11/25/2025

speaker
Vince
Investor Relations (Moderator)

officer and head of R&D, who will discuss our development programs, and Dan Appel, chief financial officer, who will review the financials. Following management's prepared remarks, we will open up 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. 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 that 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 Anzalone, President and CEO of the company.

speaker
Chris Anzalone
President and CEO

Chris. Thanks, Vince. Good afternoon, everyone, and thank you for joining us today. Before we begin, I'd like to announce that this will be Bruce Gibbons' final earnings call. He's been a valuable member of the Arrowhead team for almost 15 years. He will continue to help Arrowhead as a trusted advisor, but now that Redemplo has received its first FDA approval, he will be stepping back from day-to-day operational responsibilities, and hopefully he can finally enjoy his time in retirement, or in his re-retirement, which is probably more accurate. His contributions to Arrowhead's success, both current and future, have been critical, and we owe him a heartfelt thank you. Later in the call, you will hear from Bruce, who will discuss the redemptive FDA approval when she came back to Arrowhead and out of retirement to help us get across the finish line. Bruce leaves us in a strong position with a very strong group of leaders across the organization. As you all know, James Hamilton has already assumed much of Bruce's prior responsibilities as Chief Medical Officer and Head of R&D. So thank you again, Bruce, for getting us to today, and thank you, James, for taking us into the next chapter for Arrowhead. Let's now turn to our business and what progress we've made during the recent period. This has been a very busy and enormously productive last few months. The most impactful change is the FDA approval of Redempla. On November 18, we announced that the FDA approved Redempla, indicated as an adjunct to diet to reduce triglycerides in adults with familial chylomicronemia syndrome, or FCS. FCS is a severe, rare disease with an estimated 6,500 people in the United States living with genetic or clinical FCS characterized by triglyceride levels that can be 10 to 100 times higher than normal, leading to a substantially higher risk of developing acute, recurrent, and potentially fatal pancreatitis. This is Arrowhead's first FDA-approved medicine, marking a major milestone for the company as it transitions into commercial stage. Redempla is the first and only FDA-approved SIRNA medicine for people living with SDS and can be self-administered at home with a simple subcutaneous injection once every three months. Redempla is the first and only FDA-approved medicine to be backed by adequate and well-controlled studies that include patients with genetically diagnosed and clinically diagnosed SDS. After many months of preparation, our commercial team was able to hit the ground running, and I'm happy to report that we have drugged the channel a mere week after approval. We also launched Rely on Redempla, a patient support program providing support services and resources for patients at each stage of the treatment journey with Redempla, including financial assistance options for eligible patients. In addition, we also announced the One Redempla pricing model that creates one consistent price across current and potential future indications. This is important. We are committed to sustainable innovation, and this requires rational drug pricing according to the value of medicine offers to patients and healthcare systems. It also means that we will not ask different patients to pay different amounts for the same drug based solely on what disease they've been diagnosed with. Redempla is a pancreatitis drug, and when we think about pricing, we look to those patient populations who are at greatest risk of acute TG-related pancreatitis. The patients we are serving now are also those at greatest risk of pancreatitis, people with FCS. This includes those with a defined set of mutations, as well as those who share the same level of chylomicronemius in symptoms, but with more heterogeneous and often less well-characterized genetic backgrounds, who we refer to as clinically defined or phenotypic FCS. The broader patient population with substantially increased risk of acute pancreatitis are those with persistent chylomicronemia, meaning fasting triglycerides greater than 880 milligrams per deciliter. We believe there are approximately 750,000 of these patients in the U.S., and while they often have less day-to-day symptoms than FCS patients, they are clearly at high risk for acute pancreatitis. The one redemptive pricing model has these patients in mind. The $60,000 annual WAC price is designed to provide real value to patients and healthcare systems in this population. Our SHASTA III and SHASTA IV Phase III studies are designed to support an SNDA in this population, and while those studies are ongoing and we are actively serving the FCS population, we will have time to help payers properly appreciate Redemplo's value, and payers will have time to plan and budget for its possible eventual adoption, pending regulatory review and approval. Outside Redemplo, we have also made good progress with two other pipeline programs in the cardiometabolic space, Zodaciran and aerodimer PA. Let's start with Zodasteran. During the recent period, we dosed the first subject in the Yosemite Phase III clinical trial of Zodasteran, our clinical candidates being developed as a potential treatment for homozygous familial hypercholesterolemia, or HOFH. HOFH is a rare genetic condition that leads to severely elevated LDL cholesterol and early onset cardiovascular disease. Yosemite approximately 60 subjects over the age of 12 will be randomized to receive four doses once every three months of 200 milligrams of Dastarin or placebo. The primary endpoint is the percent change from baseline to month 12 in fasting LDL-C. The Phase II data in this patient population were encouraging, and we hope to have this study fully enrolled in 2026, complete the study in 2027, and if successful, enable an NDA assignment by the end of 2027 and launch in 2028. The next new pipeline program in cardiometabolic is aerodimer PA. In the last quarter, we filed a request for regulatory clearance to initiate a Phase I and II clinical trial of aerodimer PA, being developed as a potential treatment for atherosclerotic cardiovascular disease, or ASCVD, due to mixed hyperlipidemia in which both LDL cholesterol and triglycerides are elevated. This is a very large population without proper treatment options. We believe there are approximately 20 million people in the U.S. with mixed hyperlipidemia. Aeronymer PA is a dual-function RNAi therapeutic designed to silence expression of the PCSK9 and ApoC3 genes in the liver that's designed to reduce both LDL, C, and TGs. This represents an important step forward for