currently anticipate, and we may need to spend more money than currently expected because of circumstances 

61 

  
 
 
 
  
  
 
 
 
beyond our control. We may need to raise additional funds sooner than we anticipate if we choose to expand more rapidly 
than we presently anticipate.  

We may require additional capital for the further development of our product candidates. Additional capital may not be 
available  when  we  need  it,  or  on  terms  acceptable  to  us  or  at  all.  We  have  no  committed  source  of  additional  capital.  If 
adequate capital is not available to us on a timely basis, we may be required to significantly delay, limit, reduce or terminate 
our research and development programs or the commercialization of product candidates, if approved, or be unable to continue 
or expand our operations, or otherwise capitalize on our business opportunities, as desired, which could materially affect our 
business, financial condition, results of operations, and growth prospects and cause the price of our common stock to decline.  

To  the  extent  that  we  raise  additional  capital  through  the  sale  of  equity  or  convertible debt  securities,  the  ownership 
interest of our stockholders will be diluted, and the terms of these securities may include liquidation or other preferences that 
adversely  affect  your  rights  as  a  common  stockholder.  Debt  financing,  if  available,  may  involve  agreements  that  include 
covenants  limiting  or  restricting  our  ability  to  take  specific  actions,  such  as  incurring  additional  debt,  making  capital 
expenditures,  or  declaring  dividends.  If  we  raise  additional  funds  through  collaborations,  strategic  alliances,  or  licensing 
arrangements with pharmaceutical partners, we may have to relinquish valuable rights to our technologies, future revenue 
streams, research programs, or product candidates, or grant licenses on terms that may not be favorable to us.  

Global credit and financial market conditions could negatively impact the value of our portfolio of cash equivalents and 
our ability to meet our financing objectives. 

Our cash and cash equivalents are generally maintained in highly liquid investments with original maturities of 90 days 
or less at the time of purchase. While, as of the date of this filing, we are not aware of any downgrades, material losses, or 
other significant deterioration in the fair value of our cash equivalents since December 31, 2020, no assurance can be given 
that deterioration in conditions of the global credit and financial markets would not negatively impact our current portfolio of 
cash equivalents or our ability to meet our financing objectives. 

Risks Related to the Ownership of Our Common Stock  

We do not know whether a sufficient market will continue to develop for our common stock or what the market price of 
our common stock will be, and, as a result, it may be difficult for investors to sell shares of our common stock.  

If a market for our common stock is not sustained, it may be difficult to sell shares of our common stock at an attractive 
price or at all. We cannot predict the prices at which our common stock will trade. It is possible that in one or more future 
periods our results of operations and progression of our product pipeline may not meet the expectations of public market 
analysts and investors, and, as a result of these and other factors, the price of our common stock may fall.  

The market price of our common stock has historically been highly volatile, and we expect it to continue to be volatile, 
which could result in substantial losses for investors who purchase our shares.  

For example, the closing price of our common stock has fluctuated from a low of $2.04 to a high of $87.95 over the 12 
months preceding the filing date of this Form 10-K. Some of the factors that may cause the market price of our common stock 
to fluctuate include:  

• 
• 

• 
• 

• 
• 
• 
• 

the success of existing or new competitive products or technologies; 
the timing and results of clinical studies for our current product candidates and any future product candidates that we 
may develop; 
failure or discontinuation of any of our product development and research programs; 
results of preclinical studies, clinical studies, or regulatory approvals of product candidates of our  competitors, or 
announcements about new research programs or product candidates of our competitors; 
regulatory or legal developments in the United States and other countries; 
developments or disputes concerning patent applications, issued patents, or other proprietary rights; 
the recruitment or departure of key personnel; 
the level of expenses related to any of our research programs, clinical development programs, or product candidates 
that we may develop; 

62 

  
 
 
 
 
 
 
 
 
 
 
the results of our efforts to develop additional product candidates or products; 
actual or anticipated changes in estimates as to financial results or development timelines; 
announcement or expectation of additional financing efforts; 
sales of our common stock by us, our insiders, or other stockholders; 
variations in our financial results or those of companies that are perceived to be similar to us; 
changes in estimates or recommendations by securities analysts, if any, that cover our stock; 

• 
• 
• 
• 
• 
• 
•  market conditions in the pharmaceutical and biotechnology sectors; and 
• 

general economic, industry, and market conditions. 

In recent years, the stock market in general, Nasdaq, and the markets for early stage companies and pharmaceutical and 
biotechnology  companies,  has  experienced  significant  price  and  volume  fluctuations  that  have  often  been  unrelated  or 
disproportionate to changes in the operating performance of the companies whose stock is experiencing those price and volume 
fluctuations. Broad market and industry factors may seriously affect the market price of our common stock, regardless of our 
actual operating performance. Following periods of such volatility in the market price of a company’s securities, securities 
class action litigation has often been brought against that company. Because of the potential volatility of our stock price, we 
may become the target of securities litigation in the future. Securities litigation could result in substantial costs and divert 
management’s attention and resources from our business.  

If we are unable to maintain effective internal controls, our business, financial position, and results of operations could 
be adversely affected.  

As a public company, we are subject to reporting and other obligations under the Securities Exchange Act of 1934, as 
amended (Exchange Act), including the requirements of Section 404 of SOX, which require annual management assessments 
of the effectiveness of our internal control over financial reporting.  

The rules governing the standards that must be met for management to assess our internal control over financial reporting 
are complex and require significant documentation, testing and possible remediation to meet the detailed standards under the 
rules. During testing, our management may identify material weaknesses or deficiencies which may not be remedied in time 
to meet the deadline imposed by SOX. These reporting and other obligations place significant demands on our management 
and administrative and operational resources, including accounting resources.  

Our management is responsible for establishing and maintaining adequate internal control over financial reporting. Our 
internal  control  over financial  reporting  is  a process  designed  to provide  reasonable  assurance  regarding  the  reliability  of 
financial reporting and the preparation of financial statements for external purposes in accordance with accounting principles 
generally accepted in the U.S. Any failure to maintain effective internal controls could have an adverse effect on our business, 
financial position, and results of operations.  

Anti-takeover  provisions  in  our  charter  documents  and  Delaware  law  may  prevent  or  delay  removal  of  incumbent 
management or a change of control.  

Anti-takeover provisions of our amended and restated certificate of incorporation and amended and restated bylaws and 
Delaware law may have the effect of deterring or delaying attempts by our stockholders to remove or replace management, 
engage in proxy contests and effect changes in control. The provisions of our charter documents include:  

• 

• 
• 
• 
• 

a classified board so that only one of the three classes of directors on our Board of Directors (the “Board”) is elected 
each year;  
elimination of cumulative voting in the election of directors;  
procedures for advance notification of stockholder nominations and proposals;  
the ability of the Board to amend our bylaws without stockholder approval; and 
the ability of the Board to issue up to 10,000,000 shares of preferred stock without stockholder approval upon the 
terms and conditions and with the rights, privileges and preferences as the Board may determine.  

In addition, as a Delaware corporation, we are subject to Delaware law, including Section 203 of the Delaware General 
Corporation Law. In general, Section 203 prohibits a Delaware corporation from engaging in any business combination with 

63 

  
 
 
 
 
 
 
 
 
 
any interested stockholder for a period of three years following the date that the stockholder became an interested stockholder 
unless certain specific requirements are met as set forth in Section 203.  

These provisions, alone or together, could have the effect of deterring or delaying changes in incumbent management, 

proxy contests or changes in control.  

Changes in our ownership could limit our ability to utilize net operating loss carryforwards. 

As of December 31, 2020, we had aggregate federal net operating loss carryforwards of approximately $87.3 million, 
which  begin  to  expire  in  2029.  Under  Section  382  of  the  Internal  Revenue  Code  of  1986,  as  amended,  changes  in  our 
ownership may limit the amount of our net operating loss carryforwards that could be utilized annually to offset our future 
taxable income, if any. This limitation would generally apply in the event of a cumulative change in ownership of our company 
of more than 50% within a rolling three-year period. Any such limitation may significantly reduce our ability to utilize our 
net operating loss carryforwards and tax credit carryforwards. Any such limitation, whether as the result of past offerings, 
sales of our common stock by our existing stockholders or additional sales of our common stock by us in the future could 
have a material adverse effect on our results of operations in future years. We have not completed a study to assess whether 
an ownership change for purposes of Section 382 has occurred, or whether there have been multiple ownership changes since 
our inception, nor do we plan to do so due to the significant costs and complexities associated with such study. 

We may sell additional equity or debt securities to fund our operations, and have outstanding securities exercisable for our 
common stock, which may result in dilution to our stockholders and impose restrictions on our business. 

In order to raise additional capital to support our operations, we may sell additional shares of our common stock or other 

securities convertible into or exchangeable for our common stock which could result in dilution our stockholders.  

We cannot assure you that we will be able to sell shares or other securities in any other offering at a price per share that 
is equal to or greater than the price per share paid by investors in prior offerings, and investors purchasing our shares or other 
securities in the future could have rights superior to existing shareholders. The price per share at which we sell  additional 
shares of our common stock or securities convertible into or exchangeable for our common stock in future transactions may 
be higher or lower than the price per share in prior offerings. You may also be diluted upon the exercise of outstanding stock 
options as of December 31, 2020 to purchase 2,817,504 shares of our common stock at a weighted average price of $11.30 
per share, and the future issuance of up to 252,188 compensatory equity awards authorized under our 2018 Omnibus Incentive 
Plan and up to 58,017 shares we may sell under our Employee Stock Purchase Plan. 

Item 1B.     Unresolved Staff Comments 

None. 

Item 2.     Properties 

We lease approximately 6,000 square feet of office space pursuant to a non-cancelable operating lease in Austin, TX that 

expires April 30, 2024. 

Item 3.     Legal Proceedings 

From time to time, we may become involved in litigation or other legal proceedings. We are not currently a party to any 
litigation or legal proceedings that, in the opinion of our management, are likely to have a material adverse effect on our 
business.  Regardless  of  outcome,  litigation  can  have  an  adverse  impact  on  us  because  of  defense  and  settlement  costs, 
diversion of management resources, and other factors. 

Item 4.     Mine Safety Disclosures 

Not applicable. 

64 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
PART II 

Item 5.    Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities 

Market Price of Dividends of the Registrants Common Equity and Related Stockholder Matters 

Our common stock is quoted on Nasdaq, under the symbol "SAVA."  

We  currently  expect  to  retain  future  earnings,  if  any,  for  use  in  the  operation  and  expansion  of  our  business  and, 
notwithstanding  our  special  non-dividend  distributions  in  December  2012  (of  $0.75  per  share  of  common  stock  totaling 
$34.0 million) and December 2010 (of $2.00 per share of common stock totaling $85.7 million), we have not paid and do not 
anticipate paying any cash dividends in the foreseeable future. As of January 25, 2021, there were approximately 28 registered 
holders of record of our common stock.  

Item 6.    Selected Financial Data 

Not applicable. 

65 

  
 
 
 
 
 
 
 
 
Item 7.    Management’s Discussion and Analysis of Financial Condition and Results of Operations 

This discussion and analysis should be read in conjunction with our financial statements and accompanying notes included 

elsewhere in this report. Operating results are not necessarily indicative of results that may occur in future periods. 

Overview  

Cassava Sciences, Inc. is a clinical-stage biotechnology company. Our mission is to detect and treat neurodegenerative 
diseases, such as Alzheimer’s disease. Our novel science is based on stabilizing – but not removing – a critical protein in the 
brain. 

Over the past 10 years, we have combined state-of-the-art technology with new insights in neurobiology to develop novel 
solutions  for  Alzheimer’s  disease  and  other  neurodegenerative  diseases.  Our  strategy  is  to  leverage  our  unique 
scientific/clinical platform to develop a first-in-class program for treating neurodegenerative diseases, such as Alzheimer’s.  

We currently have two clinical-stage biopharmaceutical assets under development:  

• 
• 

our lead therapeutic product candidate is called simufilam, and it is a novel treatment for Alzheimer’s disease; and  
our lead investigational diagnostic product candidate is called SavaDx, and it is a novel way to detect the presence 
of  Alzheimer’s  disease  from  a  small  sample  of  blood,  possibly  years  before  the  overt  appearance  of  clinical 
symptoms. 

