RIGL Rigel Pharmaceuticals Inc.
$39.65
Rigel Pharmaceuticals Inc. Q3 F2026 Earnings Call Transcript
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Operator
Greetings and welcome to Rigel Pharmaceuticals' financial conference call for the third quarter, 2026. At this time, all participants are in a listen-only mode. A brief question and answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce our first speaker, Ray Furey, Rigel's Executive Vice President, General Counsel, and Corporate Secretary. Thank you, Mr. Furey. You may begin.
Ray Furey
Executive Vice President, General Counsel, and Corporate Secretary
Thank you. Welcome to our third quarter 2026 financial results conference call. The financial press release for the third quarter 2026 was issued earlier today and can be viewed, along with the slides for this presentation, in the news and events section of our investor relations site on Rigel.com. As a reminder, during today's call, we may make forward-looking statements regarding our financial outlook and our plans and timing for commercial regulatory product development and other business activities. These statements are subject to risks and uncertainties that may cause actual results to differ from those forecasted. A description of these risks can be found on our most recent annual report on Form 10-K for the year ended December 31st, 2025, on file with the SEC, and subsequent filings with the SEC, including our Q3 quarterly report on Form 10Q with the SEC. Any forward-looking statements are made only as of today's date, and we undertake no obligation to update these forward-looking statements to reflect subsequent events or circumstances, except as required by law. At this time, I would like to turn the call over to our President
Raul Rodriguez
President and Chief Executive Officer
and Chief Executive Officer Raul Rodriguez. Raul? Thank you, Ray, and thank you all for joining us today. Also joining me on the call are Dave Santos, our Chief Commercial Officer, Dr. Alison Hannah, our Chief Medical Officer, and Dean Schorno, our Chief Financial Officer. Before we begin, I'd like to share a few key highlights from the quarter. We delivered over $72 million in net product sales, our highest ever, and another profitable quarter. This while making important, taking important steps towards Rigel's next phase of growth. Fepinu, Rigel's fourth commercial product, is now available in the U.S. with an encouraging start to its launch, and we continue to advance R289 towards its next stage of development. I'll start with an overview of this progress before the team takes you through the details. Moving to slide four. Webino became commercially available in the U.S. on August 13th and generated 6.6 million in net product sales through the end of the third quarter. Following the close of the Global In-License Agreement in June, our team moved quickly to initiate launch activities, leveraging our established commercial and medical infrastructure to engage physicians and build awareness ahead of commercial availability. Within just two months of closing the transaction, Vepinu was successfully integrated into our existing distribution network and ready for commercial launch. During Q3, we shipped Vepinu to over 100 patients and clinics. Encouragingly, the majority of the patients who received Vepinu during the early weeks of launch had already refilled their prescriptions by quarter end. We also have strong payer coverage with patients able to access Vepinu through either formulary coverage or through the exception process. In addition, we are seeing positive engagement with healthcare providers with our efforts focused on high docile prescribers. As the first and only FDA-approved ProTac therapy or prognosis targeting Chimera, Vepinu offers a new mechanism of action and an important treatment option for patients with ER-positive, HER2-negative, ESR1-mutated advanced or metastatic breast cancer. Our focus now is on building awareness of its differentiated mechanism and clinical data, then translating this into adoption through multifaceted campaigns. Dave will share more about our early launch experience and plans shortly. Overall, we're excited by VetBeneu's early launch performance and believe it has the potential to be Rytel's largest sales contributor. On slide five, we outline our transformational growth strategy. The Bepinu launch is a clear example of this strategy in action. We identified a differentiated, late-stage asset in oncology and leveraged our established infrastructure to rapidly integrate and launch the product. We intend to build on that approach as we continue to grow our portfolio for commercial products and evaluate additional in-license opportunities. At the same time, we are investing in our development pipeline, led by R289, our dual IRAC 1 and 4 inhibitor, which is currently being evaluated in a Phase 1B clinical studies in patients with low and risk MDS. We look forward to presenting updated data on this study at the ASH meeting in December. Financial discipline is what connects these strategic objectives. Our growing commercial business enables us to invest in opportunities with substantial long-term potential We believe this combination of commercial execution, pipeline advancement, and financial discipline sets us apart and positions Rigel well for its next phase of growth. Slide 6 highlights our track record of commercial growth, and more importantly, the opportunities ahead for Rigel. We grew our net product sales by a compound annual growth rate of approximately 35% annually since 2022. Looking into the future, we have two sequential engines of significant growth, Vepinu and then R289. We are encouraged by Vepinu's early performance and see significant potential in a large and growing market. Turning to R289, we continue to advance its development in patients with lower risk MDS. A disease with significant unmet medical need. At the ASH meeting in December, we plan to present updated data from the Phase 1b study, including preliminary efficacy data from the dose expansion phase. We also remain on track to complete enrollment and select the recommended Phase 2 dose for future development by the end of 2026. We plan to initiate a registrational program in lower-risk MDS next year and believe that R289 has the potential to be a billion-dollar-plus commercial opportunity in this syndication. Together, Vepinu and R289 offer significant commercial potential, and they are central to our plans to substantially expand Rigel's business over the coming years and drive long-term shareholder value. With that, I'll turn the call over to Dave to discuss our commercial performance and the latest on the Vepinu launch. Dave?
