• New Data Suggests Rapid, Sustained, and Consistent Migraine Relief with Trudhesa Treatment
• New Analysis Considers Efficacy of Trudhesa After Variety of Acute Therapies
• Post Hoc Pivotal Trial Data Indicates that Trudhesa Use Was Associated with Reduction in Disability and Frequency of Monthly Migraine Attacks

Impel NeuroPharma (NASDAQ: IMPL), a commercial-stage pharmaceutical company developing transformative therapies for people suffering from diseases with high unmet medical needs, with an initial focus on the central nervous system, today announced planned poster presentations at the upcoming American Academy of Neurology (AAN) annual meeting, to be held April 2 – 7, 2022 in Seattle, Washington. Impel will be presenting additional data from the pivotal, Phase 3 STOP-301 trial exploring the safety and efficacy of INP104, marketed as Trudhesa™ (dihydroergotamine mesylate) nasal spray (0.725 mg per spray).

Using Impel’s proprietary POD^® technology, Trudhesa delivers dihydroergotamine mesylate (DHE)—a proven, well-established therapeutic for the acute treatment of migraine for adults—quickly to the bloodstream through the vascular-rich upper nasal space. Trudhesa bypasses the gut and reduces potential absorption issues, offering rapid, sustained, and consistent symptom relief without nausea commonly associated with injection or infusion DHE, even when administered hours after the onset of a migraine attack.

“Patient dissatisfaction with current acute treatment for migraine therapies represents an ongoing unmet need, and inadequate treatment may lead to increased disability and disease progression^1,2,3,” said Sheena K. Aurora, M.D., Vice President Medical Affairs, Impel NeuroPharma. “There is a need for additional, effective acute therapies to resolve migraine symptoms, especially in patients who are not adequately managed by their current therapies,⁴ and we are pleased to present these additional data from our pivotal trial that underscore the potential benefits these data have shown with Trudhesa treatment.”

• Impel will present additional data from the pivotal, Phase 3 STOP-301 Trial, looking at the exploratory efficacy of Trudhesa treatment over 24 weeks based on acute medications used prior to Trudhesa. There are many evidence-based migraine acute treatments currently available and these are either migraine non-specific (i.e., non-steroidal anti-inflammatory drugs [NSAIDs], acetaminophen) or migraine-specific (i.e., triptans, DHE). Since there are numerous acute therapies available, it is important to determine if the efficacy of Trudhesa is impacted by prior acute treatment history. Acute therapies most commonly used prior to initiation of treatment with Trudhesa treatment initiation were acetaminophen, NSAIDs, and triptans. This analysis suggests that Trudhesa is an effective treatment for migraine patients who have previously used a variety of acute therapies.⁴
  
  
• A second post hoc analysis aimed to determine if early treatment response to Trudhesa could predict response over consecutive migraine attacks. These data found that patients who self-report mild or no pain at two hours for their first three Trudhesa-treated migraine attacks are extremely likely (>89%) to respond to Trudhesa treatment. Those with no or mild pain for their first two Trudhesa treated migraine attacks were also likely (>75%) to respond to Trudhesa treatment. Results suggest that if Trudhesa provides pain relief for the first two to three migraine attacks, it is likely a patient will respond to Trudhesa with long-term use, which is informative for clinical decision making.⁵
  
  
• An additional post hoc analysis, from the STOP-301 trial, supports the need for new and effective acute therapies that will rapidly resolve migraine symptoms and provide a sustained benefit to potentially reduce interictal symptoms. The analysis investigated headache-related disability, time between migraine attacks, and frequency of migraine attacks over 24 weeks, which were exploratory outcome measures relevant to interictal burden. The data suggest that repeated acute use of Trudhesa may have positive effects on interictal burden by reducing migraine-associated disability, prolonging the headache-free period, and decreasing the number of migraine attacks over time.⁶

“Despite many new migraine treatments being available, patients remain dissatisfied. Patients still need treatments that provide relief on a consistent basis,” says Sara Sacco, M.D., Neurologist with the Carolinas Headache Clinic, Charlotte, North Carolina and lead author on the prediction of response AAN analysis. “As a clinician, I am pleased to see that the data we are presenting at AAN suggests that patients who respond to Trudhesa during the first two migraine attacks will continue to respond to the medication for future attacks. The hope is that this treatment may help the patients feel more confident in their migraine regimen.”

The meeting abstracts are available online on the AAN meeting website at www.AAN.com.