Our scientific approach for the treatment of Alzheimer’s disease seeks to simultaneously improve both neurodegeneration 
and neuroinflammation. We believe our ability to improve multiple vital functions in the brain represents a new, different and 
crucial approach to address Alzheimer’s disease.  

Our  lead  therapeutic  product  candidate,  simufilam,  is  a  proprietary  small  molecule  (oral)  drug.  Simufilam  targets  an 
altered form of a protein called filamin A (FLNA) in the Alzheimer’s brain. Published studies have demonstrated that the 
altered form of FLNA causes neuronal dysfunction, neuronal degeneration and neuroinflammation.   

We believe simufilam improves brain health by reverting altered FLNA back to its native, healthy conformation, thus 
countering  the  downstream  toxic  effects  of  altered  FLNA.  We  have  generated  and  published  experimental  and  clinical 
evidence of improved brain health with simufilam.  Importantly, simufilam is not dependent on clearing amyloid from the 
brain.  Since  simufilam  has  a unique  mechanism  of  action, we  believe  its  potential  therapeutic  effects  may  be  additive  or 
synergistic with that of other therapeutic candidates aiming to treat neurodegeneration. 

Simufilam  has  demonstrated  a  multitude  of  beneficial  effects  in  animal  models  of  disease,  including  normalizing 

neurotransmission, decreasing neuroinflammation, suppressing neurodegeneration, and restoring memory and cognition.   

In 2019, we completed a small, first-in-patient, clinical-proof-of-concept, open-label Phase 2a study of simufilam in the 
U.S., with substantial support from the National Institute on Aging (NIA), a division of the NIH. Treatment with simufilam 
for  28  days  significantly  improved  key  biomarkers  of  Alzheimer’s  pathology,  neurodegeneration  and  neuroinflammation 
(p<0.001). Biomarkers effects were seen in all patients in both cerebrospinal fluid (CSF) and plasma. 

In September 2020, we announced final results of a Phase 2b study with simufilam in Alzheimer’s disease. In this clinical 
study funded by the NIH, Alzheimer’s patients treated with 50 mg or 100 mg of simufilam twice-daily for 28 days showed 
statistically  significant  (p<0.05)  improvements  in  CSF  biomarkers  of  disease  pathology,  neurodegeneration  and 
neuroinflammation, versus Alzheimer’s patients who took placebo. In addition, Alzheimer’s patients treated with simufilam 
showed improvements in validated tests of episodic memory and spatial working memory, versus patients on placebo (Effect 
Size 17-46%). Cognitive improvements correlated most strongly (R2=0.5) with decreases in levels of P-tau181. 

In March 2020, we initiated a long-term open-label extension study to evaluate simufilam in patients with Alzheimer’s 
disease. This  open-label,  multi-center,  extension  study is  intended  to  monitor  the  long-term  safety  and  tolerability 
of simufilam 100 mg twice-daily for 12 or more months. The study’s initial target enrollment was approximately 100 patients 
with mild-to-moderate Alzheimer’s disease and, in February 2021, was increased to approximately 150 patients. This study 
uses  the  Alzheimer's  Disease  Assessment  Scale-Cognitive  Subscale  (ADAS-Cog-11)  to  assess  cognitive  symptoms  of 

66 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
dementia and the Neuropsychiatric Inventory (NPI) to assess the presence and severity of dementia-related behavior. Both 
scales are widely used clinical tools in trials of Alzheimer’s disease. 

On February 2, 2021, we announced results of the first of two preplanned interim analysis of our open-label study of 
simufilam. The first interim analysis summarizes clinical data at the midway point of enrollment, i.e., the first 50 patients who 
have completed at least 6 months of drug treatment.  Patients’  cognition and behavior scores both improved following six 
months of simufilam treatment, with no safety issues. Six months of simufilam treatment improved cognition scores by 1.6 
points on ADAS-Cog11, a 10% mean improvement from baseline to month 6. In these same patients, simufilam also improved 
dementia-related behavior, such as anxiety, delusions and agitation, by 1.3 points on the Neuropsychiatric Inventory, a 29% 
mean improvement from baseline to month 6.   

Based  on  the  interim  results  and  inbound  demand  from  Alzheimer’s  patients  and  their  caregivers,  we  announced 
significant changes to the open-label program, including an increase in the enrollment target by up to 50 additional patients, 
for a total target of approximately 150 patients. This study had enrolled approximately 80 patients as of February 2021. 

We  expect to announce results of a  second planned interim analysis on safety and cognition for our open-label study 
approximately  mid-2021. The  second  interim  analysis  is  intended  to  summarize  clinical data  on  the  first 50 patients  who 
complete at least 12 months of open label drug treatment. 

On February 22, 2021, we announced the successful completion of an End-of-Phase 2 (EOP2) meeting with the FDA for 
simufilam.  Official  EOP2  meeting  minutes  indicate  we  and  the  FDA  agree  on  key  elements  of  a  pivotal  Phase  3  clinical 
program in support of a New Drug Application (NDA) filing for simufilam in Alzheimer’s disease.  We believe agreements 
reached during the EOP2 meeting show a clear path forward for advancing simufilam into Phase 3 studies. We expect to 
initiate a pivotal Phase 3 program with simufilam in Alzheimer’s disease in the second half of 2021. 

Our diagnostic effort, called SavaDx, is an early-stage program focused on detecting the presence of Alzheimer’s disease 
from a small sample of blood, possibly years before the overt appearance of clinical symptoms. We are developing SavaDx 
as  a  fast,  accurate  and  quantitative  blood-based  investigational  biomarker/diagnostic  to  detect  and  monitor  Alzheimer's 
disease. The goal is to make the detection of Alzheimer’s disease as simple as getting a blood test. We expect to initiate a 
validation/disease specificity study of SavaDx in 2021.  

Financial Overview 

We  have  yet  to  generate  any  revenues  from  product  sales.  We  have  an  accumulated  deficit  of  $174.9 million  at 
December 31, 2020. These losses have resulted principally from costs incurred in connection with research and development 
activities,  salaries  and  other  personnel-related  costs  and  general  corporate  expenses.  Research  and  development  activities 
include costs of preclinical and clinical studies as well as clinical supplies associated with our product candidates. Salaries 
and other personnel-related costs include non-cash stock-based compensation associated with options and other equity awards 
granted to employees and non-employees. Our operating results may fluctuate substantially from period to period as a result 
of the timing of preclinical activities, enrollment rates of clinical studies for our product candidates and our need for clinical 
supplies. 

We believe that our cash and cash equivalents at December 31, 2020, will enable us to fund our operating expenses for 
at least the next 12 months. In addition, we may seek in the future to fund our operations through additional public or private 
equity or debt financings or other sources. However, we may be unable to raise additional funds or enter into such other 
arrangements when needed on favorable terms or at all. If we are unable to obtain financing or reach profitability, the related 
lack of liquidity will have a material adverse effect on our operations and future prospects. 

We expect to continue to use significant cash resources in our operations for the next several years. Our cash requirements 

for operating activities and capital expenditures may increase substantially in the future as we: 

• 
• 
• 
• 

initiate a large-scale manufacturing campaign for simufilam; 
plan to initiate a Phase 3 program with simufilam 
conduct other preclinical and clinical studies for our product candidates; 
seek regulatory approvals for our product candidates;  

67 

  
 
 
 
 
 
 
 
 
 
 
develop, formulate, manufacture and commercialize our product candidates;  
implement additional internal systems and develop new infrastructure; 
acquire or in-license additional products or technologies, or expand the use of our technology;  

• 
• 
• 
•  maintain, defend and expand the scope of our intellectual property; and 
• 

hire additional personnel. 

Product  revenue  will  depend on  our  ability  to  receive  regulatory  approvals  for,  and  successfully  market,  our  product 
candidates.  If  our  development  efforts  result  in  regulatory  approval  and  successful  commercialization  of  our  product 
candidates, we will generate revenue from direct sales of our drugs and/or, if we license our drugs to future collaborators, 
from  the  receipt  of  license  fees  and  royalties  from  sales  of  licensed  products.  We  conduct  our  research  and  development 
programs  through  a  combination  of  internal  and  collaborative  programs.  We  rely  on  arrangements  with  universities,  our 
collaborators, CDMOs, CROs and clinical research sites for a significant portion of our product development efforts. 

The  following  table  summarizes  expenses  which  have  been  reduced  for  reimbursements  received  for  NIH  grants  (in 

thousands):  

Research and development expenses - gross 
Less:  Reimbursement from NIH grants 
  Research and development expenses - net 

Year ended 

December 31, 

2020 

2019 

$ 

$ 

 7,292   
 4,239   
 3,053   

$ 

$ 

 6,297   
 4,729   
 1,568   

Research and development expenses include compensation, contractor fees and supplies as well as allocated common 
costs.  Contractor  fees  and  supplies  generally  include  expenses  for  preclinical  studies  and  clinical  studies  and  costs  for 
formulation  and  manufacturing  activities.  Other  common  costs  include  the  allocation  of  common  costs  such  as  facilities. 
During the year ended December 31, 2020 and 2019, we received $4.2 million and $4.7 million from research grants from the 
NIH. These reimbursements were recorded as a reduction to our research and development expenses. 

Our  technology  has  been  applied  across  certain  of  our  portfolio  of  product  candidates.  Data,  know-how,  personnel, 
clinical results, research results and other matters related to the research and development of any one of our product candidates 
also relate to, and further the development of, our other product candidates. As a result, costs allocated to a specific product 
candidate may not necessarily reflect the actual costs surrounding research and development of such product candidate due to 
cross application of the foregoing. 

Estimating  the  dates  of  completion  of  clinical  development,  and  the  costs  to  complete  development,  of  our  product 
candidates  would  be highly  speculative,  subjective  and potentially  misleading.  Pharmaceutical  products  take  a  significant 
amount of time to research, develop and commercialize. The clinical study portion of the development of a new drug alone 
usually spans several years. We expect to reassess our future research and development plans based on our review of data we 
receive  from  our  current  research  and  development  activities.  The  cost  and  pace  of  our  future  research  and  development 
activities are linked and subject to change. 

Critical Accounting Policies 

The preparation of our financial statements in accordance with U.S. generally accepted accounting principles requires us 
to  make  estimates  and  assumptions  that  affect  the  reported  amounts  of  assets,  liabilities,  revenues,  expenses  and  interest 
income in our financial statements and accompanying notes. We evaluate our estimates on an ongoing basis, including those 
estimates related to agreements and research collaborations. We base our estimates on historical experience and various other 
assumptions  that  we  believe  to  be  reasonable  under  the  circumstances,  the  results  of  which  form  the  basis  for  making 
judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results 

68 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
may differ from these estimates under different assumptions or conditions. The following items in our financial statements 
require significant estimates and judgments: 

•  Research Contract Costs and Accruals. The Company has entered into various research and development contracts 
with  research  institutions  and  other  third-party  vendors.  These  agreements  are  generally  cancelable,  and  related 
payments  are  recorded  as  research  and  development  expenses  as  incurred.  The  Company  records  accruals  for 
estimated ongoing research costs. When evaluating the adequacy of the accrued liabilities, the Company analyzes 
progress  of  the  studies  including  the  phase  or  completion  of  events,  invoices  received  and  contracted  costs. 
Significant judgments and estimates are made in determining the accrued balances at the end of any reporting period. 
Actual results could differ from the Company’s estimates. The Company’s historical accrual estimates have not been 
materially different from the actual costs. 

• 

2020  Cash  Incentive  Bonus  Plan.  In  2020,  we  established  the  2020  Cash  Incentive  Bonus  Plan  (the  “Plan”)  to 
incentivize Plan participants. Awards under the Plan are accounted for as liability awards under ASC 718  “Stock-
based  Compensation”. The  fair  value  of  each potential  Plan award will  be determined once a grant  date  occurs 
and will be remeasured each reporting period. Compensation expense associated with the Plan will be recognized 
over the expected achievement period for each Plan award, when a Performance Condition is considered probable of 
being met.   

