PPS Shows Significant Pain Benefit in Rest of World Analysis
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ASX RELEASE 15 October 2026
Paradigm reports significant pain and function findings in ROW
Phase 3 analysis
Key Highlights
• Further analysis identifies significant pain relief outside the US. Following the
overall interim futility result and findings in the US data, Paradigm investigated
whether the result was consistent across regions. Analysis of 16 sites in Australia,
Hong Kong and Moldova, collectively the rest of world (ROW), showed statistically
significant improvement in weekly average daily pain (wADP) with iPPS compared
with placebo at Day 112 (p=0.0007).
• The benefit represents additional pain relief beyond placebo. ROW
participants receiving iPPS experienced an adjusted average pain reduction
approximately 1.1 points greater than placebo on a 0–10 scale. The reported
standardised effect size was 0.71 in favour of iPPS, measuring the size of the
treatment benefit relative to variability in patient outcomes. This analysis included
95 participants with available Day 112 pain assessments.
• The positive findings extended beyond daily pain. At Day 112, ROW
participants receiving iPPS also demonstrated statistically significant benefits in
physical function (p=0.0026), pain assessed using the WOMAC questionnaire
(p=0.0147), and patients’ overall assessment of improvement (p=0.0032),
compared with placebo.
• The ROW findings add to the evidence from earlier studies. The ROW group
included 114 randomised participants, 58 receiving iPPS and 56 receiving placebo,
approximately 2.8 times the corresponding twice-weekly iPPS and placebo
population in PARA_OA_008. Day 112 pain assessments were available for 95
participants, representing 83.3% of the randomised ROW group.
• Missing Day 112 pain data was concentrated in the US. US participants
accounted for 91 of the 97 participants with missing Day 112 wADP data at the
interim analysis. The review identified a number of factors affecting dosing,
including laboratory delays. Further analysis is assessing how these factors and
the statistical handling of missing data may have contributed to the different
regional outcomes.
• The Administrators have received notice that the former Board is preparing
a proposal to preserve the program. The proposal is being prepared for
consideration by the Administrators and aims to establish a funded path for
continued development of iPPS. No proposal has yet been received or assessed,
and any proposal will be considered alongside other options in the administration.
Further details will be provided when available.
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Paradigm Biopharmaceuticals Limited (Administrators Appointed) (ASX: PAR)
(Paradigm or the Company) reports statistically significant and clinically meaningful
improvements in pain, physical function and patient-reported overall improvement at Day 112 in
a regional analysis of its Phase 3 PARA_OA_012 knee osteoarthritis trial. The analysis covered
16 sites across Australia (12), Moldova (3) and Hong Kong (1), collectively referred to as the
rest of world (ROW). For the trial’s primary measure of weekly average daily pain (wADP), iPPS
delivered 1.1 points greater pain reduction than placebo on a 0–10 scale (p=0.0007), with a
reported standardised effect-size magnitude of 0.708 in favour of iPPS.
The trial met its interim futility criteria and the overall interim result did not meet the threshold
required for continuation. Following that result, Company management immediately initiated a
review of the available data, both overall and by region, to understand the outcome and
determine whether it was consistent across the trial.
The review identified a marked difference between the US and ROW results. The US dataset
contained substantial missing assessments and dosing interruptions, including missed doses
associated with specialist laboratory delays. Missing assessments required statistical
imputation, meaning replacement values were assigned or returned to baseline under the trial’s
analysis rules. The US Day 112 pain and function results favoured placebo. In contrast, the
ROW analysis favoured iPPS across average daily pain, WOMAC pain, WOMAC physical
function and patients’ overall assessment of improvement, with statistically significant and
clinically meaningful differences on all four measures.
The consistency of the ROW findings across pain, function and patient-reported improvement
provides an important basis for assessing the program’s development options. The Company is
investigating the extent to which operational issues, treatment exposure and missing-data
handling contributed to the regional differences, alongside its assessment of a funded path
forward.
These findings arise from an internal, post hoc regional analysis of observed data extracted
from the electronic data capture (EDC) system as at 30 September 2026. The overall interim
futility outcome remains unchanged and as previously announced, the trial will not proceed.
