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    DGAP-News  1129  0 Kommentare RedHill Biopharma Provides Progress Update on RHB-104 Phase III Crohn's Disease Program and Introduces Option for Early Stop for Success in Q2/2017

    DGAP-News: RedHill Biopharma Ltd. / Key word(s): Study
    RedHill Biopharma Provides Progress Update on RHB-104 Phase III Crohn's
    Disease Program and Introduces Option for Early Stop for Success in Q2/2017

    11.10.2016 / 15:30
    The issuer is solely responsible for the content of this announcement.

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    RedHill Biopharma Provides Progress Update on RHB-104 Phase III Crohn's
    Disease Program and Introduces Option for Early Stop for Success in Q2/2017

    - An option for early stop for success for overwhelming efficacy has been
    introduced into the ongoing first Phase III study with RHB-104 for
    Crohn's disease (the "MAP US" study) and analysis is expected in the
    second quarter of 2017 as part of a second independent data safety and
    monitoring board (DSMB) interim safety and efficacy review; The
    introduction of an early stop for success option may provide an
    opportunity to significantly shorten the time for study completion

    - An independent safety-focused DSMB meeting for the Phase III MAP US
    study is on track for the fourth quarter of 2016

    - RHB-104 is a potential paradigm-changing treatment for Crohn's disease,
    targeting a suspected underlying bacterial infectious cause of the
    disease, Mycobacterium avium subspecies paratuberculosis (MAP)

    - Ongoing work on RedHill's companion MAP diagnostic test has led to the
    successful identification of MAP DNA in blood samples from Crohn's
    disease patients; Further development work on the MAP companion
    diagnostic is in progress; RedHill has recently entered into a
    collaboration with Baylor College of Medicine - RedHill's third such
    MAP diagnostics collaboration with a leading U.S. university

    - In order to enhance the overall robustness of the MAP US Phase III
    study, provide a more comprehensive assessment of RHB-104's treatment
    effect and bolster the likelihood of the study's success even further,
    RedHill is implementing several improvements to the study's protocol
    and introducing additional enhancements to the overall RHB-104
    development program, including:

    - The total number of patients to be enrolled in the MAP US study has
    been increased from 270 to 410 in order to expand the collection of
    clinical data, including mucosal healing, and to compensate for
    early terminations; The increase is in line with historical power
    assumptions and remission rates of Phase III studies with approved
    Crohn's disease drugs

    - Overall 90% power has been maintained and sample size calculations
    have been modified to reduce the detectable effect from 21% to 15%,
    reflecting a more clinically expected treatment effect;
    Furthermore, with this modified sample size, more precise estimates
    of the treatment effect can be ascertained; No changes are planned
    to the primary endpoint of remission, defined as CDAI (Crohn's
    Disease Activity Index) of less than 150 at week 26

    - With 219 of the targeted 410 patients already enrolled in the MAP US
    study, the second independent DSMB meeting is expected in the second
    quarter of 2017, when the first 205 patients will have completed 26
    weeks of study participation; This independent DSMB review will include
    safety and interim efficacy analysis, with evaluation of an early stop
    for success under pre-specified efficacy criteria, providing an
    opportunity to significantly shorten the time to study completion in
    the event of overwhelming efficacy and potentially expediting the data
    locking process, once the study is fully completed

    - The modifications to the statistical design allow for sequential tests
    to be made; If the pre-specified statistical significance threshold is
    met at the interim analysis in the second quarter of 2017, the study
    could be stopped for efficacy or inefficacy; Should the pre-specified
    threshold not be met in the interim analysis, the study is planned to
    continue through randomization of all 410 patients and follow-up at 26
    weeks, with final efficacy testing performed using a two-sided p-value
    of 0.049

    - The increase in the number of patients in the MAP US study is also
    intended to allow for collection of significantly more colonoscopic
    mucosal healing data, supporting future potential marketing
    applications and reflecting and adhering to the most recent FDA and EMA
    guidance

    - A third safety-focused independent DSMB meeting is planned for when 75%
    of the 410 patients will have completed 26 weeks of study participation

    - In order to improve patient retention and further expedite recruitment,
    RedHill is preparing to initiate an open-label extension study,
    offering all patients who complete 26 weeks of study drug
    administration and remain out of remission (CDAI>150) the opportunity
    to receive treatment with RHB-104 for a 52-week period

    - To further expedite recruitment and expand data collection in Europe,
    RedHill is increasing the number of European sites by adding
    approximately 30 new sites in up to four additional European countries,
    more than doubling the current number of European sites in the MAP US
    study

    - In the coming months, RedHill intends to initiate two additional ex-
    U.S. small-scale open-label clinical studies with RHB-104, each with up
    to 20 Crohn's disease patients, to provide additional supportive
    clinical data to potential future marketing applications, as well as
    evaluate RHB-104's efficacy in newly diagnosed and treatment-naïve
    Crohn's disease patients and as an add-on therapy to current standard
    of care

    - RedHill will remain blinded to the interim and ongoing results from the
    Phase III study; No changes are planned to the MAP US Phase III study's
    primary endpoint or 90% power; Assuming enrollment of all 410 planned
    subjects, completion of patient recruitment is expected by the end of
    2017