The  Plan  was  established  to promote  the  long-term  success  of  the  Company  by  creating  an  “at-risk”  cash bonus 
program that rewards Plan participants with additional cash compensation in lockstep with significant increases in 
our  market  capitalization.  The  Plan  is  considered  “at-risk”  because  Plan  participants will not  receive  a  cash 
bonus unless our  market  capitalization  increases significantly  and  (1)  we  complete  a merger  or  acquisition 
transaction  that  constitutes  a  sale  of  ownership  of  the  Company  or  its  assets  (a  Merger  Transaction)  or  (2)  the 
Compensation Committee of the Board (the Compensation Committee) determines the Company has sufficient cash 
on hand, as defined in the Plan, to render payment (each, a “Performance Condition”), neither of which may ever 
occur.  Because of  the  inherent  discretion  and  uncertainty  regarding these requirements,  we  have  concluded 
that a Plan grant date has not occurred as of December 31, 2020. No actual cash payments were authorized or made 
to participants under the Plan during the year ended December 31, 2020. 

•  Stock-based Compensation. We recognize non-cash expense for the fair value of stock options and other share-based 
awards.  We  use  the  Black-Scholes  option  valuation  model  to  calculate  the  fair  value  of  stock  options,  using  the 
single-option award approach and straight-line attribution method. It recognizes the resulting fair value as expense 
on a straight-line basis over the vesting period of each respective stock option, generally four years. 

We have granted share-based awards that vest upon achievement of certain performance criteria, or performance 
awards. We multiply the number of performance awards by the fair market value of our common stock on the date 
of grant to calculate the fair value of each award. We estimate an implicit service period for achieving performance 
criteria for each award. We recognize the resulting fair value as expense over the implicit service period when we 
conclude that achieving the performance criteria is probable. We periodically review and update as appropriate our 
estimates of implicit service periods and determinations on achievement of the performance criteria. Performance 
awards vest and common stock is issued upon achievement of the performance criteria. 

• 

Income Taxes. The Company accounts for income taxes under the asset and liability method.   Deferred tax assets 
and  liabilities  are  recognized  for  the  estimated  future  tax  consequences  attributable  to  differences  between  the 
financial statement carrying amounts of existing assets and liabilities and their respective tax bases.   Deferred tax 
balances are adjusted to reflect tax rates based on currently enacted tax laws, which will be in effect in the years in 
which the temporary differences are expected to reverse.  The Company has accumulated significant deferred tax 
assets that reflect the tax effects of net operating loss and tax credit carryovers and temporary differences between 
the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax 
purposes. Realization of certain deferred tax assets is dependent upon future earnings. The Company is uncertain 
about the timing and amount of any future earnings. Accordingly, the Company offsets these deferred tax assets with 
a valuation allowance. 

69 

  
 
 
 
 
 
 
 
The Company accounts for uncertain tax positions in accordance with ASC 740, “Income Taxes”, which clarifies the 
accounting for uncertainty in tax positions. These provisions require recognition of the impact of a tax position in the 
Company’s financial statements only if that position is more likely than not of being sustained upon examination by 
taxing authorities, based on the technical merits of the position. Any interest and penalties related to uncertain tax 
positions will be reflected as a component of income tax expense. 

Recent Accounting Pronouncements 

In December 2019, the FABS issued ASU No. 2019-12, Income Taxes (Topic 740) Simplifying Accounting for Income 
Taxes  as  part of  its  initiative to  reduce  complexity  in  the  accounting  standards.  The  guidance  amended  certain  disclosure 
requirements  that  had  become  redundant,  outdated  or  superseded.  Additionally,  this  guidance  amends  accounting  for  the 
interim period effects of changes in tax laws or rates, and simplifies aspects of the accounting for franchise taxes. The guidance 
is effective for annual periods beginning after December 15, 2020, and is applicable for the Company in fiscal 2021. Early 
adoption is permitted. The Company does not anticipate that this guidance will have a material impact on its consolidated 
financial statements. 

In  November  2018,  the  FASB  issued  ASU  No.  2018-18,  Collaborative  Arrangements  (Topic  808):  Clarifying  the 
Interaction Between Topic 808 and Topic 606. The amendments in this update provide guidance on how to assess whether 
certain transactions between collaborative arrangement participants should be accounted for within the revenue recognition 
standard. The amendments in this update are effective for interim and annual periods for the Company beginning on January 1, 
2020. The adoption of this guidance did not have a material impact on the Company’s financial statements. 

In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820) - Disclosure Framework - 
Changes  to  the  Disclosure  Requirements  for  Fair  Value  Measurement  (ASU  2018-13),  which  is  designed  to  improve  the 
effectiveness of disclosures by removing, modifying and adding disclosures related to fair value measurements. ASU  2018-
13 is effective for fiscal years beginning after December 15, 2019, including interim periods within those fiscal years. The 
adoption of ASU 2018-13 did not have a material impact on the Company’s financial statements. 

Results of Operations 

Research and Development Expense 

Research and development expense consist primarily of costs of drug development work associated with our product 

candidates, including: 

• 
• 
• 
• 

clinical studies, 
preclinical testing, 
clinical supplies and related formulation and design costs, and 
compensation and other personnel-related expenses. 

Research and development expenses increased to $3.1 million in 2020 from $1.6 million in 2019, representing a 95% 
increase. This increase was due primarily to costs related to manufacture clinical trial supplies in anticipation of launching a 
Phase 3 clinical program in simufilam as well as lower NIH reimbursement compared to the prior year. We received NIH 
reimbursement of $4.2 million from research grants in 2020 recorded as a reduction to research and development expense, as 
compared to $4.7 million in 2019. 

Research and development expenses included non-cash stock-based compensation expenses of $0.5 million in both 2020 

and 2019. 

We expect research and development expense to increase in future periods as we plan to hire new personnel, manufacture 

drug supply, continue our development efforts and launch a Phase 3 clinical program in simufilam. 

70 

  
 
 
 
 
 
 
 
 
 
 
 
 
General and Administrative Expense 

General  and  administrative  expenses  consist  of  personnel  costs,  allocated  expenses  and  other  expenses  for  outside 
professional services, including legal, human resources, audit and accounting services.  Personnel costs consist of salaries, 
bonus,  benefits  and  stock-based  compensation.  Allocated  expenses  consist  primarily  of  facility  costs.  We  incur  expenses 
associated with operating as a public company, including expenses related to compliance with the rules and regulations of the 
SEC  and  Nasdaq,  additional  insurance  expenses,  additional  audit  expenses,  investor  relations  activities,  SOX  compliance 
expenses  and  other  administrative  expenses  and  professional  services.  General  and  administrative  expense  increased  to 
$3.7 million  in  2020  from  $3.4 million  in  2019,  representing  a  10%  increase.  The  increase  was  due  primarily  to  higher 
insurance  expenses  and  professional  fees  compared  to  the  prior  year,  partially  offset  by  lower  non-cash  stock-based 
compensation expense.   

General  and  administrative  expenses  included  non-cash  stock-based  compensation  expenses  of  $0.5 million  in  2020 
compared to $0.8 million in 2019. We expect general and administrative expense for 2021 will  increase compared to 2020 
due to higher operating costs such as insurance, office space and information technology related expenses. 

Gain on Sale of Property and Equipment 

During the year ended December 31, 2020, we sold surplus manufacturing equipment to an independent third party and 
received  proceeds  totaling  $360,000.  The  original cost  of  the  property  and  equipment  was  $892,000 and  accumulated 
depreciation  was  $878,000, resulting  in  a  gain  on  sale of  property  and  equipment  of  $346,000 during  the year 
ended December 31, 2020. There were no sales of property and equipment during the year ended December 31, 2019. 

We do not expect any future gains on sales of property and equipment. 

Interest Income 

Interest and other income, net, was $112,000 in 2020 compared to $328,000 in 2019. The decrease was due primarily to 

a significant decrease in interest rates in 2020 compared to the prior year. 

Liquidity and Capital Resources 

Since inception, we have financed our operations primarily through public and private stock offerings, payments received 
under collaborative agreements and interest earned on our investments. We intend to continue to use our capital resources to 
fund  research  and  development  activities,  capital  expenditures,  working  capital  requirements  and  other  general  corporate 
purposes. As of December 31, 2020, cash and cash equivalents totaled $93.5 million. 

2021 Registered Direct Offering 

On February 12, 2021, we completed a common stock offering pursuant to which certain investors purchased 4,081,633 
shares of common stock at a price of $49.00 per share. Net proceeds of the offering were approximately $189.7 million after 
deducting offering expenses. 

2020 Follow-on Public Offering 

On  November 13,  2020,  we  completed  the  sale  of 9,375,000 shares  of  our  common  stock  in  an  underwritten  public 
offering  at  a  price  of $8.00 per  share.  We  received  net  proceeds  from  the  offering  of approximately  $70.3  million after 
deducting underwriting discounts and offering expenses. 

Common Stock Warrants 

In  August  2018,  we  issued  warrants  to purchase  up  to  an  aggregate  of 9.1 million  shares  of  its  common  stock  in 

conjunction with an offering of our common stock. 

During 2019, we received proceeds of $5.9 million from the exercise of 4.6 million shares pursuant to warrants. During 
2020, we received proceeds of $4.9 million from the exercise of 4.0 million shares pursuant to warrants. During 2021, we 

71 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
received proceeds of $0.7 million from the exercise of an additional 0.6 million shares pursuant to warrants. There were no 
warrants outstanding following the 2021 exercises. 

At the Market (ATM) Common Stock Issuance  

On March 27, 2020, we established an at-the-market offering program (ATM) to sell, from time to time, shares of our 
common  stock  having  an  aggregate  offering  price  of  up  to $100 million in  transactions  pursuant  to  a  shelf  registration 
statement that was declared effective by the U.S. Securities and Exchange Commission (the SEC) on May 5, 2020. We are 
obligated to pay a commission of 3.0% of the gross proceeds from the sale of shares of common stock in the offering. We are 
not obligated to sell any shares in the offering. 

There were no common stock sales under the ATM during the year ended December 31, 2020. 

NIH Research Grant Awards 

Our research has been supported by NIH under multiple research grant awards. Strong, long-term support from NIH has 

allowed us to advance our two lead product candidates, simufilam and SavaDx, into clinical development. 

In March 2020, we were awarded a supplemental research funding grant from NIH of up to $374,000.  In April 2020, we 
were  awarded  a  research  grant  from  NIH  of  up  to  $2.5 million.  These  new,  non-dilutive  research  grants  are  intended  to 
strengthen our clinical program of simufilam, our investigational drug to treat Alzheimer’s disease. All of our NIH research 
grant awards are paid out on a reimbursement basis and require milestone-based technical progress. 

2020 Cash Incentive Bonus Plan Obligations 

On August 26, 2020, the Board approved the 2020 Cash Incentive Bonus Plan (the Plan). The Plan was established to 
promote the long-term success of the Company by creating an “at-risk” cash bonus program that rewards Plan participants 
with additional cash compensation in lockstep with significant increases in the Company’s market capitalization. The Plan is 
considered  “at-risk”  because  Plan  participants will not  receive  a  cash  bonus unless the  Company’s  market  capitalization 
increases significantly  and certain other conditions  specified  in  the  Plan are  met. Specifically,  Plan  participants will not be 
paid any  cash  bonuses  unless  (1)  the  Company  completes  a merger  or  acquisition  transaction  that  constitutes  a  sale  of 
ownership of the Company or its assets (a Merger Transaction) or (2) the Compensation Committee determines the Company 
has sufficient cash on hand, as defined in the Plan. Plan participants will be paid all earned cash bonuses in the event of a 
Merger Transaction. 

The Company’s market capitalization, including all outstanding stock options, was $89.4 million at the inception of the 
Plan on August 26, 2020. If the Company were to exceed a $5 billion market capitalization for no less than 20 consecutive 
trading days, and conditions noted above for payment are met, all Plan milestones would be deemed achieved, in which case 
total cash bonus awards would range from a minimum of $137.4 million up to a hypothetical maximum of $322.3 million. 

The Company’s potential financial obligation to plan participants at December 31, 2020 totaled $7.3 million, based upon 
the achievement of one Plan milestone in the Company’s market capitalization. No actual cash bonus payments have been 
made to any Plan participant, as the Company has not yet satisfied all the conditions necessary for amounts to be paid under 
the Plan. Subsequent to  December 31, 2020, the Company’s market capitalization increased substantially. These increases 
triggered the achievement of eight additional Plan milestones. Collectively, the achievement of such milestones could trigger 
potential Company obligations to Plan participants ranging from a minimum of $59.9 million up to a hypothetical maximum 
of $145.0 million, with exact amounts to be determined by the Compensation Committee.  

No actual cash payments were made to participants under the Plan during the year ended December 31, 2020, or through 

the filing date of this Form 10-K. 