The ROW pain results show a clear difference
The forest plot compares the additional pain reduction with iPPS relative to placebo at each
assessment. It puts the ROW and US results side by side so investors can see the direction,
size and precision of the treatment differences.
Figure 1. Adjusted wADP treatment differences by region and timepoint, with 95% confidence intervals.
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Each point shows the adjusted treatment difference between iPPS and placebo at that timepoint.
Points to the left of zero favour iPPS; points to the right favour placebo. The horizontal bars
show the 95% confidence intervals. Where an entire bar sits to the left of zero, the comparison
shows statistically significant greater pain relief with iPPS.
The ROW results show a sustained benefit in favour of iPPS. Every plotted timepoint favours
iPPS, with statistically significant differences from Day 25 through Day 140, including the
primary assessment at Day 112. At Day 112, iPPS delivered 1.105 points of additional pain
reduction versus placebo on the 0–10 scale, with a 95% confidence interval of 0.476 to 1.733
points in favour of iPPS.
The US results show a different pattern. At Day 112, the treatment difference favours placebo,
while the confidence intervals cross zero at every plotted visit, meaning no statistically significant
difference between treatments was demonstrated at those visits. The Company’s review is
examining the reasons for this regional contrast, including operational issues, dosing
interruptions and missing-data handling.
The key finding is that the ROW pain benefit was seen across multiple assessments and is
supported by improvements in physical function and patients’ overall assessment of benefit at
Day 112. The Administrators understand that the Board considers that these findings support
the case for pursuing a funded path for further development of iPPS, subject to the matters
described in this announcement.
Primary endpoint measure shows additional pain relief at Day 112
Weekly average daily pain (wADP) measures patients’ day-to-day pain on a 0–10 scale. At Day
112, observed assessments were available for 45 ROW participants receiving iPPS and 50
receiving placebo. Adjusted pain reductions were 2.098 points with iPPS and 0.993 points with
placebo. The difference was 1.105 points in favour of iPPS (95% CI −1.733 to −0.476; p=0.0007,
ES=-0.708).
Figure 2. ROW Day 112 wADP: adjusted LS mean changes from baseline,
shown as positive reductions. Supplied intervals; n assessed at visit.
The Day 112 comparison (Fig 2) shows the benefit beyond placebo: patients receiving iPPS
had approximately 1.1 points more improvement on the 0–10 pain scale. The treatment
difference, rather than the improvement in the iPPS group alone, is the key measure of
additional benefit.
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Figure 3. wADP adjusted LS mean change from baseline. Blue: iPPS; red: placebo. More negative
values mean greater pain relief. ROW: left; US: right.
The time-course graphs (Fig 3) show how that difference developed. In ROW, the curves
separate early, widen towards Day 112 and remain separated at Day 140 before narrowing at
Day 168. At Day 168, the ROW analysis included only 25 observed assessments, compared
with 95 at Day 112. The treatment difference continued to numerically favour iPPS but narrowed,
with a wider confidence interval that included zero. The substantially smaller number of
observations limits the precision of this later estimate, and further analysis is needed to establish
the reasons for the narrowing. In the US, placebo generally shows greater improvement from
Day 39.
Understanding the strength of the ROW pain result
The ROW pain analysis showed a sizeable treatment benefit over placebo, with an effect size
of −0.708 and strong statistical evidence supporting the difference (p=0.0007). In practical
terms, the treatment group achieved better pain relief, and a result this extreme would be very
unusual if there were no genuine treatment difference.
A growing global need for better OA treatments
A 2023 study in The Lancet Rheumatology projects nearly one billion people living with OA by
2050 if current trends continue. This growing burden underscores the need for additional
treatments for pain and impaired function, reinforcing the importance of evaluating the potential
shown by iPPS1
.