    - RedHill maintained a debt-free balance sheet with $47.7 million in cash
    and cash equivalents at the end of the second quarter of 2016; The cash
    burn resulting from the changes outlined above in the third quarter of
    2016 was insignificant; The expected total impact of cash burn
    resulting from the expanded recruitment and the initiation of the open-
    label extension study up until the second independent DSMB meeting and
    the option for early stop for success in the second quarter of 2017, is
    approximately $6 million

    - Two recent non-clinical studies by researchers from the University of
    Central Florida (UCF) College of Medicine suggest that RHB-104 capsule
    proprietary formulation should be more effective in eradicating MAP
    infection than regimens with multi-individualized antibiotics and that
    RHB-104 active components at minimum inhibitory concentrations provide
    synergistic anti-MAP growth activity compared to individual or dual
    combinations

    - RedHill will host a conference call and webcast to discuss the updates
    on the RHB-104 Phase III development program today, Thursday, October
    6th, 2016, at 8:30 am EDT; Please visit the Company's website for dial-
    in information and webcast access: http://ir.redhillbio.com/events.cfm

    TEL-AVIV, Israel, October 11, 2016 RedHill Biopharma Ltd. (NASDAQ: RDHL)
    (TASE: RDHL) ("RedHill" or the "Company"), a biopharmaceutical company
    primarily focused on development and commercialization of late clinical-
    stage, proprietary, orally-administered, small molecule drugs for
    gastrointestinal and inflammatory diseases and cancer, provided an update
    on the RHB-104 Phase III Crohn's disease development program, planned
    enhancements to the MAP US first Phase III study and expected milestones,
    including an option for early stop for success for overwhelming efficacy.

    Ira Kalfus, MD, Medical Director at RedHill Biopharma, noted: "The
    increased number of patients and new open-label program reflect the strong
    and growing interest we have had from our current investigators who see the
    potential benefit of RHB-104 and the value of participating in this
    important study." Dr. Kalfus further stated: "We do not expect these
    changes to significantly impact timelines and the addition of an interim
    analysis for early stop for success, expected in the second quarter of
    2017, may in fact substantially shorten time to study completion."

    Professor David Graham, MD, M.A.C.G., internationally-renowned researcher
    and physician at the Baylor College of Medicine and the lead investigator
    of the RHB-104 MAP US Phase III study, said: "Crohn's disease is a chronic
    inflammatory condition with a devastating impact on patient's overall
    health and quality of life. With the cause of the disease remaining
    unknown, current standard of care therapies offer only to control the
    disease symptoms by suppressing the immune system. RHB-104 targets a
    specific pathogen believed to be the cause of the disease and thus presents
    a new approach to treating Crohn's disease. If the RHB-104 MAP US Phase III
    study is successful, it could completely change the treatment paradigm with
    therapy being based on the etiology of this disease."

    "We are introducing an option for early stop for success, expected in the
    second quarter of 2017, providing a new near-term catalyst and an
    opportunity to considerably speed up the study's timelines, without
    compromising its integrity," said Dror Ben-Asher, RedHill's CEO. "RHB-104
    is one of RedHill's three ongoing gastrointestinal Phase III flagship
    programs in the U.S., along with RHB-105 for H. pylori infection and
    BEKINDA(R) for gastroenteritis and gastritis. RHB-104 is a potential
    ground-breaking therapy for the treatment of Crohn's disease and a
    potential blockbuster, if approved. Given the important unmet medical need
    in Crohn's disease, the large commercial opportunity it presents and the
    clinical data already accumulated, we are determined to optimally position
    this study for success. The purpose of this update is to provide a detailed
    and transparent report of RedHill's RHB-104 Crohn's disease program and the
    important actions we are taking to further enhance the program and the
    ongoing Phase III study protocol, while maintaining the same endpoints and
    powering and keeping cash burn in check." Mr. Ben-Asher added: "We are very
    pleased with the current recruitment pace of the MAP US Phase III study and
    we are taking additional steps to accelerate recruitment even further. The
    changes introduced to the study's protocol are intended to expand the
    analyzable data to support future potential marketing applications and
    further bolster the study's likelihood of success. We are excited about the
    significant progress achieved with RHB-104, including the successful
    identification of MAP DNA in blood samples from Crohn's disease patients as
    part of our diagnostic development program. Our hope is to address the
    strong unmet medical need in Crohn's disease by potentially changing the
    treatment paradigm for patients suffering from this debilitating and
    painful disease."

    Professor Thomas Borody, MD, a leading innovator of therapeutic approaches
    for gastrointestinal diseases, inventor of the original anti-MAP
    combination, which included the RHB-104 actives (Myoconda), as well as the
    first patented triple antibiotic therapy for H. pylori peptic ulcer
    disease, and a member of RedHill's Advisory Board, said: "I have been
    treating patients in my clinic with the anti-MAP combination of antibiotics
    for over 20 years and have seen remarkable results, with many patients
    achieving complete and lasting remission over time. It is very exciting to
    see RedHill continue to progress
    RHB-104 through advanced clinical development. The similarities between
    Crohn's disease in humans and Johne's disease in cattle, the strong science
    pointing to MAP as the infective suspected cause of Crohn's disease and my
    extensive experience in treating patients with these antibiotics, all lead
    me to believe that RHB-104 has the potential to become a ground-breaking
    treatment for Crohn's disease. I am therefore hopeful that RedHill's
    RHB-104 Phase III program will succeed in demonstrating the relationship
    between MAP and Crohn's disease and, if successful, help provide Crohn's
    patients with a new, safe and effective treatment option."