Use of Cash 

Net cash used in operating activities was $5.4 million for the year ended December 31, 2020, resulting primarily from the 
net loss reported of $6.3 million and a gain on sale of property and equipment of $0.3 million, partially offset by non-cash 
stock-based compensation expense of $1.0 million and changes in operating assets and liabilities of $0.3 million. 

72 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
Net cash used in operating activities was $2.5 million for 2019, resulting primarily from a $4.6 million net loss incurred 
partially offset by $1.3 million of non-cash stock-based compensation expense and $0.8 million from changes in operating 
assets and liabilities.  

Net cash provided by investing activities during the year ended December 31, 2020 was $360,000 for proceeds received 

from the sale of property and equipment. 

Net cash used in investing activities was $18,000 for 2019 from purchases of computer equipment. 

Net  cash  provided  by  financing  activities  during  the year  ended December 31,  2020  was  $75.4 million  consisting  of 
$70.3 million proceeds from our follow-on public offering of common stock in November 2020, $4.9 million proceeds from 
exercise of common stock warrants and $0.3 million from exercise of stock options. 

Net cash provided by financing activities for 2019 was $5.8 million consisting of $5.9 million proceeds from exercise of 
common  stock  warrants  partially  offset  by  $0.1 million  in  offering  expenses  related  the  2018  sale  of  common  stock  and 
warrants. 

Realization of our deferred tax assets is dependent on future earnings, if any. We are uncertain about the timing and 

amount of any future earnings. Accordingly, we offset these net deferred tax assets with a valuation allowance. 

We lease approximately 6,000 square feet of office space pursuant to a non-cancelable operating lease in Austin, TX that 

expires in April 2024. Future lease payments are as follows (in thousands): 

For the year ending December 31, 

2021 

2022 

2023 

2024 

Total future lease payments 

$ 

$ 

 66  

 102  

 107  

 36  

 311  

We  have  an  accumulated  deficit  of  $174.9 million  at  December 31,  2020.  We  expect  our  cash  requirements  to  be 
significant  in  the  future.  The  amount  and  timing  of  our  future  cash  requirements  will  depend  on  regulatory  and  market 
acceptance of our product candidates and the resources we devote to researching and developing, formulating, manufacturing, 
commercializing and supporting our products. We believe that our current resources should be sufficient to fund our operations 
for at least the next 12 months. We may seek additional future funding through public or private financing in the future, if 
such funding is available and on terms acceptable to us. 

Off-balance Sheet Arrangements 

As of December 31, 2020, we did not have any relationships with unconsolidated entities or financial partnerships, such 
as entities often referred to as structured finance or special purpose entities, which would have been established for the purpose 
of facilitating off-balance sheet arrangements or other contractually narrow or limited purposes. In addition, we do not engage 
in trading activities involving non-exchange traded contracts. Therefore, we are not materially exposed to financing, liquidity, 
market or credit risk that could arise if we had engaged in these relationships. We do not have relationships or transactions 
with persons or entities that derive benefits from their non-independent relationship with us or our related parties. 

Item 7A.    Quantitative and Qualitative Disclosures about Market Risk 

Pursuant to Item 305(e) of Regulation S-K, the information called for by Item 7A is not required. 

73 

  
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Item 8.    Financial Statements and Supplementary Data 

INDEX TO FINANCIAL STATEMENTS 

Report of Independent Registered Public Accounting Firm 
Balance Sheets 
Statements of Operations 
Statements of Stockholders' Equity  
Statements of Cash Flows 
Notes to Financial Statements 

Page 
75 
77 
78 
79 
80 
81 

74 

  
 
 
 
 
 
 
 
 
Report of Independent Registered Public Accounting Firm 

To the Stockholders and the Board of Directors of Cassava Sciences, Inc. 

Opinion on the Financial Statements  

We have audited the accompanying balance sheets of Cassava Sciences, Inc. (the Company) as of  December 31, 2020 and 
2019,  the  related  statements  of  operations, stockholders'  equity  and  cash  flows  for  the  years  then  ended,  and  the  related 
notes (collectively  referred  to  as  the  “financial  statements”).  In  our  opinion,  the  financial  statements  present  fairly,  in  all 
material respects, the financial position of the Company at December 31, 2020 and 2019, and the results of its operations and 
its cash flows for the years then ended, in conformity with U.S. generally accepted accounting principles. 

Basis for Opinion 

These financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion 
on  the  Company’s  financial  statements  based  on  our  audits.  We  are  a  public  accounting  firm  registered  with  the  Public 
Company  Accounting  Oversight  Board  (United  States)  (PCAOB)  and  are  required  to  be  independent  with  respect  to  the 
Company in accordance with the U.S. federal securities laws and the applicable rules and regulations of the Securities and 
Exchange Commission and the PCAOB. 

We conducted our audits in accordance with the standards of the PCAOB. Those standards require that we plan and perform 
the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement, whether due 
to error or fraud. The Company is not required to have, nor were we engaged to perform, an audit of its internal control over 
financial reporting. As part of our audits we are required to obtain an understanding of internal control over financial reporting 
but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control over financial reporting. 
Accordingly, we express no such opinion. 

Our audits included performing procedures to assess the risks of material misstatement of the financial statements, whether 
due to error or fraud, and performing procedures that respond to those risks. Such procedures included examining, on a test 
basis, evidence regarding the amounts and disclosures in the  financial statements. Our audits also included evaluating the 
accounting principles used and significant estimates made by management, as well as evaluating the overall presentation of 
the financial statements. We believe that our audits provide a reasonable basis for our opinion. 

Critical Audit Matter 

The critical audit matter communicated below is a matter arising from the current period audit of the financial statements that 
was communicated or required to be communicated to the audit committee and that: (1) relates to accounts or disclosures that 
are material to the financial statements and (2) involved our especially challenging, subjective, or complex judgments. The 
communication of the critical audit matter does not alter in any way our opinion on the financial statements, taken as a whole, 
and we are not, by communicating the critical audit matter below, providing a separate opinion on the critical audit matter or 
on the accounts or disclosures to which it relates. 

75 

  
 
 
 
 
 
 
 
 
 
 
 
Accrued Development Expenses 

Description of 
the Matter 

As explained in Note 2 to the financial statements, the Company has various research and development 
contracts with research institutions and other third-party vendors, the costs under which are recorded as 
research and development expenses as incurred. The Company records an accrual for estimated ongoing 
research and development costs incurred but not yet billed at the end of each reporting period. At December 
31, 2020, accrued development expense totaled $719,000, resulting primarily from patient clinical trials and 
ongoing drug manufacturing activities. 

Auditing the Company’s accrued development expense was challenging because the accrual involved a 
higher degree of management judgment to estimate costs incurred for patient clinical trials and drug 
manufacturing activities at the end of the reporting period. An estimate of the costs incurred was necessary 
due to the long duration of the clinical trials, the progress of drug manufacturing activities, and the delayed 
timing of invoices received from third parties.  

How We 
Addressed the 
 Matter in Our 
Audit 

To evaluate the adequacy of the Company’s accrued development expense, our audit procedures included, 
among others, testing the accuracy and completeness of the underlying data used in the estimate, evaluating 
the significant assumptions used by management to estimate the accrual, and recalculating the accrual. To 
evaluate the significant assumptions (i.e., progress of patient clinical trials, progress of drug manufacturing 
activities), on a sample basis, we obtained external confirmation of key clinical trial contract terms and 
conditions directly from third parties, agreed information used in the estimate to the contracts with third 
parties and any amendments thereto, and corroborated the progress of clinical trials and drug manufacturing 
activities through inquiry of Company personnel who oversee research and development efforts. We also 
obtained and reviewed subsequent invoices received from third parties to corroborate the accrual at the end 
of the reporting period. 

/s/ Ernst & Young LLP  

We have served as the Company’s auditor since 2002. 
Austin, Texas 
March 23, 2021 

76 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
CASSAVA SCIENCES, INC. 

BALANCE SHEETS 
(In thousands, except share and par value data) 

ASSETS 

Current assets: 

Cash and cash equivalents 
Other current assets 
Total current assets 

Operating lease right-of-use assets 
Property and equipment, net 

Total assets 

December 31, 

2020 

2019 

$ 

$ 

 93,506   $ 
 488  
 93,994  
 295  
 11  
 94,300   $ 

 23,081  
 268  
 23,349  
 90  
 47  
 23,486  

LIABILITIES AND STOCKHOLDERS' EQUITY 

Current liabilities: 
Accounts payable 
Accrued development expense 
Accrued compensation and benefits 
Operating lease liabilities, current 
Other current liabilities 
Total current liabilities 

Operating lease liabilities, non-current 

Total liabilities 

$ 

 911   $ 
 719  
 83  
 58  
 94  
 1,865  
 235  
 2,100  

 453  
 777  
 58  
 90  
 9  
 1,387  
 —  
 1,387  

Commitments and contingencies (Notes 7 and 8) 
Stockholders' equity: 
Preferred  stock,  $.001  par  value;  10,000,000  shares  authorized,  none  issued  and 
outstanding 
Common  stock,  $.001  par  value;  120,000,000  shares  authorized;  35,237,987  and 
21,841,810 shares issued and outstanding at December 31, 2020 and 2019, respectively  

Additional paid-in capital 
Accumulated deficit 

Total stockholders' equity  
Total liabilities and stockholders' equity 

$ 

 —  

 —   

 35  
 267,086  
 (174,921)  
 92,200  
 94,300   $ 

22   
 190,664  
 (168,587)  
 22,099  
 23,486  

See accompanying notes to financial statements. 

77 

  
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
  
 
  
 
  
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
CASSAVA SCIENCES, INC. 

STATEMENTS OF OPERATIONS 
(In thousands, except per share data) 

Operating expenses: 

Research and development, net of grant reimbursement 
General and administrative  
Gain on sale of property and equipment 

Total operating expenses 

Operating loss 
Interest income 
Net loss 
Net loss per share, basic and diluted 
Shares used in computing net loss per share, basic and diluted 

Year ended December 31, 
2019 
2020 

 3,053   $ 
 3,739  
 (346)  
 6,446  
 (6,446) 
 112  
 (6,334)   $ 
 (0.24)   $ 

 26,105  

 1,568 
 3,391 
 — 
 4,959 
 (4,959) 
 328 
 (4,631) 
 (0.27) 
 17,412 

  $ 

  $ 
  $ 

See accompanying notes to financial statements. 

78 

  
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
CASSAVA SCIENCES, INC. 

STATEMENTS OF STOCKHOLDERS' EQUITY 
(in thousands) 

Common stock 

Additional 

  comprehensive 

  Accumulated 

  Accumulated 

other 

Shares 

 17,219,300   $ 

  Par value 
 17 

  paid-in capital 
 $ 

 183,567   $ 

income 

 — 

 $ 

deficit 
 (163,956)   $ 

Total 
stockholders' 
equity 
 19,628 

 Balance at December 31, 2018 

Non-cash stock-based compensation for: 

Stock options for employees 
Stock options for non-employees 

Issuance costs from 2018 sale of common stock and warrants 
Issuance of common stock pursuant to exercise of warrants 
Net loss 

 Balance at December 31, 2019 

Non-cash stock-based compensation for: 

Stock options for employees 
Stock options for non-employees 

Issuance of common stock pursuant to exercise of stock options 
Issuance of common stock pursuant to exercise of warrants 
Common stock issued in conjunction with follow-on public offering, net of 
issuance costs 
Net loss 

 Balance at December 31, 2020 

 — 
 — 
 — 
 4,622,510 
 — 

 21,841,810   $ 

 — 
 — 

 71,105 
 3,950,072 

 9,375,000 
 — 

 35,237,987   $ 

 — 
 — 
 — 
 5 
 — 
 22 

 — 
 — 
 — 
 4 

 9 
 — 
 35 

 1,287 
 9 
 (60)    

 5,861 
 — 
 190,664   $ 

 $ 

 961 
 27 
 256 
 4,936 

 — 
 — 
 — 
 — 
 — 
 — 

 $ 

 — 
 — 
 — 
 — 
 (4,631)    
 (168,587)   $ 

 — 
 — 
 —    
 — 

 — 
 — 
 — 
 — 

 1,287 
 9 
 (60) 
 5,866 
 (4,631) 
 22,099 

 961 
 27 
 256 
 4,940 

 70,242 
 — 
 267,086   $ 

 $ 

 — 
 — 
 — 

 $ 

 — 
 (6,334)    
 (174,921)   $ 

 70,251 
 (6,334) 
 92,200 

See accompanying notes to financial statements. 