the RNAi field as we believe it is the first clinical candidate to target two genes simultaneously in one molecule and an important step forward for preventative cardiology as both LDL and TGs have epidemiologic support as being important drivers of ASCVD risk. Both of these programs fit well strategically with our growing commercial focus on the cardiometabolic space and on the physicians that treat these patients. Also during the quarter, we expanded our clinical pipeline in CNS. We filed a CTA to initiate a Phase I-II clinical trial of Aromap-T as a potential treatment for tauopathies, including Alzheimer's disease. Aromap-T is Arrowhead's first therapy to utilize a new proprietary delivery system, which in preclinical studies has achieved blood-brain barrier penetration and deep knockdown of target genes across the CMS, including deep brain regions, after subcutaneous injections. Non-clinical evaluations in monkeys with subcutaneous administration of Aromap-T using clinically translatable doses, have shown better than 75% knockdown of tissue-level MAPT mRNA in the CNS. Importantly, monkey tissue-level knockdown has translated into CSF tau protein reductions with duration of effect supportive of either monthly or quarterly subcutaneous dose regimens. This is an exciting program, and we look forward to initiating the study shortly. We also continue to make good progress on our first two obesity programs, aero-INHBE, and aero-ALK7. Together, we have randomized 192 patients, all with a BMI greater than 30. Because we started aero-INHBE earlier, it is about two quarters further into the phase one study than aero-ALK7. Our plan has been to share early data at the end of the year, but due to travel schedules and the holidays, this will push a couple weeks later into the early part of January. We also expect to have more wholesome data toward the end of the first half of 2026. We also made important progress in dose development. First, as we announced yesterday, we earned a $200 million milestone payment from Sarepta, following a Drug Safety Committee review and subsequent authorization to dose escalate, and achievement of the second pre-specified patient enrollment target for Arrow DM1. This follows a $100 million milestone earned previously when Arrow had reached the first of two pre-specified enrollment targets and subsequent authorization. The partnership continues to be productive, and we look forward to continued progress. In addition to progress on the strategy partnership, we announced a new global licensing collaboration agreement with Novartis for AeroSNCA, Arrowhead's preclinical stage SIRNA therapy against alpha-synuclein for the treatment of Parkinson's disease. The collaboration includes a limited number of additional targets outside our pipeline that will utilize Arrowhead's proprietary trim platform. Arrowhead received a $200 million upfront payment from Novartis and is also eligible to receive development, regulatory, and sales milestone payments of up to $2 billion. Arrowhead is further eligible to receive tiered royalties on commercial sales up to low double digits. As I mentioned before, the recent approval of Redemplo is clearly the most important recent development. Arrowhead has been busy across the pipeline and in business development during the recent period. Business development and licensing is critical to our business model, so we are pleased to have these two significant deals closed this year. Without a review, I'd now like to turn the call over to Bruce Gibbett. Bruce? Thanks, Chris. Good afternoon, everyone. I'm happy to give my final update to Arrowhead shareholders. At such an important time and with Arrowhead in such a position of strength, we have built something truly unique and powerful at Arrowhead, and with the first FDA approval behind us, it feels like the right time for me to step back and retire. So let's review some of the key parts of the recent FDA approval that we announced last week. Mostly, I'll discuss the label and information contained in the package insert. Redeflo is approved as an adjunct to diet to reduce triglycerides in adults with FCS. The recommended dose of Redeflo is 25 milligrams, and it can be self-administered at home by subcutaneous injection once every three months. Redeflo has no contraindications, warnings, or precautions. The most common adverse reactions include hyperglycemia, headache, nausea, and injection site reactions. The FDA submission was supported by clinical data from the Phase III Palisade study in patients with both genetic FCS and those with the same clinical manifestations of disease, but without solely a genetic cause referred to as clinically diagnosed FCS. The blinded portion of the trial compared a year of therapy with plazaciran or placebo dosed every three months, and tested two doses of plazacirin versus placebo. The primary endpoint was change in median triglycerides at month 10. There were also multiplicity-controlled secondary endpoints, all of which were statistically significant, including, notably, the occurrence of acute pancreatitis, for which the 25- to 50-milligram doses were combined for comparison to placebo, as called for in the analysis plan. Losazarin achieved deep and durable reductions in median triglycerides as early as one month when the first measurement was taken. Overall, these reductions were around 80% from baseline, and reductions largely maintained medium triglyceride levels below the usual guideline-directed threshold of 500 milligrams per deciliter throughout the year of treatment. 500 milligrams per deciliter is the recognized threshold where the risk of pancreatitis increases relative to a normal population. Importantly, patients with genetic FCS versus clinical FCS showed similar reductions from baseline. We see the clinical FCS population as having the same high unmet need as the genetic FCS group, and as such, we think it is crucial to have shown that both patient populations showed similar large reductions from baseline in triglycerides with redemptive therapy. Plasastran is also labeled as having reduced the rate of adjudicated pancreatitis events versus placebo, a very welcome finding for FCS patients and their caregivers, and an important validation that reductions in triglycerides can, in fact, lead to reductions in pancreatitis. Let me close by saying that it's gratifying to have been a part of Arrowhead from the early days of our SIRNA developments and part of the Plasastran program and its inception, and again, over the last several years. And more importantly, it's exciting to hear the enthusiasm about this new medicine from patients, caregivers, and physicians. I'd also like to wish all of you an enjoyable Thanksgiving holiday. I'll now turn the call over to Andy Davis. Andy? Thank you, Bruce. It's been exactly one week since the commercial launch of Redemplo, and the early feedback we've received from healthcare professionals, patient societies, and payers has been very encouraging. We