    Professor Colm O'Morain, MD, internationally-renowned researcher and
    physician, former Dean of Healthcare Sciences at Trinity College Dublin,
    past president of the United European Gastroenterology Federation (UEG) and
    advisor to RedHill, said: "Crohn's disease incidence in Europe is one of
    the highest in the world and has increased in several European countries
    over the past few decades. Patients suffering from Crohn's disease are
    limited in their therapeutic options, with existing therapies targeting
    only symptomatic relief and accompanied by major potential side effects.
    The expansion of the European leg of the MAP US Phase III study is very
    encouraging, as this drug is targeting the suspected cause of the disease,
    rather than only disease symptoms. I hope that the expansion of the MAP US
    study in Europe will help advance the development of RHB-104 and provide
    additional European patients, who are in need of a new therapeutic
    alternative, the opportunity to receive treatment with this potential
    paradigm-changing new therapy."

    RHB-104 Crohn's Disease Program and the Microbiome Revolution

    RHB-104 is a proprietary and potentially groundbreaking antibiotic
    combination therapy in oral capsule formulation, with potent intracellular,
    anti-mycobacterial and anti-inflammatory properties. The development of
    RHB-104 is based on increasing evidence supporting the hypothesis that
    Crohn's disease and potentially other autoimmune diseases are related to
    Mycobacterium avium subspecies paratuberculosis (MAP) infection in
    susceptible patients. The development of RHB-104 is consistent with the
    growing awareness of the possibility that a bacterially-induced
    dysregulated immune system may contribute to the pathogenesis of various
    autoimmune diseases of unknown etiology.

    RHB-104 and the Ongoing RHB-104 MAP US First Phase III Study for Crohn's
    Disease

    RedHill is developing RHB-104 for the treatment of Crohn's disease, with an
    ongoing first Phase III study (the MAP US study). RHB-104 is also being
    developed for multiple sclerosis, with a Phase IIa proof of concept study
    recently completed in Israel (the CEASE-MS study). Final results from the
    Phase IIa study for multiple sclerosis are currently under analysis,
    following encouraging top-line interim results.

    The ongoing RHB-104 MAP US Phase III study for Crohn's disease is enrolling
    in up to 150 clinical sites in the U.S, Canada, Europe, Israel, Australia
    and New Zealand. Additional studies will likely be required to support a
    U.S. New Drug Application (NDA) for RHB-104.

    The MAP US study is a randomized, double-blind, placebo-controlled first
    Phase III study intended to evaluate the safety and efficacy of RHB-104 in
    patients with moderately to severely-active Crohn's disease, defined as
    Crohn's Disease Activity Index (CDAI) between 220 and 450. Subjects
    enrolled in the study are randomized in a 1:1 fashion to receive RHB-104 or
    a placebo, with a primary endpoint of disease remission, defined as
    reduction in CDAI to less than 150 at week 26. Secondary and exploratory
    endpoints include, among others, state of response at week 26, maintenance
    of remission through week 52 and efficacy outcome measures in relation to
    the presence of MAP bacterial infection. Exploratory endpoints include
    endoscopic evaluation of mucosal healing.

    219 subjects have already been randomized in the MAP US study, with a data
    and safety monitoring board (DSMB) meeting on track to take place in the
    fourth quarter of 2016. This independent DSMB meeting will focus on safety.
    RedHill will remain blinded to the interim and ongoing results from the
    Phase III study.

    In order to further enhance the overall robustness of the MAP US Phase III
    study, provide a more comprehensive assessment of RHB-104's treatment
    effect, better evaluate the Crohn's disease population enrolled in the
    study, further improve recruitment pace, address retention and early
    terminations and bolster the likelihood of study success even further,
    RedHill is implementing several changes to the study's protocol and
    introducing additional enhancements to the overall RHB-104 development
    program, including:

    - RedHill has increased the number of subjects planned to be enrolled in
    the study from 270 to 410, in order to enhance the study's overall
    robustness, account for early terminations and increase precision of
    estimates of efficacy.

    Overall, 90% power has been maintained and sample size calculations have
    been modified to reduce the detectable effect from 21% to 15%, reflecting a
    more clinically expected treatment effect. Furthermore, with this modified
    sample size, more precise estimates of the treatment effect can be
    ascertained. No changes are planned to the primary endpoint of remission at
    week 26.

    219 patients have already been enrolled in the MAP US study and an
    independent DSMB review, focused on safety, is on track for the fourth
    quarter of 2016. Two additional DSMB meetings are expected to take place in
    the MAP US study after 50% and after 75% of the 410 patients planned to be
    enrolled in the study will complete 26 weeks of study participation. The
    second independent DSMB meeting is expected in the second quarter of 2017,
    after the first 205 patients complete 26 weeks of study participation.
    Patient 205 was randomized in August 2016.

    The second DSMB meeting will include safety and interim efficacy analysis
    and could potentially provide the opportunity to expedite the data locking
    process for the final analysis, once the study is complete.