79 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
     
     
     
     
     
 
 
   
 
   
 
   
 
   
 
   
 
 
 
   
 
   
 
   
 
   
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
  
 
 
 
 
 
 
 
 
 
    
    
    
    
    
 
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
    
    
    
    
    
 
  
  
  
  
  
  
  
  
  
  
   
 
 
   
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
 
 
     
     
     
     
     
 
 
CASSAVA SCIENCES, INC. 

STATEMENTS OF CASH FLOWS 
(In thousands) 

Cash flows from operating activities: 

Net loss 
Adjustments to reconcile net loss to net cash used in operating activities: 

Non-cash stock-based compensation 
Depreciation and amortization 
Gain on sale of property and equipment 
Changes in operating assets and liabilities: 

Other current assets 
Operating lease right-of-use assets and liabilities 
Accounts payable 
Accrued development expense 
Accrued compensation and benefits 
Other current liabilities 

Net cash used in operating activities 

Cash flows from investing activities: 
Purchases of property and equipment 
Proceeds from sale of property and equipment 

Net cash provided by (used in) investing activities 

Cash flows from financing activities: 

Issuance costs from 2018 sale of common stock and warrants 
Proceeds from exercise of stock options 
Proceeds from exercise of common stock warrants 
Proceeds from follow-on public offering, net of issuance costs 

Net cash provided by financing activities 

Net increase in cash and cash equivalents 
Cash and cash equivalents at beginning of period 
Cash and cash equivalents at end of period 

Year ended December 31, 
2019 
2020 

$ 

 (6,334)   $ 

 (4,631) 

 988  
 22  
 (346)  

 (220)  
 (2)  
 458  
 (58)  
 25  
 85  
  (5,382)  

 —  
 360  
 360  

 —  
 256  
 4,940  
 70,251  
  75,447  
 70,425  
 23,081  
 93,506   $ 

$ 

 1,296 
 58 
 — 

 (23) 
 — 
 159 
 621 
 (3) 
 9 
 (2,514) 

 (18) 
 — 
 (18) 

 (60) 
 — 
 5,866 
 — 
 5,806 
 3,274 
 19,807 
 23,081 

See accompanying notes to financial statements.  

80 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CASSAVA SCIENCES, INC. 
NOTES TO FINANCIAL STATEMENTS 

1.  General and Liquidity 

Cassava Sciences, Inc. (the Company), formerly known as Pain Therapeutics, Inc., develops proprietary  products 
that offer significant improvements to patients and healthcare professionals. The Company generally focuses its product 
development efforts on disorders of the nervous system.  

Coronavirus Disease 2019 (COVID-19) 

The recent, widespread outbreak of a novel infectious disease called Coronavirus Disease 2019, or COVID-19, has 
not significantly impacted the Company’s operations or financial condition as of March 23, 2021. However, this pandemic 
has created a dynamic and uncertain situation in the national economy. The Company continues to closely monitor the 
latest information to make timely, informed business decisions and public disclosures regarding the potential impact of 
pandemic on its operations and financial condition. The scope of pandemic is unprecedented and its long-term impact on 
the Company’s operations and financial condition cannot be reasonably estimated at this time. 

Liquidity   

The  Company  has  incurred  significant net  losses  and  negative  cash flows  since  inception,  and  as  a  result has  an 
accumulated deficit of $174.9 million at December 31, 2020. The Company expects its cash requirements to be significant 
in the future. The amount and timing of its future cash requirements will depend on regulatory and market acceptance of 
the  Company’s  product  candidates  and  the  resources  it  devotes  to  researching  and  developing,  formulating, 
manufacturing, commercializing and supporting its products. The Company may seek additional future funding through 
public or private financing in the future, if such funding is available and on terms acceptable to the Company. There are 
no assurances that additional financing will be available on favorable terms, or at all. However, management believes that 
the current working capital position will be sufficient to meet the Company’s working capital needs for at least the next 
12 months. 

2.  Summary of Significant Accounting Policies 

Use of Estimates 

The preparation of financial statements in conformity with accounting principles generally accepted in the United 
States requires that management make estimates and assumptions that affect the reported amounts of assets and liabilities 
and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amount of revenue 
earned and expenses incurred during the reporting period. Actual results could differ from those estimates. 

Proceeds from Grants 

In 2020, the Company received $4.2 million of reimbursement from the National Institutes of Health and National 
Institute on Drug Abuse and $4.7 million in 2019. The Company records the proceeds from these grants as reductions to 
its research and development expenses. 

Cash and Cash Equivalents and Concentration of Credit Risk 

The Company invests in cash and cash equivalents and, in the past, marketable securities. The Company considers 
highly-liquid financial instruments with original maturities of three months or less to be cash equivalents. Highly liquid 
investments that are considered cash equivalents include money market accounts, money market funds and certificates of 
deposit. The carrying value of cash equivalents approximates fair value due to the short-term maturity of these securities. 

The Company’s investment policy allows for investments in marketable securities with active secondary or resale 
markets, establishes diversification and credit quality requirements and limits investments by maturity and issuer. The 
Company maintains its investments at one financial institution.  

81 

 
 
  
 
 
 
 
 
  
 
 
 
 
 
 
 
 
Fair Value Measurements  

The Company reports its cash and cash equivalents at fair value as Level 1, Level 2 or Level 3 using the following 

inputs: 

•  Level 1 includes quoted prices in active markets. The Company bases the fair value of money market funds on 

Level 1 inputs. 

•  Level 2 includes significant observable inputs, such as quoted prices for identical or similar investments, or other 
inputs that are observable and can be corroborated by observable market data for similar securities. The Company 
uses market pricing and other observable market inputs obtained from third-party providers. It uses the bid price 
to establish fair value where a bid price  is available. The  Company bases the  fair value of its certificates of 
deposit, if any, on Level 2 inputs. 

•  Level 3 includes unobservable inputs that are supported by little or no market activity. The Company does not 

have any investments where the fair value is based on Level 3 inputs. 

If a financial instrument uses inputs that fall in different levels of the hierarchy, the instrument will be categorized 
based  upon  the  lowest  level  of  input  that  is  significant  to  the  fair  value  calculation.  A  certificate  of  deposit  totaling 
$13.0 million  at  December 31,  2019  was  included  within  cash  equivalents  as  a  Level  2  input.  The  fair  value  of  the 
remainder of cash and cash equivalents, including money market accounts, was based on Level 1 inputs at December 31, 
2020 and 2019. 

Business Segments 

The Company reports segment information based on how it internally evaluates the operating performance of its 
business units, or segments. The Company’s operations are confined to one business segment: the development of novel 
drugs and diagnostics. 

Stock-based Compensation  

The Company recognizes non-cash expense for the fair value of all stock options and other share-based awards. The 
Company uses the Black-Scholes option valuation model to calculate the fair value of stock options, using the single-
option  award  approach  and  straight-line  attribution  method.  This  model  requires  the  input  of  subjective  assumptions 
including expected stock price volatility, expected life and estimated forfeitures of each award. These assumptions consist 
of  estimates  of  future  market  conditions,  which  are  inherently  uncertain,  and  therefore,  are  subject  to  management's 
judgment. The Company recognizes the resulting fair value as expense on a straight-line basis over the vesting period of 
each respective stock option, generally four years.  

The  Company  has  granted  share-based  awards  that  vest  upon  achievement  of  certain  performance  criteria,  or 
performance awards. The Company multiplies the number of performance awards by the fair value of its common stock 
on  the  date  of  grant  to  calculate  the  fair  value  of  each  award.  It  estimates  an  implicit  service  period  for  achieving 
performance criteria for each award. The Company recognizes the resulting fair value as expense over the implicit service 
period when it concludes that achieving the performance criteria is probable. The Company periodically reviews and 
updates as appropriate its estimates of implicit service periods and conclusions on achieving the performance criteria. 
Performance awards vest and common stock is issued upon achievement of the performance criteria. 

82 

 
 
 
 
 
 
 
 
 
 
 
Net Loss per Share 

Basic net loss per share is computed on the basis of the weighted-average number of common shares outstanding for 
the reporting period. Diluted net loss per share is computed on the basis of the weighted-average number of common 
shares outstanding plus dilutive potential common shares outstanding using the treasury-stock method. Potential dilutive 
common shares consist of outstanding equity awards and warrants. There is no difference between the Company’s net 
loss and comprehensive loss. The numerators and denominators in the calculation of basic and diluted net loss per share 
were as follows (in thousands, except net loss per share data): 

Numerator: 
Net loss 
Denominator: 

Shares used in computing net loss per share, basic and diluted 

Net loss per share, basic and diluted 

 Dilutive common stock options excluded from net loss per share, diluted 
 Common stock warrants excluded from net loss per share, diluted 

Year ended December 31, 

2020 

2019 

  $ 

 (6,334)   $ 

 (4,631) 

 26,105   

  $ 

 (0.24)   $ 

 2,145   
 554   

 17,412  
 (0.27) 

 2,932  
 4,504  

The  Company  excluded  weighted  equity  awards  and  warrants  outstanding  to  purchase  common  stock  from  the 
calculation of diluted net loss per share because the effect of including these shares in this calculation would be anti-
dilutive. 

Fair Value of Financial Instruments  

Financial instruments include cash and cash equivalents, accounts payable and accrued liabilities. The estimated fair 
value of financial instruments has been determined using available market information or other appropriate  valuation 
methodologies. However, considerable judgment is required in interpreting market data to develop estimates of fair value; 
therefore, the estimates are not necessarily indicative of the amounts that could be realized or would be paid in a current 
market exchange. The effect of using different market assumptions and/or estimation methodologies may be material to 
the  estimated  fair  value  amounts.  The  carrying  amounts  of  cash  and  cash  equivalents,  accounts  payable  and  accrued 
liabilities are at cost, which approximates fair value due to the short maturity of those instruments. 

Research Contract Costs and Accruals 

The Company has entered into various research and development contracts with research institutions and other third-
party vendors. These agreements are generally cancelable, and related payments are recorded as research and development 
expenses as incurred. The Company records accruals for estimated ongoing research costs. When evaluating the adequacy 
of  the  accrued  liabilities,  the Company  analyzes  progress  of  the  studies  including  the  phase  or  completion  of  events, 
invoices received and contracted costs. Significant judgments and estimates are made in determining the accrued balances 
at the end of any reporting period. Actual results could differ from the Company’s estimates. The Company’s historical 
accrual estimates have not been materially different from actual costs. 

Incentive Bonus Plan 

In 2020, the Company established the 2020 Cash Incentive Bonus Plan (the “Plan”) to incentivize Plan participants.  
Awards under the Plan are accounted for as liability awards under ASC 718 “Stock-based Compensation”. The fair value 
of  each potential  Plan award will  be determined once a grant  date  occurs  and will  be remeasured  each  reporting 
period. Compensation  expense  associated  with  the  Plan will  be recognized  over  the  expected  achievement  period  for 
each Plan award, when a Performance Condition is considered probable of being met.  See Note 8 for further discussion 
of the Plan. 

Leases 

83 

 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
   
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
The Company recognizes assets and liabilities that arise from leases. For operating leases, the Company is required 
to recognize a right-of-use asset and a lease liability, initially measured at the present value of the lease payments, in 
the statements of  financial  position. As  the  Company`s  leases  do  not  provide  an  implicit  rate,  it  uses  its  incremental 
borrowing rate based on the information available at the commencement date in determining the present value of lease 
payments. Lease expense for lease payments is recognized on a straight-line basis over the lease term. 

Income Taxes 

The Company accounts for income taxes under the asset and liability method. Deferred tax assets and liabilities are 
recognized for the estimated future tax consequences attributable to differences between the financial statement carrying 
amounts of existing assets and liabilities and their respective tax bases.  Deferred tax balances are adjusted to reflect tax 
rates based on currently enacted tax laws, which will be in effect in the years in which the temporary differences are 
expected  to  reverse. The  Company  has  accumulated  significant  deferred  tax  assets  that  reflect  the  tax  effects  of  net 
operating loss and tax credit carryovers and temporary differences between the carrying amounts of assets and liabilities 
for financial reporting purposes and the amounts used for income tax purposes. Realization of certain deferred tax assets 
is  dependent  upon  future  earnings.  The  Company  is  uncertain  about  the  timing  and  amount  of  any  future  earnings. 
Accordingly, the Company offsets these deferred tax assets with a valuation allowance. 

