Recognizing the Burden of Patients Living With EGPA: An Exploration of Best Practices in Diagnosis and Treatment in the Context of a Multidisciplinary Approach

Chair and Presenter, Praveen Akuthota, MD, Paneez Khoury, MD, MHSc, FAAAAI, and Philip Seo, MD, MHS, discuss EGPA in this CME/MOC activity titled “Recognizing the Burden of Patients Living With EGPA: An Exploration of Best Practices in Diagnosis and Treatment in the Context of a Multidisciplinary Approach.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3VojzFr. CME/MOC credit will be available until July 18, 2025.

1. Recognizing the Burden of
Patients Living With EGPA

An Exploration of Best Practices in Diagnosis and Treatment
in the Context of a Multidisciplinary Approach

Paneez Khoury, MD, MHSc, FAAAAI
Allergist-Immunologist J

Praveen Akuthota, MD Clinical Researcher, Eosinophilic Disorders

Professor of Medicine Bethesda, Maryland

Division of Pulmonary and Critical /
Care Medicine

University of California San Diego Philip Seo, MD, MHS

La Jolla, California Associate Professor of Medicine

Johns Hopkins University School

of Medicine

Baltimore, Maryland

Go online to access full CME/MOC information, including faculty disclosures.

Copyright © 2000-2024, PeerView

2. Our Goals for Today

Expand your knowledge regarding the association between EGPA
and comorbid or associated eosinophilic conditions and burden on
patient quality of life

Improve your understanding of the pathophysiology of EGPA and
the rationale for targeted biologic therapy

Enhance your ability to use evidence-based approaches to
diagnose and differentiate EGPA from other eosinophilic disorders

Help you select personalized treatment for your patients with EGPA
based on evidence-based guidelines and recent clinical data

PeerView.com/TTA827

3. Confronting the Challenges
Associated With the Recognition,
Diagnosis, and Burden of EGPA

Paneez Khoury, MD, MHSc, FAAAAI
Allergist-Immunologist

Clinical Researcher, Eosinophilic Disorders ff 4
Bethesda, Maryland
A

Copyright © 2000-2024, PeerView

4. EGPA: Epidemiology!?

‘Small-Vessel Vasculitis

Immune complex vasculitis

+ Cryoglobulinemic vasculitis

+ IgA vasculitis (Henoch-Schönlei

+ Hypocomplementemic urticarial
vasculiis (ani-C1q vasculitis)

Classically considered
among the small vessel
disorders of the

ANCA-associated group

Medium-Sized
Vessel Vasculitis
+ Polyarteritis nodosa

+ Kawasaki disease

Relatively rare: estimated
5,000 cases/year in the
United States; approximately
14 cases per million

Antiglomerular basement

membrane disease Mean age at onset ~40 years

but varies

Occurs equally in men
and women

Large-Vessel Vasculit
Giant cell arteritis
Takayasu arteritis

May be underestimated

Microscopic polyangiitis

1. Schnapel A Hodich CM. Front Pediatr 2019{6:421. 2. Jonnatte JC ota. In: Gershwin ME, Tsokos GC, eds. The Autoimmune Diseases. Sth ed. 9
Elsevier2014:1067-1086 3. Keogh KA etal. Somin Respir Ct Caro Mod, 2006.27:148-157. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

5. EGPA May Be Underestimated Due to ...12

Lack of recognition due to rarity

EGPA respiratory symptoms being treated with systemic
corticosteroids for “severe asthma”

1. Mouthon Let al. Autoimmun. 2014:48-49:39-103. 2. Gore A eta. Front Immunol 2014:5:549. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

6. Characterization of EGPA!

+ Moderate to severe asthma

+ Peripheral blood eosinophilia
(>10% or 1,000/mm?)