Poster Presentations:

1. Poster 0012: Early Prediction of Response to INP104 for the Acute Treatment of Migraine
   Session P12 Headache: Migraine Therapeutics 2; 5:30 PM - 6:30 PM, Tuesday, April 5
   
   
2. Poster 001: Exploratory Efficacy of INP104 in Migraine Patients by Prior Treatment.
   Session P13: Headache: Migraine Therapeutics 3; 8:00 AM - 9:00 AM, Wednesday, April 6
   
   
3. Poster 003: Exploratory Efficacy of INP104 by Migraine Attack Severity and Time of Dosing: Results from the Phase 3 STOP 301 Study
   Session P15: Headache: Migraine Therapeutics 5; 5:30 PM - 6:30 PM, Wednesday, April 6
   
   
4. Poster 005: Improvements in Disability, Migraine Frequency, and the Interictal Period with INP104: Results from the Phase 3 STOP 301 Study
   Session P15: Headache: Migraine Therapeutics 5; 5:30 PM - 6:30 PM, Wednesday, April 6

About STOP 301

The New Drug Application for Trudhesa included the results of the Phase 3, open-label, pivotal safety study, STOP 301, which is the largest longitudinal study ever conducted with DHE using nasal spray delivery.⁷ More than 5,650 migraine attacks were treated over 24 or 52 weeks during the study. The primary objective of the study was to assess the safety and tolerability of Trudhesa. Exploratory objectives included efficacy assessments of migraine measures and a patient acceptability questionnaire. In the trial, Trudhesa was generally well tolerated and exploratory efficacy findings showed it provided rapid, sustained, and consistent symptom relief. Unlike some oral acute treatments that need to be taken within one hour of attack onset to be most effective, the STOP 301 study reported Trudhesa offered consistent efficacy even when taken late into a migraine attack.⁸

There were no serious Trudhesa-related treatment-emergent adverse events (TEAEs) observed in the STOP 301 study and the majority of TEAEs were mild and transient in nature.⁹ Some of the most frequently reported Trudhesa-related TEAEs (≥2%) during the entire 52-week study period were nasal congestion (17.8%), nausea (6.8%), nasal discomfort (6.8%), abnormal olfactory test (6.8%) and vomiting (2.7%).¹⁰

In the STOP 301 study, patient-reported exploratory efficacy findings reported that more than a third of patients (38%) had pain freedom,⁹ two-thirds (66%) had pain relief,¹¹ and more than half (52%) had freedom from their most bothersome migraine symptom¹² at two hours after their first dose of Trudhesa. For one in six patients (16%), pain relief started as early as 15 minutes.¹³ Of patients who were pain free at two hours after their first migraine attack, 98 percent were still pain free at 24 hours,¹³ and 95 percent were still pain free through two days respectively, during weeks 21-24.¹⁴ The great majority of patients (84%) reported that Trudhesa was easy to use and preferred it over their current therapy. ¹⁵

About Migraine

Approximately 31 million adults in the U.S. are living with migraine,¹⁶ and there is a need for more treatment options. In a survey of nearly 4,000 U.S. patients using oral acute prescription medication for migraine, 96 percent said they were dissatisfied with at least one aspect of their treatment—including lack of sustained relief, inconsistent relief, and lack of relief from a rapid-onset attack. Nearly half (48%) said they can still have pain two hours after taking medication and 38 percent say their headache returns within 24 hours of getting relief.¹⁷ Additionally, there is a need for non-oral routes of administration given the high prevalence of gastrointestinal issues among people with migraine.

About Trudhesa™ (dihydroergotamine mesylate) Nasal Spray

Trudhesa™ (dihydroergotamine mesylate) nasal spray (0.725 mg per spray) is approved by the U.S. Food and Drug Administration for the acute treatment of migraine with or without aura in adults in the U.S. Using Impel’s proprietary Precision Olfactory Delivery (POD^®) technology, Trudhesa gently delivers dihydroergotamine mesylate (DHE)—a proven, well-established therapeutic⁸—quickly to the bloodstream through the vascular-rich upper nasal space. Trudhesa bypasses the gut and potential absorption issues, offering the potential for rapid, sustained, and consistent relief without injection or infusion, even when administered hours after the start of a migraine attack.¹⁸

Trudhesa is a single use, drug-device combination product containing a vial of DHE (4 mg DHE in a 1 mL solution that is clear and colorless to faintly yellow) and a POD^® device. Prior to initiation of Trudhesa, a cardiovascular evaluation is recommended. For patients with risk factors predictive of coronary artery disease who are determined to have a satisfactory cardiovascular evaluation, it is strongly recommended that administration of the first dose of Trudhesa take place in the setting of an appropriately equipped healthcare facility.