    Importantly, this independent DSMB meeting will evaluate the option of an
    early stop for success, according to a pre-specified statistical
    significance threshold for analysis requiring overwhelming efficacy of
    RHB-104 versus placebo in the primary endpoint (two sided p-value< 0.003).
    Potentially, this could shorten the time to study completion considerably
    without compromising its integrity. The modifications to the statistical
    design allow for sequential tests to be made using the O'Brien-Fleming
    spending function to determine the test boundaries. If the pre-specified
    threshold is met at the second DSMB meeting, the study could be stopped for
    efficacy or inefficacy. If the pre-specified threshold is not met during
    the interim analysis, the study is planned to continue through
    randomization of all 410 patients and follow-up at week 26, with final
    efficacy testing performed using two sided p-value of 0.049. Given the high
    thresholds for determining interim efficacy (or inefficacy) set by the pre-
    specified test boundaries using the O'Brien-Fleming method, RedHill expects
    to continue the MAP US Phase III study through completion of enrolment of
    all 410 patients and that the DSMB will not recommend an early stop.

    Taking into account the increase in the total number of patients in the
    study, and assuming the study is not stopped for success or inefficacy
    following the DSMB meeting in the second quarter of 2017, completion of
    recruitment is expected by the end of 2017.

    The expansion of the MAP US study is also expected to improve the ability
    to capture more data related to mucosal healing with endoscopic testing, an
    exploratory endpoint in the MAP US study. Both the U.S. Food and Drug
    Administration (FDA) and the European Medicines Agency (EMA) have stressed
    the increasing importance of mucosal healing data in Crohn's disease
    studies. Mucosal healing is a voluntary exploratory endpoint in the MAP US
    Phase III study and the additional imaging data from this study, as well as
    from two planned ex-U.S. small-scale clinical studies with RHB-104, will
    potentially add to the understanding of RHB-104's therapeutic effect and
    may support future potential marketing applications.

    - In order to improve patient retention, further expedite recruitment and
    expand the safety and efficacy data set of RHB-104, RedHill plans to
    initiate an open-label extension study for all patients who have
    completed 26 weeks of treatment in the MAP US study and failed to
    achieve remission at week 26, the study's primary endpoint. Patients
    with a Crohn's Disease Active Index (CDAI) score of greater than 150 at
    week 26 will be offered the opportunity to receive treatment with
    active drug (RHB-104) for a 52-week period. This study is considered
    separate from the MAP US study results and data collected will be
    supplemental to the MAP US study data.

    - To further expedite recruitment and expand data collection in Europe,
    RedHill is increasing the number of European sites in the MAP US study
    by adding approximately 30 new sites in up to four additional European
    countries, more than doubling the current number of sites in Europe.

    - In support of future potential marketing applications, RedHill also
    plans to initiate two additional open-label, ex-U.S. clinical studies
    of up to 20 Crohn's disease patients each to further evaluate the
    safety and efficacy of RHB-104, including generation of additional
    efficacy data in newly diagnosed and treatment-naïve Crohn's disease
    patients and as an add-on therapy to current standard-of-care. In
    addition, an extensive pharmacokinetic (PK) program is ongoing,
    including a population PK (pop PK) study which is being conducted as
    part of the MAP US study along with previously completed food effect
    and drug-drug interaction studies.

    - RedHill maintained debt-free balance sheet with $47.7 million in cash
    and cash equivalents at the end of the second quarter of 2016. The
    expected cash burn resulting from the changes outlined above in the
    third quarter of 2016 was insignificant. The expected total cash burn
    impact resulting from the expanded recruitment and the initiation of
    the open-label extension study, up until the second independent DSMB
    meeting and the option for early stop for success in the second quarter
    of 2017, is approximately $6 million.

    Mycobacterium avium subspecies paratuberculosis (MAP) - Johne's and Crohn's
    diseases

    MAP is a slow-growing, Gram-positive bacterium which is the causative agent
    of Johne's disease, a severe enteritis that afflicts cattle and other
    ruminant animals. Heinrich Albert Johne first characterized the condition
    in 1895 when he demonstrated the presence of acid fast microorganisms in
    intestinal mucosa of cattle with enteritis[1]. Nearly two decades later,
    T. K. Dalziel identified a human enteritis similar to Johne's disease yet
    distinctly different from tuberculosis, another acid fast organism[2]. At
    the same time, F. W. Twort succeeded in cultivating a new mycobacterium
    which produced experimental enteritis formally designated mycobacterium
    avium paratuberculosis[2]and the veterinary disease was renamed
    paratuberculosis. In 1932, Burril Crohn reported on the disease that bore
    his name similarly describing a non-tuberculous granulomatous regional
    ileitis[4].

    Johne's disease is a chronic granulomatous disease that primarily affects
    the ileum. It is characterized by progressive weight loss and chronic
    diarrhea, resulting in wasting and eventual death. Initial clinical signs
    typically arise after maturity and the birth of first calf following a
    healthy appearing prolonged incubation period of two to ten years[5].
    Infected animals may shed up to one million infectious doses of MAP in
    their feces per day[6] and it is estimated that over 90% of U.S. dairy
    herds[7] and roughly 5-10% of U.S. dairy cattle are infected[8].