+ Mononeuropathy or polyneuropathy
+ Pulmonary infiltrates
+ Paranasal sinus abnormality

+ Extravascular eosinophils/eosinophilic
vasculitis

+ Positive ANCA (30%-40% of all patients)

1. Mas AT et al. Anis Rheum. 1980:33:1094-1100. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

7. Clinical Presentation of EGPA Can Vary Greatly’

A multidisciplinary

Otorhinolaryngologic System
+ Neurosensory hearing loss
L Pulmonary + Serous otitis
approach is + Asthma + Nasal polyps
+ Pulmonary infiltrates.
necessary for < Pleural effusions
accurate

+ Sinusitis

Cardiac

> + Pericarditis

recognition and eae
diagnosis of EGPA + CHF, MI

Renal Gastrointestinal
+ Glomerulonephritis + Eosinophilic gastritis.

Nervous system
+ Peripheral neuropathy
+ Mononeuritis multiplex

1: Lanham JG etal. Medicine (Baltimore). 1984;63:65-81 PeerView.com

PeerView.com/TTA827

Copyright © 2000-2024, PeerView

8. Differential Diagnosis of EGPA‘

CEP EGPA HES
Indolent Indolent Indolent
(Weeks/Months) (Weeks/Months) (Weeks/Months)
Imaging Peripheral Patchy Patchy
Fulminant respiratory failure - - -
Asthma/allergy history + + +
Smoking history - - -
Vasculitis = + =
ANCA = +h -
Cardiac involvement +l + +h
Neurologic +h + +
as therapies other _ en en
‘ect ME lms! logy Cin Noh am 200727477102 PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

9. Diagnostic Criteria: EGPA Criteria Used in Phase 3 Trials!

Asthma plus eosinophilia (>1.0 x 109L and/or >10% of leukocytes)
plus at least 2 of the following
+ Abiopsy showing histopathological + Sino-nasal abnormality

evidence of eosinophilic vasculitis, + Cardiomyopathy (established by
or perivascular eosinophilic echocardiography or MRI)

infiltration, or eosinophil-rich = Glomerdionenhritis Thematuri
granulomatous inflammation omerlonep its ( ematurla,
red cell casts, proteinuria)

+ Alveolar hemorrhage
(by bronchoalveolar lavage)
+ Palpable purpura
+ Positive test for ANCA (MPO or PR3)

+ Neuropathy, mono or poly
(motor deficit or
nerve conduction abnormality)

« Pulmonary infiltrates, nonfixed

1. Wechsler ME et al N Engl J Med. 2017:376:1921-1992, PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

10. 2022 ACR/EULAR Classification Criteria for EGPA!

Considerations when applying these criteria

+ These classification criteria should be applied to classify a patient as having eosinophilic granulomatosis with
polyangiitis when a diagnosis of small- or medium-vessel vasculitis has been made

«Alternate diagnoses mimicking vasculitis should be excluded prior to applying the criteria

Clinical Criteria Score
Obstructive airway disease +3
Nasal polyps +
Mononeuritis multiplex +

Laboratory and Biopsy Criteria
Blood eosinophil count 21 x 10% +5
Extravascular eosinophilic-predominant inflammation on biopsy +2
Positive test for cytoplasmic antineutrophil cytoplasmic antibodies or 5
antiproteinase 3 antibodies
Hematuria -

Total the score of the 7 items, if present. A score of 26 is needed for classification of EGPA.

1.Grayson PC eta. Ann Rheum Dis. 2022:81:309-314. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

11. EGPA Diagnostic Workup:
Investigations to Be Considered In Selected Cases!

Indications Procedure(s)

Peripheral neuropathy -ENG (sural nerve biopsy)
Renal function impairment,

urinary abnormalities® Kidney blopey:
GI symptoms and/or bleeding Endoscopy
ENT abnormalities (eg, polyps, sino-nasal pond
obstruction symptoms, hearing loss) pas
Lung infitrates/pleural effusions BAL, pleural puncture, lung biopsy
Clinical signs of allergic Aspergillus-specific IgE and/or IgG sputum
bronchopulmonary aspergillosis (or BAL) cultures for Aspergillus species
Purpura Skin biopsy
Clinical or echocardiogram signs Cardiac MRI (end: dial bi
poplin teed ardiac MRI (endomyocardial biopsy)
Vascular events and/or high CV risk Arterial and venous Doppler ultrasonography
CNS manifestations Brain andlor spinal cord MRI (CSF analysis)