Trudhesa is designed to be self-administered. Once assembled, Trudhesa should be primed before initial use by releasing 4 sprays. A patient should use Trudhesa immediately after priming. The recommended dose of Trudhesa is 1.45 mg administered as two metered sprays into the nose (one spray of 0.725 mg into each nostril). The dose may be repeated, if needed, a minimum of 1 hour after the first dose. A patient should not use more than 2 doses of Trudhesa within a 24-hour period or 3 doses within a 7-day period. A patient should use or discard Trudhesa within 8 hours once the vial has been opened or the product has been assembled. A consumer assembly video is available on www.TRUDHESA.com and please refer to the Instructions for Use for more details.

The most common adverse reactions (incidence ≥2%) to Trudhesa were nasal congestion, nasal discomfort, nausea, product taste abnormal, and product package associated injury. For more information about Trudhesa and Full Prescribing Information, including BOXED WARNING, please visit, www.TRUDHESA.com.

About Dihydroergotamine Mesylate (DHE)

Dihydroergotamine Mesylate (DHE) was approved for the treatment of migraine in 1946⁸ and has more than 70 years of therapeutic use.⁸ Migraine treatment with DHE has demonstrated efficacy independent of when the treatment is initiated.¹⁹ Unlike other available treatments for migraine, DHE is known to bind to multiple receptors theorized to be implicated in migraine onset and duration.¹⁹

Trudhesa™ Indication and Important Safety Information

Indication

Trudhesa™ is used to treat an active migraine headache with or without aura in adults. Do not use Trudhesa to prevent migraine when you have no symptoms. It is not known if Trudhesa is safe and effective in children.

Important Safety Information

Do not use Trudhesa if you:

• Have any disease affecting your heart, arteries, or blood circulation.
• Are taking certain anti-HIV medications known as protease inhibitors (such as ritonavir or nelfinavir).
• Are taking a macrolide antibiotic such as clarithromycin or erythromycin.
• Are taking certain antifungals such as ketoconazole or itraconazole.
• Have taken certain medications such as triptans or ergot-type medications for the treatment or prevention of migraine within the last 24 hours.
• Have taken any medications that constrict your blood vessels or raise your blood pressure.
• Have severe liver or kidney disease.
• Are allergic to ergotamine or dihydroergotamine.

Before taking Trudhesa, tell your doctor if:

• You have high blood pressure, chest pain, shortness of breath, heart disease; or risk factors for heart disease (such as high blood pressure, high cholesterol, obesity, diabetes, smoking, strong family history of heart disease or you are postmenopausal, or male over 40); or problems with blood circulation in your arms, legs, fingers, or toes.
• You have or had any disease of the liver or kidney.
• You are taking any prescription or over-the-counter medications, including vitamins or herbal supplements.
• You are pregnant, planning to become pregnant or are nursing, or have ever stopped medication due to an allergy or bad reaction.
• This headache is different from your usual migraine attacks.

The use of Trudhesa should not exceed dosing guidelines and should not be used on a daily basis. Serious cardiac (heart) events, including some that have been fatal, have occurred following the use of dihydroergotamine mesylate, particularly with dihydroergotamine for injection, but are extremely rare.

You may experience some nasal congestion or irritation, altered sense of taste, sore throat, nausea, vomiting, dizziness, and fatigue after using Trudhesa.
Contact your doctor immediately if you experience:

• Numbness or tingling in your fingers and toes
• Severe tightness, pain, pressure, heaviness, or discomfort in your chest
• Muscle pain or cramps in your arms or legs
• Cold feeling or color changes in 1 or both legs or feet
• Sudden weakness
• Slurred speech
• Swelling or itching

The risk information provided here is not comprehensive. To learn more, talk about Trudhesa with your healthcare provider or pharmacist. The FDA-approved product labeling can be found at www.Trudhesa.com or 1-800-555-DRUG. You can also call 1-833-TRUDHESA (1-833-878-3437) for additional information.

About Impel NeuroPharma

Impel NeuroPharma, Inc. is a commercial-stage biopharmaceutical company developing transformative therapies for people suffering from diseases with high unmet medical needs, with an initial focus on diseases of the central nervous system. Impel offers and is developing treatments that pair its proprietary Precision Olfactory Delivery (POD^®) technology with well-established therapeutics. In addition to Trudhesa™ (dihydroergotamine mesylate) nasal spray, which is approved in the United States for the acute treatment of migraine with or without aura in adults, Impel is also developing INP105 for the acute treatment of agitation and aggression in patients with autism.