Dave Santos
Chief Commercial Officer
Thank you, Raul. On slide eight, you'll see our four commercial products, Vepinu, Tavalise, ResLydia, and Givretto. Moving to slide nine, our net product sales were $72.3 million for the third quarter of 2026, an increase of 13% Thank you for joining us today. and we reported $6.6 million in net product sales for the third quarter, which reflects approximately six weeks of product availability. I'll talk more about Fepidu in a few minutes. For Tavalese, we generated $46 million in net product sales, an increase of 3% compared to the third quarter of 2025. Eight years after launch, Tavalise continues to be a strong and consistent contributor to our portfolio. For ResLydia, we reported $9.9 million in net product sales, an increase of 20% compared to the prior year period. We continue to believe ResLydia adoption will grow in the community setting and in the post-Venetoclax patient population. And finally, for Gavretto, We delivered $9.8 million in net product sales, a decrease of 11% compared to the third quarter of 2025. Givretto continues to be a stable, contributing product in our portfolio. Overall, we are very pleased with our third quarter results. While Vepinu is now our lead focus, we remain committed to supporting Tavalise, ResLydia, and Givretto. Importantly, The engagement of our field team has had around Vepidu is opening doors to more accounts, which also creates opportunities to support our other products where there are appropriate patients. Moving to slide 10, we generated $8.6 million in revenues from collaborations in the third quarter, driven primarily by the availability of Tavalise in global markets. Tavalise is commercially available in key European countries under the brand name Tavles, in Japan and South Korea, in Canada and Israel, and in Mexico through our partners Give Cripples, Kisei, Medicine, and Knight. Knight also announced regulatory approval of Tavales in Colombia in September and the launch of Tavales in Brazil in October. Our partners continue to pursue regulatory approvals for Tavales in new markets. and we are pleased that access to Tavalise continues to spread outside the U.S. For ResLydia, our partners Kise and Dr. Redis are advancing elutacitinib in their territories. I'll now turn to Vepinu. Before I get into the commercial launch, let me briefly remind you of the ER-positive, HER2-negative, ESR1-mutated advanced hermetostatic patient opportunity which you can see on slide 12. Of approximately 170,000 US metastatic breast cancer patients, about 119,000 have ER-positive HER2-negative disease. Prior endocrine and CDK4-6 therapy drives ESR1 resistance in about 40% of patients. Upon ctDNA testing, roughly 60%, corresponding to around 26,000 patients, are diagnosed with ESR1 mutated disease. Most of these patients are in the second or later line setting, resulting in about 20,000 patients with a critical unmet need in second line and later ER positive, HER2 negative, ESR1 mutated metastatic breast cancer. This represents a US market opportunity of $1 billion plus. I'm now on slide 13. Resistance driven by ESR1 mutations continues to be a challenge for metastatic breast cancer patients, and ER degradation is an important therapeutic strategy for addressing these mutations. Oral SIRDs degrade estrogen receptors by binding them and causing a conformational change, which indirectly results in degradation of estrogen receptors. In a preclinical study, the scale of ER degradation was 8 to 68%. Proteolysis targeting Chimera, or ProTac, is not a SIRT and is a very different mechanism to eliminate estrogen receptors. ProTac is heterobifunctional, binding to the estrogen receptor on one end and the E3 ligase on the other, bringing them close together to initialize polyubicaminidation, directly degrading the receptor through the proteasome. In addition, the ProTac can then release and degrade multiple estrogen receptors until it's metabolized. This ability to recruit the E3 ligase, remove the estrogen receptor, and repeat the process differentiates ProTac from SIRT. In a preclinical study, The ProTac Vepinu degraded 79% to 86% of estrogen receptors. This is why we believe Vepinu represents an important therapeutic advance for ER positive, HER2 negative, ESR1 mutated metastatic breast cancer. And as we continue to create awareness of Vepinu as the first and only FDA approved ProTac, more clinicians will want to try it in their patients. Moving to slide 14, HCPs are interested in this new therapeutic option for their patients, and we are highly encouraged by the speed and breadth of uptake of Vepinu during Q3. I'll be providing some