T-cell immunophenotyping

Miscellaneous/hematological Bare maven bey

+ Urinary protein ern >1 9 per dy, glomerular hematuria :
1. Emm G et al. Nat Rev Rheumatol. 2028:19:378-393, PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, Peerview

12. EGPA: Clinical Course‘

Historically described as evolving in a phasic, developmental pattern
However, stages may overlap or may not be present in every patient

Stage 3:
Vasculitic

Stage 2:
Eosinophilic

Stage 1:
Prodromal

+ Initial allergic diathesis + Peripheral blood + Terminal vasculitis stage:
(usually allergic rhinitis), eosinophilia, eosinophilic necrotizing vasculitis and
progressing into asthma infiltration in various granuloma formation

+ May precede systemic omens:

disease by many years

but can develop over m

Mostly develops over year:

1. Lanham JG et al, Medicine (Botimoro). 1964:63:65-81. 2. Vagio A et al. Alorgy. 20136 261-273. a
3, Bain Cet al. Rhoum Dis Cin North Am, 2010;96:527-543, 4. Noth | ot al. Lancet. 2003,361:587-594. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

13. EGPA: Burden of Disease’

Despite the rarity of EGPA, the range of organ systems involved
and its relapsing-remitting nature exert a large burden on patients
and healthcare systems, including

+ Substantial levels of OCS use
+ Asthma exacerbations
» Healthcare resource utilization and costs

[ Under

recognition

d to this burden

1. Siver J etal. J Cin Rheumatol, 2023:29:381-387. PeerView.com

/TTA827 Copyright © 2000-2024, PeerView

14. EGPA: Burden of Disease—Patient Survey!

Interim results of a longitudinal, qualitative substudy of

patients (n = 9)* with relapsing/refractory EGPA from the
phase 3 MANDARA study who were interviewed showed

>35 different symptoms were reported as bothersome

All patients experienced difficulty breathing/shortness of breath

78% reported coughing, wheezing, and neuropathy

67% had fatigue and nasal congestion/discharge

89% reported impaired ability to work and exercise

67% had an impact to their sleep

56% experienced disruption in their ability to engage in social activities
+ 44% experienced difficulty in everyday activities

PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

15. Overall, What Effect Do Your EGPA Symptoms
Have on Your Quality of Life?

‘Based on 10 survey responses cotected by the CURED Foundation.

PeerView.com/TTA827

Mi No effect
WSlightly affected
Mi Moderately affected

MExtremely affected

PeerView.com

Copyright © 2000-2024, PeerView

16. How Long Did It Take to Receive a Diagnosis After
Beginning to Experience Symptoms?

‘Based on 10 survey responses colectad by the CURED Foundation.

PeerView.com/TTA827

0-12 months
M>1 year-3 years
M>3 years-5 years

M>5 years

PeerView.com

Copyright © 2000-2024, PeerView

17. Please Feel Free to Share Any Additional Thoughts or Experiences About Living
ith EGPA That May Not Have Been Covered in the Previous Questions.

I wish I could regain the feeling in my feet, caused by the EGPA neuropathy.

I have nerve pain in bottom of feet, itching and rash. Sinus issues and so tired all the time.

ase and because of that!

g ongoing en care is exhausting, on top of being
munication between providers is also ı difficult.

sick. The lack of

There are not enough doctors aware or educated in the disease making it extremely
difficult to find care. Insurance companies make it difficult for sick patients to get the
medicine they need, especially biologic medicines and steroid inhalers.