Cautionary Note on Forward-Looking Statements

This press release contains “forward-looking” statements within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995, including, but not limited to, the potential clinical benefits of Trudhesa™, the market opportunities of Trudhesa within the migraine market, the speed of uptake and market growth of Trudhesa, and the timing of announcements of clinical results and clinical development activities of Impel’s product candidates. Forward-looking statements can be identified by words such as: “believe,” “may,” “will,” “potentially,” “estimate,” “continue,” “anticipate,” “intend,” “could,” “would,” “project,” “plan,” “expect” or the negative or plural of these words or similar expressions. These statements are subject to numerous risks and uncertainties that could cause actual results and events to differ materially from those anticipated, including but not limited to, Impel’s ability to maintain regulatory approval of Trudhesa, its ability to execute its commercialization strategy for Trudhesa, its ability to develop, manufacture and commercialize its other product candidates including plans for future development of its POD devices and plans to address additional indications for which Impel may pursue regulatory approval, whether results of preclinical studies or clinical trials will be indicative of the results of future trials, and the effects of COVID-19 on its clinical programs and business operations. Many of these risks are described in greater detail in Impel’s filings with the Securities and Exchange Commission. Any forward-looking statements in this press release speak only as of the date of this press release. Impel assumes no obligation to update forward-looking statements whether as a result of new information, future events or otherwise, after the date of this press release.

Impel, POD and the Impel logo are trademarks of Impel NeuroPharma, Inc. To learn more about Impel NeuroPharma, please visit our website at https://impelnp.com/.

Contact:

Media Relations:
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Elixir Health Public Relations
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¹ Cooper W, et al. Postgrad Med. 2020;132:581-589.
² Lipton RB, et al. Headache. 2019; 59:1310-1323.
³ Lipton RB, et al. Neurology. 2015; 84:688-695.
⁴ Bilchik T.; Vann R.; Ray S.; Shrewsbury SB.; Aurora S. Exploratory Efficacy of INP104 in Migraine Patients By Prior Treatment. AAN 2022 Annual Conference, April 2-7, 2022.
⁵ Sacco S.; Vann R.; Ray S.; Shrewsbury SB; Aurora, S. Early Prediction of Response to INP104 for the Acute Treatment of Migraine. AAN 2022 Annual Conference, April 2-7, 2022. 
⁶ Buse, D.; Armand, C.; Vann, R.; Ray, S.; Shrewsbury, SB.; Aurora, SH. Improvements in Disability and the Interictal Period With INP104: Results From the Phase 3 STOP 301 Study. AAN 2022 Annual Conference, April 2-7, 2022. 
⁷ On file at Impel
⁸ Smith, TR, Winner, P, Aurora, SK, Jeleva, M, Hocevar-Trnka, J, Shrewsbury, SB. STOP 301: A Phase 3, open-label study of safety, tolerability, and exploratory efficacy of INP104, Precision Olfactory Delivery (POD^®) of dihydroergotamine mesylate, over 24/52 weeks in acute treatment of migraine attacks in adult patients. Headache. 2021; 00: 1– 13. https://doi.org/10.1111/head.14184
⁹ Impel Neuropharma. (2020). INP104-301. Table 3.4.5.
¹⁰ Impel Neuropharma. (2020). Clinical Study Report, Protocol No. INP104-301. Version 1.0. Tables 14.3.1.1.3b.
¹¹ Impel Neuropharma. (2020). INP104-301. Table 3.3.1.
¹² Impel Neuropharma. (2020). INP104-301. Table 3.3.4.
¹³ Shrewsbury SB, Hoekman J, Jeleva M, Hocevar-Trnka J, Hoekman J, Shrewsbury SB, A long term, open label study of Safety and Tolerability Of Precision olfactory delivery of DHE in acute migraine (STOP 301): Clinical Results, PainWEEK Live Virtual Conference Sept 11-13, 2020
¹⁴ Impel Neuropharma. (2020). INP104-301. Table 3.3.6.
¹⁵ Impel Neuropharma. (2020). Clinical Study Report, Protocol No. INP104-301. Version 1.0. Tables 14.3.11.1a
¹⁶ R. B. Lipton, M. E. Bigal, M. Diamond, F. Freitag, M. L. Reed, W. F. Stewart. Migraine prevalence, Disease Burden, and the Need for Preventive Therapy. Neurology 2007;68;343-349 DOI: 10.1212/01.wnl.0000252808.97649.21
¹⁷ Impel Neuropharma. (2020). INP104-301. Table 3.8.2.
¹⁸ Aurora SK, et al. J Headache Pain. 2013;14(Suppl 1):P143.
¹⁹ Impel Neuropharma. (2020). INP104-301. Table 3.3.6.