ARWR Arrowhead Pharmaceuticals, Inc.
$47.15
Arrowhead Pharmaceuticals, Inc. Q4 F2026 Earnings Call Transcript
AI Conference Call Analysis
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Conference Call Operator
Ladies and gentlemen, welcome to the Arrowhead Pharmaceuticals conference call. Throughout today's recorded presentation, all participants will be in a listen-only mode. After the presentation, there will be an opportunity to ask questions. I will now hand the conference call over to Vince Anzalone, Senior Vice President of Investor Relations for Arrowhead. Please go ahead, Vince.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Good afternoon, and thank you for joining us today to discuss Arrowhead's results for its 2026 fiscal year, ended September 30, 2026.
Dr. Chris Anzalone
President and Chief Executive Officer
With us today from management are President and CEO, Dr. Chris Anzalone, who will provide an overview, Andy Davis, Senior Vice President and Head of the Global Cardiometabolic Franchise, who will provide an update on commercialization activities, Dr. James Hamilton, Chief Medical Officer and Head of R&D, who will discuss our development programs, and Dan Apel, Chief Financial Officer, who will give a review of the financials.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Following management's prepared remarks, we will open the call to questions. Before we begin, I would like to remind you the comments made during today's call contain certain forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934.
Dr. Chris Anzalone
President and Chief Executive Officer
All statements other than statements of historical fact are forward-looking statements. and are subject to numerous risks and uncertainties that could cause actual results to differ materially from those expressed in any forward-looking statements. For further details concerning these risks and uncertainties, please refer to our SEC filings, including our most recent annual report on Form 10-K and our quarterly reports on Form 10-Q. I'd now like to turn the call over to Chris. Thanks, Vince. Good afternoon, everyone. Thank you for joining us today. AeroEd has fundamentally changed over the past 12 months. Where there was once a company that relied solely on great scientific promise, there is now a company that is beginning to translate promise into real patient outcomes and the potential for durable shareholder value growth. We are building a commercial business around Redemplo. We have delivered the pivotal data we believe is needed to pursue a much larger market in severe hyperglyceridemia, or SHTG. and we have demonstrated new capabilities that substantially expand what our RNAi platform can do. I believe we approach 2027 with the strongest combination of near-term commercial opportunity and scientific capability in our history. For the long term, we intend Arrowhead to become a substantial pharmaceutical company that introduces important new medicines into the market virtually every year. We believe we've demonstrated that we have the platforms and development capabilities to do this. and the result could be an engine that improves innumerable patient lives and creates substantial value. But first things first, we need to build a commercial presence that matches the excellence we've built in discovery and development and we need to demonstrate that we are capable of building out a new market, finding the patients who could benefit from our medicines and growing a profitable business. Simply put, commercial progress with Regenplo is critical. We are focused on continued success serving the FCS market, planning a rapid launch into SHTG and positioning Arrowhead to maximize the SHCG market opportunity. Of course, revenue levels, growth and profitability will ultimately be the only metrics that matter when assessing how we are doing with Redempo. However, that will not tell the full story until after the first several quarters of our planned SHCG launch as payer policies are being worked out, coverage is being secured and provider outreach is initiated. So during this period, we will regularly refer to three metrics that we believe capture the breadth and depth of Early Market Penetration. They are one, total number of new-to-brand patient prescriptions, two, number of distinct prescribers writing prescriptions, and three, number of lives covered on payer formularies. We believe there are large pools of patients who can benefit from Regenplo, and these three metrics are intended to reflect how well we are building pipes to reach them. We launched into the narrow FCS market about 11 months ago and are still in the pipe-building phase. This work has progressed well. As of September 30, we had 950 new-to-brand patient prescriptions representing a 63% increase over the prior quarter end. This growth rate continues to increase rapidly as we have added another 300 since then. As of September 30, over 640 distinct individual prescribers wrote first-time prescriptions, and that number has grown to over 860 since then. There are now over 160 million lives covered in payer formularies in the U.S. We are seeing strong demand for Regempla and continue to work with payers to increase the rate at which prescriptions are converted to paid shipments. This is still a choke point, and there is substantial work to do, but we are off to a good start. The pipes we are laying are critical for the FCS market and, importantly, directly applicable to the next stage of our business in SHCG. We intend to enter SHCG with an organization that already understands the medicine, its prescribers, and the practical work needed to get patients on treatment. Let's now look forward. We are preparing aggressively for a potential U.S. launch in SHCG in the second quarter of 2027, subject to successful FDA review and approval. The FDA granted Plozacerin entry into the Split Real-Time Application Review, or STAR, pilot program for our planned SHCG supplements. Star provides a six-month priority review framework and the possibility of action earlier than the formal goal date. We submitted our SNDA on November 2nd, so we expect to receive our PDUFA date over the next 50 days or so. We are very optimistic about the potential for this launch. We believe the clinical profile, the unmet need, and the capabilities we are building position Redemplo to become the leading treatment in this market. That conviction begins with data. In July, we announced that Shasta 3 and Shasta 4 met their primary endpoint and every pre-specified secondary endpoint. The detailed results presented at the European Society of Cardiology Congress in August, and at the American Heart Association just last weekend, reinforced the consistency of the Pladaciran's activity. Median triglyceride reductions from baseline were 79% and 81% at month 12. In the pooled analysis, cumulative acute pancreatitis events were reduced by 78% versus placebo across the broad SHCG population study with an impressive 100% reduction in patients at the highest risk of acute pancreatitis. These are results that we believe can change treatment expectations. Physicians see patients whose triglycerides remain dangerously elevated despite existing approaches. Our goal is to deliver those physicians a medicine We continue to describe the profile we are pursuing as safe, simple, and strong. Safe reflects the favorable tolerability observed in all our studies, no increase in liver fat, no hypersensitivity, and no notable changes in liver values. We continue to see the potential for a demo to generate $3 billion to $4 billion in annual U.S. We