‘Based on survey responses collected by the CURED Foundation PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

18. Panel Discussion

Patient Burden

Copyright © 2000-2024, PeerView

19. Underlying Mechanisms of
EGPA and the Rationale for

Targeted Treatment

Praveen Akuthota, MD
Professor of Medicine

Division of Pulmonary and Critical Care Medicine
University of California San Diego
La Jolla, California

Copyright © 2000-2024, Peerview

20. Eosinophils Play a Major Role
in the Pathophysiology of EGPA!

Eosinophils cause tissue
damage through release
of cationic granule
proteins

Can cause organ
damage mediated
through associated
fibrosis

1. Akuthota Petal Immuno! Allorgy Cn North Am. 2015:35:403-411 PeerView.com

PeerView.com/TTA827

21. EGPA: Likely a Result of Complex Interactions Between
Genetic and Environmental Factors!

Acquired Determinants Genetic Determinants
+ Allergens + HLA-DRB1"04 and "07
+ Infections + HLA-DRB4
+ Vaccinations. + IL-10 SNP

+ Drugs
+ Sica exposure a‘ /

Eosinophilic Granulomatosis With Polyangiitis

1964
Eotaxin3 —— 7 ANCA
T regs
Thi7
B cells
147 Là
“a = Tells ¡Cho
1. GiofrediA et al. Front Immunol 2014;5:548 PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

22. Pathogenesis of EGPA!

talaciors | | immune

Environmental
at

1. Caron-Hemer A et al. Explor Asthma Alergy. 2023:1:31-8. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

23. Eosinophil-Mediated End-Organ Damage in EGPA‘?

Eosinophil accumulation
and activation causes

+ Tissue fibrosis

+ Thrombosis
+ Allergic inflammation

Eosinophil

1. Fagni Fe al. Front Med (Lausanne). 2021:24:8:627776. 2. Khoury Petal. Not Rev Rheumatol. 2014:10:474-483. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

24. The Effect of IL-5 on Eosinophil Activity’
IL-5 is the most important cytokine ©)
for eosinophil differentiation,
growth, activation, survival, ILS
and recruitment to tissues ns |

Blood and Tissue

Bone Marrow

LS
>
Differentiation

Ls E à: 1.5

>
Extravasation N, Activation
to issues
CD34+ stem cell
Ls

Prevention

of apoptosis a
1. Sczokk W otal. Cin Rev Allergy Immunol, 2013:44:39:50. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

25. 3D Animation

Pathophysiology

of EGPA

26. IL-5-Targeting Bi

logic Agents!

Anti-IL-5
monoclonal
antibody

Anti-IL:
a-receptor monoclonal [A
antibody [

NK cell

Antibody-dependent
8 cell-mediated
Eosinophil cytotoxicity
FDA approved forthe treatment of EGPA. Eosinophil .
1: Pavord et al. Alergy. 2022:77.778-797. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

27. Personalizing Treatment for

Patients With EGPA
What’s the Latest Evidence?

Philip Seo, MD, MHS

Associate Professor of Medicine

Johns Hopkins University School of Medicine
Baltimore, Maryland

Copyright © 2000-2024, PeerView

28. Goals of EGPA Treatment

Treat inflammation
Prevent relapse

Reduce to:

duction therapy

PeerView.com

PeerView.com/TTA827 Copyright ©

29. Key Recommendations for Treatment of EGPA:
2021 ACR/Vasculitis Foundation Guidelines!

Active nonsevere EGPA

Options in order of preference
C + MEP
+ MTX, GC + AZA, or GC + MMF
+RTX
sider GC alone in selected patients

Active severe EGPA

V or high-dose daily oral GC
YC or RTX

Nonsevere disease Nonsevere disease
relapse on MTX or AZA relapse on MEP
or MMF or on GC alone