    Crohn's disease shares many similarities with Johne's disease. They both
    were first described as occurring in the ileum, and like Johne's disease,
    Crohn's disease presents as a disease of the young. Typical onset of
    Crohn's disease is between the ages of 15-25 and it is characterized by
    chronic, recurrent abdominal pain, diarrhea, weight loss and failure to
    thrive. Pathologically, granulomatous inflammation of the intestinal wall
    is seen in both Crohn's disease and Johne's disease as is a cobblestone
    appearance of the intestinal mucosa, which is pathognomonic of Crohn's
    disease in humans. The principal pathological changes found in the
    intestine, such as thickening of the ileum and ulcerations of the mucosa,
    usually with underlying nodules of lymphoid tissue, have been observed in
    both Johne's disease and Crohn's disease.

    In humans, MAP is an intracellular pathogen that resides in monocytes and
    macrophages and may persist for months in a dormant spheroplast form
    without a cell wall. This makes detection by standard staining methods
    difficult. MAP takes up to six months to grow and requires a highly
    specialized media, further confounding its identification. Mycobacterium
    paratuberculosis is a Gram-positive, acid-fast, non-spore forming and non-
    motile bacteria with a straight or curved rod shape. Within macrophages,
    MAP drops its cell wall, the component of the bacterium that takes up the
    characteristic acid stain and enhances the ability of the mycobacterium to
    resist host defenses. The lipid-rich cell wall is believed to determine
    many of the properties of the organism, such as virulence and resistance to
    extracellular degradation. In addition, without the cell wall, the
    bacterium is no longer 'acid fast' and cannot be detected microscopically.
    Recent studies have demonstrated the capacity of MAP to undergo a
    morphologic change to become spore-like. The spore morphotype survives heat
    and may lead to increased persistence in hosts and the environment[9][10].

    There is currently no FDA-approved commercial diagnostic test for MAP.
    However, recent advances in diagnostic technology have led to increasingly
    higher identification of MAP, with studies demonstrating high prevalence of
    MAP in Crohn's disease patients[11].

    Clinical Study History - MAP and Crohn's disease

    In the summer of 1998, the Paratuberculosis Awareness and Research
    Association issued a plea to the United States Government to investigate
    the relationship between the cattle pathogen, MAP, and the devastating
    human condition known as Crohn's disease. In 1999, the U.S. National
    Institute of Allergy and Infectious Disease (NIAID), part of the National
    Institutes of Health (NIH), published a research agenda which targeted
    research into the relationship between infection and Crohn's disease, with
    particular reference to infection with MAP.

    Since the 1998 NIH / NIAID-sponsored conference on MAP in Crohn's disease,
    there have been numerous studies published in peer-reviewed journals
    regarding MAP detection in human blood, tissues and stool samples taken
    from Crohn's disease patients demonstrating a strong relationship between
    Crohn's disease and MAP.

    The resemblance of intestinal pathology in Johne's disease to Crohn's
    disease was more recently identified and studied by Professor Thomas
    Borody[12], an innovator of therapeutic approaches to treating
    gastrointestinal tract diseases. Professor Borody pioneered anti-MAP
    therapy approximately 20 years ago and has since treated over 300 Crohn's
    disease patients with the same antibiotics as are used in RHB-104.
    Professor Borody has published results from several of his studies,
    including a retrospective analysis of 12 Crohn's disease patients
    demonstrating complete remission in half of those treated with anti-MAP
    therapy[13]. Pharmacia Corporation ("Pharmacia"), which was later acquired
    by Pfizer Inc., licensed the product from Professor Borody and conducted a
    large 213 patient study which, until RedHill's current study, had been the
    largest study ever done with anti-MAP therapy in Crohn's disease.
    Unfortunately, the Pharmacia study design left it significantly
    underpowered and led to its missing its primary endpoints, although the
    active arm was better than placebo throughout study drug administration (16
    weeks, 52 weeks and 104 weeks)[14]. A reanalysis of the study conducted by
    McGill University researchers Drs. Marcel A. Behr, MD, and Professor James
    A. Hanley, PhD, and published in the Lancet Infectious Diseases[15] found
    that flaws in the study design led not only to an analysis of incremental
    benefit instead of maintenance of benefit, but also to the introduction of
    bias in the treatment groups as well. Correcting for these concerns, Drs.
    Behr and Hanley demonstrated that anti-MAP therapy was significantly more
    efficacious than placebo with a persistent treatment effect of
    approximately 16% from week 16 through week 104. According to the Behr and
    Hanley reanalysis, the Pharmacia study demonstrated a 66% vs. 50% treatment
    effect favoring anti-MAP therapy at 16 weeks (p=0.02). This was maintained
    through 52 weeks, with results of 40% vs. 22% (p=0.003) and through 104
    weeks with 30% vs. 14% (p=0.005), favoring anti-MAP therapy.

    In 2010, following publication of the Lancet article, RedHill acquired the
    worldwide exclusive rights to RHB-104 from the Sydney, Australia-based
    company, Giaconda. RedHill has since initiated an extensive R&D program and
    significantly advanced the development of RHB-104, which included an
    improved reformulation of the active ingredients in higher doses in an
    all-in-one single oral capsule, clinical PK studies, a development program
    for a companion diagnostic for MAP and discussions with the FDA and
    additional regulatory agencies to clarify the potential regulatory path for
    approval.