believe the early adopters will be the population at highest risk within this group. This is comprised of those patients with TGs greater than 880 without a history of pancreatitis and those with TGs greater than 500 that have a history of acute pancreatitis. Together, we believe this population totals almost 1 million people in the U.S., and their enhanced risk of acute pancreatitis would suggest that they are in real need of treatment. In Shasta 3 and 4, the number of patients needed to treat in order to prevent a single acute pancreatitis event was 9 in patients with TGs greater than 880 without a history of pancreatitis and those with TGs greater than 500 and a history of pancreatitis. Within that latter group alone, the NNT was only 3, These are very compelling numbers, and keep in mind that this is just after one year. We would expect those NMTs to decrease further over longer treatment periods. Our data suggests that this patient population could benefit from Redemplo, but a valid question is how long it will take to educate patients and providers about the need to treat. There is clearly already some appreciation for this. For instance, we believe that around 1 million people with TGs greater than 500 are on prescription fish oils. This suggests to us that providers already have an urgency to treat TG levels for at least these patients. Remember that these fish oils only reduce TGs by 20 to 30%, while Redempla reduced TGs by around 80% from baseline in Shasta 3 and 4. Outside the US, our business is advancing as well. Redempla became available for prescription, dispensing, and reimbursement in Germany in August, following the European Commission's June authorization. In addition, In October, the UK Medicines and Healthcare Products Regulatory Agency, or MHRA, authorized Redemptilo in the United Kingdom for adults with FCS, and the UK National Institute for Health and Care Excellence, or NICE, issued guidance recommending funding in England and Wales. These milestones expand the foundation of our global cardiometabolic business. Besides our commercial build-out, our discovery engine has delivered two important clinical advances. AeroDimerPA demonstrated that one RNAi molecule can silence both PCSK9 and ApoC3 in people with mixed hyperlipidemia. That opens an important new approach to ASCVD due to mixed hyperlipidemia and gives us a basis for developing additional medicines that address more than one disease driver at a time. Then in October, Aromat-T produced substantial and sustained reductions in tau measured in the cerebrospinal fluid after subcutaneous administration. We view this as early clinical validation of our ability to deliver RNAi across the blood-brain barrier. The opportunity to address CNS targets with an injection under the skin could dramatically expand the diseases we can pursue. I do not think this breakthrough can be overstated. We intend to move decisively to build on these results. This is the model we have been building for years. Establish delivery to a cell site, learn how to do it reliably, and then apply that capability to additional targets. Our clinical work now spans the liver, lung, muscle, adipose tissue, and CNS with additional tissue types being studied pre-clinically. Every successful expansion gives us the potential to create multiple new medicines and additional opportunities for partnerships. Our cardiometabolic franchise illustrates how that can translate into an efficient commercial business. Regempla, Zodaciran, AeroDimer PA, and our Obesity and MASH programs could serve related physician audiences. We intend to build an organization that can support several products through much of the same infrastructure. That is an important part of how we think about growth and long-term returns on the capital we invest. We have also announced an agreement with Sixth Street to retire our existing debt at a discount to the minimum multiple on invested capital provided for in existing agreements and to establish a new facility at a lower cost of capital. The refinancing is designed to extend our debt maturity and provide financing terms more consistent with Arrowhead's current stage. We have a great deal to execute and we are approaching it with urgency. The potential SHTG launch is our most important year-term commercial priority. We believe it can change the scale of Arrowhead's business while the rest of our pipeline creates opportunities well beyond our debt flow. I am more optimistic than ever about the patience we can help and the value we can build. With that overview, I now like to turn the call over to Andy Davis. Andy?
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Thank you, Chris, and good afternoon, everyone. We are approaching one year since Redemplo's initial FDA approval, and the FCS launch continues to progress. I'll cover three measures of this progress. Number one, growth in prescriptions. Number two, expansion of the prescriber base. And number three, advancements in market access. Then I'll connect them to our planned SHTG launch anticipated in the second calendar quarter of 2027. First, growth in prescriptions. Total new-to-brand prescriptions grew 63% in the fiscal fourth quarter, and that momentum has carried into this quarter, taking us well past 1,250 cumulative new-to-brand prescriptions. On prior calls, I cited a run rate of 20 to 30 new prescriptions per week. We are encouraged by the sustained increase in demand. Since expanding our field team this summer, we are reaching substantially more healthcare professionals, and we are seeing strong interest and redemptive from prescribers across specialties. It's important to note, however, that these are written prescriptions, not paid claims. Moving from prescription to treatment requires patient engagement, benefit verification, physician office support, and prior authorization, submission, and approval. Our dedicated Redemblo reimbursement navigator team is heavily focused on educating offices on the reimbursement process to convert this demand into treatment starts and durable access. Second, expansion of the prescriber base. Unique prescribers grew over 50% in the fiscal fourth quarter. Since then, in the last five weeks alone, we added as many prescribers as in the entire fourth quarter, bringing the total as of the first week of November to over 860. We view this as an important indicator of future growth and of productive field engagement with the right providers. The specialty mix is led by cardiology and endocrinology with internal medicine of grow and share. These are the same specialties we expect to engage for SHTG should Redemptible be approved for that use next year. Repeat prescribing is also building with approximately 27% of prescribers have been written for more than one patient. and recent market tracking research prescribing physicians report strong satisfaction and high and increasing likelihood to recommend Redemplo since launch. Third, advancements in market access. Payers representing the vast majority of U.S. covered lives have published utilization management policies for Redemplo and SCS. These policies describe the criteria by which a payer will evaluate a reimbursement request. More than 160 million U.S. lives now have coverage for Redemplo, with coverage defined as those eligible patients with a reimbursement pathway under the applicable policy criteria. Both of these metrics have grown steadily since launch. Our objective is to expand access for appropriate patients with genetically confirmed or clinically diagnosed FCS and to help practices navigate requirements efficiently. We are