hear lots of enthusiasm about the differentiating attributes of Redemplo, which generally fall into five value pillars, some of which the team has touched on briefly already. First, the reduction in triglycerides is both significant and sustained. In Palisade, Redemplo reduced triglycerides by an unprecedented minus 80% from baseline as early as month one and maintained this marked reduction with minimal variation throughout the full 12-month treatment period. This compared to a minus 17% reduction in the pooled placebo group. With Redemplo, patients now have real hope, many for the first time, of achieving triglyceride levels below guideline-directed risk thresholds associated with acute pancreatitis, such as 500 milligrams per deciliter. In Palisade, 50% of patients at the 25 milligram dose achieved TG levels below 500 milligrams per deciliter. with approximately 75% achieving levels below 880 milligrams per deciliter at month 10. Second, the numerical incidence of acute pancreatitis in patients treated with Redempla was lower compared to placebo. As we all know, this is the outcome of most importance for healthcare professionals, patients, and payers. Third, Redempla demonstrated favorable safety and tolerability, importantly, The U.S. approved package insert contains no contraindications, no warnings, and no precautions associated with the use of Redemplo. Fourth, Redemplo can be self-administered at home with a simple subcutaneous injection once every three months, just four injections per year. Physicians tell us this infrequent dosing schedule is likely to reduce the treatment burden on physicians, patients, and caregivers. And fifth, early feedback on the one redemptive pricing model has been positive. As Chris highlighted, this model creates one consistent price, 60,000 per patient per year, across current and potential future indications such as severe hypertriglyceridemia. Again, this means that we will not ask different patients to pay different amounts for the same drug based solely on what disease they have. We have been in important discussions with payers, and early signs for market access are encouraging. As a reminder, we believe there are an estimated 6,500 people in the U.S. living with genetic or clinical FCS, and the prescriber base comprises specialist physicians such as lipidologists, endocrinologists, preventive cardiologists, and internal medicine physicians with a focus on lipid disorders. These specialists often operate within multidisciplinary teams that may include gastroenterologists, advanced practice providers, and specialized dieticians. At launch, we are targeting approximately 5,000 healthcare professionals through personal engagement. And finally, our Rely on Redemplo patient support program is operational and designed to make every step of the journey easier. This program is designed to assist patients and physicians with insurance verification, financial assistance options, a first-dose starter kit, and supplemental injection training. We launched just one week ago, but our care coordinators are already actively processing Redemplo start forms conducting patient welcome calls, and engaging payers to obtain approvals. And as Chris stated, we're happy to announce that we already have drug available in-channel ahead of schedule. I will now turn the call over to James Hamilton to discuss the broader R&D portfolio. James? Thank you, Andy. I'd like to give a quick review of the status of our late-stage Phase III studies and also describe the design of a couple of our early-stage programs. Let's start with the suite of Phase III studies of plazacirin designed to potentially support supplemental NDA filing to expand the label beyond genetic and clinical STS. Shasta III and Shasta IV are Phase III studies designed to compare reductions in triglycerides with 25 milligrams plazacirin compared to placebo over 12 months of treatment. Between the two studies, we enrolled approximately 750 patients. In addition, the MIRA3 study enrolled approximately 1,400 patients. This study in patients with mixed hyperlipidemia is designed to supplement the safety database when we file the SMDA for plazaciran and severe hypertriglyceridemia. We are not planning to seek approval in the mixed hyperlipidemia patient population. We completed enrollment in the global Shasta 3 and Shasta 4, as well as MIRA 3 Phase 3 clinical studies in June of 2025. We anticipate completing the primary portions of these studies in mid-2026, with top-line data expected in the third quarter of 26. If successful, we plan to make submissions before the end of 2026 for regulatory review and potential approval. The SHTG program also features a study named SHASTA-5 to directly assess the ability of plazaciran to reduce the risk of acute pancreatitis as the primary endpoint in SHTG patients at high risk of acute pancreatitis. We are currently enrolling patients in that study. Of note, we will also be assessing pancreatitis risk reductions in SHASTA-3 and SHASTA-4 as a key secondary endpoint, but SHASTA-5 is the first event-driven study to assess acute pancreatitis as the primary endpoint. I would also like to provide an update on our obesity programs, aro-inhibit E and aro-LK7. Both of these programs target the known activin pathway that is involved in signaling to adipocytes to store fat. Arrow Inhibit E inhibits one of the ligands in the pathway, and Arrow Elk 7 inhibits the receptor on the adipocyte that these ligands bind. So essentially, we are trying to reduce the message sent to store fat and the way the message is received at the adipocyte. Arrow Inhibit E started enrolling patients in December 2024, and Arrow Elk 7 initiated in May of 2025. Both programs are currently in phase 1, 2A, first-in-human dose-escalating studies to evaluate safety, tolerability, pharmacokinetics, and pharmacodynamics. Both programs include Part 1, designed to assess single and multiple doses as monotherapy, and Part 2, designed to assess multiple doses in combination with truzepatide. As Eroin hit an E, started about two quarters earlier, we had more mature data in that study. The study is nearly fully enrolled, and we are on schedule and currently planning to share initial data from this program around the first week of 2026. This is a rather robust first-in-man study that is collecting multiple measures of drug activity and pathway activity, and we are eager to share initial findings. We were originally planning on sharing the first data around the end of the year, but due to the holidays and travel, the first week of January worked the best for all schedules. For Arrow Elk 7, we intend to provide a brief snapshot of early safety and target engagement results from that study. Both targets have strong genetic validation, and both programs have yielded promising results in preclinical studies, so it will be interesting to see similarities and differences in patient response in clinical trials. I will now turn the call over to Dan Appel.