    A recent non-clinical study conducted at the University of Central Florida
    (UCF) College of Medicine's Burnett School of Biomedical Sciences compared
    the minimum inhibitory concentrations of RHB-104 proprietary all-in-one
    oral capsule with an RHB-104 analog of the three antibiotics dissolved
    individually for eradication of MAP infection, as well as other organisms.
    The study was designed to evaluate the synergistic properties of the
    RHB-104 all-in-one formulation of three antibiotics and was described by
    the researchers in an article titled "A single capsule formulation of
    RHB-104 demonstrates higher anti-microbial growth potency for effective
    treatment of Crohn's disease associated with Mycobacterium avium subspecies
    paratuberculosis" which has been accepted for publication in the peer-
    reviewed journal Gut Pathogens[16]. The article concludes that the RHB-104
    proprietary formulation of three antibiotics in a single oral capsule
    results in potent synergistic anti-microbial activity far exceeding the
    treatment efficacy of multi-individually dissolved drugs. The study
    strongly suggests that the proprietary RHB-104 capsule formulation should
    be more effective in eradication of MAP infection than regimens with multi-
    individualized antibiotics.

    This study follows a previous publication by researchers from the
    University of Central Florida (UCF) College of Medicine's Burnett School of
    Biomedical Sciences, which was also published in Gut Pathogens under the
    title "RHB-104 triple antibiotics combination in culture is bactericidal
    and should be effective for treatment of Crohn's disease associated with
    Mycobacterium paratuberculosis"[17]. The results described in this article
    demonstrated that the RHB-104 active components, in their individual
    concentrations or in dual combinations, were not as effective compared to
    the triple combination of RHB-104, at minimum inhibitory concentration
    levels, against all microorganisms. The authors concluded that the triple
    combination of RHB-104 active components at minimum inhibitory
    concentration (MIC) provided synergistic anti-MAP growth activity compared
    to individual or dual combinations of the drugs and, consequently,
    administration of RHB-104 is considered favorable and should lead to
    tolerable dosage that is desirable for long-term treatment of Crohn's
    disease.

    RedHill's MAP Diagnostics Development Program

    RedHill continues to advance the development program for a commercial
    companion diagnostic for the detection of MAP bacteria in Crohn's disease
    patients.

    Results to date include initial validation of RedHill's platform PCR
    (polymerase chain reaction) detection methodology licensed from UCF and
    developed by Professor Saleh A. Naser, a leading investigator in the field
    of Mycobacterium avium subspecies paratuberculosis (MAP) and its
    association with Crohn's disease. Further testing of the methodology at
    three different U.S. laboratories has successfully identified MAP DNA in
    blood samples drawn from patients with Crohn's disease outside of the MAP
    US study. Further optimization of the processes for rapid detection of MAP
    is currently in progress.

    The development of the commercial companion diagnostic is an extension of
    RedHill's RHB-104 Phase III development program. RedHill has also recently
    initiated a third U.S. university collaboration with Baylor College of
    Medicine intended to further advance the efforts to develop a companion
    diagnostic for MAP. RedHill had previously acquired the rights to two
    separate patented technologies from the laboratory of Professor Saleh A.
    Naser at the UCF College of Medicine's Burnett School of Biomedical
    Sciences and from the University of Minnesota.

    Critical to the successful development of a companion diagnostic will be
    ensuring that any future commercial test is accurate and reproducible.
    RedHill believes that PCR (polymerase chain reaction) technology is the
    most promising approach currently available and is focusing its efforts in
    that direction.

    There is currently no validated, FDA-approved, commercially available
    method of detecting the presence or absence of MAP in patients suffering
    from Crohn's disease and other diseases. The development of a companion
    diagnostic is expected to contribute to the understanding of the role of
    MAP infection in Crohn's disease and potentially other inflammatory
    diseases.

    RedHill's RHB-104 Phase IIa Multiple Sclerosis Program

    RHB-104 is also under development for relapsing-remitting multiple
    sclerosis (RRMS). Top-line final results from the Phase IIa CEASE-MS study
    with RHB-104 for RRMS are expected in the fourth quarter of 2016, following
    the recently announced last patient follow-up visit in the study. In the
    first 24 weeks, patients enrolled in the CEASE-MS study received treatment
    with RHB-104 as an add-on therapy to interferon beta-1a and were then
    evaluated for an additional 24-week follow-up period during which they were
    treated with interferon beta-1a alone. Top-line interim results announced
    in March 2016, after completion of the 24-week treatment period,
    demonstrated positive safety and efficacy signals, including an encouraging
    relapse-free rate, Expanded Disability Status Scale (EDSS) scores and MRI
    results, which support further clinical development.

    RHB-104 - Strong Patent Protection

    RedHill has built a robust patent portfolio, including protection of the
    RHB-104 formulation and method-of-use through 2032. RedHill's formidable
    patent portfolio covering its oral antibiotic combination therapy includes
    more than 25 patents in various countries including the U.S., Australia,
    Canada, Japan and multiple European countries with additional patent claims
    being pursued worldwide.

    RHB-104 is composed of three active pharmaceutical ingredients (APIs) and
    RedHill has been working with various manufacturers to obtain secure and
    reliable sourcing of these active components. In some cases, this has
    required the development of proprietary manufacturing processes, which
    RedHill believes may be an added source of protection for RHB-104.