working with payers, specialty pharmacies, and physician offices to move prescriptions through the process and resolve points of friction. Broadening access and improving the patient journey are central priorities as we prepare for a much larger opportunity. Turning to SHTG, our enthusiasm is high. We are preparing for a potential launch in the second calendar quarter of 2027 subject to FDA approval. Our initial focus is on patients at high risk of acute pancreatitis including those with triglycerides at or above 880 milligrams per deciliter or above 500 milligrams per deciliter with a prior history of pancreatitis. We have described this as approximately 1 million people in the U.S. within the broader SHTG market. We have identified more than 20,000 healthcare professionals across relevant specialties as likely SHTG treaters and we are well advanced in building our HCP engagement, patient services, Distribution, and Market Access Capabilities. Our expanded sales team is now largely in place building relationships and mapping priority accounts in preparation for a potential SHTG launch. What we are learning now will help us execute as the addressable population expands. Our one redemptible pricing approach supports this transition. The current U.S. wholesale acquisition cost is $45,000 per patient per year. We intend to hold a consistent U.S. price across FCS and SHTG if the broader indication is approved. We believe that simplicity supports productive payer discussions and a clear value proposition. Outside the U.S., Germany and the U.K. are now active commercial markets. In the U.K., the Reimbursement Authority recently issued final guidance recommending Redemplo for genetically confirmed FCS, supporting reimbursement in England and Wales. And we are working to serve eligible patients there now. To recap, the FCS launch is showing increased prescription demand, a broadening prescriber base, and important advancements in access. This is the progress we intend to carry into SHTG. We believe the opportunity ahead is significant and our team is preparing accordingly. With that, I'll turn the call over to James.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Thank you, Andy. The fourth quarter and subsequent period included important progress in our late-stage cardiometabolic programs and Clinical Validation of Two New Applications of Arrowhead's Trim Platform. I'll begin with Plazaciran and then discuss Zodaciran, Aerodimer PA, our CNS efforts as well as Obesity and MASH. For Plazaciran, the Shasta 3 and Shasta 4 results give us a strong basis for the SHTG-SMDA, which as Chris mentioned, has been submitted. Both trials evaluated 25 milligrams every three months and both met their primary and all pre-specified secondary endpoints. In addition to the triglyceride reductions Chris described, more than 90% of treated patients achieved triglycerides below 500 milligrams per deciliter in month 12 and more than half achieved triglycerides below 150 milligrams per deciliter. In the pooled acute pancreatitis analysis, the overall reduction in cumulative events was 78% versus placebo. Among patients with a prior history of acute pancreatitis, the event rate reduction was 91%, with an estimated number needed to treat of three over one year to prevent one event. In the highest risk group, with triglycerides above 880 and a prior history of pancreatitis, there were no events observed in the plazaciran group. These subgroup findings support our focus on patients with substantial ongoing risk. Safety remained favorable overall and consistent with our previous experience. Treatment emergent adverse event rates were similar in the pooled placebo and pooled active groups. There were no cases of anaphylaxis or systemic hypersensitivity, no clinically meaningful platelet changes, and no meaningful liver enzyme elevations relative to placebo. The MRI substudies showed no statistically significant change in hepatic fat fraction. Worsening glycemic control was reported more frequently with plazaciran at 14.3% versus 8.7% in placebo with mean changes in hemoglobin A1C consistent with previous experience and importantly, No progressive worsening of A1C over time. Our regulatory package draws on Shasta 3, Shasta 4, and the MIR-3 safety database. Working within STAR, which includes priority review, we continue to anticipate an efficient review process. Entry into STAR reflects the FDA's assessment that the application meets the program's criteria for a potentially meaningful improvement over available therapy on clinically relevant endpoints. Approval and the ultimate label remain subject to regulatory review. Now, turning to Zadaciran, in July, we completed enrollment in the Global Phase III Yosemite Study in homozygous familial hypercholesterolemia. We enrolled 70 patients above the original target of 60, reflecting strong interest in this population. The trial evaluates quarterly dosing and the change in LDL cholesterol at month 12 as the primary endpoint. We anticipate study completion in mid-2027 and data in the second half of next year, with a potential regulatory filing thereafter if the results are supportive. Our previously stated goal has been an NDA filing by year-end 2027. Next, Aerodimer PA. The interim single dose results announced in September showed mean maximal reductions of 89% in PCSK9 and 95% in ApoC3. The corresponding mean maximal lipid reductions were 65% for LDL cholesterol, 78% for triglycerides, 73% for remnant cholesterol, and 66% for ApoB. These are early dose escalation results, but the ability to affect both pathways with one molecule leading to large reductions in atherogenic lipoproteins is highly encouraging. No drug-related serious adverse events were reported in that interim analysis. Injection site events and headaches around mid-2027. We are evaluating a development strategy that could first seek approval based on LDL cholesterol lowering subject to regulatory agreement. Turning to the CNS, our October 14 presentation included the first interim healthy volunteer results for subcutaneous Aromat-T. At the 12.8 milligram per kilogram regimen administered on day one and 15, Mean CSF total Tau fell 73% by day 105 with a maximum individual reduction of 85%. Day 105 was 90 days after the last dose and these findings support the potential for maintenance dosing every three months or less frequently. Aromant T was generally well tolerated in the interim analysis. and there were no serious treatment emergent adverse events or adverse events leading to discontinuation. No persistent anemia or neurobehavioral adverse events were reported. These results provide evidence of target engagement in healthy volunteers. Multi-dose healthy volunteer cohorts are fully enrolled and enrollment in early Alzheimer's patient cohorts is ongoing. We expect additional healthy volunteer data and Alzheimer's patient data in 2027. We've also begun regulatory discussions around clinical studies in MAT-T associated frontotemporal dementia and progressive supranuclear palsy. We have multiple additional CNS programs in development. As discussed at our October webinar, we are targeting CTAs for two wholly owned candidates around end of 2026 or early 2027, and additional CNS clinical entries by the end of 2027. The objective is to apply the CNS delivery capability across a broad set of diseases. Lastly, we remain on track to share updates from our obesity programs, specifically focused on ALK7 non-diabetic monotherapy cohorts, as well as the type 2 diabetic-truzepatide combo cohorts before the end of the year. I will now turn the call over to Dan Apel.