speaker
Dan Appel
Chief Financial Officer

Thank you, James, and good afternoon, everyone. I'll provide a brief outline of our financial results. As we reported today, our net loss for fiscal year 2025 was $2 million for a loss of one cent per share, based on $133.8 million, fully diluted weighted average shares outstanding. This near break-even result compares with a net loss of approximately $599 million for a loss of $5 per share, based on 119.8 million fully diluted weighted average shares outstanding in fiscal year 2024. Revenue for fiscal year 2025 totaled $829 million and was driven entirely by our license and collaboration agreements with Sarepta, Sanofi, and GSK. Of the $829 million, roughly $697 million pertained to the Sarepta arrangement. OF THAT $697 MILLION, $587 MILLION RELATES TO THE ONGOING RECOGNITION OF INITIAL SURRENDER CONSIDERATION, $94 MILLION RELATES TO THE ACHIEVEMENT OF THE FIRST EM-1 MILESTONE, AND $16 MILLION RELATES TO THE REIMBURSEMENT OF INCURRED COLLABORATION PROGRAM COSTS. ADDITIONALLY, THE LICENSE TO SINOPE FOR GREATER CHINA RIGHTS TO PLAZASRAN CONTRIBUTED $130 MILLION TO OUR FISCAL 2025 REVENUE, And lastly, to round things out, we recorded $2.6 million earlier in the year related to a milestone payment under the GSK-HBV agreement. Turning to expenses, total operating expenses for fiscal year 2025 were approximately $731 million, compared to $605 million for fiscal 2024, an increase of $126 million. The year-over-year increase was driven by $101 million of higher R&D expenses and $25 million of higher SG&A costs, both of which I will explain in brief. The key drivers of research and development spend included costs to run our clinical trials, our clinical manufacturing costs, as well as expenses related to active programs in the preclinical stage. 2025 R&D costs were heavily impacted by our Phase III clinical trials for prozacrin and SHTG. It's worth noting that in fiscal year 2025, nearly two-thirds of our clinical trial spend can be attributed to the late-stage development of prozacrin and SHTG. As we have mentioned, the SHTG registration of studies are now fully enrolled, and we expect data to read out next year. Accordingly, the majority of remaining phase three registration of clinical trial costs are expected to occur over the next 12 months. Our SG&A costs increased by 25 year over year, driven primarily by our preparations for the commercialization of Redempto. All of us here at Arrowhead are enormously proud of the capabilities we have built to commercialize Redempto, not only in our commercial function, but also across regulatory, supply chain, order to cash, and indeed across all of our enabling support functions. Turning now to cash flow, net cash provided by operating activities during fiscal year 2025 was $180 million, paired with net cash used in operating activities of $463 million in the prior year, for a net positive change year-over-year of $643 million. This increase in cash from operating activities is driven by cash received from licensing and collaboration agreements, partially offset by the aforementioned increase in RD and SG&A costs. Turning to the balance sheet, our cash and investments, including available for sale securities, totaled $919 million as of September 30, 2025, compared to $681 million as of September 30, 2024. The increase in our cash and investments was primarily related to our licensing and collaboration agreements with Sarepta, Sanofi, and GSK, partly offset by our ongoing cash burn. Our common shares outstanding as of the end of the quarter were $135.7 million, down $2.4 million from the prior quarter due mainly to the repurchase of shares from Sarepta. I'll use this opportunity to reiterate two developments that are leading up to today, which were financially meaningful for Arrowhead and our balance sheet. Firstly, as Chris mentioned earlier on the call, we announced a licensing and collaboration agreement with Novartis for Arrow SMTA. Arrowhead's preclinical stage siRNA program targeting alpha-synucline for the treatment of synucleinopathies, such as Parkinson's disease. Novartis will also be eligible to select a limited number of additional collaboration targets outside of Arrowhead's current pipeline to be developed using our proprietary trim platform. The closing occurred last month, and we have already received $200 million in the bank as an upfront payment. As a reminder, we are also eligible to receive up to $2 billion in future milestone payments from Novartis, as well as royalties on commercial sales. Secondly, just yesterday, we announced we earned our second development milestone under the SREPTA collaboration agreement for Arrowhead DM1, As Chris mentioned, this triggers a $200 million obligation from Sarepta that will be recorded in the first quarter of fiscal 2026, and we expect to receive the cash in January of 2026. This is, of course, additional to the $100 million earned for the first DM-1 milestone in fiscal quarter 4, 2025. Finally, we are not providing detailed financial guidance at this time for the coming fiscal year. Beyond reiterating that, while we view the launch of Redempo as a truly transformational event for the company, we do not anticipate that the commercial sales of Redempo will have a substantial impact on our financial statements in fiscal year 2026. We also believe our cash runway, even in the absence of any further capital from new deals or other sources, and all the while funding With that, I will now turn the call back to Chris.

speaker
Chris Anzalone
President and CEO

Thanks, Dan. Arrowhead has been working to bring important new medicines to patients in need for over 15 years. As Bruce mentioned, it's very gratifying to see Redempolo approved by the FDA and the overwhelmingly encouraging feedback we've received from the FCS community. But Redempolo is just one part of a large pipeline that we've created to help potentially millions of patients in a diverse set of disease areas. We spent years building the TRIM platform to enable us to bring RNAi where it is needed. We are now able to address seven different cell types and have current clinical programs in five of these. Further, we will meet our 20 and 25 goal, whereby we will have 20 individual drug candidates in clinical trials by the end of this year. Our partnering has been helpful but judicious, with approximately half of our clinical pipeline wholly owned and half partnered. We have late-stage studies ongoing, again, both independently and with partners, that may potentially lead to multiple new commercial launches over the next few years. In addition, we have a strong financial position that enables us to properly invest in our growth today and in the future. We believe we now have everything we need to be in the next class of large and ultimately profitable biotech companies. Thank you for joining us today, and I would now like to open the call to your questions. Operator?

speaker
Operator
Conference Operator

Thank you. To ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1-1 again. And we ask that you please limit yourself to one question. One moment, please. Our first question comes from the line of Luca Issi with RBC Capital Markets.

speaker
Luca Issi
Analyst, RBC Capital Markets

Well, great. Thanks so much for taking my question. And Bruce, congrats on your re-retirement. I should say it's all the best in the next chapter. And then maybe if I can stick with you, can you just maybe talk about what's the plan to show benefit in term of acute pancreatitis for Prozaciran? Are you confident Shasta 3 and 4 in Q3-26 can actually hit acute pancreatitis? Or is the base case scenario, those two trials, are maybe under power to show benefit and you actually need Shasta 5 to actually hit on acute pancreatitis, given that the population is enriched for history of acute pancreatitis. The only reason why I'm asking is it looks like you doubled the size of the N, I should say, in the SHASTA-5 trial, according to Clifftrata.gov, as of Monday last week. So again, any call there, much appreciated. Thanks so much.