metrics today to provide color on the early days of the launch, given Q3 reflects only approximately six weeks of availability. Going forward, we'll not provide this level of detail, We are very pleased that immediately after product became available in mid-August, we began shipping Vepinu to patients and clinics. In the first six weeks of Vepinu availability during Q3, we shipped Vepinu to more than 100 patients and clinics. and impressively, by the end of the quarter, the majority of patients who started in August had already received their first refill. In terms of prescribers, we have seen both breast cancer specialists at academic institutions and community ecologists across the country try Vepidu. In fact, all six of our sales regions had a prescriber on day one of product availability a second prescriber by the end of week one and a third by the end of week two. Overall, to give an idea of our geographic adoption, 75% of our territories had prescribers during the first six weeks of product availability in Q3. Similarly, we had good adoption at direct ordering accounts across academic and community settings. All six regions had direct accounts ordered by the end of August, and nearly two thirds of our territories had direct account orders by the end of Q3. These early launch signals indicate that clinicians treating breast cancer have seen the value of having a new treatment option for their patients, and with increased awareness and experience, Vepinu will grow. Moving to slide 15, We have also been encouraged by the early trends in patient access. Prior authorization approval, or PA approval, is an important metric in determining how well a drug can be accessed. During the third quarter, we were pleased to see that overall, our PA approval rate was estimated to be 88%. Of commercially insured patients, even at this very early stage, More than 80% of PAs were approved. And in Medicare patients, that PA approval rate was even higher, above 90%. And once patients receive approval, it is important that they get their fill quickly. And we are pleased to report that the median time to fill Vapidu prescriptions through our specialty pharmacies was just four days. More than 80% of prescriptions were filled within two weeks and more than one-third of patients got their Vepinu within three days. We continue to provide services for both patients and providers through our Rigel OneCare patient support hub. This hub can assist with benefits verification and coverage support, prior authorizations, temporary drug supply for eligible patients, as well as Copay and other assistance. These services combined with our specialty pharmacy partners are ensuring we maximize patient access to Vepinu and minimize the time to fill approved Vepinu prescriptions. Moving to slide 16, as discussed earlier, it is important that we continue to raise awareness of Vepinu among HCPs as the first and only FDA-approved ProTac for their patients with ESR1-mutated metastatic breast cancer. We have made great early progress in creating awareness, and those efforts are continuing. Because Vepinu's mechanism is so important, we have updated tools highlighting Vepinu's novel mechanism of action and our newest promotional materials highlight a new campaign to give ER-positive HER2-negative ESR1 metastatic breast cancer patients more progression-free time to live vividly. This is supported by our efficacy results from Veritac2 of a 2.4-fold increase in medium PFS of 5 months for Vepinu versus 2.1 months for Fulvestrin, as well as health-related quality-of-life patient reported outcomes data that were reported. We are implementing plans to ensure this new promotional campaign will rapidly reach more customers as we move forward in Q4 and into 2027. I'm on slide 17. To that end, we will have a strong first-time presence at the most important breast cancer conference of the year. The San Antonio Breast Cancer Symposium in December. This will be Rigel's first opportunity to have a presence at this conference and it will be strong. We have a large booth planned for the exhibit hall that prominently displays our new Vepidu campaign. In addition to our new HCP promotional campaign, including the newly launched website you see on the right, We will be activating numerous patient and caregiver directed Vepinu education through several different channels. Overall, we are highly encouraged by our early results and look forward to expanding awareness and adoption of Vepinu as we move through our first full quarter of product availability and into 2027. With that, I'll turn the call over to Alison for an update on our development pipeline. Alison?