Dan Apel
Chief Financial Officer
Thank you, James. Good afternoon, everyone. I'll provide a brief outline of our financial results for the full fiscal year ended September 30, 2026, and then discuss our financial position following several recent developments. As we reported today, net loss attributed to Arrowhead for fiscal year 2026 was $724.2 million, or a loss of $5.11 per share, based on 141.6 million fully valued weighted average shares outstanding in the year. This compares to a net loss of $1.6 million, or loss of one cent per share, based on 133.8 million fully diluted weighted average shares in fiscal year 2025. Two factors drove much of the year-over-year change. First, fiscal year 2025 benefited from $829 million in collaboration revenue, largely from the initial recognition of the Sarepta and Sanofi arrangements. Second, fiscal year 2026 included a one-time $215 million expense with a priority review voucher we acquired in September. Excluding that expense, net loss would have been approximately $509 million. Turning to revenue. Revenue for fiscal year 2026 totaled $450.8 million compared to $829.4 million in fiscal 2025. Revenue in fiscal 2026 was driven by our license and collaboration agreements with Sarepta, Novartis, Madrigal, and Sanofi, together with our first year of commercial sales of Redempto. Of that total, $317 million related to our Sarepta collaboration. This includes $181 million recognized for the second DM-1 milestone, ongoing recognition of initial Sarepta consideration, reimbursement of incurred collaboration program costs and revenue under the clinical supply agreement. The $317 million compares to $697 million from the prior year, with the year-over-year decrease related to the one-time recognition in 2025 of the transfer of the initial subject licenses. For our Novartis collaboration, we recognized $89 million during the year, nearly all of which relates to the $200 million upfront payment we received in October. As of September 30, 2026, we still carried approximately $113 million of deferred revenue, which will be recognized over time as we fulfill our research and development obligations. During the year, we also recognized the $25 million upfront payment from Madrigal for Arrow PNPLA III following completion of that license and technology transfer. and we recognized $13.3 million related to Sanofi in Greater China compared to $130 million in the prior year which related to the upfront consideration received when that agreement closed. Finally, fiscal year 2026 also marked our first year of commercial sales of Redemplo with net product revenue of approximately $6.6 million. As both Chris and Andy have mentioned, we are very pleased by the reception from patients, physicians and payers and how the underlying prescription volume and net sales are developing. While we have consistently stated that FCS revenue will have an immaterial impact to our 2026 financial statements, we continue to invest in supporting this FCS launch and preparing for the potential blockbuster opportunity in SHTG. Turning to expenses, total operating expenses for fiscal 2026 were approximately $1.16 billion compared to $731 million in fiscal 2025. The $427 million increase includes the $215 million priority review voucher expense. Excluding the voucher, operating expenses were approximately $943 million, an increase of $212 million year-over-year, driven by $132 million of higher R&D and $78 million of higher SG&A expense. R&D for the year was $739 million, compared to $607 million in the prior year. Candidate costs accounted for $96 million or the majority of that increase. Taken as a whole, these R&D investments supported the positive pivotal SHTG results reported this summer, the advancement of our broader pipeline, and our efforts toward commercial manufacturing readiness in Verona. As a reminder, the Verona plant provides us accelerated and enhanced ability to prioritize, and make new clinical GMP oligonucleotide drug substance and will be used to support future commercial products, the first one planned being Sedacerin. SG&A expense for the year was $202 million compared to $124 million in the prior year. The increase was driven primarily by our investment in the commercialization of Redemplum. As we have discussed, these capabilities more than support the current SCS launch, and were built with the intention of being fully leverageable for the potential SHTG launch and ultimately for Sudacerin and HOFH. As of today, our commercial organization is largely in place and we expect only incremental addition as we approach a potential US SHTG launch. Turning now to the balance sheet, cash and investments totaled nearly $1.2 billion as of September 30, 2026, compared to $0.9 billion a year earlier. Cash used in operating activities was approximately $272 million for the fiscal year. Importantly, that year-end balance is after funding both our operating activities and the $215 million purchase of the Priority Review Voucher. Common shares outstanding at year-end were approximately $141.3 million. As to the voucher, following the FDA's acceptance of Plasacin into the Star Pilot Program in October, It is no longer needed for our planned SHCG supplemental application and is eligible to be sold to a third party. Publicly announced PRB transactions over the last 12 months have ranged from approximately $180 million to $220 million. Purely illustratively, if we were to sell our PRB at prevailing market rates, our cash and investments would be approximately $1.4 billion on a rounded pro forma basis. To be clear, though, we have not entered into a sale agreement and no PRV sale proceeds are included in our reported statements. Finally, I'd like to highlight the refinancing we recently completed at Sixth Street on November 2nd. We replaced the prior facility with a new $400 million senior secured term loan and three months so for plus 5.5% compared to the prior facility's 15% annual rate. We also negotiated significantly a $68 million discount to the minimum amount required to retire the old facility in 2028. The new loan matures on November 2, 2031, has no scheduled principal amortization before maturity, and importantly, eliminates any and all required cash streaks to six feet tied to product sales, loyalty, milestones, or any existing or new licensing and partnership proceeds. To put our debt position in context, our funded debt now consists principally of the $400 million term loan due in November 2031 and $700 million of 0% convertible notes due in January 2032. In other words, no principal payments are required before late 2031. Compared with the retired structure, this materially lowers our borrowing costs, extends maturity, and improves our near-term liquidity and flexibility. Taking together, we believe our strong balance sheet with approximately $1.2 billion of reported cash and investments, a transferable PRV with demonstrated market value, and a meaningfully lower-cost, longer-dated debt structure provides a substantial financial flexibility to support our current clinical and preclinical priorities, current and future commercialization activities, and our long-term strategic priorities. Lastly, and unrelated to our financial position, we announced today our decision to change our fiscal year end to December to align with the calendar year. The calendar quarter ranging from October to December of 2026 will be what is called a transitional quarter period with fiscal quarter one 2027 now referring to January through March 2027. We believe this change will ease a number of administrative burdens associated with a September year end and the head of a potential SHTG launch will improve company and investor communication. With that brief overview, I will now turn the call back to Chris.