speaker
Chris Anzalone
President and CEO

Well, sure, Luke. Thank you for your kind regards. SHASTA-3 and 4 were powered on the basis of triglyceride reduction, which is the primary endpoint. So, you know, we did not specifically power Shasta 3 and 4 for pancreatitis. However, it was on our mind, and as was also done in the core studies, you know, there is the intent and by design the capability to pool both Shasta 3 and 4 for evaluating versus, you know, placebo on reduction of pancreatitis. And, of course, we only have one dose of Pladaciran instead of two doses, you know, two different doses like we had, for instance, in the Phase II program. So, you know, there's, I would say, reasonably good power for, you know, for seeing a difference in acute pancreatitis. But we're not dependent on it because we've designed ShASP5 specifically to obviously be able to have a primary endpoint of acute pancreatitis. We did change the design of it in Shasta 5 recently to make it a more generalizable population in patients with persistent chylomicronemia and a history of pancreatitis. The original design was a much more enriched population but it would have actually, you know, been less representative than, you know, the duly designed trial. So it's not so much a matter that we've increased power so much as we, you know, broadened the patient population to be more inclusive of the high-risk population in SHTG. So, you know, we certainly, we oftentimes refer to it as a belt and suspenders approach. You know, there's obviously a decent chance that we will show statistical significance in the Shasta 3 and 4 programs, but we're not entirely dependent on that because of Shasta 5, which is a study, the first of its kind, specifically designed to demonstrate a benefit versus placebo in acute pancreatitis. Got it.

speaker
Luca Issi
Analyst, RBC Capital Markets

Thanks so much. Congrats again.

speaker
Operator
Conference Operator

Thank you. One moment, please. Our next question comes from the line of Prakhar Agrawal with Cantor Fitzgerald.

speaker
Prakhar Agrawal
Analyst, Cantor Fitzgerald

Hi. Thank you for taking my questions, and congrats on the quarter, as well as the updates throughout the quarter. Maybe on the obesity side, I had a couple of questions. So on 11A for the update early next year, if you can just provide more details on how much data will be disclosed, especially on the MAT side, and how much follow-up will you have on NMNE for both monotherapy and combo cohorts? And also the same question on ALK7, what cohorts will be disclosed, and will there be any weight loss data at all from ALK7 early in the year? Thank you so much.

speaker
Chris Anzalone
President and CEO

Yeah, sure. This is James. I can cover that. So NMNE is a little bit ahead, as Chris mentioned, probably by a couple quarters. The study is nearly fully enrolled. We have a good amount of data in both the SAD and MAD healthy volunteer or obese healthy volunteer cohorts. So we'll have biomarker data, MRI data, as well as safety in those cohorts. And then the combo cohorts are almost fully enrolled. I think we're waiting on a few more diabetic patients to enroll the highest dose. combo cohorts and that should have, probably not through end of study, but ample post-dose follow-up in both the diabetic and the non-diabetic cohorts from inhibiting. And then ALK7 will be a little bit more limited, focused mostly on monotherapy safety and knockdown data, knockdown of the target for that study. And keep in mind here that We want to present data that are interpretable, and we're not going to have all cohorts. We're not going to have all patient data in all cohorts, even if they're fully enrolled. We don't get data in real time necessarily. And so you'll have probably two bites of this apple, maybe three bites, but certainly two bites of the apple. an idea about how these are going, and then the fuller story should come out once we have the more wholesome data set later in 26.

speaker
Prakhar Agrawal
Analyst, Cantor Fitzgerald

Got it. Thank you so much. You're welcome.

speaker
Operator
Conference Operator

Thank you. And our next question comes from the line of Maury Raycroft with Jefferies.

speaker
Maury Raycroft
Analyst, Jefferies

Hi. Thanks for taking my question, and congrats on the progress, and best wishes, Bruce, in retirement. I was going to ask a follow-up to Luca's question earlier. We're expecting to see the patient baseline profile for your SHTG Pivotals next week. What are your estimates on AP events accrual based on your patient's baseline characteristics and also your change in plans to broaden AP adjudication criteria?

speaker
Chris Anzalone
President and CEO

Maury, I think it's a little bit hard to answer the question just because we have adapted our protocols now to go ahead and adopt the modified Atlanta criteria since those have been accepted by both FDA and EMA and here in the US at least payers. And this is really going to be our first experience with using that particular scale. which makes it a little hard to estimate exactly how many events we will have. So it's hard to say. What you will see next week is you will see the percentage of patients that had a history of pancreatitis that were enrolled in the study. And based on that, I think you'll see that there's a good chance that we'll have the necessary number of events. But I'm a little bit uncomfortable trying to give any real predictions when we're using a scale that we haven't used before.

speaker
Maury Raycroft
Analyst, Jefferies

Understood. That's helpful. Thanks for taking my question. Thanks, Warren.

speaker
Operator
Conference Operator

Thank you. And our next question comes from the line of Jason Gerberry with Bank of America.

speaker
Gina Ahn
Analyst, Bank of America Securities

Hi, this is Gina Ahn for Jason. Congrats on all the progress this quarter and thank you so much for taking our question. Just a couple from us. I guess first on your Aromapti program, can you maybe just discuss which aspects of the drug is maybe differentiated from ANJ's recently failed anti-tau antibody and what kind of still gives you the confidence in the target after the failure? And then It's kind of based on your current cash position and the progress that you've made on these partnership milestone triggers. Do you have any maybe updates on your visibility on launching a CBOT study? Is that more tied to kind of seeing how the FCS and potential SHTG launches are progressing? And then can you just remind us, like, any potential milestone triggers from the disruptive programs that you're expecting in 2026? Thank you so much.

speaker
Chris Anzalone
President and CEO

All right, I count three questions. Gene, do you want to take the first one? Sure, yeah, I'll take the first one on the MAP-T program. So the J&J antibody, the monoclonal as well as other monoclonals, are IV-administrated monoclonal antibodies, probably a small fraction. those molecules across the blood-brain barrier, and then are primarily focused on binding to extracellular tau, so tau that's been released from damaged cells or has been secreted and that can propagate and bind to tau that's outside the cell. Our approach is very different. We use a targeting ligand to facilitate delivery of the siRNA across the blood-brain barrier into the neuron and silence the expression of tau. So we're sort of turning off the faucet for all of the expression and preventing the neurofibrillary tangles to form in the first place. So we should get, over time, be able to reduce the level of intracellular tau and extracellular tau, whereas the monoclonal antibodies are really just able to get the extracellular tau. So that's the key differentiation. And on the other two questions, I'll answer the last one first. So we are eligible to receive the first of five $50 million annuities in February. So we expect that over the next several months. That's correct, February, right, Dan?