Alison Hannah
Chief Medical Officer
Thank you, Dave. On slide 19, you can see our three hematology and oncology focus areas. R289, our dual IRAC 1 and 4 inhibitor, is currently under evaluation in a phase 1b study for patients with relapsed or refractory lower risk MDS. And I am pleased that we will present updated data from the study in an oral session at ASH in December, which will include preliminary efficacy data from the dose expansion phase of the study. In addition, we are continuing to evaluate other potential indications for R289, where the pro-inflammatory cascade plays a role. For Bebdegestrant, studies are ongoing. Pfizer and Arvanith remain responsible for these studies. I'll touch more on this in a moment. And finally, for Alutacitinib, we are focused on its evaluation through strategic collaborations with MD Anderson, The Connect Consortium, and MyloMatch. Alutacitinib is being evaluated in IDH1 mutated AML and other haematologic malignancies, as well as in IDH1 mutated high-grade glioma. You can find more information on these collaborations in our corporate presentation that's available in the Investors section of our website. On slide 20, you'll see more on the specific development for vebdigestrin. As I mentioned, there are several ongoing studies for which Pfizer and Arvanis remain responsible. RIGEO will also contribute to these studies. These trials remain active, but are no longer enrolling except for the hepatic impairment trial. VERITAC-2, the Registrational Phase 3 study, remains ongoing for time to event endpoints, such as overall survival. In addition, There are several combination studies that we expect will provide us additional safety and efficacy data. That data will be important as we consider our future development of vebdigestrin, which includes the potential for Rigel to initiate its own studies or new collaborations. We have heard from thought leaders that because vebdigestrin is so tolerable, it has a great potential as a combination agent. They have also told us that its differentiated mechanism of action from oral SIRDs could be very important as oral SIRDs are used earlier in breast cancer treatment. Thus, combination studies and studies in the post-SIRD setting are of high interest and priority for Bebdegestrin. Also for Bebdegestrin, as Dave mentioned, we're looking forward to the upcoming San Antonio Breast Cancer Symposium. On slide 21, are the titles of the veb-digestrin abstracts that have been accepted, including post-SERD data and combination data, and includes an abstract that discusses the impact of ESR1 mutations in the ER-positive HER2-negative metastatic breast cancer. We look forward to discussing the abstract data after the abstract embargo lifts later this month. Now let's move on to R289 and lower-risk MDS. On slide 23, you can see the current treatment landscape for this indication. MDS is a clonal disorder of hematopoietic stem cells that leads to ineffective hematopoiesis, with consequences that include anemia, infections, iron overload, and organ dysfunction, and possible progression to acute myeloid leukemia. The primary goal of therapy is to reduce or eliminate Transfusion Dependents. In the first line setting, patients typically receive erythropoiesis stimulating agents, or ESAs, or luspatercept. If the patient has a 5q deletion, lenalidomide, if eligible. After ESA failure, or for ESA ineligible patients, luspatercept and imitelstat are approved. In the second line setting, these treatments each have a response rate of approximately 38 to 40% respectively. For more aggressive disease, hypomethylating agents can be used with response rates of approximately 18 to 20%. There remains a clear need for new treatments for previously treated transfusion-dependent patients who are relapsed or refractory to or ineligible for ESAs. If the data for R289 plays out, and it earns FDA approval, we see the potential for R289 to be an important therapy option for these patients. On slide 24, we summarize the value proposition for R289 in lower risk MDS. There are approximately 12,200 previously treated lower risk MDS patients in the United States and effective therapies for transfusion-dependent patients in this setting are limited. As I mentioned, R289 offers dual targeting against IRAC1 and 4. Since dysregulated inflammatory signaling in the bone marrow is associated with MDS, co-targeting of IRAC1 and 4 may suppress inflammation and LSPC function, restoring normal blood cell production. R289 blocks TOLAC receptors and IL-1 receptor signaling in vitro and has been active in preclinical models of inflammation. We established clinical proof of concept in a randomized controlled trial in healthy volunteers where R835, the active moiety of R289, markedly suppressed LPS-induced cytokine release. The FDA has granted R289 fast-track designation for previously treated transfusion-dependent lower-risk MDS and orphan drug designation for MDS. The preliminary Phase 1b study data presented at ASH in 2025 showed R289 had promising preliminary safety and efficacy in 33 elderly, heavily pretreated patients with relapsed or refractory lower-risk MDS. You can see the design of our open-label multi-center Phase 1b study evaluating the safety tolerability, pharmacokinetics, and preliminary efficacy of R289 in patients with relapsed or refractory lower-risk MDS on slide 25. The study is designed to select the recommended Phase 2 dose for future studies. We expect to select the dose by the end of this year. will then work with the FDA to align on the registrational path. We are targeting initiating a registration study in 2027. We also plan to open the exploratory cohort of the Phase 1B study, which will evaluate R289 in transfusion-dependent, lower-risk MDS patients who are refractory to or ineligible for ESAs, but are otherwise naive to other MDS-directed therapies. This cohort will help us understand R289's potential in earlier lines of therapy. On the left side of slide 26 is this year's ASH R289 abstract data that was released yesterday, which is primarily related to safety, given the data of the timing cut for the submission. As of the 16th of July data cutoff, 64 patients were enrolled in the study, 33 patients in dose escalation, 31 patients in dose expansion. The median number of prior therapies was three, with a range of one to eight. Most patients were exposed to commonly used MDS-targeted agents, including ESAs, lispatracept, imetelstat, hypomethylating agents, and lenalidomide. 