Dr. Chris Anzalone
President and Chief Executive Officer
Thanks, Dan. I want to close with what we believe the next year can mean for Arrowhead. Redemplo has given us our first commercial foundation. We view that as a launching pad that is intended to enable us to address the SHTG opportunity rapidly. We are targeting the second quarter of 2027 for a potential US SHCG launch subject to FDA approval. We believe we have the data to support a highly differentiated medicine, a large population with substantial unmet need, and a growing commercial organization that understands how to serve physicians and patients and how to navigate the payer landscape. We intend to build the leading franchise around that combination. The coming period should also bring important opportunities beyond redemption, including additional obesity data by the end of 2026 additional Aero-Dimer PA data in the first half of 2027, the 70 Phase III readout in HOFH in the second half of 2027, so the SRN NDA filing by the end of 2027, initial patient data from AeroMAP-T in the second half of 2027, new candidates emerging from our Dimer and CNS platforms throughout 2027, and the opportunity to receive milestone payments from existing partnerships and the possibility of new deals throughout 2027. We have worked for years to build a company that can repeatedly create important medicines and participate meaningfully in the value they generate. We now have much more evidence that this model can work. We are commercial. Our mid- and late-stage pipeline is advancing, and our ability to reach new tissues and targets continues to expand. That is why we are so optimistic. We believe that the next stage of Aravind's growth can be substantially larger than the last, and we are working to make that happen. Thank you for joining us today, and I would now like to open the call to your questions. Are you ready?
Belinda
Conference Call Operator
Thank you. To ask a question, you will need to press star 1-1 on your telephone. To withdraw your question, press star 1-1 again. Due to time restraints, we ask that you please limit yourself to one question. You may then return to the queue. Please stand by while we compile the Q&A roster. and our first question will come from the line of Maury Raycroft with Jefferies. Your line is open.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Hi. Thanks for taking my questions. Given that Ionis has set expectations for their early SHTG launch to be softer than expected, do you view that as a company-specific execution issue or evidence that the SHTG market may take longer to develop than anticipated? And how do you reconcile the Ionis comments on broad access the 1 million people on prescription fish oils with the perception that there may be headwinds to the launch.
Dr. Chris Anzalone
President and Chief Executive Officer
And I guess, can you help us identify what those headwinds could be? Boy, you jammed several questions into one question. So, broadly, look, what we learned from IONIS doesn't affect our expectations in FHCG at all. You know, I think what we've seen from them are some missteps in communications and missteps in commercial execution. and we don't expect to have those missteps. And so we are full steam ahead towards a rapid launch in SHTG. That's a large market. We have a good differentiated medicine that can address that market. And we are building towards that as we speak. So we are as bullish as ever on our ability to help those patients. You've seen the increase in demand as reflected by prescriptions. We saw a good and other prescriptions, but then an additional 30% increase just over the last four to five weeks. Same thing with increase in prescribers, another 30 or so percent increase just over the last four to five weeks. And so we see a lot of demand out there waiting for a download to be available for SHTG individuals. And also look, we've got some structural as it relates to an SHTG launch just because we are second. We are able to see what has been done in the market and I think adjust accordingly. We are also having early discussions with payers to hopefully allow us to hit the ground running with respect to payers once we are approved in SHTG. I think we're doing a good job in preparation to that. As we talked about, the slow piece of this has been what we call the middle of the funnel. So once prescriptions are written, we have to go through a number of machinations with payers in order to get paid shipments. We're working through that, and I think that our expectation is that we should be able to work through that even quicker in FHTG because we're talking about it right now.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Jason Gerberry with Bank of America. Your line is open.
Jason Gerberry
Bank of America Analyst
Hey, guys. Thanks for taking my question. A follow-up just kind of on the competitor launch. You guys have said twice, I think, on this call, rapid launch, but then also said it'll take several quarters. I wasn't sure if the several quarters was into the Tringolza launch or several quarters into the Redemplo launch. and maybe because you guys, you know, highlighted communication and kind of expectation setting, is your definition of a rapid launch on sort of the metrics that you guys outlined like NBRX as opposed to revenues? So just wanted to perhaps clarify that so everybody's level set.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Sure, Andy, you want to start with that? Yeah, thanks for the call, Jason. I'm happy to comment. As we had mentioned at the outset of this call, the three leading indicators that we will be tracking in looking to consistently report to you and others are the three metrics you mentioned at the outset of the call. That's new-to-brand prescriptions, which is largely synonymous with new patients, breadth of prescribers, so are we able to communicate to the prescribers who we're interested in educating, and number three, how are we navigating the payer space? That is through the metric of coverage. And we had mentioned that in FCS alone, we currently have 160 million lives covered for Redemplo and FCS. We think that is a very good number at this place in the launch. And so these are the three leading indicators that we'll continue to report on as we define what would be a rapid launch for Redemplo into SHTG as well.
Dr. Chris Anzalone
President and Chief Executive Officer
Yeah, and look, you know, we're not walking away from revenue. Obviously, revenue is important. Our point here is that in the early stages of a launch, that may not tell the entire story. So while we'll be talking about revenue and how we increase that, in place, and have coverage in place. Got it. Thank you, guys.
Belinda
Conference Call Operator
You're welcome. One moment for our next question. And that will come from the line of Mike Oles with Morgan Stanley. Your line is open.
Mike Oles
Morgan Stanley Analyst
Good afternoon. Thanks for taking the question. Maybe just another follow-up on Redemplo and the pending launch here. Just wanted to get your thoughts on potentially providing guidance. You know, what's the current thinking there? Is that something you might share next year at some point or any thoughts there would be helpful? Thanks.