Severe disease relapse
after remission
with CYC or RTX

Remission
on CYC

Pulse IV h-dose

daily oral GC + RTX Aad SC MER

1. Chung SA otal. Arthritis Rhoum. 2021:73:1366-1383. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

30. Adverse Effects of Corticosteroids

+ Corticosteroids remain the mainstay of treatment for EGPA because they
effectively and quickly treat asthma and airway disease control vasculitis

+ But corticosteroids have drawbacks

n
Fil ones

Immunosuppression, infections Growth suppression

Adverse
Effects

PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

31. Importance of a Multidisciplinary Approach in EGPA:
Monitoring and Follow-Up of Patients

Allergist

PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

32. Monitoring/Follow-Up of Patients

Laboratory
(EOS, CRP, ESR, kidney disease especially in ANCA+ patients,
drug toxicities)

Emphasize to patients to be vigilant for
any new signs or symptoms!

PeerView.com

w.com/TTA827 Copyright © 2000-2024, PeerView

33. Addition of Azathioprine to Glucocorticoids for Nonsevere
EGPA Does Not Improve Remission Rates!

+ In a randomized controlled trial,47.8% of patients receiving azathioprine vs 49% of patients
on placebo had remission induction failures or relapses

+ Azathioprine also did not improve relapse risk, was not steroid sparing, and did not diminish
the EGPA asthma/rhinosinusitis exacerbation rate in 95 patients with nonsevere systemic
necrotizing vasculitides (51 with EGPA) m

10

El
2 ?
= os go
de Ea
Ze 06 2
53 2
28. Arango 5
38 acne in
en io
E 2
Pacovo
o o
S TOTO AAA STA mm
Time to Relapse Since Randomization, mo Time Since Randomization, mo
1. Puechal Xetal Arthritis Rheum, 2017:69:2175-2186. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

34. Azathioprine vs Methotrexate as Induction and
Maintenance Therapy in EGPA!

Remission Defined as BVAS = 0
and Prednisone <3.75

Retrospective study of A
57 patients divided PUEDO

Average Cumulative Dose of Prednisone Equivalents (mg) in
into 4 groups °

First 5 Years of Follow-Up After Start of 2L Therapy

non Methotrexate
on Azathioprine

‘Azathioprine

according to treatment ° Time From Start of 1L Therapy, mo.

received to analyze
the efficacy, safety,

and steroid-sparing Persistence on Therapy
effect of azathioprine
and methotrexate as i
induction and Fa

:

Methotrexate

‘Average Cumulative Dose
of Prednisone Equivalente, mg

maintenance therapy
in EGPA

Time From Start of 2L Therapy, y

Azathioprine

Time From Start of Therapy, mo

1: Milanes! A et al. Ann Rheum Dis. 2023/82: 1594-1595, PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

35. Return to Patient Survey: Which of the Following Treatment
Options Have You Been Given? (Select All That Apply)

Methotrexate Es : «>
Oral corticosteroids es ©
Bronchodilators/inhaled steroids ES 770
Biologic treatment (IL-5 inhibitor) BE 0.
Azathioprine «>
Rituximab DE :
Cyclophosphamide BE : 20%
Mycophenolate DS : x
IVIG DM +00»

0 1 2 3 4 5 6 7 8 9

Based on 10 survey responses collected by the CURED Foundation. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

36. IL-5-Targeted Therapy for EGPA: Mepolizumab‘

Remission

End of
‘Odds ratio with mepolizumab = 5.91 intervention
(95% Cl, 2.68-13.03) period
P<.001

Participants With Remission, %
c8888883888

88

Relapse

Hazard ratio with mepolizumab = 0.32

Placebo

® (95% Cl, 0.21-0.50)
E P<.001
go
= 70
= 6
a)
Mepolizumab 20
Es
¿o
E 10
o
Baseline 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 0 4 8 12 16 20 24 28 32 38 40 44 48 52
Time, wk Time to Event, wk
No. at Risk
Mepolzumab 68 ss 43 25
Placebo 68 33 16 9
PeerView.com