20% had received a prior investigational agent indicating this was a heavily pretreated population, including some with end-stage disease. These patient characteristics are consistent with the patient characteristics that were presented at ASH in 2025. From a safety perspective, R289's profile remains consistent with what has been previously reported. Most common treatment emergent adverse events were low-grade diarrhea, cough, dose expansion, No treatment emergent adverse events leading to discontinuation were observed. There were no dose-limiting toxicities. Overall, R289 continues to be well tolerated in this elderly, heavily pre-treated patient population with a high baseline transfusion burden. At the meeting, updated data from the study will be presented by Dr. Garcia-Maneira. The oral presentation will be included in the MDS session listed here on Saturday, December 12th, and will include incremental study safety data and preliminary efficacy data from the dose expansion from a planned data cut in mid-November. On slide 27, I'll quickly summarize the next steps for R289. We are on track to complete enrollment and select the R289 dose for future development by the end of the year. will present updated data from the study at ASH in December. Once the recommended phase two dose has been selected, we will evaluate R289 in a cohort of less heavily pretreated patients who are relapsed or refractory to or ineligible for ESAs in the same study. We also plan to follow up with the FDA to discuss a potential registrational trial. Finally, we're continuing to evaluate other potential indications for R289 and plan to provide an update by the end of the year. Lastly, on slide 28, I want to highlight our key presentations at ASH. In addition to R289 data, we'll also have new data for Fostamatinib in ITP and warm autoimmune hemolytic anemia. We are looking forward to the meeting. With that, I'll pass the call to Dean to discuss our financial results.
Dean Schorno
Chief Financial Officer
Dean. Thank you, Alison. Among slide 30, we reported net product sales of $72.3 million for the third quarter, a growth of 13% year-over-year, including Tavois net product sales of $46 million, an increase of 3% year-over-year, Demaretto net product sales of $9.8 million, decrease of 11% year-over-year, Brazilian net product sales of $9.9 million, an increase of 20% year-over-year, and Definew net product sales of $6.6 million, reflecting approximately six weeks of commercial availability. Our net product sales were recorded net of estimated discounts, chargebacks, rebates, returns, copay assistance, other allowances of $21.3 million. We also reported $8.6 million of contract revenues for the third quarter, primarily consisting of $3.8 million from Griffles, are total revenues for the third quarter, or $80.9 million. Moving to slide 31. For the third quarter of 2026, our cost of product sales was approximately $10.8 million, which includes amortization of intangible assets related to the Vepinu transaction and royalties owed to Arvinas and Pfizer on Vepinu net sales. Total cost and expenses were $63.8 million, compared to $41 million for the same period of 2025. The increase in cost and expenses was primarily due to higher research and development costs related to the R-289 and VEP registrant clinical programs, as well as higher cost of product sales, commercial related expenses due to the commercial launch of Vepinube and personnel related costs. Income before income taxes for the third quarter was $17.4 million compared to $27.6 million for the same period of 2025. And we reported net income of $13.2 million for the third quarter Thank you for joining us. We've updated and narrowed our guidance and now expect total revenues in the range of approximately $290 to $295 million from the previous range of $285 to $295 million. This includes our expectation of approximately $255 to $260 million in net product sales, excluding Vepinu, from the previous range of approximately $255 to $265 million. In addition, we now expect approximately $35 million in contract revenues from the previous expectation of approximately $30 million. We also continue to anticipate reporting positive net income for the full year while funding existing and new clinical development programs and supporting the commercial launch of EpiNuke. With that, I'd like to turn the call back over to Raul. Raul?
Raul Rodriguez
President and Chief Executive Officer
Thank you, Dean. Turning to slide 32, I'd like to close with a few thoughts. This is truly an exciting time at Reichelt as we are successfully launching Bepinu. We are encouraged by its strong early start and early demand. Our commercial team is executing well, building awareness, and driving adoption. Our strategy remains unchanged. Grow our commercial portfolio, advance our development pipeline, evaluate potential in-license opportunities, and maintain financial discipline. 2026 has been a pivotal year for Reichelt. We believe the opportunities we have, particularly for Vepinu and R289, have the potential to further transform Rigel's business and create long-term shareholder value. With that, I'll turn the call back to the operator for your questions. Operator.
