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E200069A Sihuan Pharm 1..2 Hong Kong Exchanges and Clearing Limited and The Stock Exchange of Hong Kong Limited take no responsibility for the contents of this announcement, make no representation as to its accuracy or completeness and expressly disclaim any liability whatsoever for any loss howsoever arising from or in reliance upon the whole or any part of the contents of this announcement. Sihuan Pharmaceutical Holdings Group Ltd. 四環醫藥控股集團有限公司 (incorporated in Bermuda with limited liability) (Stock code: 0460) VOLUNTARY ANNOUNCEMENT ACQUISITION OF ALL INTERESTS AND INTELLECTUAL PROPERTY RIGHTS OF PLAZOMICIN, A NEW GENERATION OF AMINOGLYCOSIDE ANTIBIOTICS IN THE GREATER CHINA REGION The board of directors (the ‘‘Board’’) of Sihuan Pharmaceutical Holdings Group Ltd. (the ‘‘Company’’ or ‘‘Sihuan Pharmaceutical’’, together with its subsidiaries, the ‘‘Group’’) is pleased to announce that Xuanzhu (HK) Biopharmaceutical Limited (‘‘Xuanzhu’’), a wholly-owned subsidiary of the Group, acquired all interests and intellectual property rights of plazomicin, a new generation of aminoglycoside antibiotics, in the Greater China Region (including the People’s Republic of China (the ‘‘PRC’’), Hong Kong Special Administrative Region, Macau Special Administrative Region and Taiwan) from Achaogen, Inc. (‘‘Achaogen’’), a company incorporated in Delaware, the United States of America. Plazomicin is a new generation of semisynthetic aminoglycoside antibiotics developed by Achaogen. It produces antibacterial effect mainly through binding to bacterial 30S ribosomal subunits and is used to treat severe infections caused by multi-drug resistance (‘‘MDR’’) gram-negative bacteria and enterobacteriaceae, including the carbapenem-resistant enterobacteriaceae. In the PRC, MDR bacterial infections are mainly acquired in hospital and most of the infected individuals are immunocompromised due to various reasons. Viral infection, such as novel coronavirus infection, can cause invasion of lymphocytes and damage to immune system. A person with reduced immunity might develop secondary bacterial infections, which increase the risk of acquiring further infections in hospital. – 1 – There are very limited choices of drugs for the clinical treatment of MDR bacteria, however, the only few treatment options have limited clinical application due to issues such as severe renal toxicity. Plazomicin injection was launched in June 2018 with the approval of the U.S. Food and Drug Administration (FDA) for the treatment of complex urinary tract infections and acute pyelonephritis in adults. Currently, clinical application confirms that plazomicin significantly reduces the risk of renal toxicity than previous generations of aminoglycosides. As bacteria are becoming increasingly resistant to existing antibacterial drugs, super bacteria have posed the most serious threat to human health. The World Health Organization (WHO) has predicted that 10 million people will die as a result of super bacterial infections each year by 2050. EvaluatePharma, a pharmaceutical market research agency, has predicted that the annual sales of plazomicin will reach US$313 million in 2022. The Group expects that plazomicin will generate significant economic benefits after its launch in the Greater China Region. In addition, benapenem, a Category 1 innovative carbapenem antibiotic developed by the Group, has commenced Phase II clinical trials for complex urinary tract infections in various clinical trial units in the PRC with smooth progress. Phase III clinical trials are expected to commence in the second half of this year. Azithromycin capsule, another anti-infective product of the Group, is being selected in the second batch of the National Centralized Medicine Procurement (全國藥品集中採購). The specification of this drug is 0.25g* 6 capsules/box, and the procurement price is RMB5.46/ box. Eight provinces, namely Jiangsu, Shandong, Fujian, Liaoning, Heilongjiang, Gansu, Guangxi and Tibet, have been selected for supply of the drug and will provide a minimum of 30 million capsules. The selection of azithromycin capsule in this centralized procurement will help the Group to quickly enter the PRC domestic sales market of azithromycin capsule, increase market presence and further accelerate its development in the field of anti-infective drugs. This announcement is being made by the Company on a voluntary basis to let the investing public understand the Group’s latest business development, and does not constitute, and is not intended to be, an advertisement regarding the use of any medicine, surgical appliance, treatment or orally consumed product. By order of the Board Sihuan Pharmaceutical Holdings Group Ltd. Chairman and Executive Director Dr. Che Fengsheng Hong Kong, 20 February 2020 As at the date of this announcement, the executive directors of the Company are Dr. Che Fengsheng (Chairman), Dr. Guo Weicheng (Deputy Chairman and Chief Executive Officer), Mr. Choi Yiau Chong, Dr. Zhang Jionglong and Ms. Chen Yanling; the non-executive director of the Company is Mr. Kim Jin Ha; and the independent non-executive directors of the Company are Mr. Patrick Sun, Mr. Tsang Wah Kwong and Dr. Zhu Xun. – 2 –.