1. Wechsler ME; EGPA Mepolzumab Study Team. N Engl J Med. 2017:376:1921-1932.

PeerView.com/TTA827

Copyright © 2000-2024, PeerView

37. IL-5-Targeted Therapy for EGPA: Mepolizumab‘

50% reduction with
25 2.27 mepolizumab vs placebo

& a Rate ratio, 0.50
2 20 (95% Cl, 0.36-0.70)
o> P<.001
se
ES 15
38 1.14
= ¢ 10
oe
3s
2% 05
= E

0 + 7 à

Placebo (n = 68) Mepolizumab (n = 68)
1. Wechsler ME; EGPA Mepolizumab Study Team. N Engl J Med. 2017:376:1921-1992. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

38. Steroid Reduction With Mepolizumab!

57% of patients treated with mepolizumab achieved 250% reduction

in daily OCS compared with 21% in placebo arm

“© Placebo -#Mepolizumab
15 End of treatment period

Median Prednisolone/Prednisone
Daily Dose, mg

o
EIA PPP PL MPS

Study Week

Dally predoisolone/prednisone dose during wooks 48-52

‘Analysis in IT population A
1. Wechsler ME; EGPA Mepolizumab Study Team. N Eng! J Med. 2017:376:1921-1932. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

39. IL-5Ra-Targeted Therapy for EGPA: Benralizumab':?

Relapse
100 tients, n/N (%)
» Benralizumab 21/70 (30)
Adjusted percentage
2 5 allen CAD e 20 Mepolizumab 21/70 (30)
remission at weeks 36 £ 50 HR (95% Cl) 0.98 (0.53-1.82)
and 48 was 59% in the 3
E

benralizumab group
and 56% in the
mepolizumab group

‘Benralizumab

Mepolizumab

0 4 8 12 16 20 24 28 32 36 40 44 48 52

Time to First Relapse, wk

No. at Risk
Benralizumab 70 7

0 68 66 62 58 58 58 57 55 51 50 41
Mepolizumab 68 68 66 66

63 60 57 54 52 50 49 49 38

2 Not FDA approved. A
1 Weer ME ot al. N Engl Mod. 2024390911321 PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, Peerview

40. Other Emerging Therapies’

Dr Target Phase
Depemokimab IL-5 &
Tezepelumab TSLP 2
SHR-1703 IL-5 2/3
NS-229 JAK1 2
1. ww.cinicaltrials.gov. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

41. Overall How Satisfied Are You With Your Current Treatment
in Improving Symptoms and Your Quality of Life?

Not satisfied
WSlightly satisfied
Mi Moderately satisfied

Extremely satisfied

‘Based on 10 survey responses colected by the CURED Foundation. PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, PeerView

42. If You Were/Are on Biologic Treatment, How Satisfied Are You With Your Biologic
Treatment in Improving Symptoms and Your Quality of Life?

HENot satisfied
WSlightly satisfied
BModerately satisfied

Extremely satisfied

‘Based on 8 survey responses collected by the CURED Foundation, PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, Peerview

43. Panel Discussion
Identifying Eligible Patients for
Biologic Therapy and Integration

Into Clinical Practice

Copyright © 2000-2024, PeerView

44. Summary

+ EGPA may be underrecognized due to its rarity; high eosinophil counts on lab workup
should be noted

« EGPA requires a multidisciplinary approach in diagnosis and treatment

+ Corticosteroids are first-line therapy but are associated with significant side effects
and toxicity

+ Progress in the understanding of EGPA has provided alternative treatment options with
different mechanisms of action

* Consider biologics and cytotoxic therapy in patients with
— Steroid-refractory disease
— Step-down therapy
— Relapse

As more therapies emerge and advances in EGPA continue,

clinicians will have more tools to better diagnose, tre:

nd care for patients

PeerView.com

PeerView.com/TTA827 Copyright © 2000-2024, Peerview