    RedHill hosted a conference call and webcast call today, October 6th,
    2016 at 8:30 a.m. EDT, to review the RHB-104 development program and the
    planned changes to the MAP US Phase III study. Please visit the Company's
    website for dial-in information and webcast access: http://
    ir.redhillbio.com/events.cfm

    About RHB-104:
    Currently in a first Phase III study for the treatment of Crohn's disease
    (the MAP US study), RHB-104 is a proprietary and potentially groundbreaking
    oral antibiotic combination therapy, with potent intracellular, anti-
    mycobacterial and anti-inflammatory properties. RHB-104 is based on
    increasing evidence supporting the hypothesis that Crohn's disease is
    caused by Mycobacterium avium subspecies paratuberculosis (MAP) infection
    in susceptible patients. Clinical trials conducted with earlier
    formulations of RHB-104 include an Australian Phase III study conducted by
    Pharmacia/Pfizer. RedHill has conducted several supportive studies with the
    current formulation of RHB-104 and a long-term population pharmacokinetic
    (pop-PK) study is ongoing as part of the Phase III MAP US study. RHB-104 is
    covered by several issued and pending patents. RedHill is also conducting
    the CEASE-MS Phase IIa, proof-of-concept clinical study, evaluating RHB-104
    as an add-on therapy to interferon beta-1a in patients treated for
    relapsing-remitting multiple sclerosis (RRMS), with top-line interim
    results announced and top-line final results expected in the fourth quarter
    of 2016.

    About RedHill Biopharma Ltd.:
    RedHill Biopharma Ltd. (NASDAQ/TASE: RDHL) is a biopharmaceutical company
    headquartered in Israel, primarily focused on the development and
    commercialization of late clinical-stage, proprietary, orally-administered,
    small molecule drugs for the treatment of gastrointestinal and inflammatory
    diseases and cancer. RedHill's current pipeline of proprietary products
    includes: (i) RHB-105 - an oral combination therapy for the treatment of
    Helicobacter pylori infection with successful results from a first Phase
    III study; (ii) RHB-104 - an oral combination therapy for the treatment of
    Crohn's disease with an ongoing first Phase III study and an ongoing proof-
    of-concept Phase IIa study for multiple sclerosis; (iii) BEKINDA(R)
    (RHB-102) - a once-daily oral pill formulation of ondansetron with an
    ongoing Phase III study for acute gastroenteritis and gastritis and an
    ongoing Phase II study for IBS-D; (iv) RHB-106 - an encapsulated bowel
    preparation licensed to Salix Pharmaceuticals, Ltd.; (v) YELIVA(TM)
    (ABC294640) - a Phase II-stage, orally-administered, first-in-class SK2
    selective inhibitor targeting multiple oncology, inflammatory and
    gastrointestinal indications; (vi) MESUPRON - a Phase II-stage first-in-
    class, orally-administered uPA inhibitor, targeting gastrointestinal and
    other solid tumors; (vii) RP101 - currently subject to an option-to-acquire
    by RedHill, RP101 is a Phase II-stage first-in-class, orally-administered
    Hsp27 inhibitor, , targeting pancreatic and other gastrointestinal cancers;
    (viii) RIZAPORT(R) (RHB-103) - an oral thin film formulation of rizatriptan
    for acute migraines, with a U.S. NDA currently under discussion with the
    FDA and marketing authorization received in Germany in October 2015; and
    (ix) RHB-101 - a once-daily oral pill formulation of the cardio drug
    carvedilol.

    This press release contains "forward-looking statements" within the meaning
    of the Private Securities Litigation Reform Act of 1995. Such statements
    may be preceded by the words "intends," "may," "will," "plans," "expects,"
    "anticipates," "projects," "predicts," "estimates," "aims," "believes,"
    "hopes," "potential" or similar words. Forward-looking statements are based
    on certain assumptions and are subject to various known and unknown risks
    and uncertainties, many of which are beyond the Company's control, and
    cannot be predicted or quantified and consequently, actual results may
    differ materially from those expressed or implied by such forward-looking
    statements. Such risks and uncertainties include, without limitation, risks
    and uncertainties associated with (i) the initiation, timing, progress and
    results of the Company's research, manufacturing, preclinical studies,
    clinical trials, and other therapeutic candidate development efforts; (ii)
    the Company's ability to advance its therapeutic candidates into clinical
    trials or to successfully complete its preclinical studies or clinical
    trials; (iii) the extent and number of additional studies that the Company
    may be required to conduct and the Company's receipt of regulatory
    approvals for its therapeutic candidates, and the timing of other
    regulatory filings, approvals and feedback; (iv) the manufacturing,
    clinical development, commercialization, and market acceptance of the
    Company's therapeutic candidates; (v) the Company's ability to establish
    and maintain corporate collaborations; (vi) the Company's ability to
    acquire products approved for marketing in the U.S. that achieve commercial
    success and build its own marketing and commercialization capabilities;
    (vii) the interpretation of the properties and characteristics of the
    Company's therapeutic candidates and of the results obtained with its
    therapeutic candidates in research, preclinical studies or clinical trials;
    (viii) the implementation of the Company's business model, strategic plans
    for its business and therapeutic candidates; (ix) the scope of protection
    the Company is able to establish and maintain for intellectual property
    rights covering its therapeutic candidates and its ability to operate its
    business without infringing the intellectual property rights of others; (x)
    parties from whom the Company licenses its intellectual property defaulting
    in their obligations to the Company; (xi) estimates of the Company's
    expenses, future revenues capital requirements and the Company's needs for
    additional financing; (xii) competitive companies and technologies within
    the Company's industry; and (xiii) the impact of the political and security
    situation in Israel on the Company's business. More detailed information
    about the Company and the risk factors that may affect the realization of
    forward-looking statements is set forth in the Company's filings with the
    Securities and Exchange Commission (SEC), including the Company's Annual
    Report on Form 20-F filed with the SEC on February 25, 2016. All forward-
    looking statements included in this Press Release are made only as of the
    date of this Press Release. We assume no obligation to update any written
    or oral forward-looking statement unless required by law.