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  • Plazomicin Sulfate ASHP INJECTABLE DRUG INFORMATION
    1302 PLAZOMICIN SULFATE ASHP INJECTABLE DRUG INFORMATION Plazomicin Sulfate AHFS 8:12.02 Products Stability Plazomicin sulfate is available in a concentration equivalent Intact vials of plazomicin sulfate should be stored under refrig- to plazomicin base 50 mg/mL in 10-mL single-dose (preserva- eration at 2 to 8°C.3431 Plazomicin sulfate injection is a clear, tive-free) vials.3431 Each vial also contains sodium hydroxide colorless to yellow solution.3431 The manufacturer states that for pH adjustment and water for injection.3431 The appropriate the solution may become yellow, but that this change does not dose of plazomicin solution should be diluted in sodium chloride indicate a decrease in potency.3431 0.9% or Ringer’s injection, lactated to achieve a final volume of The manufacturer states that a solution of plazomicin diluted 3431 50 mL. for infusion in sodium chloride 0.9% or Ringer’s injection, pH lactated to concentrations of 2.5 to 45 mg/mL is stable for up to 24 hours at room temperature.3431 Adjusted to 6.5.3431 Trade Name(s) Zemdri Administration Plazomicin sulfate is administered by intravenous infusion over 30 minutes after dilution in sodium chloride 0.9% or Ringer’s injection, lactated.3431 Compatibility Information Solution Compatibility Plazomicin sulfate Test Soln Name Mfr Mfr Conc/L or % Remarks Ref C/I Ringer’s injection, lactated ACH 2.5 to 45 g Stable for 24 hr at room temperature 3431 C Sodium chloride 0.9% ACH 2.5 to 45 g Stable for 24 hr at room temperature 3431 C Y-Site Injection Compatibility (1:1 Mixture) Plazomicin
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  • The Pharmacodynamics of Plazomicin and Amikacin Studied in an in Vitro
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  • ZEMDRI (Plazomicin) Injection, for Intravenous Use (Ml/Min) ZEMDRI B Dosing Interval Initial U.S
    HIGHLIGHTS OF PRESCRIBING INFORMATION Recommended initial dosage regimen for patients with renal These highlights do not include all the information needed to use impairment is shown in the table below. (2.3) ZEMDRI safely and effectively. See full prescribing Recommended information for ZEMDRI. Estimated CLcr a Dosage for ZEMDRI (plazomicin) injection, for intravenous use (mL/min) ZEMDRI b Dosing Interval Initial U.S. Approval: 2018 Greater than or equal to 60 15 mg/kg Every 24 hours WARNING: NEPHROTOXICITY, OTOTOXICITY, to less than 90 NEUROMUSCULAR BLOCKADE and FETAL HARM Greater than or equal to 30 10 mg/kg Every 24 hours See full prescribing information for complete boxed warning. to less than 60 Nephrotoxicity has been reported with ZEMDRI. The risk Greater than or equal to 15 10 mg/kg Every 48 hours of nephrotoxicity is greater in patients with impaired renal to less than 30 a CLcr estimated by the Cockcroft-Gault formula. (2.3) function, the elderly, and in those receiving concomitant b nephrotoxic medications. (5.1) Calculate dosage using Total Body Weight (TBW). For patients Ototoxicity, manifested as hearing loss, tinnitus, and/or with TBW greater than IBW by 25% or more, use adjusted body weight. (2.3) vertigo, has been reported with ZEMDRI. Symptoms of aminoglycoside associated ototoxicity may be irreversible See Full Prescribing Information for subsequent dosage and may not become evident until after completion of adjustment based on changes in renal function or Therapeutic therapy. (5.2) Drug Monitoring (TDM). (2.3, 2.4). Aminoglycosides have been associated with neuromuscular See Full Prescribing Information for instructions on preparation blockade.