The Company accounts for uncertain tax positions in accordance with ASC 740, “Income Taxes”, which clarifies the 
accounting for uncertainty in tax positions. These provisions require recognition of the impact  of a tax position in the 
Company’s financial  statements  only  if  that  position  is  more  likely  than  not  of  being  sustained  upon  examination by 
taxing  authorities,  based  on  the  technical  merits  of  the  position.  Any  interest  and  penalties  related  to  uncertain  tax 
positions will be reflected as a component of income tax expense. 

Recent Accounting Pronouncements 

The Company reviewed recently issued accounting pronouncements and plan to adopt those that are applicable to it, 
and does not expect the adoption of these pronouncements to have a material impact on its financial position, results of 
operations or cash flows.  

In  December  2019,  the  FABS  issued  ASU  No.  2019-12,  Income  Taxes  (Topic  740)  Simplifying  Accounting  for 
Income Taxes as part of its initiative to reduce complexity in the accounting standards. The guidance amended certain 
disclosure  requirements  that  had  become  redundant,  outdated  or  superseded.  Additionally,  this  guidance  amends 
accounting  for  the  interim period  effects  of  changes  in  tax  laws  or  rates  and  simplifies aspects  of  the  accounting  for 
franchise taxes. The guidance is effective for annual periods beginning after December 15, 2020, and is applicable for the 
Company in fiscal year 2021. Early adoption is permitted. The Company does not anticipate that this guidance will have 
a material impact on its consolidated financial statements. 

In November 2018, the FASB issued ASU No. 2018-18, Collaborative Arrangements (Topic 808): Clarifying the 
Interaction Between Topic 808 and Topic 606. The amendments in this update provide guidance on how to assess whether 
certain  transactions  between  collaborative  arrangement  participants  should  be  accounted  for  within  the  revenue 
recognition  standard.  The  amendments  in  this  update  are  effective  for  interim  and  annual  periods  for  the  Company 
beginning on January 1, 2020. The adoption of this guidance did not have a material impact on the Company’s financial 
statements. 

In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820) - Disclosure Framework 
- Changes to the Disclosure Requirements for Fair Value Measurement (ASU 2018-13), which is designed to improve 
the effectiveness of disclosures by removing, modifying and adding disclosures related to fair value measurements. ASU 
2018-13 is effective for fiscal years beginning after  December 15, 2019, including interim periods within those fiscal 
years. The adoption of ASU 2018-13 did not have a material impact on the Company’s financial statements. 

3.  Property and Equipment 

The  Company’s  property  and  equipment  include  furniture  and  equipment.  Depreciation  is  recognized  using  the 

straight-line method over the expected life of the property and equipment. 

84 

 
 
 
 
 
 
 
 
 
 
  
 
 
During the year ended December 31, 2020, the Company sold surplus manufacturing equipment to an independent 
third party and received proceeds totaling $360,000. The original cost of the property and equipment was $892,000 and 
accumulated depreciation was $878,000, resulting a gain on sale of property and equipment of $346,000 during the year 
ended December 31, 2020. There were no sales of property and equipment during year ended December 31, 2019. 

4.  Stockholders' Equity and Stock-Based Compensation 

Preferred Stock 

The Company’s Board of Directors (the “Board”) has the authority to issue preferred stock in one or more series and 
to fix the rights, preferences, privileges, restrictions and the number of shares constituting any series or the designation 
of the series. 

2021 Registered Direct Offering 

On  February 12,  2021,  the  Company  completed  a  common  stock  offering  pursuant  to  which  certain  investors 
purchased  4,081,633  shares  of  common  stock  at  a  price  of  $49.00  per  share.  Net  proceeds  of  the  offering  were 
approximately $189.7 million after deducting offering expenses. 

2020 Follow-on Public Offering 

On  November 13,  2020,  the  Company  completed  the  sale  of 9,375,000 shares  of  Cassava  common  stock  in  an 
underwritten  public  offering  at  a  price  of $8.00 per  share.  The  Company  received  net  proceeds  from  the  offering 
of $70,251,000 after deducting underwriting discounts and offering expenses. 

Common Stock Warrants  

In August 2018, the Company issued warrants to purchase up to an aggregate of 9.1 million shares of its common 

stock in conjunction with an offering of its common stock.  

During 2020, the Company received proceeds of $4.9 million from the exercise of  4.0 million shares pursuant to 
warrants. During 2019, the Company received proceeds of $5.9 million from the exercise of 4.6 million shares pursuant 
to warrants.  

Subsequent to December 31, 2020, the Company received proceeds of $0.7 million from the exercise of an additional 

0.6 million shares pursuant to warrants. There were no warrants outstanding following the 2021 exercises. 

Warrants outstanding as of December 31, 2020 and 2019 were as follows: 

Issuance Date 

Expiration Date 

Exercise Price Per 
Share 

August 17, 2018  
August 17, 2018  

February 17, 2021  
February 17, 2021  

1.25  
1.59  

Number of Shares Outstanding under Warrant 
December 31, 

2020 

2019 

 554,019  
 —  
 554,019  

 4,496,116 
 7,975 
 4,504,091 

At the Market (ATM) Common Stock Issuance  

On March 27, 2020, the Company established an at-the-market offering program (ATM) to sell, from time to time, 
shares of Company common stock having an aggregate offering price of up to $100 million in transactions pursuant to a 
shelf registration statement that was declared effective by the U.S. Securities and Exchange Commission (the SEC) on 
May 5, 2020. The Company is obligated to pay a commission of 3.0% of the gross proceeds from the sale of shares of 
common stock in the offering. The Company is not obligated to sell any shares in the offering. 

85 

 
 
  
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
There were no common stock sales under the ATM during the year ended December 31, 2020. 

2008 Equity Incentive Plan  

Under the Company’s 2008 Equity Incentive Plan, or 2008 Equity Plan, its employees, directors and consultants 
received share-based awards, including grants of stock options and performance awards. The 2008 Equity Plan expired 
in December 2017. Share-based awards generally expire ten years from the date of grant. 

2018 Equity Incentive Plan  

In January 2018, the Company’s Board approved the Company’s 2018 Omnibus Incentive Plan (the 2018 Plan). The 
Company’s  Board  or  a  designated  Committee  of  the  Board  is  responsible  for  administration  of  the  2018  Plan  and 
determined the terms and conditions of each option granted, consistent with the terms of the 2018 Plan. The Company’s 
employees, directors, and consultants are eligible to receive awards under the 2018 Plan, including grants of stock options 
and performance awards. Share-based awards generally expire ten years from the date of grant. The 2018 Plan provides 
for  issuance of up  to  1,000,000  shares of  common  stock, par  value  $0.001 per  share  under  the  2018  Plan,  subject  to 
adjustment as provided in the 2018 Plan.  

When stock options or performance awards are exercised net of the exercise price and taxes, the number of shares of 
stock issued is reduced by the number of shares equal to the amount of taxes owed by the award recipient and that number 
of shares are cancelled. The Company then uses its cash to pay tax authorities the amount of statutory taxes owed by and 
on behalf of the award recipient. 

Stock Options 

The following summarizes information about stock option activity during 2020: 

Number of 
Options 

Weighted 
Average 
Exercise Price  

Outstanding as of December 31, 2019 

Options granted 
Options exercised 
Options forfeited/canceled 

Outstanding as of December 31, 2020 
Vested and expected to vest at December 31, 2020 
Exercisable at December 31, 2020 

 3,210,965    $ 
 60,000     
 (71,105)    
 (382,356)    
 2,817,504     
 2,817,504     
 2,167,633    $ 

 12.27  
 7.25  
 3.60  
 20.31  
 11.30  
 11.30  
 13.86  

Weighted 
Average 
Remaining 
Contractual 
Term 
In years 
6.05 

Aggregate Intrinsic 
Value 
In millions 
4.2 

  $ 

5.60 
5.60 
4.85 

  $ 
  $ 
  $ 

6.4 
6.4 
3.7 

The following summarizes information about stock options at December 31, 2020 by a range of exercise prices: 

Range of exercise prices 
From 
0.95 
3.24 
4.10 
14.21 
36.40 

To 
1.88 
4.09 
13.09 
35.00 
53.55 

  $ 
  $ 
  $ 
  $ 
  $ 

$ 
$ 
$ 
$ 
$ 

Options outstanding 

Options exercisable 

  Weighted 
average 
remaining 
contractual 
life (in years)   
8.4 
6.7 
5.0 
2.8 
0.7 
5.6 

  $ 
  $ 
  $ 
  $ 
  $ 
  $ 

Weighted 
average 
exercise 
price 
1.47 
3.51 
10.89 
24.02 
51.72 
11.30 

Number of 
outstanding 
options 
 659,688  
 812,094  
 598,462  
 619,599  
 127,661  
 2,817,504  

Number of 
 vested 
options 
 251,613   $ 
 643,377   $ 
 525,383   $ 
 619,599   $ 
 127,661   $ 
 2,167,633   $ 

Weighted 
average 
exercise 
price 
1.31 
3.48 
11.42 
24.02 
51.72 
13.86 

86 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
     
   
     
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
   
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
The Company uses Black-Scholes to estimate the fair value of options granted. Black-Scholes considers a number of 
factors, including the market price of the Company’s common stock. It used certain factors to value each stock option 
granted, which resulted in a weighted average fair value of options granted during 2020 and 2019, as follows: 

Volatility 
Risk-free interest rates 
Expected life of option 
Dividend yield 
Forfeiture rate 
Weighted average fair value of stock options granted 

2020 
123% to 139% 
0.46% to 0.78% 
7 years 
zero 
zero 
$6.69 

2019 
  118% to 119% 
  1.7% to 2.5% 
7 years 
zero 
zero 
$1.60 

Volatility is based on reviews of the historical volatility of the Company’s common stock. Risk-free interest rates are 
based on yields of U.S. treasury notes in effect at the date of grant. Expected life of option is based on actual historical option 
exercises. Dividend yield is zero because the Company does not anticipate paying cash dividends in the foreseeable future.  

As of December 31, 2020, the Company expects to recognize compensation expense of $1.5 million related to non-

vested options held by equity plan participants over the weighted average remaining recognition period of 2.1 years. 

Subsequent to December 31, 2020, there were 20,385 stock options exercised resulting in proceeds to the Company 

totaling $169,000. 

Performance Awards 

The following summarizes information about performance award activity during 2020: 

Outstanding as of December 31, 2019 

Granted 
Vested performance awards 
Forfeited/Canceled 

Outstanding as of December 31, 2020 

Number of Performance 
Awards 

 138,055 
 — 
 — 
 — 
 138,055 

 If and when outstanding performance awards vest, the Company would recognize  $2.3 million in non-cash stock-

based compensation expense. These performance awards expire between 2022 and 2026. 

Stock-Based Compensation Expense 

The following summarizes information about non-cash stock-based compensation expense, in thousands: 

Research and development 

General and administrative 

Total non-cash stock-based compensation expense 

Year ended 
December 31, 

2020 

2019 

 453  

 $ 

 535   

 542  

 754  

 988  

 $ 

 1,296  

 $ 

$ 

87 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
   
  
 
 
  
5.  Employee 401(k) Benefit Plan 

The Company has a defined-contribution savings plan under Section 401(k) of the Internal Revenue Code. The plan 
covers substantially all employees. Employees are eligible to participate in the plan the first day of the month after hire 
and may contribute up to the current statutory limits under Internal Revenue Service regulations. The 401(k) plan permits 
the Company to make additional matching contributions on behalf of all employees. Through  December 31, 2020, the 
Company has not made any matching contributions to the 401(k) plan. 

6.  Income Taxes 

The Company did not provide for income taxes in 2020 and 2019 because it had book and federal taxable losses in 
those  years  and  the  tax  benefit  that  would  have  resulted  from  the  pre-tax  losses  was  fully  offset  by  a  change  in  the 
valuation allowance.  