Dr. Chris Anzalone
President and Chief Executive Officer
Yeah, thanks. Unfortunately, it's just too early to provide guidance. You know, we will be happy to do that when we can. We have just filed our SNDA. We don't have a PDUFA date yet, much less a label. And so we need to see what that label looks like. You know, we need to have some experience working with PEARS. As I mentioned, we are starting to do that right now, even prior to an SHTG label. So I think that that can move relatively rapidly, but until we have better visibility on those key features, it's just too early to provide guidance.
Mike Oles
Morgan Stanley Analyst
Great. Thank you. You're welcome.
Belinda
Conference Call Operator
Thank you. And our next question, that will come from the line of Brian Chang with J.P. Morgan. Your line is open.
Brian Chang
J.P. Morgan Analyst
Hey, guys. Sorry. Thanks for taking our questions today. Just shifting away from SXTG here, on the obesity update in the coming weeks, what do you need to see to define success for the OX7 monotherapy and the terceptide combo? And, you know, when you talk about meal deals, is this an area where you think that the new deal should happen. Thank you.
Dr. Chris Anzalone
President and Chief Executive Officer
James, do you want to go first?
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Yeah, sure. I can talk a little bit about, I can't set sort of the hurdles that we plan to get over, but in terms of data that we'll be sharing by the end of the year, expect to see the changes in body composition based on MRI. Of course, we'll share safety and knockdown and then probably some changes in body weight as well.
Dr. Chris Anzalone
President and Chief Executive Officer
And relating to deals, let's see, I can't give you too much guidance on this. Maybe it's easier to tell you what's off the table. We are running towards an FHCG launch with Pladastra and with Redemplo. We see that as a as a cornerstone of our burgeoning commercial infrastructure in cardiometabolic and beyond. And so given that, at least in the United States, we have no appetite in partnering there. Within CNS, AeromapT is really, really interesting. We have something of real scarcity. We have the ability to deliver all nucleotides to the brain that is at least initially are clinically validated. We're very excited about that. And we are interrogating a drug that is targeting a gene target that is well-validated, somewhat validated in Alzheimer's, but very well-validated in primary teleopathy. And so it's hard for us to imagine doing a partnership around AromapT at this point. Beyond that, There could be areas within obesity. There could be areas within NASH that make some sense to us. Certainly on the complement side, there could be something that makes sense to us. And then just on the discovery side, we have a number of things that are characterized by great scarcity. Again, our ability to deliver all of the nucleotides to the brain via simple subcutaneous fully-owned drug candidates, but there's room there to do partnerships with other folks, as we have with Novartis so far. Same thing with other delivery, say, into the ad books, into the long. Those are also scarce. So there's a number of ways we can go. We'll just have to look at opportunities and decide.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of June Lee with UBS. Your line is open. Hi.
Dr. Chris Anzalone
President and Chief Executive Officer
Professor in progress and thanks for taking our questions. Going back to what we've done below, what's the depth of conversations with payers you can have prior to the FDA approval without a label? How are you taking advantage of this time between now and approval to ensure maximal access and conversion of script to reimbursement upon approval? Thank you.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Thanks, June. This is Andy. Good question. So we are able to interact with payers using a pre-approval information exchange deck which essentially articulates the value proposition of Redemplo both clinically and economically. And so we are able to engage with both the clinical and negotiating teams of the large payers in a pre-approval context and we're presently doing that now and we'll continue to do that up until the approval of Redemplo expected in the second quarter of next year.
Dr. Chris Anzalone
President and Chief Executive Officer
We were confident that we could do that which is why we bought the priority voucher. We're happy to report that we don't need that any longer, we can sell it. But we saw a big opportunity to have those discussions early, particularly if we could have accelerated approval or the possibility for accelerated approval. But also, let's look at what this says about our data. If our data were ambiguous, if there were clear warts on Redemplo, it would be much more difficult Don't see that as the case. And so the fact that there are players talking to us right now before we have a label, I think is indicative of the power of this medicine and the unambiguous value proposition that we've got. Thank you.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Edward Tentoff with Piper Sandler. Your line is open.
Edward Tenthoff
Piper Sandler Analyst
Great. Thank you very much. And I apologize if Asked this, I don't think anyone has, but the Kelly Carson myth in the data at AHA, any read-through or do you guys have any thoughts on Amgen partnered, I'll pass around with the Ocean trial, maybe next year. And again, I apologize if someone asks this, I'm trying to listen to everything you guys are saying.
Dr. Chris Anzalone
President and Chief Executive Officer
Hey, Ted, it's great to hear you. So, as you know, we are largely out of old Pastoran. We monetized those royalties. We still have Miles and Babes, of course, but we monetized those royalties. And we don't have good visibility on when Amgen may finish this or have data. We have no more visibility than anybody else on the planet. But from just my perspective, I don't know that the book is closed on LPLA. My recollection is that Novartis showed something like 77% reduction in Lp . Opaciran is much better than that. I think that Amgen was seen better than 90-95% reduction in Lp . That could make a difference. Of course, the baseline characteristics also could make a difference. I believe that the Amgen studies have a bit of a higher a baseline LP little a numbers than Novartis. And so that can make a difference as well. So we'll see where that goes. The data were unfortunate with Pella Carson, but I don't think the book is close.
Edward Tenthoff
Piper Sandler Analyst
I appreciate that perspective.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Eric Joseph with Citi. Your line is open.
Charles / Prakhar Agrawal
Citi Analyst / Cantor Fitzgerald Analyst
Hey, this is Charles on for Eric. You know, congrats on the quarter in the year. Maybe one from us on AeroDimer PA sort of registration strategy.
Jason Gerberry
Bank of America Analyst
Do you mind expanding on why you're seeking approval first on the LDLC lowering versus perhaps a composite-based endpoint?