speaker
Dan Appel
Chief Financial Officer

Yes, correct.

speaker
Chris Anzalone
President and CEO

On the visibility on the CBOT, so that CBOT, as you know, is for the dimer. That's a big opportunity for us. And so we are moving as quickly as we can to that C-box. We'll have a good idea, I think, this summer if we have a drug. You know, we'll know PCSK9 knockdown, we'll know ApoC3 knockdown, we'll know LDL decreases, we'll know triglyceride decreases. And so given what those data look like, I think, again, as early as the summer, I think we'll know if we have something that really could could be an important treatment for these mixed hyperlipidemia patients. Should that be successful? Should that look good? We are not waiting on anything, you know, to start those studies other than finishing this phase one, two. Our plan is to be able to roll directly into pivotal studies after these phase one, two studies. Again, should they all go well? And there's nothing, you know, there's nothing gaining there other than the data looking good. We also are hoping to have parallel pivotal studies, you know, one that will be a CVOT and one that will be looking at simply lowering LDL, you know, over the course of the year. As you know, that has been an approval endpoint in the past for PCSQ9 divoters, and we think that could be a good way to get to market very quickly and, frankly, help us to pay for the CVOTs. So, that's our plan now. We'll have a much better idea about how quickly we can move in the summertime once we start to see those data.

speaker
Jason Gerberry
Analyst, Bank of America Securities

We're really looking forward to seeing those data. Thank you. You're welcome.

speaker
Operator
Conference Operator

Thank you. And our next question comes from the line of Edward Tenthoff with Piper Sandler.

speaker
Edward Tenthoff
Analyst, Piper Sandler

Great. Thank you very much. And Bruce, wishing you all the best. James, wishing you all the best of luck. It really is a super exciting time for the company. I wanted to get a sense, just with respect to upcoming data readouts next year, specifically asking, do you think you'll have your first look from the Aerodimer PA next year? And what other data sets beyond the obesity data in the first half? should we be thinking about?

speaker
Chris Anzalone
President and CEO

Thanks, Ed. We have a bunch of, I think, potentially very interesting data readouts throughout 2026. As you mentioned, obesity will be the first. You know, as I mentioned, we should have two bites of that apple or thereabouts, and we'll have our first early data set, you know, in the very first part of January. And then as the data mature in both those programs, stay towards the end of the second quarter, something around then, we'll have a much larger data set. We think those are important. In the summertime, we expect to have dimer data. We think those are extraordinarily important. The idea that we might have have a drug candidate that can simultaneously lower LDL and triglycerides to treat the 20 million or so people in the United States with mixed hyperlipidemia is a very exciting opportunity. And again, I think we'll know if we have something that could really fit there in the summertime. Also in the summertime, I think we'll have our first bit of AROMAP-T data. and we'll be looking for tau levels in the CSF, that also would be extraordinarily exciting. We could be at once sitting on one of the most exciting potential Alzheimer's drugs in the clinic, and hopefully we'll be de-risking the entire blood-brain barrier platform that can enable us to treat a variety of CNS diseases. And so that's an important readout. Of course, also in the third quarter or so, we expect to have the readout for Shasta 3 and 4, you know, that are designed to enable our SMDA by the end of the year. And then, of course, at the end of the year, we expect to file our SMDA. So, look, there will be other things happening during the year, but those, to me, feel like the primary ones. And, of course, we'll be in the market for that. And, you know, we'll be looking forward to seeing how, you know, seeing the adoption curve that Redempo is going to have.

speaker
Edward Tenthoff
Analyst, Piper Sandler

Great. Any update on ArrowRage, just to be comprehensive? Thank you. Yeah, thank you.

speaker
Chris Anzalone
President and CEO

Yes. So, as you know, Ted, the data so far for ArrowRage has been enticing. You know, we've seen that we can not downrange deeply, both looking at circulating biomarkers as well as valid. You know, that's super interesting. Where we've struggled is looking for biomarkers to show potential clinical benefit. And so rather than running directly into a large asthma or COPD phase 2, we were hoping to have a baby step to see some evidence of that. And so we have started a challenge study. I don't expect to have data in 26, maybe at the very end of 26, but we've just started that. And so my hope is that that will show us that the knocking down rage is an important thing. Look, it's been an undruggable target for some time and now we can drug it. So now let's see what that does for us. I think at the end of that, we can then ask ourselves, do we want to build out a pulmonary franchise or do we want to partner that? And I think, you know, a positive challenge study readout, you know, would allow us to partner that in attractive, under attractive terms.

speaker
Edward Tenthoff
Analyst, Piper Sandler

Great. Well, guys, congrats on all the, uh, Great progress. I'm really excited to see the Redempto launch. It's a great truck. Thank you, Ted.

speaker
Operator
Conference Operator

Thank you. And our next question comes from the line of Manny Faruhar with Learing Partners.

speaker
Manny Faruhar
Analyst, Learing Partners

Hey, guys. Thanks for getting the question. Congrats on the progress and the first product launch. And best wishes also to Bruce on his re-retirement. There's something tells me you're going to hop up again soon. I don't think you're done with us. Apropos of the question, I want to follow up on the broader pipeline. Ted touched on new air raid study, et cetera. How do we think about aerodimer applications in terms of pursuing CVOTs and the right target for that technology? And where are the right places for you to put that to work now that you've got sort of a very different place in terms of your balance sheet?