The reconciliation of the statutory federal income tax rate to the Company’s effective tax rate for the years ended 

December 31, 2020 and 2019 was as follows: 

Tax at federal statutory rate 
State tax, net of federal benefit 
Share-based compensation 
Research and development credits 
Change in valuation allowance 
Effective income tax rate 

Deferred tax assets and valuation allowance 

Year ended December 31, 

2020 

2019 

 21.0 %   
 —  
 (42.8)  
 1.6  
 20.2  

 — %   

 21.0 %  
 —  
 (2.4)  
 0.6  
 (19.2)  

 — %  

Deferred tax assets reflect the tax effects of net operating loss and tax credit carryforwards and temporary differences 
between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income 
tax purposes. The Company’s deferred taxes assets at December 31, 2020 and 2019 were valued at the corporate tax rate 
of 21%. The Company offsets its deferred tax assets by a valuation allowance because it is uncertain about the timing and 
amount of any future profits. Significant components of its deferred tax assets are as follows (in thousands): 

Deferred tax assets: 

Net operating loss carryforwards 
Share-based compensation 
Research and development credit carryforwards 
Other 

Total deferred tax assets: 
Valuation allowance 
Net deferred tax assets: 
Deferred tax liabilities: 

Property and equipment 
Operating lease right-of-use assets 

Total deferred tax liabilities: 
Net deferred tax asset / (liability): 

December 31,  

2020 

2019 

$ 

 18,333   $ 

 3,230  
 6,687  
 264  
 28,514  
 (28,447)  
 67  

 (5)  
 (62)  
 (67)  
 —   $ 

$ 

 17,110 
 5,817 
 6,587 
 237 
 29,751 
 (29,725) 
 26 

 (7) 
 (19) 
 (26) 
 — 

88 

 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The valuation allowance decreased by $1.3 million in 2020. The valuation allowance decreased by $2.4 million due 
to a write down of the share-based compensation deferred tax asset and is offset in part by a $1.1 million increase due to 
additional book losses during the year. The valuation allowance increased by $0.9 million in 2019 due to additional book 
losses during the year.  

The Company’s pre-tax net operating loss carryforwards of $87.3 million are federal, of which $74.1 million expires 
between  2029  and  2039  and  $13.2 million  carries  forward  indefinitely.  As  of  December 31,  2020,  the  Company  had 
federal research and development tax credits of approximately  $11.1 million, which expire in the years  2023 through 
2040.  

Unrecognized tax benefits 

As of December 31, 2020 and 2019, the Company has unrecognized tax benefits related to tax credits of $4.5 million 
and  $4.4 million, respectively. None of the unrecognized tax benefits as of  December 31, 2020, if recognized, would 
impact  the  effective  tax  rate  due  to  the  valuation  allowance  and  no  interest  or  penalties  have  been  recognized.  A 
reconciliation of the beginning and ending balance of unrecognized tax benefits is as follows (in thousands):  

Beginning balance 
Additions based on tax positions related to the current year 
Ending balance 

Year ended December 31, 
2020 

2019 

$ 

$ 

 4,400   $ 
 100  
 4,500   $ 

 4,400 
 — 
 4,400 

As of December 31, 2020, there were no unrecognized tax benefits that we expect would change significantly 

over the next 12 months. 

The Company files U.S. and Texas income tax returns. In the United States, the statute of limitations with respect 
to the federal income tax returns for tax years after 2016 are open to audit; however, since the Company has net operating 
losses, the taxing authority has the ability to review tax returns prior to the 2017 tax year and make adjustments to these 
net operating loss carryforwards. We are not under audit in any taxing jurisdiction at this time. 

7.  Leases and Commitments 

Right-of-use Asset and Liability 

The Company has a single non-cancelable operating lease for approximately  6,000 square feet of office space in 
Austin, Texas, which is used for the development of novel products. On September 4, 2020, the Company entered into a 
lease  amendment  that  extended the lease  termination  date  to  April 30,  2024  and  set new  rental  rates  effective  as  of 
January 1, 2021. Future lease payments are (in thousands). 

For the year ending December 31, 
2021 
2022 
2023 
2024 
Total future lease payments 
Less: imputed interest 
Total 

$ 

$ 

 66  
 102  
 107  
 36  
 311  
 (18) 
 293  

Rent expense was $0.1 million for the year ended December 31, 2020 and 2019. 

The Company recorded a right-of-use asset and lease liability of $316,000 as a result of the lease modification in 
September 2020. The Company utilized a discount rate of 3.25% for the modified lease to determine the present value of 

89 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
the  future  lease payments, which approximated the Company’s incremental borrowing rate in  September 2020.  There 
were no right-of-use assets exchanged for operating lease liabilities during the year ended December 31, 2019. 

Cash paid for operating lease liabilities totaled $99,000 and $95,000 during the years ended December 31, 2020 and 

2019, respectively. 

Other Commitments 

The  Company  conducts  its  product  research  and  development  programs  through  a  combination  of  internal  and 
collaborative programs that include, among others, arrangements with universities, contract research organizations and 
clinical research sites. It has contractual arrangements with these organizations, however these contracts are cancelable 
on thirty days’ notice and the Company’s obligations under these contracts are largely based on services performed. 

The Company is dependent on contract development and manufacturing organizations for the manufacture of all our 

materials for clinical studies. 

Note 8.  2020 Cash Incentive Bonus Plan 

On August 26, 2020, the Board approved the Plan. The Plan was established to promote the long-term success of the 
Company by creating an “at-risk” cash bonus program that rewards Plan participants with additional cash compensation 
in lockstep with significant increases in the Company’s market capitalization. The Plan is considered “at-risk” because 
Plan  participants will not  receive  a  cash  bonus unless the  Company’s  market  capitalization  increases significantly 
and certain other conditions  specified  in  the  Plan are  met. Specifically,  Plan  participants will not be  paid any  cash 
bonuses unless (1) the Company completes a merger or acquisition transaction that constitutes a sale of ownership of the 
Company  or  its  assets  (a  Merger  Transaction)  or  (2)  the  Compensation  Committee  of  the  Board (the  Compensation 
Committee)  determines  the  Company  has  sufficient  cash  on  hand,  as  defined  in  the  Plan.  Because of  the  inherent 
discretion  and  uncertainty  regarding these requirements,  the  Company  has  concluded  that a Plan grant  date  has  not 
occurred as  of  December 31,  2020. Plan  participants  will  be  paid  all  earned  cash  bonuses  in  the  event  of  a  Merger 
Transaction. 

The  Company’s  market  capitalization  for  purposes  of  the  Plan is determined  based  on  either  (1)  the  Company’s 
closing price of one share on the Nasdaq Capital Market multiplied by the total issued and outstanding shares and options 
to purchase shares of the Company or (2) the  aggregate consideration payable to security holders of the Company in 
a Merger Transaction. This constitutes a market condition under applicable accounting guidance.    

The Plan triggers a potential cash bonus each time the Company’s market capitalization increases significantly, up 
to  a  maximum $5 billion  in  market  capitalization.  The  Plan  specifies  14 incremental amounts between $200 million 
and $5 billion  (each  increment, a  “Valuation  Milestone”).  Each Valuation  Milestone triggers a  potential  cash  bonus 
award in a pre-set amount defined in the Plan. Each Valuation Milestone must be achieved and maintained for no less 
than 20 consecutive trading days for Plan participants to be eligible for a potential cash bonus award. Approximately 59% 
of  each cash  bonus  award associated  with  a  Valuation  Milestone is  subject  to adjustment  and approval by  the 
Compensation  Committee. Any  amounts not  awarded  by  the  Compensation  Committee are no  longer  available  for 
distribution. 

If  the  Company  were  to  exceed  a  $5 billion  market  capitalization for  no  less  than  20  consecutive  trading  days, 
all Valuation Milestones would be deemed achieved, in which case cash bonus awards would range from a minimum 
of $137.4 million up to a hypothetical maximum of $322.3 million. Payment of cash bonuses is deferred until such time 
as (1) the Company completes a Merger Transaction, or (2) the Compensation Committee determines the Company has 
sufficient  cash on  hand to  render  payment (each,  a  “Performance  Condition”), neither of  which  may  ever  occur. 
Accordingly, there can be no assurance that Plan participants will ever be paid a cash bonus that is awarded under the 
Plan, even if the Company’s market capitalization increases significantly. 

The  Plan  is  accounted  for  as  a  liability  award. The  fair  value  of  each Valuation Milestone award will 
be determined once a grant date occurs and will be remeasured each reporting period. Compensation expense associated 
with the Plan will be recognized over the expected achievement period for each of the 14 Valuation Milestones, when a 
Performance Condition is considered probable of being met.    

90 

 
 
 
 
 
 
 
 
 
 
 
 
On  October 13,  2020,  the  Company achieved the  first Valuation Milestone. Subsequently,  the  Compensation 
Committee approved a  potential  cash  bonus award of $7.3 million in  total for all  Plan  participants,  subject  to  future 
satisfaction of a Performance Condition. However, no compensation expense has been recorded since no grant date has 
occurred  and  no Performance  Conditions  are  considered  probable  of  being  met. There  is  no  continuing  service 
requirement for Plan participants once the Compensation Committee approves a cash bonus award. 

Subsequent to December 31, 2020, the Company achieved eight additional Valuation Milestones triggering potential 
Company  obligations  to  all  Plan  participants  from  a  minimum  of  $59.9 million  up  to  a  hypothetical  maximum  of 
$145.0 million,  to  be  determined  by  the  Compensation  Committee  and  contingent  upon  future  satisfaction  of  a 
Performance Condition. 

No actual cash payments were authorized or made to participants under the Plan during the year ended December 31, 

2020. 

91 

 
 
 
 
 
 
Item 9.    Changes in and Disagreements with Accountants on Accounting and Financial Disclosure 

None.  

Item 9A.    Controls and Procedures 

Evaluation of disclosure controls and procedures. 

Our management, with the participation of our Chief Executive Officer and our Chief Financial Officer, evaluated 
the effectiveness of our disclosure controls and procedures as of the end of the period covered by this Annual Report on 
Form 10-K. Based on this evaluation, our Chief Executive Officer and our Chief Financial Officer have concluded that 
our disclosure controls and procedures are effective to ensure that information we are required to disclose in reports that 
we  file  or  submit  under  the  Exchange  Act  is  recorded,  processed,  summarized  and  reported  within  the  time  periods 
specified in the Securities and Exchange Commission, or SEC, rules and forms and that such information is accumulated 
and communicated to management as appropriate to allow timely decisions regarding required disclosures. 

Management’s  annual  report  on  internal  control  over  financial  reporting.  Our  management  is  responsible  for 
establishing and maintaining adequate internal control  over our financial reporting. Our management has assessed the 
effectiveness of internal control over financial reporting as of December 31, 2020. Our assessment was based on criteria 
set forth by the Committee of Sponsoring Organizations of the Treadway Commission, or COSO, in Internal Control-
Integrated Framework (2013 Framework).  

Our internal control over financial reporting is a process designed to provide reasonable assurance regarding the 
reliability  of  financial  reporting  and  the  preparation  of  financial  statements  for  external  purposes  in  accordance  with 
generally  accepted  accounting  principles.  Our  internal  control  over  financial  reporting  includes  those  policies  and 
procedures that: 

(1)  pertain to the maintenance of records that, in reasonable detail, accurately and fairly reflect our transactions and 

dispositions of our assets;  

(2)  provide  reasonable  assurance  that  transactions  are  recorded  as  necessary  to  permit  preparation  of  financial 
statements in accordance with generally accepted accounting principles, and that our receipts and expenditures 
are being made only in accordance with authorizations of our management and board of directors; and  

(3)  provide  reasonable  assurance  regarding  prevention  or  timely  detection  of  unauthorized  acquisition,  use,  or 

disposition of our assets that could have a material effect on the financial statements. 

Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. 
Also, projections of any evaluation of  effectiveness to future periods are subject to the risk that controls may become 
inadequate  because  of  changes  in  conditions,  or  that  the  degree  of  compliance  with  the  policies  or  procedures  may 
deteriorate. 

Based on the COSO criteria, we believe our internal control over financial reporting as of December 31, 2020 was 

effective. 

This  Annual  Report  on  Form  10-K  does  not  include  an  attestation  report  of  our  independent  registered  public 
accounting firm regarding internal control over financial reporting.  Management’s assessment of the effectiveness of our 
internal  control  over  financial  reporting  as  of  December 31,  2020,  was  not  subject  to  attestation  by  our  independent 
registered public accounting firm pursuant to rules of the SEC that permit a smaller reporting company to provide only 
management’s report in the Company’s Annual Report on Form 10-K. 