Day 112 findings extend beyond daily pain
Endpoint iPPS /
placebo
n
Adjusted difference
Reported interval
p-value Reported
effect size
WADP 45 / 50 -1.105
-1.733 to -0.476
0.0007 -0.708
WOMAC
function
39 / 46 -1.017
-1.675 to -0.359
0.0026 -0.659
WOMAC pain 39 / 46 -0.821
-1.480 to -0.163
0.0147 -0.532
PGIC 39 / 46 +1.077
+0.366 to +1.788
0.0032 +0.646
Table 1. ROW results at Day 112. Negative differences favour iPPS for pain and function; positive differences favour iPPS for PGIC. Number
of participants (N) are observed assessments at the visit. Regional analyses are internal analyses on observed data.
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Physical function improved alongside pain
Figure 4. WOMAC function adjusted LS mean change from baseline. Blue: iPPS; red: placebo. More negative
values mean greater improvement.
WOMAC function measures difficulty with everyday activities. At Day 112, adjusted ROW
improvement was 2.249 points with iPPS versus 1.231 with placebo, an additional 1.017-point
improvement (95% CI −1.675 to −0.359; p=0.0026; 39 and 46 observed assessments
respectively). The graph (Fig 4) shows a ROW function benefit alongside pain relief; the US
results do not show the same advantage at Day 112 (ES=0.169).
A second pain measure supports the daily pain finding
Figure 5. WOMAC pain: adjusted LS mean change from baseline. Blue: iPPS; red: placebo. More negative = more relief.
WOMAC pain captures pain during activities and situations relevant to osteoarthritis. At Day
112, adjusted ROW reductions were 2.192 points with iPPS and 1.371 with placebo. The
additional reduction was 0.821 points (95% CI −1.480 to −0.163; p=0.0147; ES = -0.532; 39 and
46 observed assessments respectively). This supports the direction of the wADP finding. The
US Day 112 estimate (ES =0.195) favoured placebo.
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Patients also reported greater overall improvement
Figure 6. ROW Day 112. Pain/function: adjusted LS mean changes from baseline, shown as positive reductions. PGIC:
adjusted LS mean score. Whiskers: supplied model mean intervals.
Patient Global Impression of Change (PGIC) asks patients to assess their overall improvement.
Adjusted ROW scores were 4.312 with iPPS versus 3.235 with placebo, a 1.077-point
advantage (95% CI 0.366 to 1.788; p=0.0032; 39 and 46 observed assessments respectively).
Higher scores on the supplied 1–7 scale indicate greater improvement. Together, the ROW
findings connect reduced pain with better function and a stronger patient perception of benefit.
Prior studies show pain benefit across multiple timepoints
The current ROW findings build on earlier pain and patient-reported improvements in
PARA_005 and PARA_OA_008. The June 2025 CMO presentation reports positive pain effect
sizes at every listed assessment in both studies. In PARA_OA_008, the WOMAC pain effect
size was -0.66 at Day 56, -0.46 at Day 112 and -0.74 at Day 365, providing evidence of a
sustained treatment difference after the six-week dosing course.
The ROW pain finding is supported by a larger assessed population than the relevant
comparison in PARA_OA_008. That earlier study randomised 19 participants to twice-weekly
iPPS and 22 to placebo, a total of 41. Its separate once-weekly arm is excluded from this
comparison because the twice-weekly regimen was taken forward into Phase 3. The current
ROW analysis has Day 112 pain assessments from 95 participants: 45 receiving iPPS and 50
placebo, more than twice that earlier randomised comparison population.
Pain assessment
PARA_005
effect size
(WOMAC
Pain)
PARA_OA_008
effect size
(WOMAC Pain)
PARA_OA_012 effect size ROW
WOMAC Pain wADP
Day 39 -0.33 -0.38 --0.135 -0.525
Day 56 (Day 53 for 005) -0.25 -0.66 --0.41 -0.562
Day 112 (Day 109 for 005) -0.20 -0.46 -0.532 -0.708
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Pain assessment
PARA_005
effect size
(WOMAC
Pain)
PARA_OA_008
effect size
(WOMAC Pain)
PARA_OA_012 effect size ROW
WOMAC Pain wADP
Day 168 (Day 165 for 005) -0.28 -0.26 Not Reported 0.412
Day 365 Not reported -0.74 Not reported Not reported
Table 2. Reported pain effect sizes from the June 30, 2025, Phase 3 Clinical Trial Webinar Presentation. Negative value favours iPPS
over placebo.