Conference Operator
Operator
Thank you. If you would like to ask a question, please press star 1 on your telephone keypad. The confirmation tone will indicate your line is in the question queue. If you would like to remove your question from the queue, you may press star 2. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment, please, for the first question. Our first questions come from the line of Joe Pangenis with HC Wingright. Please proceed with your questions.
Joseph Pantginis
Analyst, H.C. Wainwright
Hey, everybody. Good afternoon. Thanks for all the details today. So, two questions, if you don't mind. So, first, for 289. I'm curious if you could provide at least, you know, for today, it could change tomorrow, but any broad strokes about your, you know, views of a pivotal study design, you know, what would you be looking to have the same type of randomization, I mean, I'm sorry, inclusion criteria, sizes, et cetera, anything you'd like to share, number one. And then number two, with regard to Tavalise, eight years is a great run here, nice to still see continued growth. Any areas that you still see growth potential in the U.S. versus, you know, potential to start to hit steady state? And, of course, the ex-U.S. profile is still growing. Thanks.
Raul Rodriguez
President and Chief Executive Officer
Thank you, Joe. I'll ask Alison to comment on what a registrational trial would look like. We are still working on designing such a trial, so it's a little early, but maybe she'd like to make some comments.
Alison Hannah
Chief Medical Officer
So thank you. Thank you, Raul. So we are aware of the historical literature for this disease. There's three trials that were conducted in a contemporaneous manner. So this would include METALYST for luspatercept, it would include iMERGE for imitelstat, and it would also include the failed trial called Matterhorn. So we are aware of these trials, where they succeeded and where they came up short. So we're taking that into consideration. As Raul mentioned, we are planning a meeting with the FDA at this time, but We're really not in a position to discuss more particulars regarding the trial design. Thank you.
Raul Rodriguez
President and Chief Executive Officer
What we do feel comfortable saying is that next year, we fully intend to launch such a registrational trial. And as of now, or at least very much on track to do so. Dave, maybe you want to comment on Tavalise's performance?
Dave Santos
Chief Commercial Officer
Yeah, sure. Great question, Joe. First of all, I'll say that in Q3, we did hit our highest demand bottle quarter ever. in the history of the brand. So it is still growing. I think, you know, there are opportunities to grow. We can continue to get more patients out there who have ITP with our prescribers. But the real thing is, Joe, we really believe we have so much more opportunity to grow with Vepinu. And so that's what our focus is. But that doesn't mean we don't continue to support Tavalise. But I think you will see sort of Thank you, Joel. Thank you. Our next questions come from the line of Yukal Nachamovitz with Citi. Please proceed with your questions.
Caroline
Analyst, Citi (on behalf of Yigal Nochomovitz)
Hi, this is Caroline on Seagull. Thanks for taking our question. Can you help us understand how much of the new 6.6 million in sales reflected initial channel inventory stocking versus underlying patient demand? And what are October trends looking like? Thank you.
Dave Santos
Chief Commercial Officer
If you want to take a stab at that. Yeah, thanks for the question, Caroline. I'll say first and foremost, the majority of the sales that we had in the first six weeks or the third quarter was demand-related. As I said, we had a number of patients go on therapy immediately that had already refilled by the end of the quarter. We had accounts order, and that speed and breadth of adoption, like I said, we were very pleased with. So I can say very firmly that the bulk of our sales were demand-related as opposed to inventory stocking. In terms of how we're doing, of course, we believe we'll continue to grow Vepinu as we're here in the fourth quarter. And as you know, when patients start, they get refills until they progress and sometimes even beyond when they progress. So I won't make any specific comments on this quarter. You'll have to wait until next year to hear those. But we expect it to grow.
Caroline
Analyst, Citi (on behalf of Yigal Nochomovitz)
Thank you. Alison May, can you tell us what the focus will be on the ASH dose expansion data for R289? Because on the abstract, it's apparent that 500 milligrams BID is the preferred dose based on PK. What else will the expansion data reveal? Thanks.