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  • Prospects for Circumventing Aminoglycoside Kinase Mediated Antibiotic Resistance
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  • Plazomicin for Complicated Urinary Tract Infection
    October Horizon Scanning Research & 2016 Intelligence Centre Plazomicin for complicated urinary tract infection NIHR HSRIC ID: 9787 Lay summary Serious infections caused by Gram-negative bacteria are becoming increasingly resistant to commonly prescribed antibiotics and are a serious global concern. If licensed, plazomicin will offer a treatment option for those patients who have a complicated urinary tract infection or acute pyelonephritis caused by multi-drug resistant Gram-negative bacteria, a group who currently have few effective and well tolerated therapies available. This briefing is based on information available at the time of research and a limited literature search. It is not intended to be a definitive statement on the safety, efficacy or effectiveness of the health technology covered and should not be used for commercial purposes or commissioning without additional information. This briefing presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health. Horizon Scanning Research & Intelligence Centre University of Birmingham [email protected] www.hsric.nihr.ac.uk @OfficialNHSC TARGET GROUP • Complicated urinary tract infection (cUTI), including acute pyelonephritis (AP); infection caused by resistant Gram-negative bacterial pathogens, including 3rd generation cephalosporin and carbapenem-resistant enterobacteriaceae (CRE) – first line, followed by appropriate, optional oral step down therapy. TECHNOLOGY DESCRIPTION Plazomicin (ACHN-490) is a next-generation broad-spectrum aminoglycoside antibiotic. Aminoglycosides kill bacteria by inhibiting protein synthesis through binding to the bacterial 16S rRNA, and by disrupting the integrity of bacterial cell membranes.
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  • Nationwide Epidemiology of Carbapenem Resistant Klebsiella
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  • Antibiotics Currently in Clinical Development
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  • Overcoming Aminoglycoside Enzymatic Resistance: Design of Novel Antibiotics and Inhibitors
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  • Pharmacodynamics of Plazomicin and a Comparator Aminoglycoside, Amikacin, Studied in an in Vitro Pharmacokinetic Model of Infection
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    10/1/2019 "Hot Off the Patients“ What's New with Bugs & Drugs David T. Bearden, Pharm.D., FIDP, FCCP Clinical Professor, Department of Pharmacy Practice Associate Dean for Academic Integration and Clinical Advancement Clinical Assistant Director, Department of Pharmacy Services Oregon State University/Oregon Health & Science University College of Pharmacy 1 New Drugs – quick hits DISCLAIMER – “New systemic antibacterials that I like.” • Approved in the last 5 years • Excluding • TB • Topical • Anti-virals 2 1 10/1/2019 2/3 rule: Two (plus 1) “X”s and 1 (plus 2) “Z” 2015 2018 ceftazidime-avibactam (Avycaz) plazomicin (Zemdri) eravacycline (Xerava) 2017 omadacycline (Nuzyra) delafloxacin (Baxdela) mero/vaborbactam (Vabomere) 2019 secnidazole (Solosec) imi/relebactam (Recarbrio) lefamulin (Xenleta) https://www.centerwatch.com/drug-information/fda-approved-drugs/therapeutic- area/25/infections-and-infectious-diseases 3 Resistant Gram-negative Pathogens - Added β-lactamases 2015 2018 Ceftazidime/avibactam (Avycaz) plazomicin (Zemdri) eravacycline (Xerava) 2017 omadacycline (Nuzyra) delafloxacin (Baxdela) mero/vaborbactam (Vabomere) 2019 secnidazole (Solosec) imi/relebactam (Recarbrio) lefamulin (Xenleta) 4 2 10/1/2019 Bad (East Coast) GNRs ESBLs KPCs • Extended spectrum β- • Klebsiella pneumoniae lactamases carbapenemases • Oregon E. coli 8.3% , US 13.4% • Oregon K. pneumonia 6.6%, US 20% • Oregon 0%, national 8.7% • Resistance to most • Generally provide resistance to cephalosporins, penicillins, and all β-lactams, including β- aztreonam lactamase inhibitors combinations • Carbapenems are generally resistant to ESBL hydrolysis https://gis.cdc.gov/grasp/PSA/MapView.html 5 Quick Drug Facts – IV only, ESBLs, KPCs Cephalosporin/β-lactamase inhibitor Carbapenem/β-lactamase inhibitor • Ceftazidime/avibactam • Meropenem/vaborbactam • Improved activity against • Imipenem/relebactam • Pseudomonas sp.
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