speaker
Chris Anzalone
President and CEO

Actually, Bruce, you want to take where that could fit? Yeah, I'm happy to take that. You know, obviously we're excited about the Zazaran and Able C3 inhibition generally for, you know, patients with severe hypertriglyceridemia. You know, that's been essentially very, very poorly treated population, you know, for a long time. You know, LDL, you know, the LDL side of the equation, on the other hand, has been really a different story. And other than HOFH, there's a pretty good number of tools in the tool chest for dealing with LDL. The patients on that LDL side of the equation, especially patients with heterozygous familial hypercholesterolemia, which is a pretty good-sized population, for instance. But the 20-some million patients in the U.S. alone that have mixed hyperlipidemia has been an interesting population. You know, we could address the LDL part. We've done really a terrible job historically of being able to address the triglyceride piece of that. And, you know, the post hoc analyses that have been done of CBOTs have shown that, you know, for the same LDL reduction, you can really rank order the risk that patients have by how high their triglycerides are. And, of course, the Mendelian randomization data has also said that triglycerides are an independent predictor of events and mortality in that mixed hyperlipidemia population, and it's huge. It's a very big population. So there's never really been a very good way of addressing both sides of the problem in mixed hyperlipidemia, both the LDL and the triglycerides. And here we're talking about a drug that could potentially do it with a single, you know, say quarterly injection. You know, get both their LDL and their triglycerides probably on top of a statin. I think you're going to always have a statin there if the patients can tolerate it. But you could have a daily statin and a quarterly dimer injection and potentially treat that 20 million patients to low risk levels of LDL and triglycerides, that would be quite an amazing opportunity, I think, from a marketing perspective compared to what you can do today, which is you can probably get the LDL taken care of today, but you probably can't do much at all worthwhile in the triglycerides. So this is what makes this you know, to us, such an interesting proposition. Yeah, and as you know, Manny, what we used to, our former strategy was to make Lidacirin, now Redenblo, you know, a three-step drug. Step one is FCS. Step two is FHCG. Step three, after a CBOT, would be to be part of a treatment in mid-hyperlipidemia. Once we were able to perfect, at least in animals, the dimer platform, it didn't make any sense any longer. You know, we like the idea of keeping Redemblo as a pure-play pancreatitis drug, full stop. And now, I think we'll have a tool to more completely treat that mixed hyperlipidemia population, you know, should this dimer translate well from animals to humans.

speaker
Manny Faruhar
Analyst, Learing Partners

That's helpful. And as a follow-up, when you think about potential dimer applications, etc., How are you thinking about the data next year from Horizon and potentially applications of combining what hopefully will be a validated OPAA target with other approaches to their risk elevating elements of the lipid profile?

speaker
Chris Anzalone
President and CEO

Yeah, sure. So, of course, our SIRNA is targeting LP-LLA is partnering with Amgen. So, we would have to work with them on any kind of dimer applications. But there are other applications beyond, of course, the PCSK9, APOC3. I mean, we're looking at other dimers in the CV space, both targeting hepatocytes and extracompatic cell types. So, this is probably not the only dimer. that you'll see .

speaker
Manny Faruhar
Analyst, Learing Partners

All right. Thanks, guys. That's really helpful.

speaker
Chris Anzalone
President and CEO

Gracias.

speaker
Operator
Conference Operator

Thank you. Thank you. And our next question comes from the line of Patrick Truccio with HC Wainwright.

speaker
Patrick Truccio
Analyst, H.C. Wainwright

Thanks. Congrats on all the progress. I have a few follow-up questions. Just the first is just regarding Redempto. I'm wondering if the FDA has provided clarity on what level of pancreatitis evidence would be required for a future pancreatitis risk reduction claim, particularly in the high-risk SHTG patient population. And separately, I'm wondering if there's been discussions around potential pediatric pathway, just given it presents in childhood. And then just a follow-up on the MAP-T program. I'm wondering what level of CSF tau knockdown or biomarker response would you consider clear clinical proof of concept in humans? Just given I think you have greater than 75% knockdown in the NHP data.

speaker
Chris Anzalone
President and CEO

Bruce, why don't you take the first, and then Jake can take that too. So the first was? Level of AP that we think the FDA is required to have it on the label. Yeah, you know, we have not discussed with the FDA specifically what it would take to get a claim per se.

speaker
Vince
Investor Relations (Moderator)

I'm not sure we've really felt that was necessary. I mean, I think physicians, you know, have no real question about the relationship of triglycerides to pancreatitis risk, especially now that it's been proven.

speaker
Chris Anzalone
President and CEO

And payers haven't seemed to be concerned about that either, at least in the U.S. So I'm not sure, you know, what the value of a claim would be. And of course, at this point, it's untested, you know, whether the agency, you know, would consider providing that, you know, that claim. I don't know that we've really thought of it as being necessary, Patrick, to be clear in FCS. Patrick, is your question on SHTG or FCS?

speaker
Patrick Truccio
Analyst, H.C. Wainwright

Actually, the high-risk SHTG patient population.

speaker
Chris Anzalone
President and CEO

Yeah, but the answer, you know, is the same, I think. You know, we at least have not approached asking them would they give a claim, what it would take to get that claim. It's very possible that what they would require is something like Shasta 5, but the Shasta 5 was really designed primarily on the possibility that the payers in countries outside the U.S. might require an actual dedicated outcome study. So it was more payer-focused than it was regulatory-focused. And we really were not committed one way or the other about whether it be submitted to regulators asking for a label change. We were more interested really in protecting the possibility that there would be payers outside of the U.S. that would require a specific proof of concept in a dedicated study. So we really haven't raised this with regulators anywhere on a global basis at this point. Do you want to address the PEATS question? The PEATS question, we absolutely plan to do pediatric work at FCS. We have those plans in place. We have a pediatric plan in Europe and in the U.S. The only thing holding us back right now is just that we have to have a formulation that we can use for weight-based dosing. And that's just, you know, we're in the process of getting that formulation put together so that we can go ahead and do those studies. But we're absolutely planning on doing that. James, do you want to talk about MAPT knockdown? Yeah, sure. In terms of what... what we're looking for, based on the CINO data, as you mentioned, at the tissue level, we were seeing 75% plus reductions and similar reductions in the CSF in monkeys. I mean, we typically translate well from CINOs into the clinic, into humans. And I think based on some of the other data out there with the intrathecally administered ASO, they were able to achieve improved tau-PET signals. So, you know, I think that's probably where we're aiming for in our clinical study is at least 50% to 60% reduction in the CSF.