Patient-reported and functional outcomes add to the pain evidence
Study and
assessment
Reported result p-value
005 | PGIC Day 56
4.42 with iPPS versus 3.42 with placebo; difference 1.0
(95% CI 0.24–1.8).
0.0106
008 | WOMAC Pain
Day 56
Pain reduction approximately 50% versus 30%;
function improvement approximately 50% versus 25%.
Pain 0.05
Function 0.017
008 | PGIC Day 112
4.07 with twice-weekly iPPS versus 3.10 with placebo;
descriptive difference 0.97.
0.078
008 | PGIC Day 365
3.55 with iPPS versus 2.06 with placebo; descriptive
difference 1.49.
0.005
The recurring pattern of pain relief and patient-reported benefit is relevant to any assessment of
whether continued development is warranted. The current ROW Day 112 effect-size magnitude
is -0.708.
Understanding the US outcome is the next critical step
At the interim analysis, 97 of 277 participants had missing Day 112 wADP data. Of those 97, 91
were in the US and six in ROW. This concentration made the US operational and data review
central to understanding the trial outcome.
The review separated missed doses, missing pain assessments and statistical handling of
unavailable assessments. Specialist laboratory delays appear to have contributed to missed US
doses. The findings may inform any future development plan, regulatory discussions and the
design of future trials.
Imputation assigns a value when an assessment cannot be used. Carrying baseline forward
assigns no improvement. Missed doses instead affect treatment exposure. Each issue’s impact
depends on the patients affected, their treatment allocation and the analysis rules.
Reviews examined laboratory delays, dosing, diary completion, site follow-up, monitoring and
sponsor oversight.
US observed-data results did not show an iPPS advantage at Day 112 (wADP p=0.1933;
function p=0.1188; WOMAC pain p=0.0728; PGIC p=0.8216). Imputation alone cannot be
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assumed to explain the regional difference, and the review is assessing whether operational
factors may also have contributed.
Administration process and proposal from former Board
The Administrators understand that the Board is finalising a proposal to preserve iPPS and
establish a funded path forward, which may combine clinical development, regulatory
engagement, funding and restructuring options. Any proposal received will be assessed by the
Administrators in the interests of creditors as a whole, alongside other options available in the
administration. There is no certainty that any proposal will be received or accepted, that funding
will be obtained or that further development of iPPS will proceed.
The Company expects to update the market on the data in the coming weeks and provide further
details of the Board proposal when available. Progress will depend on the proposal being
finalised, funding, applicable approvals and the administration process.
The Company’s securities remain suspended from trading.
-ENDS-
Forward-Looking Statements and Disclaimer
The analysis was prepared by Company management and its clinical advisers. The
Administrators have not independently verified the data or the analysis and make no
representation as to their accuracy or completeness. The Administrators are releasing this
information to keep the market informed.
Authorised for release by the Voluntary Administrators*.
References
1. GBD 2021 Osteoarthritis Collaborators (2023). Global, regional, and national burden of osteoarthritis, 1990–
2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet
Rheumatology, 5, e508–e522.
To learn more please visit: www.paradigmbiopharma.com
FOR FURTHER INFORMATION PLEASE CONTACT:
Media Enquiries Creditor and Supplier Enquiries Investor
Cameron Morse
Strategic Communications
FTI Consulting
T: +61 (0) 433 886 871
E: cameron.morse@fticonsulting.com
James Dunne
Corporate Finance
FTI Consulting
T: +61 8 6430 1303
E: James.Dunne@fticonsulting.com
Simon White
Director of Investor Relations
Paradigm Biopharma
E: investorrelations@paradigmbiopharma.com
*Christopher Pattinson and Hayden White of FTI Consulting were appointed as joint and several
voluntary administrators of Paradigm Biopharmaceuticals Limited (Administrators Appointed)
ACN 169 346 963 on 29 September 2026.
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