Alison Hannah
Chief Medical Officer
So this is Alison here. I'm happy to discuss. But frankly, the presentation, you know, we are embargoed from talking about what the slide presentation will be on the 12th of December. We provided, in order to support a comparison of both doses, we provided safety, we provided pharmacokinetics, and we also provided some cytokine data. But I'm really not at liberty to go into any more specifics. I'm afraid you'll have to join us on the 12th of December when Dr. Garcia-Maneiro will present a more comprehensive update and really the justification for the proposed dose moving forward.
Caroline
Analyst, Citi (on behalf of Yigal Nochomovitz)
We'll be there. Thank you. Thank you.
Conference Operator
Operator
Thank you. Our next questions come from the line of Farzin Haque with Jefferies. Please proceed with your questions.
James On
Analyst, Jefferies (on behalf of Farzin Haque)
Hi, this is James On for Farzin. Congrats on the quarter and thanks for taking our question. Two from us. You lower the upper end of guidance from 265 to 260. Is there anything you're seeing in the underlying business, whether around patient starts, persistency, gross to net or seasonality that makes You're more cautious in the upper end into 4Q. And then the second question on R289 for the data at ASH, what RBCTI rate in the randomized expansion would you consider a clear success? Is about 40% the internal bogey? And how much follow-up will you have on durability? And what is the benchmark of transfusion independence you're trying to beat?
Raul Rodriguez
President and Chief Executive Officer
Maybe I'll ask Dave to mention how we're doing with the commercial business excluding Bepinu. I think he mentioned a little bit about Tavalise.
Dave Santos
Chief Commercial Officer
Yeah, again, James, Tavalise hit its record demand in Q3. And I'll also say that from a ResLydia perspective, you know, you saw that we grew that year over year, but we also hit a record demand quarter and it was actually 10% above, double digit growth above second quarter. So we are growing our business. And, you know, I think from a standpoint of our guidance, the only thing I would say is it doesn't include that. And that is our growth driver. So, you know, I think the health of our business, though, is very strong.
Raul Rodriguez
President and Chief Executive Officer
Keep in mind, the demand is the most important metric underlying those products. But we also have to consider gross to net adjustments, which is driven by patient type. and it's a change in inventory as the other variable that also contribute to that. On 289, ASH data durability.
Alison Hannah
Chief Medical Officer
Yes, I'm happy to comment. This is Alison here. So what we have in our Phase 1B study in the dose expansion, we have a unique population. We're very different from the population that was represented in the MEDALIS trial for Lispatercept or the and a TELSTAT trial called iMERGE. Those populations really had received only prior ESA, whereas if you look at the ASH abstract and you look at our priors, you know, we have a very, very highly, heavily pre-treated population who have gotten not just ESAs, but nearly all patients had Lispatercept, a very large number had received a hypomethylating agent, and really in abstract it says 29% investigational. So talking about a true end stage population. So we are aware of the MEDALIS data, the iMERGE data, but in terms of a target for what we would think would be worthy of future studies, what we're hoping to be able to show is a very well tolerated agent, an oral agent that's true convenience for this elderly population. I think we have a median age of 75 for our patient data set. So we don't want to come up with a target at this point. We will show the data at ASH. We did actually talk last year at ASH what our durability was. We do believe we need to have durability and a good eight-week transfusion independence to make the case to hematologists that this is a product worthy for additional investigation.
Raul Rodriguez
President and Chief Executive Officer
And we look forward to presenting this information.
James On
Analyst, Jefferies (on behalf of Farzin Haque)
Yes, that's very true. Got it. Thanks for taking our question. I'll be back in a few.
Conference Operator
Operator
Thank you. Our next question has come from the line of Kristin Kleska with Cantor Fitzgerald. Please proceed with your questions.
Kristen Kluska
Analyst, Cantor Fitzgerald
Hi, thanks for taking the question. For Vepin, you wanted to understand what's been the driving factor for utilization. Are these doctors with direct experience already, or is there a factor that they've been pointing out in particular for wanting to be kind of some of the early adopters here, like durability and safety?
Dave Santos
Chief Commercial Officer
I'm sorry, I didn't get the last part of your question, Kristen.
Kristen Kluska
Analyst, Cantor Fitzgerald
Yeah, I wanted to know of the doctors that are using the product now if they are ones that have had direct experience from a trial perspective, but then just given that they're really kind of the first early adopters here, what has been their, the main driving factor you hear from them about why they want to be the first to give this a chance? Is it durability, safety, or another factor?