speaker
Jason Gerberry
Analyst, Bank of America Securities

That's what others have shown, and that seems to have translated into a meaningful tau-PET signal.

speaker
Patrick Truccio
Analyst, H.C. Wainwright

Great. Thanks so much.

speaker
Jason Gerberry
Analyst, Bank of America Securities

You're welcome.

speaker
Operator
Conference Operator

Thank you. And our next question comes from the line of Andrea Newkirk with Goldman Sachs.

speaker
Andrea Newkirk
Analyst, Goldman Sachs

Good afternoon. Thanks for taking the question. Maybe one more on the Redemplo launch. Recognize it's only been about a week since the approval. But now that you have launched, just curious if you'd be willing to comment on your expectations for the cadence of the initial launch here in FCS and how you think it may be similar or different from that of the Tringolza launch. particularly in the context of the significant pricing differential that you have. Thank you so much.

speaker
Chris Anzalone
President and CEO

Yeah, happy to take that, Andrea. This is Andy. So we do have very high ambitions for the Redemplo launch, expect it to be best in class. And as you know, there are a number of reasons why we believe that to be the case, largely around the attributes of Redemplo that we do believe make it a special molecule in this category. We talked about, obviously, the significant and sustained TG reduction. We've talked about the reduced incidence of acute pancreatitis. But even more importantly, we hear a lot of positive feedback around the safety and tolerability profile. So no contraindications, no warnings, and no precautions. And we do have a lot of physicians and patients who are enthusiastic about the once every three-month dosing regimen. So with those product attributes, we have very high ambitions for the launch of Redempla in FCS specifically.

speaker
Jason Gerberry
Analyst, Bank of America Securities

Thank you.

speaker
Operator
Conference Operator

And our next question comes from the line of Mike Alts with Morgan Stanley.

speaker
Mike Alts
Analyst, Morgan Stanley

Good afternoon. Thanks for taking the question and congratulations on all the progress as well. Maybe just to follow up on the Shasta 3 and 4 studies, you mentioned adopting the modified Atlanta criteria. We're just curious now that you've seen some more detail around the core studies, are you considering any sort of you know, adjustments or fine-tuning to your studies going forward. Thanks.

speaker
Chris Anzalone
President and CEO

Other than adapting the Atlantic criteria, I think we're, you know, feeling pretty good about the design and, you know, it was negotiated with the FDA. I don't think we saw anything in CORE that, you know, would cause us to, you know, change anything else. There's nothing that comes to mind. James, do you see it any differently? No. You looked closely at this too. Yeah, I agree. It didn't inspire any changes in the protocol.

speaker
Mike Alts
Analyst, Morgan Stanley

Yeah. Great. Thank you.

speaker
Operator
Conference Operator

Thank you. Our next question comes from the line of Madison Elsati with P. Riley.

speaker
Madison Elsati
Analyst, Piper Sandler

Good afternoon. Thanks for taking our questions. I wanted to ask about your neuromuscular franchise. Just given your integrin targeted delivery mechanism, which one could assume may be safer and perhaps more targeted on a TFR-mediated approach. Should we expect DMPK knockdown and splice correction data comparable to kind of the peer benchmark levels? And relatedly, wondering at which dose do you anticipate observing really optimal biomarker activity? I believe previously you said that even a low dose may be active. Thanks.

speaker
Chris Anzalone
President and CEO

Sure, I think most of that will defer to Sarepta. Probably can't comment on the dose where we'd expect to see maximal knockdown. We don't know that yet, so I wouldn't want to venture a guess there yet. In terms of the knockdown, I think that is probably a goal is to have something that looks at least similar

speaker
Jason Gerberry
Analyst, Bank of America Securities

to or equivalent to what others have shown for DMPK knockdown and splice correction with this platform. Got it.

speaker
Madison Elsati
Analyst, Piper Sandler

And then, if I may, are there any milestones associated with hitting a certain threshold, or are the milestones largely related to the regulatory progression?

speaker
Chris Anzalone
President and CEO

Yeah, based solely on regulatory and commercial, there are no sort of activity-based or PD-based milestones.

speaker
Jason Gerberry
Analyst, Bank of America Securities

Got it. Got it. Thanks. You're welcome.

speaker
Operator
Conference Operator

Thank you. And our last question comes from the line of Joseph Tone with TD Cowan.

speaker
Joseph Tone
Analyst, TD Cowan

Hi there. Good afternoon. Thank you for taking my question. Just another quick one on the dimer. Just curious, based on your work in SHTG, what proportion of patients are already on an anti-PCSK9 treatment? Is this, you know, an undertreated population on both sides? And then can you give us an indication in terms of the triglyceride and LDL cutoffs that you're looking at in patients enrolled into the early dimer study? Thank you.

speaker
Chris Anzalone
President and CEO

Sure, yeah, I think based on the work that we've done, I mean, a lot of those patients may be on a statin, probably less so on fibrates, and very few of them on PCSK9 inhibitors. It's actually not that commonly used in that population. In terms of the cutoffs and the inclusion criteria, so we allow patients in that study with mixed hyperlipidemia with triglycerides up to 880, so this is a pretty high threshold. And they have to have either a non-HDL of 100 or an LDL greater than 70 to get into the study. So they have to have a true mixed type of lipidemia, both high triglycerides and high non-HDL or LDL cholesterol.

speaker
Jason Gerberry
Analyst, Bank of America Securities

Thank you.

speaker
Operator
Conference Operator

I'll now hand the call back over to President and CEO Chris Anzalone for any closing remarks.

speaker
Chris Anzalone
President and CEO

Thanks very much for joining us today. Again, thank you. Thank you to Bruce. You know, for all he has brought to the company. He is re-retiring. He is not going to be gone, however, and I do trust that he will still be around and helping us out going forward. So again, thanks to Bruce and thanks to James for continued and ongoing leadership. Again, thank you all for joining us today, and I hope you have a pleasant Thanksgiving holiday.

speaker
Operator
Conference Operator

Ladies and gentlemen, thank you for participating. This does conclude today's program and you may now disconnect.

Disclaimer

This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.

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