Charles / Prakhar Agrawal
Citi Analyst / Cantor Fitzgerald Analyst
More clarity would be great. Thanks.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Yeah, sure, Charles. I can take that. Of course, this is all The LDL cholesterol is probably one of the most validated surrogate endpoints out there, and that's our thought, is that if we could get approval and get on the market with an LDL endpoint in the mixed hyperlipidemia population, that would be great. The triglyceride component of mixed hyperlipidemia, that is more of a surrogate and less widely accepted for the less severe mixed hyperlipidemia population. So that's why we're focusing on LDL at least for now.
Dr. Chris Anzalone
President and Chief Executive Officer
And if we're able to do that, that's a relatively quick time to approval to a fairly large market. We look forward to continuing to see data with Airedown or PA and to start to have discussions with regulators.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Prakhar Agrawal with Cantor. Your line is open.
Charles / Prakhar Agrawal
Citi Analyst / Cantor Fitzgerald Analyst
Hi, thank you so much for taking my questions. Maybe firstly on Redemplo and SHTG. On the payer side, do you think you're at the right pricing range given some of the initial friction that's happening with the Tringolta launch? We obviously have the flexibility of seeing what's happening on the market and change accordingly. So just wanted to see the latest thoughts on pricing to get broad access. And secondly, if I can sneak in one more, on the AeroDimer data at AHA, efficacy obviously great. But if you can talk about some of the detailed safety data in the SAT portion, I think there were some injection reactions and pyrexia. So I wanted to understand how long these events lasted. Are these going to be single-dose effect and implications for the MAD dosing? Thank you so much.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Thanks, Prakash, for the question. This is Andy. We do believe we have the right pricing range here for Redemplo. And there are two kind of leading indicators that give us confidence. The first would be the currently currently published policies related to Tringles and SHTG, which do appear to have policy criteria consistent with label. We are optimistic that we will see in the future similar policy criteria to label for Redemplo. And then second, we are engaging with payers, as we mentioned, through the pre-approval information exchange process, and we haven't received pushback through those conversations with payers about the pricing range SHTG, so we think we're in a great spot. And look, you mentioned friction related to price. I don't know that we have seen that.
Dr. Chris Anzalone
President and Chief Executive Officer
There is always friction early between prescriptions and working with payers to get that paid. It just takes a little bit of time to establish those processes. We're doing that now. I don't know that that is price related. James, do you want to talk about Airdyne? Yeah, I can cover the question on the
Dr. James Hamilton
Chief Medical Officer and Head of R&D
We saw some immune-related AEs, specifically pyrexia, some headaches, some ISRs. In terms of ISRs, they're generally consistent with what we've seen and what others have reported with SIRA therapeutics in terms of duration of activity. I'd say when it comes to dose selection, we still don't have all the data. We need to get the PD and the safety for at least some doses, a further step down upon second dosing.
Dr. Chris Anzalone
President and Chief Executive Officer
So we will see what the right doses are. I think there's a reasonable chance it's going to be less than 200 milligrams. Thank you.
Belinda
Conference Call Operator
Thank you. And one moment for our next question. And that will come from the line of Luca Issy with RBC. Your line is open.
Cassie
RBC Capital Markets Analyst (calling for Luca Issi)
Great. Thanks, Tim. And congrats on the quarter. Good afternoon. This is Cassie for Luca. and coming back to the APOC Food Lunch, Redempto, both you and Ionis have described having another competitor in the market as a tail wing. Recently we've learned that the Quick Start program that Ionis has adopted as essentially a bridge program before patients get covered. So wanted to get your thoughts on if Redempto follows a similar playbook here for FCS, given that many of the patients may be first to therapy and not yet approved Related to it, is there a version of the world where maybe you don't see as many of your patients having to go through such program? Because one, going back to the point of having a competitor in the market being a tailwind, providers are already pretty comfortable with the ApoC3 class by the time Redempto arrives. And two, for Redempto, perhaps you're getting some switch patients who already qualify for coverage. Any comment on how we should think about your new class versus same-cost switch patients? both in FCS and upcoming SSTG launch will be super helpful. Thank you so much.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Yeah, I think, Cassie, I can take the first part of that question. So like any rare disease launch, we do have a quick start bridge program ourselves and a patient assistance program so patients can start therapy while coverage is being established. And so we would expect a quick start program to be in place for SHTG as well, should we be indicated for that next year. What matters to us is that patients in the end convert to paid therapy as payer policies are put in place. And what matters is that persistence is high once these patients are on therapy. So we will be heavily focused on ensuring that appropriate patients can get on Redemplo, whether that's through a paid Pay Claim, or through a quick start program as their coverage is being determined and helping support them with our patient access program so they can remain on therapy. Thanks.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Andrea Newkirk with Goldman Sachs. Your line is open.
Andrea Newkirk
Goldman Sachs Analyst
Hi, Ms. Bernan. Thanks for taking the question. You know at this at the recent liver meeting Regeneron reported some proof of concept data for its side B targeted siRNA in an all-comer mass old population and I'm just curious in light of this how you view the mechanistic positioning of arrow PNPL3 which you are partnered with Madrigal on but recognizing that that may that may have efficacy only in a in a smaller subset of patients and then in parallel to that, as others have stepped back from HSD to prioritize these other targets, I'm curious what your scientific conviction is in aero HSD to drive that clinically meaningful antifibrotic effect that may be independent of steatosis reduction. Thanks so much.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Yeah, I can take both of those. So, the first question about PNPLA3, You'd have to ask Madrigal what their plan is with that in terms of how they plan the development of populations to look at. I would highlight one other presentation that was interesting at ASLD that implied even on GLPs, the patients that were homozygous for the I-148M PNPLA3 variant seemed to have less of a reduction in liver fat. So there might be an opportunity there for combination therapy. But again, this is all up to Madrigal. And the same is true for HSD, really. That asset, of course, has been licensed to GSK. And so any development plans around where that one would go are up to GSK exclusively.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of James Condoles with Stifel. Your line is open.