Changes in internal control over financial reporting. 

There  was  no  change  in  our  internal  control  over  financial  reporting  that  occurred  during  the  quarter  ended 
December 31,  2020 that  has  materially  affected,  or  is  reasonably  likely  to  materially  affect,  our  internal  control  over 
financial reporting.  

92 

 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
Item 9B.    Other Information 

None. 

PART III 

Item 10.    Directors and Executive Officers and Corporate Governance  

The information regarding our directors, executive officers, director nomination process and the audit committee of 
the  Board is incorporated by reference from "Directors and Executive Officers" in our Proxy Statement for our 2021 
Annual Meeting of Stockholders. 

Section 16(a) Beneficial Ownership Reporting Compliance 

Section 16(a) of the Exchange Act requires our executive officers and directors and persons who own more than ten 
percent (10%) of a registered class of our equity securities to file reports of ownership and changes in ownership with the 
SEC. Executive officers, directors and greater than ten percent (10%) stockholders are required to furnish us with copies 
of all Section 16(a) forms they file. We believe all of our executive officers and directors complied with all applicable 
filing requirements during 2020. 

Code of Ethics  

We have adopted a Code of Ethics that applies to all of our directors, officers and employees, including our principal 
executive  officer  and  principal  financial  officer.  We  publicize  the  Code  of  Ethics  through  posting  the  policy  on  our 
website, http://www.cassavasciences.com. We will disclose on our website any waivers of, or amendments to, our Code 
of Ethics. 

Item 11.    Executive Compensation 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading "Executive Compensation and Other Matters." 

Item 12.  Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 

The information required by this Item regarding security ownership of certain beneficial owners and management is 
incorporated by reference from our definitive Proxy Statement referred to in Item 10 above where it appears under the 
heading "Security Ownership of Certain Beneficial Owners and Management." 

The following table summarizes the securities authorized for issuance under our equity compensation plans as of 

December 31, 2020: 

Equity compensation plans approved by stockholders 
Equity compensation plans not approved by stockholders  

Number of 
Securities to be 
Issued Upon 
Exercise of 
Outstanding 
Options, 
Warrants 
and Rights 
 2,955,559  (1) $ 

 —  

 2,955,559   $ 

Weighted Average 
Exercise Price of 
Outstanding 
Options, 
Warrants 
and Rights 

Number of Securities 
Remaining Available 
for Future Issuance 
Under Equity 
Compensation 
Plans 

 10.77  (2) 
 —  
 10.77  

 310,205  (3) 

 —  
 310,205  

(1)  Includes outstanding stock options and awards for 2,220,871 shares of our common stock under the 2008 Plan 

and 734,688 shares of our common stock under the 2018 Plan. 

93 

 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
(2)  Includes the weighted average stock price for outstanding stock options of $14.54 under the 2008 Plan and 

$2.11 for the 2018 Plan. 

(3)  Represents 252,188 shares of our common stock for the 2018 Plan and 58,017 for the Employee Stock Purchase 

Plan. No future awards shall occur under the 2008 Plan. 

Item 13.    Certain Relationships and Related Transactions and Director Independence 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading "Certain Relationships and Related Transactions." 

Item 14.    Principal Accountant Fees and Services 

The information required by this Item is incorporated by reference from our definitive Proxy Statement referred to 

in Item 10 above where it appears under the heading “Principal Accountant Fees and Services.” 

94 

 
 
 
 
 
 
  
 
 
 
Item 15.    Exhibits and Financial Statement Schedules 

(a)  The following documents are filed as part of this Form 10-K: 

PART IV 

(1) 

(2) 

Financial Statements (included in Part II of this report): 
Report of Independent Registered Public Accounting Firm 
Balance Sheets 
Statements of Operations 
Statements of Stockholders' Equity 
Statements of Cash Flows 
Notes to Financial Statements 
Financial Statement Schedules: 
All financial statement schedules are omitted because the information is inapplicable or presented in the notes 
to the financial statements. 

(3)  Management Contracts, Compensatory Plans and Arrangements.  

Management contracts, compensatory plans and arrangements are indicated by the symbol 
“*” in the applicable exhibits listed in Item 15(b), below. 

(b)  Exhibits  

The exhibits listed below are filed as part of this Form 10-K other than Exhibit 32.1, which shall be deemed furnished. 

Exhibit 
No. 
3.1 
3.2 
3.3 
3.4 
4.1 
4.2 
4.3 
4.4 
10.1 

10.2 

10.5 

10.6 
10.7 
10.8 

10.9 

 Form  
  Description 
   Amended and Restated Certificate of Incorporation. 
 10-Q  
   Certificate of Amendment of Restated Certificate of Incorporation.    8-K   
   Certificate of Amendment of Restated Certificate of Incorporation.   10-K  
   Amended and Restated Bylaws of Cassava Sciences, Inc. 
  8-K   
   Specimen Common Stock Certificate. 
 10-Q  
   Description of Registrant’s Securities. 
 10-K  
   Form of Common Stock Purchase Warrant. 
  8-K   
   Form of Wainwright Warrant. 
  8-K   
* 
S-1   
Form of Indemnification Agreement between Registrant and each of 
its directors and officers. 
* 
Employment  Agreement,  dated  October 23,  2001,  between 
Registrant and Nadav Friedmann, PhD. M.D.  
* 
Employment  Agreement,  dated  July 1,  1998  and  amended 
December 17, 2008, between Registrant and Remi Barbier. 
*  2000 Employee Stock Purchase Plan, as amended and restated. 
*  Amendment Number 1 to the 2008 Equity Incentive Plan. 
* 
Amendment  No.  2  to  Employment  Agreement  between  Registrant 
and Remi Barbier. 
Lease Agreement, dated as of February 14, 2011 between Registrant 
and StoneCliff Office, L.P. 

 10-Q  
 10-Q  
10-Q  

10-K  

10-K  

10-Q  

10.10  *  First Amendment to Lease Agreement, dated September 21, 2011. 
10.11 

Second Amendment to Lease Agreement, dated as of April 3, 2014 
between Registrant and StoneCliff Office, L.P.  
Third  Amendment  to  Lease  Agreement,  dated  as  of  November 3, 
2017 between Registrant US REIF Eurus Austin, LLC dba StoneCliff 
Building as successor in interest to StoneCliff Office, L.P. 
Fourth  Amendment  to  Lease Agreement,  dated  September 4,  2020 
between  Registrant  US  REIF  Eurus  Austin,  LLC  dba  StoneCliff 
Building as successor in interest to StoneCliff Office, L.P. 

10.12 

10.13 

 10-K  
10-Q  

10-K  

Filed 
Herewith 

  Incorporated by Reference    
Exhibit 
Filing 
No. 
Date 
  3.1 
7/29/2005 
  3.1 
5/8/2017 
  3.3 
3/29/2019 
  3.1 
12/11/2020 
  4.1 
8/12/2019 
  4.2 
3/26/2020 
  4.1 
8/20/2018 
  4.2 
8/20/2018 
  10.1   
3/14/2000 

3/22/2002 

  10.5   

2/13/2009 

  10.12   

7/29/2010 
8/1/2013 
8/1/2013 

  10.1   
  10.1   
  10.2   

4/27/2011 

  10.1   

2/9/2012 
8/6/2014 

  10.20   
  10.1   

2/6/2018 

  10.17   

8-K   

9/10/2020 

  10.1   

10.14  *  2018 Omnibus Incentive Plan. 

  8-K   

5/11/2018 

  10.1   

95 

 
 
 
 
 
 
 
 
 
 
 
  
   
  
  
   
 
 
  
   
  
  
   
 
    
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
10.15 

10.16 

10.17 

Form of Securities Purchase Agreement, dated August 15, 2018, by 
and between Registrant and the purchasers named therein. 
Agreement between Registrant and H.C. Wainwright & Co., dated 
August 15, 2018. 
Sales  Agreement,  Dated  March 27,  2020,  between  Registrant  and 
SVB Leerink LLC. 

8-K   

8/20/2018 

  10.1   

8-K   

8/20/2018 

  10.2   

S-3   

3/27/2020 

  1.1 

10.21  * 

10.18  *  Cassava Sciences, Inc. 2020 Cash Incentive Bonus Plan 
10.19 
10.20  * 

   Underwriting Agreement, dated November 13, 2020 
Employment  Agreement,  executed  on  October 9,  2018,  by  and 
between Registrant and Eric Schoen. 
Employment  Agreement,  executed  on  January 1,  2020,  by  and 
between Registrant and Dr. James Kupiec. 
   Consent of Independent Registered Public Accounting Firm. 
   Power of Attorney (included in the signature page to this report). 
Certification of Principal Executive Officer pursuant to Section 302 
of the Sarbanes-Oxley Act of 2002.  
Certification of Principal Financial Officer pursuant to Section 302 
of the Sarbanes-Oxley Act of 2002.  
Certifications of the Chief Executive Officer and the Chief Financial 
Officer pursuant to 18 U.S.C. Section 1350, as adopted pursuant to 
Section 906 of the Sarbanes-Oxley Act of 2002. 

23.1 
24.1 
31.1 

31.2 

32.1 

101.INS    XBRL Instance Document. 
101.SCH    XBRL Taxonomy Extension Schema Document. 
101.CAL    XBRL Taxonomy Extension Calculation Linkbase Document. 
101.DEF    XBRL Taxonomy Extension Definition Linkbase Document. 
101.LAB    XBRL Taxonomy Extension Labels Linkbase Document. 
101.PRE    XBRL Taxonomy Extension Presentation Linkbase Document. 
* Management contract, compensatory plan or arrangement. 

(c)  Financial Statement Schedules  

  8-K   
  8-K   
8-K   

9/1/2020 
11/13/2020 
10/11/2018 

  10.1   
  1.1 
  10.1   

8-K   

1/6/2021 

  10.1   

  X 
  X 

X 

X 

X 

  X 
  X 
  X 
  X 
  X 
  X 

All financial statement schedules are omitted because the information is inapplicable or presented in the notes to the 

financial statements. 

Item 16.    Form 10-K Summary 

The Company has elected not to include summary information. 

96 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly 

caused this report to be signed on its behalf by the undersigned, thereunto duly authorized. 

SIGNATURES 

(Principal Executive 

Cassava Sciences, Inc. 
(Registrant) 

/s/ REMI BARBIER 
Remi Barbier, 
Chairman of the Board of Directors, 
President and Chief Executive Officer 

Dated: March 23, 2021 

POWER OF ATTORNEY 

KNOW ALL PERSONS BY THESE PRESENTS, that each person whose signature appears below constitutes and 
appoints  Remi  Barbier  his  true  and  lawful  attorneys-in-fact,  with  full  power  of  substitution,  for  him  in  any  and  all 
capacities, to sign any amendments to this Annual Report on Form 10-K and to file the same, with exhibits thereto and 
other documents in connection therewith, with the Securities and Exchange Commission, hereby ratifying and confirming 
all that each of said attorneys-in-fact or their substitute or substitutes may do or cause to be done by virtue hereof. 

Pursuant  to  the  requirements  of  the  Securities  Exchange  Act  of  1934,  this  report  has  been  signed  below  by  the 

following persons on behalf of the registrant and in the capacities and on the dates indicated. 

Signature  

Title  

Date 

/s/  REMI BARBIER 

Remi Barbier 

President, Chief Executive Officer and  
Chairman of the Board of Directors 
(Principal Executive Officer) 

March 23, 2021 

/s/  ERIC J. SCHOEN 

Eric J. Schoen 

Chief Financial Officer 
(Principal Financial Officer) 

March 23, 2021 

/s/  NADAV FRIEDMANN, PH.D., M.D. 

Nadav Friedmann, Ph.D., M.D. 

Chief Medical Officer 
 and Director 

  March 23, 2021 

/s/  ROBERT Z. GUSSIN, PH.D.  
Robert Z. Gussin, Ph.D. 

/s/  MICHAEL J. O'DONNELL, ESQ.  

Michael J. O'Donnell, Esq. 

/s/  SANFORD R. ROBERTSON 
Sanford R. Robertson 

/s/  PATRICK SCANNON, M.D., PH.D.  

Patrick Scannon, M.D., Ph.D. 

Director 

Director 

Director 

Director 

March 23, 2021 

March 23, 2021 

March 23, 2021 

March 23, 2021 

97