Dave Santos
Chief Commercial Officer
I think, first of all, we've had both. We've had clinicians who had experience in the clinical trial and were in either the early phase one or two, could have been in Veritac, could have been in later studies that were done. But by and large, the majority of clinicians who've tried it have never used the product before, and they've become aware of it. And why are they interested in using it? Because it is a different kind of drug than an oral surge. And number two, the tolerability of the agent is something that really appeals to this patient population and to clinicians. You know, we just posted on our website some data that came from Veritac2 on patient-related outcomes or patient-reported outcomes in quality of life. and I think when people see the whole picture here of very good efficacy, proven efficacy for assist fulvestrin and the tolerability of the agent as well as a new mechanism, they're interested in trying it. And so I think, like I said, the best, I've always tell the team, I think, and what we're seeing is the best selling part of this Fepinu experience is physicians who finally try the drug. because they really like it when they try it.
Kristen Kluska
Analyst, Cantor Fitzgerald
Thanks so much. And then on R289, was hoping you could further elaborate on your strategy when it comes to FDA discussions potentially next year. I guess like how much of the open exploratory cohort data might you want to see and how is that ultimately going to factor in how you guys are thinking about a potential registrational study?
Alison Hannah
Chief Medical Officer
So I'm happy to comment, Alison. The post-ESA, what we call the exploratory cohort, provides us the ability to investigate R289 in a combination of patients who have only been exposed to an ESA or for those patients in whom an ESA is not indicated. For example, they have Thank you very much. in that post-ESA population when we talk to the FDA.
Raul Rodriguez
President and Chief Executive Officer
That does not preclude us from starting a clinical trial in 27. That is the plan.
Alison Hannah
Chief Medical Officer
Correct. Thank you.
Conference Operator
Operator
Thank you. Our next question has come from the line of Alison Bratzel with Piper Sandler. Please proceed with your questions.
Peter
Analyst, Piper Sandler (on behalf of Allison Bratzel)
Hi there, this is Peter. I'm for Alison Brassel. Thank you for taking my questions. Just wondering on Vepinu, if you can comment on the sales split between academic and community oncologists thus far. And then when might you be in a position to provide more specific revenue guidance? And then one on 289. How will the ASH data inform your evaluation of 289 and other potential indications and any color on what those might be? Thank you.
Raul Rodriguez
President and Chief Executive Officer
Let me ask Dave to address the first and then Alison the second.
Dave Santos
Chief Commercial Officer
Yeah, our current breakdown and again, we'll give a little color because we are early in launch and it's important for you guys to to realize what's going on. But I'm not sure we'll be able to give these kind of specifics as we move forward. But currently our community business is actually the overwhelming majority of our business. It's about 70 to 80% of our business if you consider HCPs who prescribe as well as accounts who order. So it's taking off very nicely in the community. which is a little bit different than you might expect for a launch of a new agent, but it's good news for us. I think we were really happy to see that. I think we said that we would eventually see more community business, but we're almost at the split that we were talking about before, 80%, 20%, so it is the majority community.
Raul Rodriguez
President and Chief Executive Officer
David, did you want to comment on guidance?
Dean Schorno
Chief Financial Officer
Yeah, and with respect to guidance, as Dave said, we provide some color on some of the details during the quarter. We're just six weeks in to our launch. As we think about guidance, we want to be in a position where we've got enough clarity of the business and the trends and trajectory. So after the first of the year, we'll consider kind of the appropriate time to provide that guidance where we believe we've got enough clarity of the business to produce a good guidance range.
Alison Hannah
Chief Medical Officer
And I'm happy to discuss your final question, which was, how will the ASH evaluation lead to our internal discussions regarding other potential indications? IRAC 1.4, the mechanism of action, really could lend itself to a variety of other diseases. including both other hematological malignancies and even potentially autoimmune disorders. So we have these under active consideration at this time. We're not in the position to actually really prioritize where we would put the drug after we've moved it forward in low risk MDS, but we do think the agent has really great potential and it's not restricted to just low risk MDS.
Raul Rodriguez
President and Chief Executive Officer
Thank you, Alison. Thank you.
Conference Operator
Operator
Thank you. There are no further questions at this time. I would now like to turn the floor back over to Mr. Raul Rodriguez for closing comments.
Raul Rodriguez
President and Chief Executive Officer
Thank you. And thank you, everyone, for joining us today. We are very pleased with the early results of the VEPINUTE launch, and we're looking forward to presenting the updated data on the Phase 1B study of R289 and low-risk MDS at the oral session on Saturday afternoon, December 12th. and your support of Rigel. Have a good evening.
Conference Operator
Operator
This concludes today's teleconference. You may disconnect your lines at this time. Thank you for your participation and enjoy the rest of your day.