Jason Gerberry
Bank of America Analyst
Hey, thanks for taking my question. Maybe one going back to Triggs here. Just curious what your latest thinking is around how many patients in the U.S. have had a prior pancreatitis event and Just in general, I guess kind of what you think the timeline and path is to really getting broad uptake outside those patients and kind of more of the primary prevention setting. Thanks so much.
Andy Davis
Senior Vice President and Head of the Global Cardiometabolic Franchise
Yeah, thanks, James. We estimate there are around 200,000 patients in the U.S. who have a prior history of AEP due to high triglycerides. There are various estimates on that, but we think that's a fairly good range for your modeling. Clearly, that is the population of highest unmet medical need. It was clearly determined through the data that was reported at AHA this past week, and that of the two variables of importance here, high TGs or prior history of AP, prior history of AP is a very, very key determinant of recurrent AP, and the number needed to treat in those populations that secondary prevention population were incredibly high. And so clearly that will be a heavy focus for us as we head into the SHTG launch. It's also a high willingness to prescribe from providers and a high willingness to pay from payers. Clearly it will take some more time over the years to continue to expand into the broader SHTG population. As you would be aware, that high risk segment we think is about a third of the broader SHTG and a half million. So it will take a little bit more time to penetrate that broader SHTG population, and that will largely depend on favorable payer policies, and we do anticipate that those payer policies will allow for penetration of that segment over time. Thanks. And look, that primary prevention is
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Makes sense. Thanks.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Joseph Stone with TD Cowan. Your line is open.
Dr. Chris Anzalone
President and Chief Executive Officer
Hi there, good evening, and thank you for taking my question. Maybe on the obesity ALK7 program, I guess, how clear is the FDA guidance on what you would need to do next if the data are supportive? Is there a clear registrational path for a combination approach? And do you see a path forward to study the agent as a monotherapy or commercially? Do you not think, you know, that that's going to be the way to go here, that basically future of obesity treatments are going to be some form of combination? Thank you.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Well, we've said all along that we think that either one of these, if we study them as a fat loss or a weight loss drug, would be a combination that would be on top of GLP-1 or in combination with GLP-1. And that's still our strategy. In terms of what that development pathway looks like, I mean, the guidance for obesity drugs is a little bit old. I think the 5% weight loss May still be relevant, but of course, there's a lot of combination products out there. So I would imagine we're not the only company that's having these combination type questions and discussions with FDA. I don't have a definitive answer for you in terms of what this would look like from a development and regulatory pathway for the combination product. in combination with the GOPs.
Belinda
Conference Call Operator
Thank you. One moment for our next question. And that will come from the line of Madison L. Sadie with B. Riley. Your line is open.
Dr. Chris Anzalone
President and Chief Executive Officer
Hi, guys. Thanks for taking our question. Maybe with focusing on aerodimer, on a patient-by-patient basis, Did the biomarker knockdown move together? For example, did anyone achieve deep APOC3 lowering but weak PCSK9 lowering or the reverse? And then secondly, across the cohorts, is there a responder profile emerging based on triglyceride level? Thanks.
Dr. James Hamilton
Chief Medical Officer and Head of R&D
Yeah, I think in general they move together. Maybe you get a little slightly better AplC3 knockdown at lower doses, but we're able to get plenty of PCSK9 knockdowns, so they move pretty much in lots as we dose escalate. And so far the response, like we've seen with plazacirin, has been pretty homogeneous. I mean, there's not really patients who we call non-responders or hyper-responders. I don't think we can pinpoint any population that's more likely to respond than others, at least not at this point.
Dan Apel
Chief Financial Officer
Understood. Thanks.
Belinda
Conference Call Operator
One moment for our next question. And that will come from the line of Patrick Truccio with AC Wainwright. Your line is open.
Patrick Truccio
H.C. Wainwright Analyst
Thanks. Just a follow-up on the ARROWMAP-T. I'm wondering what the next patient data set is that can connect the CSF total TAL lowering to an effect on disease biology and what result would justify advancing toward a registrational program and what will determine the sequencing of Alzheimer's disease, MAP-T-associated frontotemporal dementia, and progressive supranuclear palsy development?
Dr. James Hamilton
Chief Medical Officer and Head of R&D
So we're looking at the latter right now, meaning MAP-T, FTD, and PSP. And we've got study designs for Phase IIs or things that could be adaptive and progress potentially even into Phase III and having some of those regulatory discussions now based on the knockdown data we have from Healthy Volunteers. We think that showing the knockdown and the safety Eventually, we'll look more at Phase IIs and Alzheimer's, but we have the Alzheimer's cohorts in the current study up and running, and I'd like to get some data from those cohorts first. In terms of bridging data, I think the next data points from this program are still going to be in the healthy volunteers, probably the multi-dose healthy volunteer safety and MAT-T Reduction data will come out first. Then beyond that, we'll have Alzheimer's patient data, of course, safety, and then total tau knockdown, but also starting to look at some of the phosphatau, the p-tau-181, p-tau-217. Those are probably somewhat bridging biomarkers indicating that we're influencing sort of more disease-relevant biomarkers. and then of course pet data, the pet tau data we'll have probably more towards the end of the year. But those are the next few bridging biomarkers that we'd anticipate to help us make a call if we want to take something forward into later stage Alzheimer's development.
Dr. Chris Anzalone
President and Chief Executive Officer
Yeah, I think qualitatively, I think it's fair to say that we are moving quickly. in PSP and FTD, and slowly in Alzheimer's.
Belinda
Conference Call Operator
Thank you. I'm showing no further questions in the queue at this time. I would now like to turn the call over to Mr. Chris Anzalone for any closing remarks.
Dr. Chris Anzalone
President and Chief Executive Officer
Thank you, Belinda, for joining us today, and I wish you all a nice Thanksgiving holiday in the next couple of weeks.
Belinda
Conference Call Operator
This concludes today's program. Thank you all for participating. You may now disconnect.