    Company contact: IR & PR contact (Europe)
    Adi Frish Anne Hennecke
    Senior VP Business Development & Managing Partner
    Licensing MC Services AG
    RedHill Biopharma +49-211-529252-22
    +972-54-6543-112 anne.hennecke@mc-services.eu
    adi@redhillbio.com




    [1] Cocito C. et al., Paratuberculosis, Clin Microbiol Rev, Jul 1994;
    328-345.

    [2] Dalziel TK, Chronic interstitial enteritis, British Medical Journal.
    1913;2:1068-1070.

    [3] Twort F. W. et al., A Method for Isolating and Cultivating the
    Mycobacterium enteritidis chronicae pseudotuberculosae bovis, Johne, and
    some Experiments on the Preparation of a Diagnostic Vaccine for
    Pseudo-tuberculous Enteritis of Bovines, The Royal Society, Mar 1912, Vet.
    J. 68, 353-365.

    [4] Crohn BB et al., Regional Ileitis - A Pathological and Clinical Entity,
    JAMA. 1932;99(16):1323-1329.

    [5] Tiwari A. et al., Johne's disease in Canada: Part I: Clinical symptoms,
    pathophysiology, diagnosis, and prevalence in dairy herds, 2006, Can Vet J,
    Sep; 47(9): 874-882.

    [6] Marce C, Predicting fadeout versus persistence of paratuberculosis in a
    dairy cattle herd for management and control purposes: a modelling study,
    2011, Vet Res, 42:36; Wu C et al. Defining the Stressome of Mycobacterium
    avium subsp. paratuberculosis In Vitro and in Naturally Infected Cows,
    2007, J. Bacteriol. Nov. 7877-7886.

    [7] Lombard JE et al. Herd-level prevalence of Mycobacterium avium subsp.
    paratuberculosis infection in the United States dairy herd in 2007, Prev
    Vet Med, 2013; 108, 234-238.

    [8] Lombard JE, Epidemiology and Economics of Paratuberculosis, Vet Clin
    North Am Food Anim Pract. 2011 Nov;27(3):525-35.

    [9] Tessema MZ et al., Bacteriology: Review paratuberculosis: How does
    mycobacterium avium subsp. Paratuberculosis resist intracellular
    degradation?, Vet Quart, 2011 23:4, 153-162.

    [10] Dow CT, Mycobacterium avium Subspecies Paratuberculosis and Human
    Disease: Bridging Infection and Autoimmunity, Infection and Autoimmunity,
    2015 Elsevier B.V.

    [11] Bull TJ et al. Detection and verification of Mycobacterium avium
    subsp. paratuberculosis in fresh ileocolonic mucosal biopsy specimens from
    individuals with and without Crohn's disease, J Clin Microbiol, 2003,
    Jul;41(7):2915-23.; Shafran I et al. Seroreactivities against Saccharomyces
    cerevisiae and Mycobacterium avium subsp. paratuberculosis p35 and p36
    antigens in Crohn's disease patients, Dig Dis Sci, 2002, Sep;47(9):2079-81.

    [12] Prof. Borody is a member of RedHill's Advisory Board.

    [13] Borody TJ et al., Treatment of severe Crohn's disease using
    antimycobacterial triple therapy - approaching a cure? Digest Liver Dis
    2002;34:29-38.

    [14] Selby W, Pavli P, Crotty B, Florin T, et al. Antibiotics in Crohn's
    Disease Study Group.Two year combination antibiotic therapy with
    clarithromycin, rifabutin, and clofazimine for Crohn's disease.
    Gastroenterology. 2007; 132(7):2313-9.

    [15] Behr MA, Hanley J, Antimycobacterial therapy for Crohn's disease: a
    reanalysis, Lancet Infectious Diseases, 2008; 8:344.

    [16] Qasem A, Safavikhasraghi M, Naser SA. A single capsule formulation of
    RHB-104 demonstrates higher anti-microbial growth potency for effective
    treatment of Crohn's disease associated with Mycobacterium avium subspecies
    paratuberculosis, Gut Pathogens, 2016, 8:45.

    [17] Alcedo KP, Thanigachalam S, Naser SA. RHB-104 triple antibiotics
    combination in culture is bactericidal and should be effective for
    treatment of Crohn's disease associated with Mycobacterium
    paratuberculosis, Gut Pathogens, 2016, 8:32.


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